Sarah W. Kinsinger

Perceived partner support and psychosexual adjustment to breast cancer

Support from a partner can play a key role in a womans emotional adjustment to breast cancer. However, little is known about the influence of partner behaviours on a womans sexual adjustment. This study examined the prospective relationship between baseline levels of several types of perceived partner support (instrumental, informational, emotional and negative) and psychosexual adjustment (sexual functioning and relationship satisfaction) over the course of 12 months post-surgery in a sample of 130 women with breast cancer. Results indicated that perceptions of greater emotional and informational support from the partner at baseline were associated with less sexual difficulties among breast cancer patients concurrently and 6 months post-surgery. Baseline perceptions of greater emotional and instrumental support from a partner were associated with greater relationship satisfaction at all time points. Perceptions of informational support at baseline were related to greater concurrent relationship satisfaction. Baseline perceptions of negative partner support were related to less relationship satisfaction, but only concurrently. These findings suggest that the perception of a partners provision of emotional, instrumental and informational support may each play a role in facilitating sexual adjustment and relationship satisfaction.

Control condition design and implementation features in controlled trials: a meta-analysis of trials evaluating psychotherapy for depression

Control conditions are the primary methodology used to reduce threats to internal validity in randomized controlled trials (RCTs). This meta-analysis examined the effects of control arm design and implementation on outcomes in RCTs examining psychological treatments for depression. A search of MEDLINE, PsycINFO, and EMBASE identified all RCTs evaluating psychological treatments for depression published through June 2009. Data were analyzed using mixed-effects models. One hundred twenty-five trials were identified yielding 188 comparisons. Outcomes varied significantly depending control condition design (p < 0.0001). Significantly smaller effect sizes were seen when control arms used manualization (p = 0.006), therapist training (p = 0.002), therapist supervision (p = 0.009), and treatment fidelity monitoring (p = 0.003). There were no significant effects for differences in therapist experience, level of expertise in the treatment delivered, or nesting vs. crossing therapists in treatment arms. These findings demonstrate the substantial effect that decisions regarding control arm definition and implementation can have on RCT outcomes.

Perceived Breast Cancer Risk, Social Support, and Distress Among a Community-Based Sample of Women

Four dimensions of perceived social support (emotional/informational, tangible, affectionate, positive social interaction) were examined as moderators of the effect of perceived breast cancer risk on distress in a cross-sectional sample of 1,366 women recruited from the general population. Heightened perceived breast cancer risk predicted higher levels of depression, but only among women who reported low levels of perceived emotional/informational, tangible, affectionate, and positive social interaction support. Tangible and positive social interaction support mitigated the negative effect of heightened risk perception on anxiety. Perceived breast cancer risk was associated with greater cancer worry, regardless of the degree of social support perception. However, this association was weaker for women who perceived greater positive social interaction support. The results suggest that womens perceptions of social support availability can protect them against some of the adverse emotional consequences of heightened breast cancer risk perceptions.

Methodological Issues in Randomized Controlled Trials for the Treatment of Psychiatric Comorbidity in Medical Illness

This chapter discusses how medical illness can influence outcomes in standard randomized controlled trial (RCT) methodology. We review how medical illness can affect the occurrence, identification, and measurement of psychiatric disorders and how medical illness and environmental factors can affect psychiatric symptoms longitudinally over the course of an RCT. Finally, we argue that when outcomes for RCTs of validated psychological and behavioral treatments are substantially smaller among medical populations than among non-medical populations, the problem may lie in our ability to accurately identify the psychiatric disorder in that population, rather than in the intervention. We will discuss the implications of this for RCT design.