Michael J. Dolgin

Using Problem-Solving Skills Training to Reduce Negative Affectivity in Mothers of Children With Newly Diagnosed Cancer: Report of a Multisite Randomized Trial.

Mothers of children with cancer experience significant distress associated with their childrens diagnosis and treatment. The efficacy of problem-solving skills training (PSST), a cognitive-behavioral intervention based on problem-solving therapy, was assessed among 430 English- and Spanish-speaking mothers of recently diagnosed patients. Participants were randomized to usual psychosocial care (UPC; n=213) or UPC plus 8 sessions of PSST (PSST; n=217). Compared with UPC mothers, PSST mothers reported significantly enhanced problem-solving skills and significantly decreased negative affectivity. Although effects were largest immediately after PSST, several differences in problem-solving skills and distress levels persisted to the 3-month follow-up. In general, efficacy for Spanish-speaking mothers exceeded that for English-speaking mothers. Findings also suggest young, single mothers profit most from PSST.

Problem-solving skills training for mothers of children with newly diagnosed cancer: a randomized trial.

ABSTRACT. Mothers of children with serious illnesses have lower levels of well-being than mothers in the general population. Problem-solving therapy (PST), a cognitive-behavioral intervention, has been shown to be effective in treating negative affectivity (depression, anxiety) and other manifestations of reduced well-being. This report describes a problem-solving skills training (PSST) intervention, based on problem-solving therapy, for mothers of newly diagnosed pediatric cancer patients. Ninety-two mothers were randomly assigned to receive PSST or to receive standard psychosocial care (Control Group). After the 8-week intervention, mothers in the PSST Group had significantly enhanced problem-solving skills and significantly decreased negative affectivity compared with controls. Analysis revealed that changes in self-reports of problem-solving behaviors accounted for 40% of the difference in mood scores between the two groups. Interestingly, PSST had the greatest impact on improving constructive problem solving, whereas improvement in mood was most influenced by decreases in dysfunctional problem solving. The implications of these findings for refinement of the PSST intervention and for extension to other groups of children with serious illnesses are discussed.

Perceived Social Support and Adjustment of Children with Newly Diagnosed Cancer

The negative impact on psychologic adjustment from the stress of living with newly diagnosed cancer is hypothesized to be affected by perceived social support. Thirty children with newly diagnosed cancer completed standardized assessment instruments measuring depressive symptoms, state anxiety, trait anxiety, social anxiety, general self-esteem, and perceived social support from classmates, parents, teachers, and friends. Their parents completed a standardized assessment instrument measuring internalizing and externalizing behavior problems. Perceived classmate, parent, and teacher social support were variously correlated with the psychologic adjustment parameters in the hypothesized direction of greater support predicting lower psychologic distress and higher self-esteem. Hierarchical multiple regression analyses identified perceived classmate social support as the most consistent predictor of adaptation, providing further evidence of the essential function of the social environment of the school setting in affecting the adjustment of children with newly diagnosed cancer. J Dev Behav Pediatr 15:20-26, 1994

Sibling adaptation to childhood cancer collaborative study: prevalence of sibling distress and definition of adaptation levels

A multisite collaborative study assessed the frequency and intensity of emotional/behavioral distress in siblings of children with cancer. A sample of 254 siblings, aged 4 to 18 years, and their parents completed interviews and self-report measures 6 to 42 (average 22.5) months after diagnosis of cancer in a brother or sister. Matched controls were obtained from respondents to the Child Health Supplement of the National Health Interview Survey administered in 1988 (CHS88). Before diagnosis, the prevalence of parent-reported emotional/behavioral problems among siblings was similar to that in the general population (7.7% vs 6.3%; p = not significant). After diagnosis, prevalence rose to 18% among siblings. When siblings were grouped according to the presence or absence of problems exacerbated by and/or arising after diagnosis, four levels of adaptation, consistent with scores on the Behavior Problem Scales from the CHS88, emerged. This differentiation may help explain inconsistencies in sibling response reported previously and provides a framework for investigating factors that enhance adaptation. J Dev Behav Pediatr 15:353–366, 1994. Index terms: chronic illness, childhood cancer, siblings, adaptation, coping, psychosocial stress.

Perceived physical appearance and adjustment of children with newly diagnosed cancer : a path analytic model

More intensive medical treatment protocols have been initiated with the goal of improving survival of pediatric cancer patients. Evaluation of the adjustment of this cohort of children with newly diagnosed cancer being treated with these modern regimens is essential in order to enhance quality of life. Children with cancer who experience disease and treatment-related changes in physical appearance are hypothesized to be at greater risk for psychological and social adjustment problems given societys attitudes toward visible physical differences. Within a risk and resistance theoretical framework, perceived physical appearance was investigated as a predictor of depressive symptoms, social anxiety, and general self-esteem in newly diagnosed pediatric cancer patients. In support of the a priori conceptual model, path analysis findings indicate that perceived physical appearance has direct and indirect effects on depressive symptoms and social anxiety with the indirect effects mediated by general self-esteem. Exploratory analysis suggests that the effect of perceived.

Sibling adaptation to childhood cancer collaborative study : The association of sibling adaptation with maternal well-being, physical health, and resource use

This multi-institutional study investigated the association of behavioral/emotional adaptation among siblings of children with cancer with maternal general well-being, physical health, and resource use. One hundred seventy siblings and mothers completed standardized interviews and self-report measures 6 to 42 months after the cancer was diagnosed. As a group, mothers of children with cancer reported significantly lower levels of well-being than matched controls. When stratified according to the level of the siblings behavioral/emotional adaptation, mothers of siblings in the Dysfunctional group (1) reported the lowest levels of well-being; (2) during the preceding year, were more likely to have sought professional services than mothers of children in the Resilient group; and (3) were least likely to have found social support helpful. Our results support an association between maternal well-being and sibling adjustment but show it is unlikely that nonspecific social support will improve adjustment. The rationale for problem-solving training for mothers is provided.

Validation of the Hebrew version of the Dissociative Experiences Scale (H-DES) in Israel

Abstract Ob jec tives : The pur pose of this re search was to ex plore the va lid ity of the con cept of dis so ci a tion as mea sured by a He brew version of the Dissociative Ex pe ri ences Scale (H-DES) in Is rael. De sign: The first study ex am ined the re li abil ity and va lid ity of the H-DES by as sess ing 340 con sec u tive ad mis sions to an Is raeli out pa tient clinic, and 290 nonclin i cal sub jects. The sec ond study ex plored the construct va lid ity of the con cept of dis so ci a tion by study ing re la tion ships be tween re ported past traumatization and cur rent lev els of dis so ci a tion among a dif fer ent co hort of 70 women Is raeli out pa tients. Re sults: The H-DES has good testre test and split-half re li abil ity in clin i cal and nonclin i cal sub jects, and is in ter nally con sis tent. Its con vergent va lid ity with the MMPI 2 Philips Dis so ci a tion Scale is good, and it has good cri te rionre lated va lid ity with DSM-IV dissociative dis or der di ag no ses. The con cept of dis so ci a tion as mea sured in Is rael by the H-DES has high re li abil ity and va lid ity. Con clu sions : The re li able iden ti fi ca tion of dis sociative ex pe ri ences in Is rael as well as in sev eral cul tures out side North Amer ica sup ports dis soci a tion as a valid psy cho log i cal con struct with wide spread cross cul tural ap pli ca bil ity. This study con tra dicts claims that dis so ci a tion is merely a pass ing North Amer i can pro fes sional fash ion.

Perceived Stress and Adjustment of Long-Term Survivors of Childhood Cancer

With the increased probability of long-term survival from childhood cancer, quality of life has assumed an increasingly prominent role. The objective of the present study was to predict statistically the observed variability in adaptation of long-term survivors of childhood cancer. Perceived stress was selected for investigation as a potentially modifiable predictor variable, given its hypothesized role in patient functioning. Higher perceived stress statistically predicted increased psychological distress and lower general self-esteem after controlling for relevant demographic and medical variables. The implications of these findings suggest that stress management interventions may enhance the quality of life of long-term survivors of childhood cancer.

A structured group intervention for siblings of children with cancer

The current study describes the development and evaluation of a structured group intervention for school-aged and adolescent siblings of childhood cancer patients. Twenty-three siblings participated in a six-week program in which parallel groups of younger (ages 7–11) and older (ages 12–17) siblings were conducted. Defined topics were selected from the clinical and research literature and on the basis of a pre-intervention survey, and were addressed at each session. Methods included facilitated group discussion, art therapy techniques, role playing, and informal social interaction. Pre- and postmeasures of cancer-related knowledge, feelings and attitudes towards cancer, and overall mood state were administered. Results indicated statistically and clinically significant improvements in interpersonal problems, intrapsychic preoccupation, disease-related communication, mood, and cancer-related knowledge. Consent and attendance rates, as well as post-intervention satisfaction ratings highlight the subjective need felt by siblings and parents for direct, focused work with this population. Salient issues for siblings of pediatric cancer patients, specific techniques, group dynamics and processes, and staff and parent responses to the intervention program are discussed. The need for replicable, empirically validated interventions for family members of seriously-ill children is emphasized.

Qualitative Analysis of the Role of Culture in Coping Themes of Latina and European American Mothers of Children With Cancer

It has been well established that mothers of children diagnosed with cancer experience high levels of distress. Latina mothers may be at risk for higher levels of distress related to language barriers, cultural factors, and economic, immigration, and acculturation stressors. Despite the increasing US Latino population, few studies have examined the role of culture within pediatric oncology, including how mothers cope with their childs cancer. This study used qualitative analysis of 24 sessions from 3 Latina and 3 European American mothers of children recently diagnosed with cancer. The session transcripts were divided into a total of 2328 thought segments that were then analyzed for themes using a collaborative iterative process. Analysis identified 9 shared coping themes that included, with some variations: gathering information, professional help-seeking, activities, problem solving, positive thinking, present orientation, reframing, avoidance, and religion. Three themes were culture specific: only European American mothers discussed compromise, whereas normalization and perspective taking were unique to the Latina mothers and suggest that the cultural value of simpatía influences coping. Clinical and research recommendations are discussed.