Salsman et al published an impressive series of metaanalyses regarding the association between re... more Salsman et al published an impressive series of metaanalyses regarding the association between religion and spirituality (R/S) and various outcome variables. Herein, we will focus on the meta-analysis that described the association between R/S and mental health. The authors found an impressive number of 148 studies. However, we were somewhat disappointed that they did not go one step further than earlier reviews and meta-analyses concerning the relationship between R/S and mental health by leaving out all studies that used spiritual well-being (SWB) as an R/S predictor, and by focusing on longitudinal studies.
This work has been done without special funding ABSTRACT Objective: The primary aim of this study... more This work has been done without special funding ABSTRACT Objective: The primary aim of this study was to determine the characteristics of clients and interventions in routine psycho-oncological care. The secondary aim was to determine the course of symptomatology during and after the psychological interventions.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright a b s t r a c t The immune system's efficacy in detecting and destroying cancer cells varies considerably throughout the stages of cancer development and its role may be critical particularly during the surgical period. Although surgery causes tumor cells to shed into the blood, immune cells have the capacity to destroy these tumor cells. However, surgery also suppresses cytotoxic capacity. It is particularly during this surgical period that psychological factors can have a significant dampening or strengthening impact on surgery-related immunomodulation response, thus exerting an effect on survival. This review describes the immune changes during the peri-surgical period and the influences psychological factors have on immune function, including the immune effects caused by psychological interventions in cancer patients. We recommend that future studies exploring the role of psychological factors on immune function and survival focus more on their influence during the peri-surgical period.
Repression is typically associated in literature with terms such as non-expression, emotional con... more Repression is typically associated in literature with terms such as non-expression, emotional control, rationality, anti-emotionality, defensiveness and restraint. Whether these terms are synonymous with repression, indicate a variation, or are essentially different from repression is uncertain. We have discussed the similarities and differences between these concepts elsewhere (Garssen, 2007). In addition, a multitude of questionnaires has been developed in this field, which presents yet another problem for evaluating studies. In the present review, we critically discuss the various questionnaires used for measuring repression and related constructs, and then present our assessment on which scales are reliable and valid and which are not. The most appropriate repression measure is the Marlow Social Desirability (MC SD) scale, or the combination of the MC SD and an anxiety/distress scale. The question whether the MC SD scale alone, or the combination measure is
Literature on repression is abundant with terms such as repression, non-expression of negative em... more Literature on repression is abundant with terms such as repression, non-expression of negative emotions, emotional control, rationality, type C response style and defensiveness. However, it is uncertain whether these terms are synonymous with repression, denote a variation, or are essentially different from repression. In addition, a multitude of questionnaires has been developed in this field, which presents yet another problem for evaluating studies. Elsewhere we have discussed overlap of and differences between the various repression-related concepts (Garssen, 2007a) and critically reviewed eleven repression-related questionnaires (Garssen, 2009). The present study compares various repression questionnaires in two groups of women with breast cancer (N = 102 and 145). A secondary factor analysis yielded two factors, which were labelled: repression and anxious defensiveness. The relevance of this finding for future studies is that only scales belonging to the repression cluster are valid measures for measuring repression. The Marlowe Crowne Social Desirability scale is recommended as the most adequate repression measure.
In order to study synchronization of respiration, three different videofragments were presented t... more In order to study synchronization of respiration, three different videofragments were presented to 21 normal subjects. Each fragment showed a 'therapeutic interview' specially performed for this purpose, with a 'patient' breathing in a particular way. The respiration of model 1 was deep, slow and clearly audible, the pattern of model 2 was rapid, superficial and slightly audible and that of model 3 was normal, and hardly perceptible. The fragments were presented in three different sequences and each sequence was followed by seven subjects. Respiration amplitude (Vt), respiration irregularity (SD of Vt), respiration frequency (RF) and frequency of skin conductance responses (SCRF) were measured. Changes in mean values of these variables were demonstrated during the fragments; an increase in RF was the most pronounced and reliable change. These 'overall' physiological changes did not support the synchronization hypothesis, nor were they at variance with it: they seemed to be effects of attention. A detailed (cycle by cycle) analysis did reveal a synchronization effect in fragment 1. The number of cycles in the subject which were in rhythm with the model's respiration was significantly larger than could have been expected by chance. The effect of synchronization, however, was small and transient as it did not affect the mean RF and V t of fragment 1.
It is generally accepted that spiritual attitude may help one to cope better with the consequence... more It is generally accepted that spiritual attitude may help one to cope better with the consequences of illness. For the progress of scientific and clinical research into the effects of spirituality a reliable and valid spirituality questionnaire is indispensable. Sessanna et al. (2011) have presented an excellent and critical review of available questionnaire. They evaluated the psychometric qualities of the scales, and -among other aspects -their clinical utility and practicality. Unfortunately one criterion was missing: the inclusion of well-being items in spirituality questionnaires. The inclusion of well-being items presents a problem when studying the relationship between spirituality and well-being. It seems self-evident that one should avoid tautology by refraining from a study into the relationship between spiritual well-being and 'general well-being'. However, several studies investigate exactly this (Visser et al. 2010). Sessana et al. make no mention of this problem. It is obvious that scales on spiritual well-being include items on well-being, such as 'I feel that life is a positive experience' (Spiritual Well-Being Scale; SWBS). Sessana et al. name the following spiritual well-being scales: the Functional Assessment of Chronic Illness Therapy -Spiritual Well-Being Scale (FACIT-sp), Spiritual Well-Being Scale (SWBS), Jarel Well-Being Scale (Jarel), and Spiritual Index of Well-Being (SIWB). However, well-being items can also be found in 'general spirituality' scales, such as the Daily Spiritual Experience Scale (DSES; 'I feel deep inner peace or harmony') and the Spiritual Scale (SS; 'I am happy about the person I have become'). In our own review of spirituality scales (Jager Meezenbroek et al. 2010), we have used the criterion that these scales should include no or very few wellbeing items. Therefore, we value the quality of the FACIT-Sp lower than Sessanna et al., who gave this scale a high score. An attractive attribute of Sessanna et al.'s review is their item analysis (a term not used in their review). They make a distinction between: (i) items measuring spirituality; (ii) items referring to religiosity; (iii) items using terms as 'spirit' or 'spirituality'; and (iv) non-spirituality items. In our view, items of the second, third and fourth category are not acceptable for spirituality questionnaires. People have different understandings of the words 'spirit', 'spiritual', or 'spirituality'. Moreover, people find these words either 'vague' and 'woolly', or 'sublime'
Objective: When comparing the efficacy of different interventions for cancer patients, there shou... more Objective: When comparing the efficacy of different interventions for cancer patients, there should be certainty that these types are sufficiently different in the way they are actually presented. The aim of the present study is to develop a method for assessing differences between the content of social support groups and experiential-existential therapy groups. Methods: Independent and blind raters assessed video fragments of both intervention types, using a selfdeveloped checklist of five questions. This checklist was first evaluated by a group of experts for appropriateness, importance, and rateability. Results: Three out of the five questions were selected on the basis of these experts' evaluation and on inter-rater reliability. The scores on these questions were used to evaluate five social support groups and six experiential-existential therapy groups for breast cancer patients. According to the independent and blind raters the content of the two intervention forms appeared to be significantly different. Conclusion: The assessment method we developed appeared reliable and valid. Practice implications: Our assessment method is feasible as a check to compare the content of psychooncological interventions and can be easily adjusted into a test for other intervention types. ß
This study tests the hypothesis that social anxiety and fear of bodily sensations are associated ... more This study tests the hypothesis that social anxiety and fear of bodily sensations are associated with the development of agoraphobic avoidance behavior in panic disorder patients. Twenty patients with panic disorder were compared to 20patients with panic disorder with agoraphobia, matched by sex and duration of disorder. The two groups did not differ on measures of fear and frequency of assertive social responses. However, the agorapho-bics scored higher on measures of interpersonal sensitivity, depression, feelings of inadequacy, and hostility. They also reported higher fear of bodily sensations. Although definitive conclusions need to be postponed until prospective studies have been conducted, there is evidence suggesting that the development of agoraphobia in panic patients is associated with hypersensi-tivity to bodily sensations and interpersonal situations.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright a b s t r a c t The immune system's efficacy in detecting and destroying cancer cells varies considerably throughout the stages of cancer development and its role may be critical particularly during the surgical period. Although surgery causes tumor cells to shed into the blood, immune cells have the capacity to destroy these tumor cells. However, surgery also suppresses cytotoxic capacity. It is particularly during this surgical period that psychological factors can have a significant dampening or strengthening impact on surgery-related immunomodulation response, thus exerting an effect on survival. This review describes the immune changes during the peri-surgical period and the influences psychological factors have on immune function, including the immune effects caused by psychological interventions in cancer patients. We recommend that future studies exploring the role of psychological factors on immune function and survival focus more on their influence during the peri-surgical period.
Objective: This study evaluated the psychological effects of a pre-surgical stress management tra... more Objective: This study evaluated the psychological effects of a pre-surgical stress management training (SMT) in cancer patients. Methods: Stress management training comprised four sessions in total: on 5 days and 1 day pre-surgery and on 2 days and 1 month post-surgery. Patients also received audio CDs with relaxation and coping skills exercises. Patients were randomly assigned to the SMT (N = 34) or a regular care condition (N = 36). Depression, anxiety, quality of life, perception of control, fatigue, pain, sleep problems, and surgery-related somatic symptoms were measured at Day 6 and Day 1 pre-surgery, and Day 2, 5, 30 and 90 post-surgery. Results: Depression and fatigue decreased in the intervention group and increased in the control group, leading to significant group differences at Day 2 (fatigue) and Day 5 post-surgery (fatigue and depression). It also appeared that surgery-related symptoms had increased more in the control group 3 months post-surgery than in the SMT group. No intervention effects were observed for anxiety, pain, and sleep problems. Conclusion: The use of a short psychological intervention is effective in reducing depression and fatigue in the post-surgical period, although the effects are of short duration.
It has been suggested that spirituality is associated with higher well-being, because it offers s... more It has been suggested that spirituality is associated with higher well-being, because it offers social support, improves the relationship with the partner, provides meaning, and reduces self-focus and worry. We performed a qualitative study among ten people with cancer, using the Consensual Qualitative Research method for the analysis of semi-structured interviews. Support was found for the mechanisms of meaning provision and of reduction of self-focus and worries. Participants also mentioned emotion-focused roles of spirituality: Feeling supported by a transcendental confidant, the expression of negative emotions (in prayer), acceptance, allowing feelings of misery, and viewing problems from a distance. There was no mention of a contribution of spirituality to adjustment through improved social support per se or a higher quality of the relationship with the partner. The results of the present study indicate that the role of spirituality in emotion regulation deserves attention in understanding how spirituality helps cancer patients to adjust to their disease.
Salsman et al published an impressive series of metaanalyses regarding the association between re... more Salsman et al published an impressive series of metaanalyses regarding the association between religion and spirituality (R/S) and various outcome variables. Herein, we will focus on the meta-analysis that described the association between R/S and mental health. The authors found an impressive number of 148 studies. However, we were somewhat disappointed that they did not go one step further than earlier reviews and meta-analyses concerning the relationship between R/S and mental health by leaving out all studies that used spiritual well-being (SWB) as an R/S predictor, and by focusing on longitudinal studies.
This work has been done without special funding ABSTRACT Objective: The primary aim of this study... more This work has been done without special funding ABSTRACT Objective: The primary aim of this study was to determine the characteristics of clients and interventions in routine psycho-oncological care. The secondary aim was to determine the course of symptomatology during and after the psychological interventions.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright a b s t r a c t The immune system's efficacy in detecting and destroying cancer cells varies considerably throughout the stages of cancer development and its role may be critical particularly during the surgical period. Although surgery causes tumor cells to shed into the blood, immune cells have the capacity to destroy these tumor cells. However, surgery also suppresses cytotoxic capacity. It is particularly during this surgical period that psychological factors can have a significant dampening or strengthening impact on surgery-related immunomodulation response, thus exerting an effect on survival. This review describes the immune changes during the peri-surgical period and the influences psychological factors have on immune function, including the immune effects caused by psychological interventions in cancer patients. We recommend that future studies exploring the role of psychological factors on immune function and survival focus more on their influence during the peri-surgical period.
Repression is typically associated in literature with terms such as non-expression, emotional con... more Repression is typically associated in literature with terms such as non-expression, emotional control, rationality, anti-emotionality, defensiveness and restraint. Whether these terms are synonymous with repression, indicate a variation, or are essentially different from repression is uncertain. We have discussed the similarities and differences between these concepts elsewhere (Garssen, 2007). In addition, a multitude of questionnaires has been developed in this field, which presents yet another problem for evaluating studies. In the present review, we critically discuss the various questionnaires used for measuring repression and related constructs, and then present our assessment on which scales are reliable and valid and which are not. The most appropriate repression measure is the Marlow Social Desirability (MC SD) scale, or the combination of the MC SD and an anxiety/distress scale. The question whether the MC SD scale alone, or the combination measure is
Literature on repression is abundant with terms such as repression, non-expression of negative em... more Literature on repression is abundant with terms such as repression, non-expression of negative emotions, emotional control, rationality, type C response style and defensiveness. However, it is uncertain whether these terms are synonymous with repression, denote a variation, or are essentially different from repression. In addition, a multitude of questionnaires has been developed in this field, which presents yet another problem for evaluating studies. Elsewhere we have discussed overlap of and differences between the various repression-related concepts (Garssen, 2007a) and critically reviewed eleven repression-related questionnaires (Garssen, 2009). The present study compares various repression questionnaires in two groups of women with breast cancer (N = 102 and 145). A secondary factor analysis yielded two factors, which were labelled: repression and anxious defensiveness. The relevance of this finding for future studies is that only scales belonging to the repression cluster are valid measures for measuring repression. The Marlowe Crowne Social Desirability scale is recommended as the most adequate repression measure.
In order to study synchronization of respiration, three different videofragments were presented t... more In order to study synchronization of respiration, three different videofragments were presented to 21 normal subjects. Each fragment showed a 'therapeutic interview' specially performed for this purpose, with a 'patient' breathing in a particular way. The respiration of model 1 was deep, slow and clearly audible, the pattern of model 2 was rapid, superficial and slightly audible and that of model 3 was normal, and hardly perceptible. The fragments were presented in three different sequences and each sequence was followed by seven subjects. Respiration amplitude (Vt), respiration irregularity (SD of Vt), respiration frequency (RF) and frequency of skin conductance responses (SCRF) were measured. Changes in mean values of these variables were demonstrated during the fragments; an increase in RF was the most pronounced and reliable change. These 'overall' physiological changes did not support the synchronization hypothesis, nor were they at variance with it: they seemed to be effects of attention. A detailed (cycle by cycle) analysis did reveal a synchronization effect in fragment 1. The number of cycles in the subject which were in rhythm with the model's respiration was significantly larger than could have been expected by chance. The effect of synchronization, however, was small and transient as it did not affect the mean RF and V t of fragment 1.
It is generally accepted that spiritual attitude may help one to cope better with the consequence... more It is generally accepted that spiritual attitude may help one to cope better with the consequences of illness. For the progress of scientific and clinical research into the effects of spirituality a reliable and valid spirituality questionnaire is indispensable. Sessanna et al. (2011) have presented an excellent and critical review of available questionnaire. They evaluated the psychometric qualities of the scales, and -among other aspects -their clinical utility and practicality. Unfortunately one criterion was missing: the inclusion of well-being items in spirituality questionnaires. The inclusion of well-being items presents a problem when studying the relationship between spirituality and well-being. It seems self-evident that one should avoid tautology by refraining from a study into the relationship between spiritual well-being and 'general well-being'. However, several studies investigate exactly this (Visser et al. 2010). Sessana et al. make no mention of this problem. It is obvious that scales on spiritual well-being include items on well-being, such as 'I feel that life is a positive experience' (Spiritual Well-Being Scale; SWBS). Sessana et al. name the following spiritual well-being scales: the Functional Assessment of Chronic Illness Therapy -Spiritual Well-Being Scale (FACIT-sp), Spiritual Well-Being Scale (SWBS), Jarel Well-Being Scale (Jarel), and Spiritual Index of Well-Being (SIWB). However, well-being items can also be found in 'general spirituality' scales, such as the Daily Spiritual Experience Scale (DSES; 'I feel deep inner peace or harmony') and the Spiritual Scale (SS; 'I am happy about the person I have become'). In our own review of spirituality scales (Jager Meezenbroek et al. 2010), we have used the criterion that these scales should include no or very few wellbeing items. Therefore, we value the quality of the FACIT-Sp lower than Sessanna et al., who gave this scale a high score. An attractive attribute of Sessanna et al.'s review is their item analysis (a term not used in their review). They make a distinction between: (i) items measuring spirituality; (ii) items referring to religiosity; (iii) items using terms as 'spirit' or 'spirituality'; and (iv) non-spirituality items. In our view, items of the second, third and fourth category are not acceptable for spirituality questionnaires. People have different understandings of the words 'spirit', 'spiritual', or 'spirituality'. Moreover, people find these words either 'vague' and 'woolly', or 'sublime'
Objective: When comparing the efficacy of different interventions for cancer patients, there shou... more Objective: When comparing the efficacy of different interventions for cancer patients, there should be certainty that these types are sufficiently different in the way they are actually presented. The aim of the present study is to develop a method for assessing differences between the content of social support groups and experiential-existential therapy groups. Methods: Independent and blind raters assessed video fragments of both intervention types, using a selfdeveloped checklist of five questions. This checklist was first evaluated by a group of experts for appropriateness, importance, and rateability. Results: Three out of the five questions were selected on the basis of these experts' evaluation and on inter-rater reliability. The scores on these questions were used to evaluate five social support groups and six experiential-existential therapy groups for breast cancer patients. According to the independent and blind raters the content of the two intervention forms appeared to be significantly different. Conclusion: The assessment method we developed appeared reliable and valid. Practice implications: Our assessment method is feasible as a check to compare the content of psychooncological interventions and can be easily adjusted into a test for other intervention types. ß
This study tests the hypothesis that social anxiety and fear of bodily sensations are associated ... more This study tests the hypothesis that social anxiety and fear of bodily sensations are associated with the development of agoraphobic avoidance behavior in panic disorder patients. Twenty patients with panic disorder were compared to 20patients with panic disorder with agoraphobia, matched by sex and duration of disorder. The two groups did not differ on measures of fear and frequency of assertive social responses. However, the agorapho-bics scored higher on measures of interpersonal sensitivity, depression, feelings of inadequacy, and hostility. They also reported higher fear of bodily sensations. Although definitive conclusions need to be postponed until prospective studies have been conducted, there is evidence suggesting that the development of agoraphobia in panic patients is associated with hypersensi-tivity to bodily sensations and interpersonal situations.
This article appeared in a journal published by Elsevier. The attached copy is furnished to the a... more This article appeared in a journal published by Elsevier. The attached copy is furnished to the author for internal non-commercial research and education use, including for instruction at the authors institution and sharing with colleagues. Other uses, including reproduction and distribution, or selling or licensing copies, or posting to personal, institutional or third party websites are prohibited. In most cases authors are permitted to post their version of the article (e.g. in Word or Tex form) to their personal website or institutional repository. Authors requiring further information regarding Elsevier's archiving and manuscript policies are encouraged to visit: http://www.elsevier.com/copyright a b s t r a c t The immune system's efficacy in detecting and destroying cancer cells varies considerably throughout the stages of cancer development and its role may be critical particularly during the surgical period. Although surgery causes tumor cells to shed into the blood, immune cells have the capacity to destroy these tumor cells. However, surgery also suppresses cytotoxic capacity. It is particularly during this surgical period that psychological factors can have a significant dampening or strengthening impact on surgery-related immunomodulation response, thus exerting an effect on survival. This review describes the immune changes during the peri-surgical period and the influences psychological factors have on immune function, including the immune effects caused by psychological interventions in cancer patients. We recommend that future studies exploring the role of psychological factors on immune function and survival focus more on their influence during the peri-surgical period.
Objective: This study evaluated the psychological effects of a pre-surgical stress management tra... more Objective: This study evaluated the psychological effects of a pre-surgical stress management training (SMT) in cancer patients. Methods: Stress management training comprised four sessions in total: on 5 days and 1 day pre-surgery and on 2 days and 1 month post-surgery. Patients also received audio CDs with relaxation and coping skills exercises. Patients were randomly assigned to the SMT (N = 34) or a regular care condition (N = 36). Depression, anxiety, quality of life, perception of control, fatigue, pain, sleep problems, and surgery-related somatic symptoms were measured at Day 6 and Day 1 pre-surgery, and Day 2, 5, 30 and 90 post-surgery. Results: Depression and fatigue decreased in the intervention group and increased in the control group, leading to significant group differences at Day 2 (fatigue) and Day 5 post-surgery (fatigue and depression). It also appeared that surgery-related symptoms had increased more in the control group 3 months post-surgery than in the SMT group. No intervention effects were observed for anxiety, pain, and sleep problems. Conclusion: The use of a short psychological intervention is effective in reducing depression and fatigue in the post-surgical period, although the effects are of short duration.
It has been suggested that spirituality is associated with higher well-being, because it offers s... more It has been suggested that spirituality is associated with higher well-being, because it offers social support, improves the relationship with the partner, provides meaning, and reduces self-focus and worry. We performed a qualitative study among ten people with cancer, using the Consensual Qualitative Research method for the analysis of semi-structured interviews. Support was found for the mechanisms of meaning provision and of reduction of self-focus and worries. Participants also mentioned emotion-focused roles of spirituality: Feeling supported by a transcendental confidant, the expression of negative emotions (in prayer), acceptance, allowing feelings of misery, and viewing problems from a distance. There was no mention of a contribution of spirituality to adjustment through improved social support per se or a higher quality of the relationship with the partner. The results of the present study indicate that the role of spirituality in emotion regulation deserves attention in understanding how spirituality helps cancer patients to adjust to their disease.
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