Scott D. Siegel

Applying latent growth curve modeling to the investigation of individual differences in cardiovascular recovery from stress.

Objective This paper provides an introduction to latent growth curve (LGC) modeling, a modern method for analyzing data resulting from change processes such as cardiovascular recovery from stress. LGC models are superior to traditional approaches such as repeated measures analysis of variance and simple change scores. Methods The basic principles of LGC modeling are introduced and applied to data from 167 men and women whose systolic blood pressure was assessed before, during, and after the cold pressor and evaluated speech stressors and who had completed the Cook-Medley Hostility Inventory. Results The LGC models revealed that systolic blood pressure recovery follows a different nonlinear trajectory after speech relative to the cold pressor. The difference resulted not from the initial decline at the completion of the stressor, but from higher levels at the end of the stressor and slower rate of change in decline for the speech. Hostility predicted the trajectory for speech but not for cold pressor. This relationship did not differ as a function of gender, although men had larger systolic blood pressure responses than women to both stressors. Conclusions LGC modeling yields an understanding of the processes and predictors of change that is not attainable through traditional statistical methods. Although our application concerns cardiovascular recovery from stress, LGC modeling has many other potential applications in psychosomatic research.

Promoting recovery of sexual functioning after radical prostatectomy with group-based stress management: The role of interpersonal sensitivity

OBJECTIVE Treatment for localized prostate carcinoma (PCa) is frequently associated with decrements in sexual functioning and satisfaction. Given the highly interpersonal nature of these decrements, interpersonal problems (such as interpersonal sensitivity) may affect recovery of sexual functioning after PCa treatment through interference with physician and partner communication and through distorted cognitions surrounding sexual dysfunction. The objective of the present study was to determine the effect of interpersonal sensitivity on several treatment indicators, including response to a group-based psychosocial intervention. METHODS Participants were 101 older men recovering from radical prostatectomy who were enrolled in a randomized controlled trial of a 10-week group-based cognitive-behavioral stress management (CBSM) intervention. Measures included the Inventory of Interpersonal Problems and the sexual functioning subscale of the University of California-Los Angeles quality-of-life measure. RESULTS At baseline, interpersonal sensitivity was related to a belief linking sexual dysfunction to core male identity (r=.29, P<.05). Using hierarchical regression, we found that (a) the CBSM intervention was effective in promoting sexual recovery in all participants, and (b) this effect was moderated by interpersonal sensitivity, such that individuals with higher levels of interpersonal sensitivity made larger improvements in sexual functioning in response to CBSM. CONCLUSIONS CBSM was effective in improving sexual function after radical prostatectomy. Individuals with higher levels of interpersonal sensitivity were more likely to perceive sexual dysfunction as a threat to masculine identity and made larger gains in the CBSM intervention. Results and relevance to the older male cancer patients are discussed from the perspective of interpersonal theory.

Social constraints on disclosure predict daily well-being in couples coping with early-stage breast cancer.

According to the social-cognitive processing model (Lepore, 2001), social constraints on disclosure can limit an individuals ability to communicate openly with others and consequently have negative effects on psychological adjustment, especially in the context of stressful experiences such as the diagnosis and treatment of cancer. The goal of the present study was to examine the influence of social constraints on daily event sharing, individual well-being, and relationship well-being in couples coping with breast cancer. Forty-five patients recently diagnosed and treated for early stage breast cancer and their spouses reported perceptions of spousal constraints on patient disclosure and completed a 7-day electronic diary. Analyses revealed that patient-reported social constraints, independent of the spouses report, were linked to reduced patient sharing of both cancer-related and other important daily events. Patient and spouse perceptions of social constraints, independent of their shared consensus, predicted reduced daily individual well-being indexed by self-esteem and negative affect, as well as reduced daily relationship well-being indexed by relationship happiness and intimacy. Moreover, many of the aforementioned effects on daily well-being remained after controlling for global marital quality. Overall, these findings reveal that individual perceptions of social constraints have a negative influence on both patient and spouse daily well-being outcomes.

A pilot study of cognitive behavioral stress management effects on stress, quality of life, and symptoms in persons with chronic fatigue syndrome.

OBJECTIVE The present pilot study was designed to test the effects of a 12-week group-based cognitive behavioral stress management (CBSM) intervention on stress, quality of life, and symptoms in chronic fatigue syndrome (CFS). We hypothesized that participants randomized to CBSM would report improvements in perceived stress, mood, quality of life, and CFS symptomatology from pre- to postintervention compared to those receiving a psychoeducational (PE) seminar control. METHOD We recruited 69 persons with a bona fide diagnosis of CFS and randomized 44 to CBSM and 25 to PE. Participants completed the Perceived Stress Scale (PSS), Profile of Mood States (POMS), Quality of Life Inventory (QOLI), and a Centers for Disease Control (CDC)-based CFS symptom checklist pre- and postintervention. RESULTS Repeated measures analysis of variance revealed a significant Group×Time interaction for PSS, POMS-total mood disturbance (TMD), and QOLI scores, such that participants in CBSM evidenced greater improvements than those in PE. Participants in CBSM also reported decreases in severity of CFS symptoms vs. those in PE. CONCLUSIONS Results suggest that CBSM is beneficial for managing distress, improving quality of life, and alleviating CFS symptom severity.

Fear of cancer recurrence: a theoretical review and its relevance for clinical presentation and management.

There is increasing recognition of the unique physical and psychosocial concerns of the growing population of cancer survivors. An emerging literature demonstrates that fear of cancer recurrence (FCR) is a problematic long‐term and late effect for cancer survivors. In fact, FCR is a top concern, and this article provides a necessary synthesis of the extant research evidence and theory.

Capitalizing on everyday positive events uniquely predicts daily intimacy and well-being in couples coping with breast cancer.

Capitalization is the relational process of savoring positive life events by sharing them with responsive relationship partners. The purpose of the present study was to use dyadic intensive longitudinal methods to examine novel hypotheses regarding links between capitalization processes and daily intimacy and well-being in women with breast cancer and their intimate partners. Although couples coping with cancer often experience an increase in negative daily life events, we hypothesized that it would be important for them to share and capitalize on positive events in addition to sharing negative events. Female patients with early stage breast cancer and their intimate partners (99 couples) completed electronic daily diaries for 7 to 10 consecutive days tapping everyday processes of sharing negative and positive events with each other. Dyadic multilevel process modeling revealed that on days when capitalization attempts (i.e., sharing the best event of the day) occurred, daily feelings of intimacy in the sharer were higher for both patients and partners. Moreover, greater perceived partner responsiveness to capitalization attempts was associated with increases in the sharers daily feelings of intimacy and decreases in the sharers daily negative affect. When the patients partner was the sharer, perceived partner responsiveness also was associated with increased daily positive affect. More important, all effects of capitalization were observed above and beyond the effects of event positivity and sharing negative events (i.e., social support attempts). Findings suggest that, even in the midst of significant life adversity, sharing daily good news with intimate partners enhances relationship well-being independently of sharing bad news.

Cancer-specific relationship awareness, relationship communication, and intimacy among couples coping with early-stage breast cancer

If couples can maintain normalcy and quality in their relationship during the cancer experience, they may experience greater relational intimacy. Cancer-specific relationship awareness, which is an attitude defined as partners focusing on the relationship and thinking about how they might maintain normalcy and cope with cancer as a couple or “team”, is one factor that may help couples achieve this goal. The main aim of this study was to evaluate the associations between cancer-specific relationship awareness, cancer-specific communication (i.e., talking about cancer’s impact on the relationship, disclosure, and responsiveness to partner disclosure), and relationship intimacy and evaluate whether relationship communication mediated the association between relationship awareness and intimacy. In the current study, a total of 254 women diagnosed with early-stage breast cancer and their partners were recruited. Participants completed measures of cancer-specific relationship awareness, relationship talk, self- and perceived partner-disclosure, perceived partner responsiveness, and relationship intimacy. Results indicated that patients and spouses who were higher in cancer-specific relationship awareness engaged in more relationship talk, reported higher levels of self-disclosure, and perceived that their partner disclosed more. Their partners reported that they were more responsive to disclosures. Relationship talk and perceived partner responsiveness mediated the association between cancer-specific relationship awareness and intimacy. Helping couples consider ways they can maintain relationship normalcy and quality during the cancer experience and framing coping with cancer as a “team” effort may facilitate better communication and ultimately enhance relationship intimacy.

Interpersonal Sensitivity, Partner Support, Patient-Physician Communication, and Sexual Functioning in Men Recovering From Prostate Carcinoma

Prostate carcinoma (PC) is the most commonly diagnosed cancer in men. Treatments for localized PC are associated with side effects including sexual dysfunction, which has been linked to decrements in health-related quality of life and elevated distress levels. In this study, we examined the relationship between 2 personality traits, interpersonal sensitivity and lack of sociability, assessed by the Inventory of Interpersonal Problems (IIP; Pilkonis, Kim, Proietti, & Barkham, 1996) and recovery of sexual functioning in 121 men (M age = 60.6 years) recently treated with radical prostatectomy. Interpersonal sensitivity refers to the predisposition to perceive and elicit criticism and rejection from others; lack of sociability refers to chronic difficulties taking the initiative in interpersonal situations. After adjusting for relevant covariates, interpersonal sensitivity, but not sociability, was significantly associated with lower levels of sexual functioning. Patient–physician communication and partner perceived social support were explored as mediators of this relationship. Although interpersonal sensitivity was significantly associated with both poorer patient–physician communication and lower levels of partner support, the results did not support mediation. This study provides preliminary evidence that certain IIP-assessed interpersonal styles may complicate the recovery of sexual functioning after surgical treatment for PC.

The cancer psychosocial care matrix: a community-derived evaluative tool for designing quality psychosocial cancer care delivery

Although the Institute of Medicine provided a vision for effective psychosocial care for cancer survivors, limited guidance exists regarding the essential components of comprehensive care or progressive steps for implementing each component. This paper describes the development of a unique tool for assessing capacity to provide quality psychosocial care to cancer survivors and the results of the first implementation of this tool in community settings.

Affective differentiation in breast cancer patients

Fifty-three breast cancer patients completed an Internet-based diary measuring daily negative affect and positive affect and daily negative and positive events for seven consecutive evenings shortly after surgery. The authors used Hierarchical Linear Modeling (Raudenbush and Bryk in Hierarchical linear models: applications and data analysis methods. Sage, Thousand Oaks, CA, 2002) to examine moderators of affective differentiation, or the daily relationship between the patients’ negative affect and positive affect. Strong affective differentiation is characterized by the relative independence of negative and positive affect. There were no significant Level 1 (within-subject) moderators of affective differentiation. However, at Level 2 (between-subject), as predicted, increased age was associated with stronger affective differentiation, as was greater use of planning to cope with breast cancer. Also as predicted, increased anxiety and greater use of behavioral disengagement and denial coping were associated with weaker affective differentiation. The results suggest the value of the affective differentiation construct, and a daily diary methodology, for research on the daily lives of breast cancer patients.