Stephen J. Lepore

A Meta-Analysis of the Effects of Written Emotional Disclosure on the Health Outcomes of Clinical Populations

A meta-analysis was conducted to examine the effects of the written emotional disclosure paradigm on health outcomes of people with physical or psychiatric disorders. After nine studies were meta-analyzed, it was determined that expressive writing significantly improved health (d = .19; p < .05). However, this positive relationship (r = .10) was not moderated by any systemic variables because of the nonsignificant test of homogeneity (Qw = 5.27; p = .73). Nonetheless, a planned contrast illustrated that expressive writing is more effective on physical (d = .21; p = .01) than on psychological (d = .07; p = .17) health outcomes (Qb > 10.83; p < .001). One explanation for the small effect size (ES) results and the nonsignificant test of homogeneity may be the small and heterogeneous samples used in some of the studies within this research synthesis. Future research with expressive writing should be tested with randomized controlled trials to increase the likelihood of detecting a larger treatment effect.

Improving Quality of Life in Men With Prostate Cancer: A Randomized Controlled Trial of Group Education Interventions

Men who were recently treated for prostate cancer (N=250) were randomly assigned to a control group, a group education intervention (GE), or a group education-plus-discussion intervention (GED). Both GE and GED increased prostate cancer knowledge. In the year postintervention, men in the GED condition were less bothered by sexual problems than men in the control condition, and they were more likely to remain steadily employed (93.0%) than men in the GE (75.6%) or control (72.5%) conditions. Among noncollege graduates, GED and GE resulted in better physical functioning than the control condition, and GED resulted in more positive health behaviors than the control or GE condition. Among college graduates, controls were comparable with the GE and GED groups in physical functioning and positive health behaviors.

Mending Broken Hearts: Effects of Expressive Writing on Mood, Cognitive Processing, Social Adjustment and Health Following a Relationship Breakup

Seventy-two male and 73 female undergraduates were randomly assigned to an experimental group, in which they wrote expressively about a relationship breakup, or to a control group, in which they wrote in a non-emotional manner about impersonal relationship topics. Control participants reported short-term increases in upper respiratory illness (URI) symptoms, tension and fatigue, whereas experimental participants did not. Further, higher levels of intrusive thoughts and avoidance were associated with short-term increases in URI symptoms in the control group, but were unrelated to URI symptoms in the experimental group. Finally, there was a trend ( p <0.06) suggesting that experimental participants were more likely to reunite with their ex-partner than were control participants. These findings indicate that expressive writing has a wide range of social, emotional, and physical health benefits for individuals coping with stressful events, particularly if they are experiencing ongoing intrusive thoughts and avoidance responses related to the stressor.

Psychological distress in spouses of men treated for early-stage prostate carcinoma.

The authors examined levels and predictors of psychological distress in the wives of men treated for early‐stage prostate carcinoma (PCa).

Spouse Social Control Efforts: Relations to Health Behavior and Well-Being among Men with Prostate Cancer

We measured perceptions of wives’ attempts to encourage appropriate health behavior among men with prostate cancer, a phenomenon known as ‘social control.’ We examined social control for health-enhancing behaviors (e.g., exercise), health-restorative behaviors (e.g., sleep), and health-compromising behaviors (e.g., smoking). We interviewed 80 married men with prostate cancer shortly after treatment, 2 months later, and 8 months later. Social control was distinct from social support and social conflict. There was no evidence that spouse social control was effective in producing positive changes in health behavior. In fact, health-restorative and health-compromising social control were associated with poorhealth behavior. There were no relations between social control and changes in health behavior over time. Spouse social control was associated with greater psychological distress, especially health-restorative and health-compromising social control. There was some evidence that social control undermined personal control beliefs over time. Future research should consider examining differences in the way that social control is conveyed, so that we may better understand its relations to health behavior and well-being.

Psychological stress, appraisal, emotion and Cardiovascular response in a public speaking task

Forty-three undergraduates (30 males, 13 females) prepared and performed a speech task (stressor) or a reading task (no-stressor control). Preparing to speak led to greater threat appraisal, negative emotion, and cardiovascular (CV) response than preparing to read aloud, particularly in speech anxious individuals. Delivering the speech, however, did not result in an increment in CV response over and above preparation. Although threat appraisals could not explain the effect of stress on CV response during task preparation, negative emotion accounted for over half of the effect. These data support the hypothesis that CV response in these studies is at least partially accounted for by psychological processes (stressor-specific anxiety and negative emotional response) and suggests that these processes may be best studied during a period of stressor anticipation.

It's not that bad: Social challenges to emotional disclosure enhance adjustment to stress

Studies conducted in the United States (n=115) and Spain (n=146) examined how talking about an acute stressor in different social contexts influences cognitive, emotional, and physiological adjustment. In both studies, female college students viewed a video dramatizing a real-life, gang rape scene on two separate days. After the first viewing, participants were randomly assigned to one of four social conditions: no talk, talk alone about their reactions, talk to a validating confederate about their reactions, or talk to a challenging confederate about their reactions. Participants in the challenge condition showed the greatest emotional, cognitive, and physiological benefits across cultures, whereas participants in the validate and talk conditions evidenced only modest benefits. These findings suggest that the social context of disclosure has a strong influence on adjustment processes and that providing an alternative and more sanguine perspective can help individuals recover from acute stressors.

Moderators of the Benefits of Psychoeducational Interventions for Men With Prostate Cancer

The authors examined whether 3 individual difference variables--self-esteem, self-efficacy, and depressive symptoms--interacted with psychoeducational group interventions for men with prostate cancer (n = 250) to predict general and prostate-specific quality of life. Men with nonmetastatic prostate cancer were randomly assigned to an education intervention, an education plus group discussion intervention, or usual care and followed for 12 months. Eight groups of 10 to 12 men were convened in each condition. Men who began the study with lower self-esteem, lower prostate-specific self-efficacy, and higher depressive symptoms benefited the most from the interventions. Of these 3 moderator variables, the most consistent results emerged for self-esteem. That is, the benefits of the intervention were strongest for men with low self-esteem.

Knowledge, Barriers, and Stage of Change as Correlates of Fruit and Vegetable Consumption among Urban and Mostly Immigrant Black Men

BACKGROUNDnDaily fruit and vegetable consumption in black men is low and has remained relatively unchanged during the past 20 years.nnnOBJECTIVEnTo examine awareness of fruit and vegetable recommendations promoted by federal agencies and correlates of fruit and vegetable consumption among an urban and mostly immigrant population of adult black men.nnnDESIGNnA cross-sectional study analyzing baseline data (n=490) from a randomized controlled trial.nnnSETTINGnA large health care workers union.nnnMAIN OUTCOME MEASURESnKnowledge, perceived benefits, stage of readiness, perceived barriers, and daily servings of fruit and vegetable intake.nnnSTATISTICAL ANALYSES PERFORMEDnOne-way analysis of variance and t tests were used to compare fruit and vegetable intake across main study variables. Regression analysis was used to identify independent predictors of fruit and vegetable intake.nnnRESULTSnFruit and vegetable intake was low (mean was three servings/day). Ninety-four percent were not aware that men should consume at least nine servings of fruits and vegetables daily and 59.8% were not aware that eating a colorful variety is important. In contrast, over half (54.7%) were aware that a single serving is equal to about a handful; 94.1% correctly reported fruit and vegetables as an important source of fiber; 79.6% correctly reported vitamin pills were not a substitute for eating fruits and vegetables; and 94.5% recognized that there are health benefits to eating fruits and vegetables, although identification of specific benefits was minimal. In regression analysis, a greater level of fruit and vegetable consumption was significantly associated with greater knowledge of fruit and vegetable recommendations, lower perceived barriers, and a more advanced stage of change (action vs contemplation/preparation). Perceived health benefits were not associated with fruit and vegetable consumption.nnnCONCLUSIONSnThere is a lack of awareness of the current fruit and vegetable recommendations. In addition, men reported fruit and vegetable intakes that were far below national recommendations. Greater efforts are needed to help urban and primarily immigrant black men realize the importance of and recommendations for fruit and vegetable consumption.

Searching for and making meaning after breast cancer: Prevalence, patterns, and negative affect ☆

This study describes the prevalence and patterns of searching for meaning in the aftermath of breast cancer and asks how the search relates to made meaning and emotional adjustment. Women (n=72) reported their level of searching for meaning, made meaning and negative affect at multiple time points in the first 18 months after breast cancer treatment. Over time, four search for meaning patterns emerged: continuous (44%), exiguous (28%), delayed (15%) and resolved (13%). Just over half of the participants reported having made meaning at early and late time points. A higher level of searching for meaning was unrelated to made meaning, but was associated with a higher level of negative affect in longitudinal analyses controlling for baseline levels. Women who engaged in an ongoing, unresolved search for meaning from baseline to follow-up also had a significantly higher level of negative affect at follow-up than women who infrequently or never engaged in a search for meaning over time. These analyses reveal that: a) there is great variability in the prevalence and pattern of searching for meaning in the aftermath of breast cancer, and b) searching for meaning may be both futile and distressing.