Meredith Rumble

Caregiver-Assisted Coping Skills Training for Lung Cancer: Results of a Randomized Clinical Trial

CONTEXT Lung cancer is one of the most common cancers in the United States and is associated with high levels of symptoms, including pain, fatigue, shortness of breath, and psychological distress. Caregivers and patients are adversely affected. However, previous studies of coping skills training (CST) interventions have not been tested in patients with lung cancer nor have systematically included caregivers. OBJECTIVES This study tested the efficacy of a caregiver-assisted CST protocol in a sample of patients with lung cancer. METHODS Two hundred thirty-three lung cancer patients and their caregivers were randomly assigned to receive 14 telephone-based sessions of either caregiver-assisted CST or education/support involving the caregiver. Patients completed measures assessing pain, psychological distress, quality of life (QOL), and self-efficacy for symptom management; caregivers completed measures assessing psychological distress, caregiver strain, and self-efficacy for helping the patient manage symptoms. RESULTS Patients in both treatment conditions showed improvements in pain, depression, QOL, and self-efficacy, and caregivers in both conditions showed improvements in anxiety and self-efficacy from baseline to four-month follow-up. Results of exploratory analyses suggested that the CST intervention was more beneficial to patients/caregivers with Stage II and III cancers, whereas the education/support intervention was more beneficial to patients/caregivers with Stage I cancer. CONCLUSION Taken together with the broader literature in this area, results from this study suggest that psychosocial interventions can lead to improvements in a range of outcomes for cancer patients. Suggestions for future studies include the use of three-group designs (e.g., comparing two active interventions with a standard-care control) and examining mechanisms of change.

Anger and persistent pain: current status and future directions.

Persons having persistent pain often report feeling angry (Zimmerman et al., 1996). These angry feelings can be directed at themselves, others, or their life situation (Okifuji et al., 1999). Anger is an important emotion because it can exacerbate pain. Theories of pain such as the gate control theory and neuromatrix theory maintain that intense negative emotions such as anger can increase pain by altering descending and central pain modulation systems (Melzack, 1991; Rumelhart and McClelland, 1986). In addition to exacerbating pain, anger can complicate pain management efforts by disrupting relationships with health care providers, thereby interfering with medical or surgical treatments for persistent pain. Furthermore, persons with persistent pain who are having difficulties coping with anger often experience problems with marriage partners, family, friends, and co-workers. In 1995, Fernandez and Turk (1995) wrote an influential review of research on anger in persons having persistent pain. Since publication of that review paper, a number of new studies have been published on this topic. The purpose of this paper is to highlight recent research on anger and pain and to discuss its implications. In this paper, we describe concepts used in anger research, highlight representative clinical studies on anger and pain, discuss biopsychosocial mechanisms of anger-pain relationships, and discuss treatment implications of this research.

Attachment styles in patients with lung cancer and their spouses: associations with patient and spouse adjustment.

PurposeThis study examined attachment styles in patients with lung cancer and their spouses and associations between attachment styles and patient and spouse adjustment.MethodsOne hundred twenty-seven patients with early stage lung cancer completed measures of attachment style, marital quality, self-efficacy, pain, depression, anxiety, and quality of life. Their spouses completed measures of attachment style, marital quality, self-efficacy, caregiver strain, and mood.ResultsAnalyses indicated that, among patients, those high in either attachment anxiety or avoidance had significantly higher levels of anxiety and poorer social well-being. Attachment avoidance was also significantly associated with higher levels of depression and poorer marital quality and functional well-being. Spouse avoidant attachment was significantly associated with patient reports of increased pain and poorer functional well-being, and spouse anxious attachment was associated with poorer patient marital quality. Among spouses, those high in attachment avoidance reported significantly higher levels of caregiver strain, anger, depressed mood, and poorer marital quality; those high in attachment anxiety reported higher anxious mood. Dyads in which both partners were insecurely attached had significantly poorer adjustment compared to dyads in which both partners reported secure attachment.ConclusionsThese preliminary findings raise the possibility that attachment styles of cancer patients and their spouses as individuals and as a dyad may be important factors affecting adjustment in multiple domains.

Behavioral medicine: 2002 and beyond.

This article highlights future directions for research and practice in behavioral medicine. Topics addressed include social and environmental issues, the role of technology, translational research, improving and developing interventions, and professional training and retraining.