Self‐compassion and hope in the context of body image disturbance and distress in breast cancer survivors

Development of a dyadic mindfulness self-compassion intervention for patients with lung cancer and their family caregivers: A multi-method study

Objective

Lung cancer and its prolonged treatment are profoundly unsettling for patients and their family caregivers, and developing dyadic measures to alleviate their negative affectivity is pivotal. This study aimed to develop a complex intervention to alleviate dyadic psychological stress among patients with lung cancer and their family caregivers.

Methods

A stepwise multi-method study was conducted following the Medical Research Council framework. Three phases were adopted, namely: (1) a preparation phase, a systematic review was conducted to identify the evidence base, (2) a development phase, empirical data from a quantitative study and a qualitative study were integrated to identify effective components, and (3) a modification phase, an online Delphi survey was carried out to refine the intervention.

Results

The dyadic Mindfulness Self-Compassion intervention developed in this study consists of six weekly sessions. The key components of the intervention include: (1) getting along with cancer (introductory session targets illness perception), (2) practising mindful awareness (core session for mindfulness), (3) defining dyadic relationships and introducing self-compassion (core session for self-compassion), (4) promoting dyadic communication (maintenance session targets communication skills), (5) promoting dyadic coping (maintenance session targets coping skills), and (6) a summary session reviewing the rewards and challenges of dyadic adaptation named embracing the future.

Conclusions

An evidence-based, theory-driven, and culturally appropriate dyadic Mindfulness Self-Compassion intervention was developed for patients with lung cancer and their family caregivers. Future studies are warranted to pilot and evaluate the usability, feasibility, acceptability, satisfaction, and effectiveness of this complex intervention.

Trial registration

ClinicalTrial.gov NCT04795700.

The role of social comparative orientation in social anxiety among breast cancer survivors: a moderated mediation model of body image and self-concept clarity

BACKGROUND

It is well known that social rehabilitation is an important part of the overall recovery of breast cancer survivors. Previous research has demonstrated that social anxiety is prevalent among breast cancer survivors, which is not only a significant psychological issue, but also impairs survivors' social rehabilitation and diminishes their quality of life. Therefore, understanding the factors and mechanisms influencing social anxiety in breast cancer survivors is crucial. This study aimed to investigate the mediating and moderating effects of body image and self-concept clarity on social comparison orientation and social anxiety in breast cancer survivors.

METHODS

The convenience sampling method was employed to survey 382 breast cancer survivors. The sample comprised participants aged 30-69 years: 69 - 56 years(28.01%), 45-55 years (39.53% ), and 30-44 years (32.46%). Data was collected using a general information questionnaire, the Social Anxiety Scale, the Body Image Scale, the Social Comparison Orientation Scale, and the Self-Concept Clarity Scale. The SPSS macro program PROCESS plug-in was utilized for mediation and moderation analyses.

RESULTS

This study revealed a partial mediation effect of body image between social comparison orientation and social anxiety (β = 0.100, 95% CI [0.052, 0.162]), accounting for 27% of the total variance. Furthermore, self-concept clarity moderates the influence of social comparison orientation on social anxiety through body image. Specifically, as self-concept clarity increases, the influence of social comparison orientation on body image is gradually weakened, and the impact of body image on social anxiety becomes progressively weaker.

CONCLUSIONS

Social comparison orientation influences the social anxiety of breast cancer survivors through body image. Self-concept clarity exerts a moderating effect, attenuating the influence of social comparison orientation on body image and body image on social anxiety. The findings provide a theoretical and practical foundation for research on the social rehabilitation of breast cancer survivors.

CLINICAL TRIAL NUMBER

Not applicable.

Mediating role of self-compassion in the relationship between psychological flexibility and psychological well-being in women with breast cancer

Previous studies have investigated the relationship between psychological flexibility and psychological well-being among several populations. In addition to examine the relationship between these two variables, this study enhances our understanding about the process underlying the relationship between psychological flexibility and psychological well-being among women with breast cancer. The aim of the present study is to test the mediating role of self-compassion in the relationship between psychological flexibility and psychological well-being among Iranian women with breast cancer. The participants of this study, 220 women with breast cancer (ages 28-58 years, mean age: 42.16, SD: ±6.9.54), from three hospitals in Tehran, Iran, completed questionnaires about psychological flexibility, self-compassion, and psychological well-being. The results from structural equation modeling indicated that psychological flexibility and self-compassion positively predicted psychological well-being and psychological inflexibility negatively predicted psychological well-being among breast cancer patients. The findings from mediation analysis demonstrated that self-compassion partially mediated the relationships between psychological flexibility and psychological inflexibility with psychological well-being. The present study brings to light an underlying mechanism of the relationships between psychological flexibility and psychological inflexibility with psychological well-being via the mediating variable of self-compassion for patients with breast cancer.

The Impact of a Positive Body Image Program (Body Image Awareness Seminars) on the Positive and Negative Body Image of Individuals Living With Cancer

OBJECTIVE

Using action research principles to address gaps in existing interventions, and in consultation with members and administrators of Wellspring Canada, the purpose of the current study was to adapt and examine the impact of a novel (concept, content, and inclusivity) positive body image program (Body Image Awareness Seminars; BIAS) on positive and negative body image in individuals living with cancer.

METHODS

The project used a single-group pretest-posttest design with a 6-week follow-up. Over the 6-week program, 37 participants engaged in 90-min weekly group sessions consisting of researcher-led psychoeducation, group discussion, and activities grounded in positive body image research. Each seminar had a unique theme designed to promote respect, acceptance, and appreciation for the body. Participants completed the Body Image Scale, Body Appreciation Scale-2, Functionality Appreciation Scale, Measure of Body Apperception, Appearance Evaluation subscale, and Self-Compassion Scale anonymously using Qualtrics at the 3 data collection points. Homework assignments included optional readings and writing exercises based on the positive body image tenet taught that week.

RESULTS

Participants reported statistically significant improvements in positive body image (i.e., body appreciation, functionality appreciation), self-compassion, and negative body image (i.e., body image distress and disturbance, investment in body integrity and appearance evaluation), which were sustained at the 6-week follow-up in a subsample of participants (n = 11).

CONCLUSIONS

This study suggests that the adapted BIAS program can lead to improvements in both positive and negative body image in individuals living with diverse types of cancer. Results support the implementation of BIAS in the standard of care for those living with cancer to continue to affect positive change.

A multi-centre prospective cohort study investigating the roles of psychological flexibility and self-compassion in appearance concerns after burn injuries

OBJECTIVES

Appearance concerns following burn injuries are common. Psychological factors are important in maintaining such concerns. However, there is a lack of longitudinal or prospective research investigating their development. This study investigated whether psychological flexibility and self-compassion at hospital admission predicted subsequent appearance concerns.

DESIGN

A multi-centre prospective cohort study across six burn services.

METHODS

Adults (n = 175; 67% male) in hospital following burn injuries were recruited. Questionnaires measuring appearance concerns, psychological flexibility, self-compassion, post-traumatic stress disorder symptoms and perceived noticeability were completed during hospital admission and two- and six-months later. Demographic and burn injury information was collected.

RESULTS

Correlational analyses showed that increased psychological flexibility and self-compassion at admission were associated with decreased appearance concerns cross-sectionally and prospectively at two- and six-month follow-up. These associations remained significant when controlling for key covariates (i.e. gender, age, ethnicity, percentage total body surface area burnt, perceived noticeability, PTSD symptoms). Multiple linear regression analyses revealed that psychological flexibility and self-compassion predicted appearance concerns during hospital admission. Although psychological flexibility significantly predicted appearance concerns over time, it became non-significant when controlling for baseline appearance concerns.

CONCLUSIONS

Psychological flexibility has a protective role against appearance concerns soon after burn injuries, although this protective role is reduced when accounting for baseline appearance concerns. Early interventions targeting psychological flexibility (i.e. acceptance and commitment therapy) may be beneficial after burns if adapted to address appearance-related concerns.

Effects of a 6-month rowing training program in breast cancer survivors

The purpose of this longitudinal study was to determine the effects of a rowing training program on physical fitness and body composition in female breast cancer survivors (56.78 ± 6.38 years). Over six months, the participants (n = 40) performed two training sessions per week for an average of 75 minutes, combining resistance and muscle strength exercises with rowing. To evaluate the impact of the program, physical fitness tests and anthropometric measurements were carried out before and after the training protocol. The results show statistically significant improvements in measures such as weight (-1.84 kg), BMI (-0.7 kg/m2), hip (-3.24 cm) and waist circumference (-2.45 cm). In addition, variables associated with physical fitness also improved including leg strength (3.04 cm), dominant handgrip strength (4.24 kgf), non-dominant handgrip strength (3.49 kgf), aerobic endurance (78.35 m) and muscle flexibility (3.96 cm). We can therefore conclude that a rowing-based exercise program is an effective strategy to improve physical fitness in this type of population, yielding improvements in both anthropometric measurements and basic physical capacity variables, essential factors for better health and quality of life.

Relationship Between Posttraumatic Growth and Illness Uncertainty in Young Women With Breast Cancer: The Mediating Role of Self-compassion

BACKGROUND

The recovery process for young women with breast cancer is influenced by several factors, including the uncertainty of disease, posttraumatic growth, and self-compassion.

OBJECTIVE

To examine the association between illness uncertainty and posttraumatic growth in young women with breast cancer and to determine the mediating role of self-compassion in this association.

METHODS

This cross-sectional, descriptive and correlational study was conducted in Western Turkey between September 2023 and December 2023. Data were collected from 153 young women with breast cancer using the demographic and clinical questionnaire, the Posttraumatic Growth Inventory, Mishel Uncertainty in Illness Scale-Community, and the Self-compassion Scale.

RESULTS

Posttraumatic growth was negatively correlated with illness uncertainty ( r = -0.304, P < .001) and positively correlated with self-compassion ( r = 0.581, P < .001). Illness uncertainty negatively predicted posttraumatic growth ( P < .001), whereas self-compassion positively predicted posttraumatic growth ( P < .001). When self-compassion was included in the model, the effect of illness uncertainty on posttraumatic growth became insignificant ( P > .05).

CONCLUSION

Results of the study indicate that self-compassion has a fully mediating effect on the relationship between illness uncertainty and posttraumatic growth in young women with breast cancer.

IMPLICATIONS FOR PRACTICE

Psychosocial care of young women with breast cancer by oncology nurses can significantly improve self-compassion, reduce illness uncertainty, and promote posttraumatic growth.

Efficacy of Compassion-Based Interventions in Breast Cancer Patients and Survivors: A Systematic Review of Randomized Controlled Trials

Breast cancer patients and survivors deal with physical and psychological challenges due to oncological treatments. The existing literature highlights the importance of compassion in reducing the main cancer-related effects in terms of emotions, quality of life, and dysfunctional coping skills. Over the past few years, compassion-based interventions (CBIs) have been considered an interesting approach to reduce anxiety and depression symptoms and improve quality of life and well-being. However, there have not been many studies that show the benefits of these interventions in breast cancer patients and survivors. The primary objective of this systematic review is to provide evidence of the impact of CBIs on specific variables identified in the literature as affected by this pathology. The variables that will be studied are (a) emotional issues (e.g., anxiety, stress, and depression symptoms); (b) quality of life; and (c) positive coping skills. A systematic search during the previous 10 years up to November 2023 was conducted following the PRISMA guidelines across multiple databases, such as PubMed, Web of Science, PsycINFO, and Scopus. Nine eligible randomized controlled trials were included in this article, with a total of 813 breast cancer patients and survivors. Findings show that CBIs increased compassion, mindful observation, and acting with awareness skills, leading to a significant reduction of anxiety and stress levels, depression, and negative affect. Additionally, less body image distress and greater body appreciation were reported as a consequence of the interventions. This review shows the CBI's efficacy on emotions, positive coping skills, and quality of life in breast cancer patients and survivors. Guidelines for future studies are listed to promote CBIs as a clinically useful intervention for breast cancer patients and survivors.

Body image, illness uncertainty and symptom clusters in surgically treated breast cancer survivors: An exploratory factor analysis and correlational study

PURPOSE

To determine the relationship among body image, illness uncertainty, and symptom clusters in surgically treated breast cancer survivors.

METHODS

A correlational, descriptive study was conducted in a convenience sample of 60 women surgically treated breast cancer survivors recruited in a private hospital and a survivor center. A questionnaire of sociodemographic characteristics, MUIS-C Scale, and QLQ-C30 and Module BR-23 were used. Variable characteristics and associations were analyzed with descriptive statistics and Pearson correlation coefficient, and exploratory factor analysis using unweighted least squares and Promax rotation was used for symptom clustering.

RESULTS

A three-factor structure was found: an anxiety symptom cluster, a breast symptom cluster, and an arm symptoms, depression, and fatigue symptom cluster, explaining 46,47% of the variance. Significant correlations were found among body image and illness uncertainty (r = -0,390, p < 0,01), body image and the anxiety symptom cluster (r = 0,613, p < 0,01), illness uncertainty and the anxiety symptom cluster (r = -0,421, p < 0,01), the breast symptom cluster (r = -0,425, p < 0,01), and the arm symptoms - depression - fatigue symptom cluster (r = -0,443, p < 0,01).

CONCLUSION

The relationships among all variables were statistically significant. Nurses providing care to BC survivors need to address the multidimensionality of the symptom experience and its correlates to better assist their patients. Further research is needed to elucidate the biopsychosocial underpinnings of those relationships.

The relationship between psychological distress and cognitive failure among breast cancer survivors: a network analysis

Background

Psychological distress is highly prevalent and has a severe impact on the quality of life among breast cancer survivors. This type of distress is associated with cognitive failure. However, previous studies have focused solely on the total scale scores of these two concepts while ignoring the unique relationship between specific components. In the present study, we utilized network analysis to explore the relationship between psychological distress and cognitive failure in breast cancer survivors.

Methods

The network analysis approach was adopted to estimate the regularized partial correlation network in a cross-sectional sample of 409 breast cancer survivors. All participants were assessed using the Depression Anxiety Stress Scale and the Cognitive Failure Questionnaire. The Gaussian Graphical Model was employed to estimate the network, centrality indices, and edge weights, providing a description of the characteristics of the network.

Results

The results indicated that anxiety-stress and depression-stress were the strongest edges in the community of psychological distress. Distractibility-memory was the strongest edge in the community of cognitive failure. Distractibility and memory were the most central nodes, with the highest expected influence in the network. Depression and motor coordination acted as important bridge nodes with the highest bridge expected influence.

Conclusion

Distractibility and memory in cognitive failure played important roles in activating and maintaining the relationship network. Motor coordination was identified as the crucial pathway for the impact of cognitive failure on psychological distress. Interventions targeting these specific issues might be more effective in improving cognitive failure and reducing psychological distress among breast cancer survivors.

Factors predicting self-compassion among patients with breast cancer undergoing chemotherapy in Thailand: A cross-sectional study

Background

Breast cancer is the most common female malignancy. Although chemotherapy is the primary treatment for breast cancer, it frequently has several detrimental side effects. Patients with breast cancer require self-compassion to regulate their emotions in order to cope with their suffering. Factors affecting self-compassion have mostly been investigated in the context of chronic diseases in general, not specifically in relation to patients receiving chemotherapy for breast cancer.

Objective

This cross-sectional study sought to describe the self-compassion level and to examine the predictive ability of self-critical judgment, body image, stress, attachment style, social support, hope, and self-reassuring on self-compassion among patients with breast cancer undergoing chemotherapy.

Methods

The participants were 210 Thai women with breast cancer who received chemotherapy in northern Thailand and were selected using proportionate random sampling. Data were collected from December 2021 to January 2023 using validated instruments. Data were analyzed using descriptive statistics and hierarchical regression analysis.

Results

Self-compassion was moderate (Mean = 2.91, SD = 0.91). Self-critical judgment (β = 0.487, p <0.001) and hope (β =0.128, p = 0.032) could predict self-compassion in patients with breast cancer undergoing chemotherapy and explained 40.1% of the variance.

Conclusion

The study's findings highlight the importance of addressing self-critical judgment and fostering hope in patients with breast cancer undergoing chemotherapy to enhance their self-compassion. Nurses and other healthcare providers can use the findings to provide interventions to promote self-compassion.

Factors impacting quality of life for breast cancer survivors

ABSTRACT

According to the World Health Organization, breast cancer became the most common cancer in the world in 2020 and accounted for 685,000 deaths globally. In this article, breast cancer risk factors, considerations for genetic testing for BRCA1 and BRCA2 variants, signs and symptoms, and treatment are briefly discussed. Factors that impact the well-being and quality of life of women who have or have had breast cancer are also explored in depth, and practice implications for primary care providers are noted.

Self-compassion and parenting efficacy among mothers who are breast cancer survivors: Implications for psychological distress

Mothers who are breast cancer survivors may experience psychological distress in relation to diminished parenting efficacy. Self-compassion may protect mothers from psychological distress, yet little is known about self-compassion in this population. The extent to which self-warmth (self-kindness, mindfulness and sense of common humanity) and self-coldness (self-judgement, isolation and over-identification) dimensions of self-compassion moderate parenting efficacy in predicting depression, anxiety and stress was examined in a sample of 95 mothers who were breast cancer survivors. Independently, poorer parenting efficacy was associated with more depression and stress symptoms. Within regression models, self-coldness was a direct predictor of depression, anxiety and stress, while self-warmth moderated the relationship between parenting efficacy and stress. Self-warmth presents as a potential protective factor for stress associated with poor parenting efficacy, while self-coldness is a potential direct risk factor for psychological distress. Mothers who are breast cancer survivors may benefit from self-compassion focused psychosocial interventions.

An investigation of the effect of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function in Iranian women with breast cancer: a randomized controlled trial

BACKGROUND

Breast cancer is an extremely unpleasant and unbearable experience that can have a profound impact on a person's life. Compared to other types of cancer, breast cancer has a more severe psychological impact on women.

PURPOSE

This study aimed to investigate the effect of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function in Iranian women with breast cancer.

METHOD

A sample of 30 women with breast cancer were randomly divided into intervention and control groups. The research was conducted in the oncology division of Imam Reza Hospital in Kermanshah by the clinical trial method with a two-group pretest-posttest design and a 2 month follow-up. Participants in the intervention group received Mindfulness-integrated cognitive behavior therapy for eight sessions. The intervention was carried out individually in weekly 60 min sessions. While the control group received self-help treatment (through an educational book). A demographic questionnaire, Demoralization Scale (DS-II), Body Image Scale (BIS), and Female Sexual Function Index (FSFI) were used to collect data. For data analysis, means and standard deviations were calculated and repeated measures and the Bonferroni test was conducted using SPSS 26.

RESULTS

The results showed the effectiveness of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function (p < 0.05). Concerning demoralization in the intervention group, the pre-test mean was 16.73 ± 3.33, and it reduced to 11.93 ± 1.49 in the post-test. The body image mean score showed a decreasing trend in the intervention group, from 12.47 ± 1.88 in the pre-test to 8.80 ± 3.21 in the post-test. The mean score for sexual function showed an increasing trend, increasing from 18.06 ± 2.29 in the pre-test to 23.07 ± 0.91 in the post-test. There was no significant difference in the mean score of the post-test compared to the pre-test and follow-up in the control group (p < 0.05).

CONCLUSION

MICBT can be used in conjunction with pharmaceuticals and medical treatments to improve the psychological symptoms of women with breast cancer, according to this study's results. Trial registration (IRCT20160103025817N6). 2022-04-06.

The longitudinal relationship between self-compassion and cancer patients' unmet supportive care needs

OBJECTIVES

Unmet supportive care needs are associated with psychological symptoms such as depression and anxiety. However, so far, few studies have explored the protective psychological factors of unmet needs. Therefore, this study intends to explore the protective effect of self-compassion on unmet needs of Chinese cancer patients and to examine the predictive role of self-compassion on these needs during treatment.

METHODS

A longitudinal study was performed at Shaanxi Provincial Cancer Hospital in Xi'an, China. A total of 153 heterogeneous cancer patients were assessed after the first diagnosis (T1), at the beginning (T2) and end (T3) of medical treatment. Hierarchical linear regression analyses were used to examine the research questions.

RESULTS

Cross-sectional regression analyses showed that self-compassion at T1 was significantly related to psychological needs at T1. Negative self-compassion at T1 was significantly related to total unmet needs, psychological needs, health system, and information and sexual needs. Longitudinal regression analyses showed that self-compassion at T1 significantly predicted total unmet needs; health system and information (HSI) needs at T2, psychological needs at T3, and negative self-compassion at T1 significantly predicted total unmet needs, HSI needs, physical needs, and patient care needs at T2 when controlling for unmet needs at T1. Positive self-compassion was not a predictor of unmet needs.

CONCLUSIONS

Self-compassion can be a protective factor of unmet needs in cancer patients. Future intervention studies should focus on improving the overall level of self-compassion and reducing the level of negative self-compassion in cancer patients to reduce patients' unmet needs.

Hope and anxiety

Anxiety-related disorders continue to be one of the most prevalent and burdensome psychiatric disorders. Research has examined resilience factors, such as hope, that can build resilience toward or mitigate the impact of anxiety disorders. The following review provides a summary of hope as a factor of resilience as well as a mechanism of change in reducing levels of anxiety. First, hope and anxiety are conceptualized as future-oriented traits. Then, hope as a source of resilience against trait anxiety is discussed. The article then discusses the moderate, indirect relationship between hope and general as well as specific forms of anxiety before providing empirical support for hope as a mechanism of change in the reduction of anxiety. Finally, considerations for future study of hope and anxiety are discussed.

Prevalence and severity of anxiety and depression in Chinese patients with breast cancer: a systematic review and meta-analysis

Context

Anxiety/depression in breast cancer (BC) is common around the world, and Chinese BC patients should not be ignored. The prevalence of anxiety and depression among BC patients are various in different regions of China, but no clear summarization has been made.

Purpose

This meta-analysis aimed to evaluate the prevalence and severity of anxiety and depression among breast cancer (BC) patients in China.

Methods

A literature search on PubMed, Web of Science, Embase, CINAHL, Scopus, PsycINFO, Cochrane database library, CNKI, Wanfang, and SinoMed was conducted up to 29 December 2021. The effect size (ES) or standard mean difference (SMD) and the corresponding 95% confidence intervals (CIs) for the prevalence and severity of anxiety/depression were calculated using the STATA 12.0 software.

Results

A total of 63 identified studies were included, containing a total of 53,513 Chinese women confirmed breast cancer. The results showed a high pooled prevalence of anxiety (38%, 95% CI, 27-50%, I2 = 99.4%, p < 0.001) and depression (38%, 95% CI, 33-44%, I2 = 99.2%, p < 0.001) among Chinese BC patients. Moreover, both anxiety (SMD = 0.30, 95% CI, 0.08-0.53, I2 = 91.6%, p < 0.001) and depression (SMD = 0.25, 95% CI, -0.05-0.55, I2 = 95.3%, p < 0.001) in BC patients were more serious than those in healthy controls, but not significantly different from patients with other diseases. Specifically, among the six regions included, the prevalence of anxiety and depression were both the highest in Northeast China, obviously superior than the second-highest region.

Conclusion

The study showed high levels of anxiety and depression among BC patients in China, especially those in the northeast. Clinicians and researchers should pay attention to the psychological problems of patients with breast cancer and regard it as one of the important prognostic outcomes of patients.

Systematic review registration

https://www.crd.york.ac.uk/prospero/index.php, PROSPERO: CRD42020151752.

Association of self-compassion and body image disturbance among young breast cancer patients: Mediating effect of body surveillance and body shame

Objective

To examine whether body surveillance and body shame mediated the association between self-compassion and body image disturbance among young breast cancer patients.

Methods

In this cross-sectional descriptive study, a total of 310 young women with breast cancer were recruited by convenience sampling. All of them completed self-report measurements of demographic and clinical characteristics, self-compassion scale, body image self-rating questionnaire for breast cancer and body surveillance scale, and body shame scale between September and December 2021 ​at a tertiary cancer hospital in Tianjin, China. Data analysis was performed with correlation analysis and structural equation modeling to verify relationships between key variables.

Results

Less self-compassion was significantly associated with greater body image disturbance, while a positive correlation was found between body image disturbance, body surveillance, and body shame. Self-compassion indirectly negative predicted body image disturbance via the chain mediation of body surveillance and body shame.

Conclusions

The links of self-compassion and body image disturbance were mediated by body surveillance and body shame. Reducing patients' excessive body surveillance and body shame by improving their ability of self-compassion may be an effective measure to reduce body image disturbance.

Determinants of Post-Traumatic Growth and Quality of Life in Ghanaian Breast Cancer Survivors

This study assessed the psychosocial factors associated with post-traumatic growth (PTG) and health-related quality of life (HRQoL) in women breast cancer survivors. Women (N = 128) completed questionnaires on social support, religiosity, hope, optimism, benefit-finding, PTG and HRQoL. Structural equation modeling was used to analyze the data. Results showed that perceived social support, religiosity, hope, optimism, and benefit finding were positively associated with PTG. Religiosity and PTG were positively associated with HRQoL. The results suggest that interventions aimed at increasing religiosity, hope, optimism, and perceived support can help survivors cope better with breast cancer.

Listening to voices from multiple sources: A qualitative text analysis of the emotional experiences of women living with breast cancer in China

Background

Receiving a breast cancer diagnosis and treatment is both a physical and emotional journey. Previous studies using single-source data have revealed common and culture-specific emotional experiences of patients living with breast cancer. However, few studies have combined such data from multiple sources. Thus, using a variety of data sources, the current study sought to explore the emotional experiences of women in China newly diagnosed, post-operative, or undergoing chemotherapy. We posited that even though women living with breast cancer in China have multiple channels through which they can express these emotional experiences, little variance would be found in their emotional expressivity and the themes they want to express due to cultural inhibitions.

Methods

Text data from female patients newly diagnosed, post-operative, or undergoing chemotherapy were collected between June 2021 and January 2022 via a Python web crawler, semi-structured interviews, and an expressive writing intervention. Data were transcribed and subjected to thematic analysis. Reporting followed the consolidated criteria for reporting qualitative studies (COREQ) guidelines.

Results

Analyses were based on 5,675 Weibo posts and comments published by 448 posters and 1,842 commenters, transcription texts from 17 semi-structured interviews, and 150 expressive writing texts. From this total collection of 461,348 Chinese characters, three major themes emerged: (i) conflicting emotions after diagnosis; (ii) long-term suffering and treatment concerns; and (iii) benefit finding and cognitive reappraisal.

Conclusions

Despite gathering information from various sources, we found that distress from body-image disturbances, gender role loss and conflict, and changes in sexuality and fertility, were consistent among this sample of female Chinese patients with breast cancer. However, when women engaged actively in benefit finding and cognitive reappraisal with strong social support, patients were able to find ways to adapt and reported post-traumatic growth. Strong social support was an important facilitator in this growth. These study findings emphasize that healthcare professionals ought to increase cultural sensitivity, provide multiple channels to encourage patients to express their emotions, and incorporate screening for patients' emotional distress at all diagnostic and treatment phases as part of routine nursing care.

Compas-Y: A mixed methods pilot evaluation of a mobile self-compassion training for people with newly diagnosed cancer

Objective

Compas-Y is a compassionate mind training app that was co-designed to be fully adapted to mobile technology and to people with newly diagnosed cancer. This study aimed to evaluate the use, appreciation and impact of the app.

Methods

Seventy-one people with cancer who created an app account were included (38% breast cancer, 72% diagnosed <4 months ago, 76% received chemotherapy). Participants had very high baseline scores of self-compassion. In a convergent mixed methods design, back-end log-data (n = 71), pre-post surveys (n = 34) and semi-structured interviews (n = 23) collected for >8 weeks and were concurrently analysed using joint displays.

Results

About half of the participants (45%) used 4 of the 6 modules. Compas-Y was highly appreciated, with all content considered relevant and a source of support. Experienced benefits related to improved mental health. Particularly, we found significant changes in anxiety, but not in depression or well-being. In the interviews, people reported experiencing more rest and more positive emotions due to using the app. Process benefits included significant reductions in self-criticism (inadequate self and self-blame), but not self-compassion. In the interviews, people reported improved self-compassion and less self-criticism, more self-awareness, recognition and support, and improved emotion regulation and coping. The surveys did not capture the full range of outcomes that participants reported in the interviews.

Conclusions

Compas-Y is a highly appreciated mobile intervention that supported users in aspects of their mental health. Findings are discussed in terms of reach and adherence, app functionalities, co-design and tailoring of cancer-related and compassion-based eHealth.

Mental Health during the Early Stage of the COVID-19 Pandemic: A Hong Kong Study

This study addressed the impact on mental health and wellbeing in relation to views of the self, the world, and the future during the early stage of the global novel coronavirus (COVID-19) pandemic outbreak. An online survey battery included the 21-item Depression Anxiety and Stress Scale (DASS-21), Subjective Happiness Scale, Self-Compassion Scale, Adult Hope Scale, and two specifically-written items measuring the valence quality and quantity of the impact of the pandemic. A total of 345 Hong Kong residents (54% females) responded; 17.1%, 24.7%, and 19.7% reported elevated levels of depression, anxiety, and stress, respectively. The prevalence of these issues was lower in this Hong Kong sample than reported in other COVID-19 studies, possibly due to the past experience of the severe acute respiratory syndrome (SARS) outbreak in Hong Kong in promoting the voluntary wearing of masks in public places and introducing social distancing measures during the early first wave of the pandemic. Correlational analyses showed associations between positive views about the self (higher self-compassion), the world (higher positive valence), and the future (more hope) and better mental health and psychological wellbeing (fewer depression, anxiety, and stress symptoms; more happiness). Regression analyses indicated a differential predicting power of the three views on the four selected mental health and psychological wellbeing indicators. Intervention programs to alleviate distress and/or promote better wellbeing should be matched to the specific problems encountered by the sufferers.

'At least there is something in my bra': A qualitative study of women's experiences with oncoplastic breast surgery

Aims

This study explores how women diagnosed with breast cancer may be supported by physicians and nurses during physical and existential changes related to oncoplastic breast surgery in Denmark. The following research questions were addressed: (a) how do women experience oncoplastic breast surgery, and (b) how does cancer treatment affect their body image?

Design

A descriptive qualitative study design with a six‐step thematic analysis influenced by Braun and Clarke was applied in this study. This paper has been prepared in accordance with the consolidated criteria for reporting qualitative research.

Methods

Fourteen in‐depth interviews with seven women diagnosed with breast cancer were conducted from August 2018 to March 2019. In this qualitative study, data analysis was performed concurrent with data construction, recognizing that the process of analysis and making sense of data should start during the interviews. We explicitly frame the discussion of the findings in a theory of embodiment influenced by Merleau‐Ponty, consistent with the construct of exploring human experiences to generate meaningful knowledge for applied practice.

Results

Two overall themes with related subthemes were identified: (1) 'Treatment is required for life‐threatening cancer', and (2) 'Striving for a new normal body'. Across both themes, women's experiences reflected a 'time pendulum' as they contemplated their past identity, their current rationale and their transition to a future beyond breast cancer with a changed body.

Conclusion

Participants reflected on their past, present and future when facing an altered body image caused by their breast cancer diagnosis and oncoplastic breast surgery. The participants in the study expressed broad levels of satisfaction with the results of the oncoplastic breast surgery. The reconstructed breast helped them to live normally again, in particular maintaining interpersonal relationships. Breast reconstruction supported participants' embodiment experiences and redefinition of their 'new normal'.

Impact

This study showed the dynamic changes in self‐definition from receiving a breast cancer diagnosis and cancer treatment to oncoplastic breast surgery. The main finding of self‐redefinition was from the perspective of breast cancer women who were in a period of transition between post‐diagnosis and consultation for oncoplastic breast surgery. The findings indicate that advanced nurse specialists in the field of oncoplastic breast surgery can enhance psychosocial wellbeing and support women pre‐ and post‐operatively by focusing on patient experiences of self‐image and embodiment.

Hope and Self-Compassion to Alleviate Parenting Stress in the Context of the COVID-19 Pandemic

As the coronavirus disease of 2019 (COVID-19) pandemic disrupted all aspects of life, parents have been subjected to more household and caregiving responsibilities and stressors. The purpose of this study is to investigate how hope, self-compassion, and perception of COVID-19 health risks influence parenting stress. In this cross-sectional study, a total of 362 parents living in the United States completed an online survey in July 2020. Multiple regression analyses revealed that higher levels of hope are related to lower levels of parenting stress. On the other hand, lower levels of self-compassion as indicated by higher scores on the subscales of isolation, self-judgment, and overidentification are related to higher levels of parenting stress. Further, testing positive for the coronavirus is positively related to parenting stress, whereas the belief that COVID-19 is a serious disease is negatively related to parenting stress. Findings also revealed the significant role of hope in moderating the relation between self-compassion and parenting stress. This study highlights the importance of nurturing and drawing from one's own psychological resources to mitigate parenting stress, particularly in the context of a chronic source of stress like a pandemic. Implications for the counseling profession are discussed.

Prevalence and biopsychosocial factors associated with depressive symptoms among patients living with systemic lupus erythematosus in clinical settings in urban Thailand

BACKGROUND

Depressive symptoms are globally recognized as a significant mental health problem in patients with chronic disease, particularly those with systemic lupus erythematosus (SLE). The purpose of this study was to estimate the prevalence and examine biopsychosocial factors of depressive symptoms among patients with SLE.

METHODS

This cross-sectional study was conducted among 185 participants diagnosed with SLE and received treatment for at least 3 months, aged 18-59 years attending the outpatient clinic of a university hospital, Bangkok, Thailand. Depressive symptoms were measured by the Thai version of the Patient Health Questionnaire-9. We assessed Demographic data, the Systemic Lupus Erythematosus Activity Index, the Systemic Lupus International Collaborating Clinics Damage Index, Numeric Rating Scale, Fatigue Severity Scale, Body Image Scale, and the ENRICHD Social Support Instrument. Data were collected from March to May 2021. Multivariable logistic regression was used to analyze the data.

RESULTS

The proportion of the participants with depressive symptoms was 43.2%, which 8.1% of those patients presented moderate to severe depressive symptoms. In a multivariable logistic regression model, SLE patients with depressive symptoms were more likely to be severe pain (aOR = 12.11, 95% CI: 1.35, 108.46), fatigue (aOR = 2.36, 95%CI: 1.08, 5.14), taking prednisolone ≥15 mg daily (aOR = 5.75, 95%CI: 1.76, 18.80), low satisfied of body image (aOR = 12.49, 95%CI: 2.23, 69.80), and low social support (aOR = 17.96, 95% CI: 1.86, 173.77). Disease flare, organ damage, and family income sufficiency did not significantly increase the risk of depressive symptoms in patients with SLE.

CONCLUSIONS

The findings highlight depressive symptoms in patients with SLE. Therefore, the health professional should be concerned about the perception of body image, level of social support, fatigue, and pain while treating patients with SLE. Public health screening programs to identify depressive symptoms in patients with SLE are needed. In addition, a high dose of prednisolone should be considered if required, along with monitoring.

Experiences of Self-Criticism and Self-Compassion in People Diagnosed With Cancer: A Multimethod Qualitative Study

Objective: Self-criticism is a self-condemning and self-compassion a supportive style of self-to-self relating. These concepts have increasingly been studied in people with cancer, but mainly with quantitative studies. This study is the first to explore how adult cancer patients experience self-criticism and self-compassion in the context of their illness. Design: A multimethod qualitative study design was used, combining individual and group semi-structured interviews. Participants were 26 people with cancer who familiarized themselves with the topic by doing various self-compassion exercises for 2 weeks prior to the interview. Individual and group interviews were analyzed together using thematic analysis. Results: Four themes regarding self-criticism were identified: (1) being harsh or strict with yourself, (2) feeling guilty or angry, (3) feeling useless or like a burden, (4) feeling ashamed and not wanting to show weakness. Six themes regarding self-compassion were identified: (1) being mild to yourself, (2) guarding your boundaries, (3) accepting the illness and limitations, (4) maintaining a positive perspective, (5) connecting to others, and (6) taking responsibility for your health. Conclusion: Our findings offer insights into practical and daily life experiences of self-criticism and self-compassion of people with cancer, which can aid the further development of theory, scales and interventions.

Mediator Roles of Social Support and Hope in the Relationship Between Body Image Distress and Resilience in Breast Cancer Patients Undergoing Treatment: A Modeling Analysis

Breast cancer and its treatment are particularly distressing for patients because of their potential impacts on body image. The most difficult phase of cancer treatment is usually the first year after a diagnosis. Cancer patients with strong resilience have the positive attitude, internal strength and external resources needed to cope with the disease and its treatment. This cross-sectional study investigated the mediator roles of hope and social support in the association between body image distress and resilience. A structured questionnaire was used to collect data for a convenience sample of 141 breast cancer patients undergoing treatment in southern Taiwan. Structural equation modeling was used for data analysis. The results showed that the final model had a good fit to the data and accounted for 51% of the total variance in resilience. The model of multiple parallel mediators of resilience revealed that hope and social support had mediator roles in the effect of body image distress on resilience. Hope had an important partial mediating role in the association between body image distress and resilience. Social support also had a partial mediating role in the relationship between body image distress and resilience. Social support did not directly affect resilience and indirectly affected resilience through hope. Psychosocial interventions aimed at reducing the impact of body image distress and increasing resilience in breast cancer patients should focus on cultivating hope and increasing social support, particularly support from family members and health professionals.

Type C Behavior and Associated Factors in Patients with Breast Cancer During Postoperative Chemotherapy: A Cross-Sectional Study

Background

Type C behavior is a cancer-prone behavior that can affect the occurrence and development of cancer. This study aimed to investigate the prevalence of type C behavior in patients with breast cancer during postoperative chemotherapy and determine its associated factors.

Methods

This study enrolled 161 patients with breast cancer who received postoperative chemotherapy. Type C personality behavior pattern questionnaire was used to assess type C behavior patterns. The following instruments were employed: medical coping modes questionnaire, social support scale, social relational quality scale, Herth hope index. logistic regression was used to identify the factors affecting type C behavior.

Results

The incidence of type C behavior was 28%. Participants aged 45-59 years (OR = 3.62, 95% CI = 1.04-12.56, P = 0.043), and who adopted a resignation coping style (OR = 1.25, 95% CI = 1.03-1.50, P = 0.021), were more likely to develop type C behavior. Type C behavior was less common in patients with employment (OR = 0.38, 95% CI = 0.15-0.97, P = 0.043), with a high level of social support (OR = 0.89, 95% CI= 0.80-0.98, P = 0.023), and more hope (OR = 0.83, 95% CI = 0.71-0.98, P = 0.079).

Conclusion

In this study, 28% patients with breast cancer during postoperative chemotherapy exhibited type C behavior. Associated factors with type C behavior were identified, which could guide health care professionals to reduce the prevalence of type C behavior through guiding patients to adopt positive coping styles and improving their level of social support and hope, especially in those aged 45 to 59 years or in those without employment.

Feasibility and pilot study of a brief self-compassion intervention addressing body image distress in breast cancer survivors

BACKGROUND

The majority of breast cancer survivors (BCSs) experience body image concerns following treatment. Body Image distress (BID) is associated with psychological distress and diminished quality of life. A web-based self-compassion focused writing activity (My Changed Body - MyCB) reduces BID in BCSs, yet limited research exists on participant characteristics associated with such intervention adherence. Self-compassion-based meditations are also efficacious in reducing BID in non-BCS populations. This parallel, double-blind pilot randomised controlled trial aimed to assess the feasibility and acceptability of MyCB, with and without an additional meditation component, on BID and related psychological outcomes in BCSs. The trial was registered with the Australian and New Zealand Clinical Trials Registry (#ACTRN12619001693112).

METHODS

BCSs were randomly allocated to MyCB (n = 39), MyCB + Meditation (MyCB + M) (n = 17) or an expressive writing (EW) active control arm (n = 23). The primary outcome was BID. Secondary outcomes were body appreciation, affect (positive and negative), psychological distress (depression, anxiety and stress) and self-compassion (state and trait). Assessments were completed online at baseline, post-intervention and 1-month.

RESULTS

Adherence to the MyCB writing (45%) and meditation (50%) was modest, and acceptability was high for both MyCB and MyCB + M. Intent to treat linear mixed model analyses indicated: Post-intervention - state self-compassion and positive affect increased for MyCB compared to EW; 1-month: BID scores decreased across all conditions; trait self-compassion increased and anxiety decreased for MyCB + M compared to MyCB and EW.

CONCLUSION

These findings provide preliminary evidence for the efficacy and potential clinical use of the MyCB brief web-based self-compassion intervention alone and with the addition of meditation, to increase self-compassion and psychological wellbeing in BCSs.

Predictors of mental health disorders in women with breast and gynecological cancer after radical surgery: A cross-sectional study

Introduction

In lower-middle-income countries, significant progress has been made in the therapeutic management of cancers. However, mental health disorders related to these diseases are usually underestimated by the health system. The aim of this study is to investigate the predictive factors for mental health disorders in Moroccan women with breast or gynecological cancer treated by radical surgery.

Material and methods

A cross-sectional study was carried out on Moroccan women treated by radical surgery for breast or gynecological cancer (N = 200). For each cancer type, patients were divided into two groups following age criteria. Hospital Anxiety and Depression Scale and Body image scale were used.

Results

Age had a significant effect on mental health disorders but not the type of cancer. Younger women showed significantly greater mental health disorders than older women (p ≤ 0.001). The predictive model for high anxiety and depression included the effect of the following variables: Being younger, having lower income, and advanced tumor stage. For higher body image dissatisfaction, the variables are as follows: being younger, having fewer children, lower-income, and advanced tumor stage.

Conclusion

The association of mental health disorders in patients with breast or gynecological cancer increases their distress. The establishment of management protocols for these disorders is strongly recommended in oncology departments.

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Age has an effect on mental disorders linked to breast and gynecological cancer.

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Cancer type does not have a significant effect on mental disorders.

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Young Age, lower income and advanced tumor stage are predictors of mental disorders.

The application of the Chinese version of the Body Image Disturbance Questionnaire in patients with systemic lupus erythematosus

This study aimed to translate the Body Image Disturbance Questionnaire (BIDQ) into Chinese and evaluate its reliability and validity in a sample of patients with systemic lupus erythematosus (SLE).Following the translation and revision of the Chinese version of the BIDQ, 169 patients with SLE were chosen as respondents to test the questionnaire's reliability and validity. We tested the content's validity through expert group evaluation. It is structural validity was examined through exploratory factor analysis and confirmatory factor analysis, and reliability was evaluated using Cronbach's α and test-retest reliability.The Chinese version of the BIDQ showed a content validity of .92. A two-factor structure was revealed by exploratory factor analysis, which explained 67.83% of the variance and proved by confirmatory factor analysis. Its overall Cronbach's α was .82 (P  < .001), and the Cronbach's α for each item ranged from .76 to .83. The test-retest reliability was .82, with the Cronbach's α for each item ranging from .76 to .84.Thus, adequate reliability and validity of the Chinese version of the BIDQ were demonstrated for use in patients with SLE.

Post-treatment Psychological Distress Among Colorectal Cancer Survivors: Relation to Emotion Regulation Patterns and Personal Resources

BACKGROUND

Post-treatment psychological distress among colorectal cancer (CRC) survivors is common, but changes over time. However, data on the effects of emotional factors on changes in psychological distress over time remain limited. The study sought to describe the patterns of change in psychological distress among CRC survivors in the short-term after treatment completion and to identify predictors of the change in psychological distress experienced by CRC survivors.

METHODS

A total of 153 CRC survivors, stages II-III at diagnosis, who were 4-24 months post-diagnosis (participation rate 89.5%) completed the Emotion Regulation Questionnaire, Acceptance and Action Questionnaire, Resilience Scale-14, Self-Compassion Scale-Short Form, and Brief Symptom Inventory-18 (psychological distress scale) at Time 1 (T1). Psychological distress was assessed again at Time 2 (T2), 6 months later.

RESULTS

Two patterns of change in post-treatment psychological distress among CRC survivors were identified: One group of patients experienced higher psychological distress at T1, which decreased at T2. A second group experienced lower psychological distress at T1, which increased at T2. Self-compassion and personal resilience predicted higher psychological distress at T2. Lower suppression and self-compassion and higher personal resilience increased the likelihood of being in the increased psychological distress group.

CONCLUSIONS

Psychological distress evaluation of CRC survivors at different time-points post-treatment is warranted. In addition, awareness is needed that self-compassion may be individually related to psychological distress among participants.

Self-compassion moderates the perceived stress and self-care behaviors link in women with breast cancer

OBJECTIVE

Women with breast cancer are exposed to various stressors, and self-care behaviors play an important role in their recovery. However, very few studies have investigated self-care behaviors specifically for women with breast cancer. The current study examined the relationship between perceived stress and self-care behaviors, and explored whether self-compassion moderated this relationship.

METHODS

A sample of 210 women with breast cancer aged 27 to 60 years old from three hospitals in Tehran, Iran completed online self-report questionnaires of self-care behaviors, self-compassion, and perceived stress.

RESULTS

Data analyses with structural equation modeling showed that perceived stress (β = -.37, P < .01) and self-compassion (β = .38, P < .01) were significant predictors of self-care behaviors. The interaction-moderation analysis showed that self-compassion acted as a moderator between perceived stress and self-care behaviors.

CONCLUSIONS

The findings enhance our understanding about the protective role of self-compassion in the relationship between perceived stress and self-care behaviors in women with breast cancer.

Anxiety and Depression Comorbidities in Moroccan Patients With Breast Cancer

Background: Breast cancer is the leading cause of cancer death in women worldwide with more than 1. 7 million new cases annually. Major advances have been made in the therapeutic management of this condition in many countries. However, neuropsychiatric disorders in patients with breast cancer constitute a significant concern due to their negative impact on patient's life and on the success of therapy itself. Methodology: In this study we aimed to evaluate psychological disorders in a population of 212 Moroccan women treated for breast cancer within the Mohammed VI Center for the Treatment of Cancers of Casablanca. A questionnaire was designed to this end on the basis of different validated scales, including the Hospital Anxiety Depression Scale (HADS), the Pittsburgh Sleep Quality Index (PSQI), and the Body Image Scale (BIS). Results: Data analysis has shown that 69.3% of participants had significant sleep disorders; 87% suffer from an anxiety-depressive syndrome (ADS), and 83.0% had significant body image dissatisfaction. A positive correlation was shown between ADS and both patients' national health insurance coverage and patients or husbands' education. Analysis further revealed that anxiety and depression were negatively correlated with different types of treatment. Similarly, both BIS and PSQI scores were positively associated with anxiety and depression disorders. Conclusion: The present investigation highlights the need to generalize and strengthen the psychological approach of patients treated for breast cancer in Morocco. We anticipate that such a strategy will alleviate suffering and promote therapy success in these patients and will diminish or prevent conjugal and familial impacts of the illness.