Laura S. Porter

STRESSORS AND MOOD MEASURED ON A MOMENTARY BASIS ARE ASSOCIATED WITH SALIVARY CORTISOL SECRETION

Effects of past, current, and anticipated naturalistic daily stressors and of affect on salivary cortisol levels were examined. Participants (120) reported on stressors and affect 6 x /day in response to a preprogrammed wristwatch. Twenty min after each assessment they took a sample of saliva for cortisol analysis. Both the experience of a current stressor and anticipating a stressor were associated with increased salivary cortisol levels. Average increases in cortisol were relatively low, but inter-individual variability in this response existed. Stressors also were associated with lower positive affect and higher negative affect. Negative affect was associated with higher cortisol levels and positive affect was associated with lower cortisol levels. Daily stressors were not significant predictors of cortisol secretion when affect was controlled. Momentary assessment of daily stressors and of salivary cortisol proved to be a useful tool for examining psychoendocrinological processes in the natural environment.

INDIVIDUAL DIFFERENCES IN THE DIURNAL CYCLE OF CORTISOL

This study investigated individual differences in the diurnal cycle of cortisol and explored their relation to several psychosocial variables and to upper-respiratory symptoms. Cortisol and daily experience were assessed for 2 days in 109 healthy employed and unemployed community residents (mean age = 36.4 +/- 12.1, 69% female); self-report upper respiratory illness (URI) symptoms were assessed for an additional 10 days. Fifty-six (51%) participants showed typical declines in cortisol during both days, 19 (17%) showed no significant diurnal pattern on both days, and 34 (31%) showed different diurnal patterns on the 2 days. Individuals with no cycles did not differ from those with normal or inconsistent cycles on demographic factors, baseline psychological measures, health behaviors, or daily experiences over the two assessment days. Individuals without cortisol cycles, however, reported fewer URI symptoms than the remaining subjects. That 17% of our sample did not exhibit diurnal cycles of cortisol was surprising, given established views of normal endocrine function. Although average daily level of cortisol is related to a number of psychosocial and psychiatric factors (e.g. stress and depression), pattern of diurnal cycle was not related to any demographic or psychosocial measures in this study. The finding that flat cycles were related to fewer reports of URI symptoms suggests that perturbations in cycle may be related to processes associated with symptom susceptibility or symptom expression.

Pain and emotion: a biopsychosocial review of recent research.

OBJECTIVE AND METHOD Research on emotion and pain has burgeoned. We review the last decades literature, focusing on links between emotional processes and persistent pain. RESULTS Neurobiological research documents the neural processes that distinguish affective from sensory pain dimensions, link emotion and pain, and generate central nervous system pain sensitization. Psychological research demonstrates that greater pain is related to emotional stress and limited emotional awareness, expression, and processing. Social research shows the potential importance of emotional communication, empathy, attachment, and rejection. CONCLUSIONS Emotions are integral to the conceptualization, assessment, and treatment of persistent pain. Research should clarify when to eliminate or attenuate negative emotions, and when to access, experience, and express them. Theory and practice should integrate emotion into cognitive-behavioral models of persistent pain.

Self-efficacy for managing pain, symptoms, and function in patients with lung cancer and their informal caregivers: associations with symptoms and distress.

&NA; This study examined self‐efficacy for managing pain, symptoms, and function in patients with lung cancer and their caregivers, and associations between self‐efficacy and patient and caregiver adjustment. One hundred and fifty‐two patients with early stage lung cancer completed measures of self‐efficacy, pain, fatigue, quality of life, depression, and anxiety. Their caregivers completed a measure assessing their self‐efficacy for helping the patient manage symptoms and measures of psychological distress and caregiver strain. Analyses indicated that, overall, patients and caregivers were relatively low in self‐efficacy for managing pain, symptoms, and function, and that there were significant associations between self‐efficacy and adjustment. Patients low in self‐efficacy reported significantly higher levels of pain, fatigue, lung cancer symptoms, depression, and anxiety, and significantly worse physical and functional well being, as did patients whose caregivers were low in self‐efficacy. When patients and caregivers both had low self‐efficacy, patients reported higher levels of anxiety and poorer quality of life than when both were high in self‐efficacy. There were also significant associations between patient and caregiver self‐efficacy and caregiver adjustment, with lower levels of self‐efficacy associated with higher levels of caregiver strain and psychological distress. These preliminary findings raise the possibility that patient and caregiver self‐efficacy for managing pain, symptoms, and function may be important factors affecting adjustment, and that interventions targeted at increasing self‐efficacy may be useful in this population.

Psychosocial Issues Confronting Young Women with Breast Cancer

The current paper reviews the literature regarding psychosocial issues confronting young women with breast cancer. The findings indicate that younger women with breast cancer experience a lower quality of life after cancer compared to older women. In part, this lower quality of life results from the effects of medical treatment. The effects of surgery and removal of the breast result in more negative feelings regarding body image, particularly for young women. With systemic treatment, many younger women experience the sudden onset of menopause, with the attendant symptoms of hot flashes, decreased sexual desire, and vaginal dryness. These physical effects along with a variety of relationship issues contribute to a high level of sexual concerns for young women. From a psychosocial perspective, breast cancer affects both females and their male partners. Both partners experience psychological distress including depression and anxiety. Within the relationship, emotional support from the partner is important in womens adjustment. In terms of psychosocial interventions for breast cancer, findings suggest that the most frequently employed interventions, which treat the woman without her partner, are not optimal. Initial findings provide encouraging evidence that couple-based psychosocial interventions for women and their partners might be of particular assistance to both partners.

Daily Mood and Stress Predict Pain, Health Care Use, and Work Activity in African American Adults with Sickle-Cell Disease

This study examined the extent to which daily mood and stress were associated with pain, health care use, and work activity in 41 adults (mean age=36 years) with sickle-cell disease. Multilevel model analyses of daily diaries (M=91 days) indicated that increases in stress and negative mood were associated with increases in same-day pain, health care use, and work absences. Lagged models suggested bidirectional relationships, with evidence that pain may be the more powerful initiating variable in pain-mood and pain-stress cycles. Of importance, positive mood was associated with lower same-day and subsequent day pain, as well as fewer health care contacts, suggesting that positive mood may serve to offset negative consequences of pain and other illness symptoms.

Triggers of uncertainty about recurrence and long-term treatment side effects in older African American and Caucasian breast cancer survivors.

PURPOSE/OBJECTIVES To examine the sources of uncertainty in older African American and Caucasian long-term breast cancer survivors by focusing on frequency of triggers of uncertainty about cancer recurrence and physical symptoms linked to long-term treatment side effects. DESIGN In the context of a larger randomized, controlled treatment-outcome study, data were gathered from 10 monthly follow-up telephone calls by nurses. SETTING Rural and urban regions of North Carolina. SAMPLE 244 older women (mean age = 64 years); 73 African American women and 171 Caucasian women who were five to nine years after breast cancer diagnosis. FINDINGS The most frequent triggers were hearing about someone elses cancer and new aches and pains. The most frequent symptoms were fatigue, joint stiffness, and pain. Although no ethnic differences occurred in the experience of symptoms, Caucasian women were more likely than African American women to report that their fears of recurrence were triggered by hearing about someone elses cancer, environmental triggers, and information or controversy about breast cancer discussed in the media. CONCLUSIONS Illness uncertainty persisted long after cancer diagnosis and treatment, with most women experiencing multiple triggers of uncertainty about recurrence and a range of symptoms and treatment side effects. IMPLICATIONS FOR NURSING Nurses can help cancer survivors to identify, monitor, and manage illness uncertainty and emotional distress.

A couple-based intervention for female breast cancer

Objective: Although womens breast cancer affects both women and their male partners, as well as their relationships, few interventions have been developed to work with couples confronting breast cancer. The current investigation presents the pilot results from a new couple‐based intervention program for breast cancer that teaches couples how to minimize negative effects and maximize positive functioning during this difficult time.

The self-efficacy of family caregivers for helping cancer patients manage pain at end-of-life.

&NA; This preliminary study examined the self‐efficacy of family caregivers with regard to helping cancer patients manage pain at end of life. A sample of 63 family caregivers of hospice‐eligible cancer patients with pain provided ratings of their self‐efficacy in assisting the patient in pain management and rated their own mood and level of caregiver strain. Patients completed measures of pain and quality of life. Data analyses revealed that caregivers who rated their self‐efficacy as high reported much lower levels of caregiver strain as well as decreased negative mood and increased positive mood. Caregiver self‐efficacy in managing the patients pain was related to the patients physical well‐being. In dyads where the caregiver reported high self‐efficacy, the patient reported having more energy, feeling less ill, and spending less time in bed. Considered overall, the results of this study suggest that caregiver self‐efficacy in pain management is important in understanding how caregivers adjust to the demands of caring for cancer patients who have pain at the end of life.

The social context of gastrointestinal cancer pain: a preliminary study examining the relation of patient pain catastrophizing to patient perceptions of social support and caregiver stress and negative responses

&NA; A number of studies have shown that catastrophizing is an important predictor of pain and disability in persons having persistent pain conditions. The newly developed communal model of catastrophizing maintains that catastrophizing is a part of broader, interpersonal style of coping in which coping efforts are directed at interpersonal goals, rather than solely at pain reduction. This study examined the potential interpersonal correlates of pain catastrophizing in a sample of 70 patients having gastrointestinal cancers and their caregivers. Measures of pain catastrophizing, perceptions of social support, pain level, and pain behavior were obtained from patients. Caregivers completed measures that included their judgments about the patients pain level, caregiver stress, and their tendency to engage in negative responses (critical or avoidant behaviors). Overall, patients who engaged in catastrophizing reported receiving higher levels of instrumental support. Caregivers of patients who catastrophized, rated the patient as having more pain and engaging in more pain behavior. Caregivers of patients who catastrophized, also reported higher levels of caregiver stress and critical behaviors. Taken together, these preliminary findings suggest that pain catastrophizing has interpersonal correlates and support the need for additional research examining the social context of pain catastrophizing.