Of babies and bathwater: a reply to Coyne and Tennen's views on positive psychology and health

General well-being of intensive care nurses: A prototype analysis

BACKGROUND

Prototype analyses of well-being have identified central characteristics and prototypicality for New Zealand teachers, lawyers, adolescents, and work well-being of nurses. What has not yet been explored is the broad construct of well-being in intensive care nurses.

AIMS

To identify intensive care nurses' conceptions of general well-being and investigate whether their general well-being is prototypically organized.

DESIGN

Prototype analysis.

METHODS

Three linked studies conceptualize well-being in this prototype analysis. In study 1, nurses reported features of well-being. Study 2 investigated the organization of these features. Study 3 sought confirmation of prototypical organization.

RESULTS

Sixty-five New Zealand nurses participated. For study 1 (n = 23), the most frequently reported elements of well-being included physical health (n = 26), work-life balance (n = 20), and personal relationships (n = 18). For study 2 (n = 25), the highest rated elements included mental and emotional health, [general] health, work-life balance, and love. Work-life balance, physical health, and personal relationships were in the top five most frequently reported and were rated in the top 12 most central. Overall, ratings of centrality and the number of times reported were positively correlated (r = 0.33, P < .005). For study 3 (n = 17), confirmatory analyses did not reach statistical significance (P = .15).

CONCLUSIONS

Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. Mental, emotional, and general health and work-life balance were considered most important for well-being.

RELEVANCE TO CLINICAL PRACTICE

Physical health, work-life balance, and personal relationships are key characteristics of well-being for intensive care nurses. These characteristics of the broad construct of well-being are helpful in both defining and identifying conceptual models of well-being that may be used to inform the development and measurement of well-being programmes.

A Systematic Review of Fear of Cancer Recurrence Among Indigenous and Minority Peoples

While cancer survivors commonly experience fear and anxiety, a substantial minority experience an enduring and debilitating fear that their cancer will return; a condition commonly referred to as fear of cancer recurrence (FCR). Despite recent advances in this area, little is known about FCR among people from Indigenous or other ethnic and racial minority populations. Given the high prevalence and poor outcomes of cancer among people from these populations, a robust understanding of FCR among people from these groups is critical. The current review identified and aggregated existing literature on FCR amongst adult cancer survivors from Indigenous and minority populations. The protocol of this review was registered with PROSPERO in July 2020 (Registration number: CRD42020161655). A systematic search of bibliographic databases was conducted for relevant articles published from 1997 to November 2019. Data from eligible articles were extracted and appraised for quality by two independent reviewers. Nineteen articles from four countries (United States of America, Canada, Australia and the United Kingdom) met the inclusion criteria, including 14 quantitative, 4 qualitative and 1 mixed-methods study. Only one article reported on an Indigenous population. Few studies reported on FCR prevalence (n = 3) or severity (n = 9). While the variation in tools used to measure FCR hindered a robust estimate of severity, results suggested some differences in FCR severity between minority and dominant populations, although these may have been due to study metholodological differences. Few factors were reported as being associated with FCR in minorities across multiple studies. The qualitative synthesis found five themes associated with the lived experience of FCR: (i) variations in the lived experience of FCR; (ii) spirituality and worldview impacting on FCR; (iii) the importance of staying positive; (iv) complexities around support; and (v) increasing cancer knowledge. The findings of this review highlight differences in FCR across cultures and contexts, which reinforces the need for culturally-specific approaches to this condition. The dearth of research in this area is of concern given the significant burden of cancer in these populations. A deeper understanding of this condition among Indigenous and minority populations is critical to developing and delivering appropriate and effective psychosocial care for cancer survivors from these groups. Systematic Review Registration: identifier [CRD42020161655].

Positive Developmental Changes after Transition to High School: Is Retrospective Growth Correlated with Measured Changes in Current Status of Personal Growth?

The transition to high school is generally considered as a stressful turning point in adolescent development, but some students experience personal growth (i.e., positive developmental changes) through that experience. It is important to examine the mechanism behind such positive changes to understand various developmental patterns of adolescents during the transition. However, the concept of growth in this research area remains unexplored. Some researchers have questioned whether retrospective, self-reported growth reflects actual positive changes in the perception of personal growth. We elaborated on the concept of growth after high school transition by examining whether retrospective appraisal of personal growth after transition to high school is correlated with measured change in growth. Two hundred and sixty-two Japanese adolescents (aged 14-16 years, 50% girls) participated in surveys right before and right after transition. We assessed five domains of growth, including improved relating to others, identification of new possibilities, increased sense of personal strength, spiritual growth, and greater appreciation of life. The results showed that retrospective assessment of growth and measured change during transition were positively associated, provided the adolescents reported the transition as an important turning point in their lives. Adolescents who experienced salient positive changes across the transition were more likely to engage in intrusive and deliberate rumination and social support than adolescents who reported fewer changes. In summary, retrospective growth covaried with measured change only when adolescents perceived the transition as impactful in their lives.

Subjective wellbeing and longevity: Findings from a 22-year cohort study

OBJECTIVE

The health implications of positive affect (PA) are still a matter of debate. The present study examined the longitudinal relationships between subjective wellbeing (SWB) components (i.e., Life satisfaction, PA and negative affect (NA)) and all-cause mortality in older adults.

METHODS

Discrete-time survival analysis within the structural equation modeling framework was applied to data from the PAQUID Cohort (n=3777, baseline age 62-101years) including ten time periods spanning 22years. Time-invariant (age, gender, baseline life satisfaction, diabetes mellitus and hypercholesterolemia status) and lagged time-varying (PA, NA, dementia, functional status and self-rated health) predictors were included sequentially in the analyses.

RESULTS

When included together in the model, only PA among the SWB components showed a significant association with longevity, which persisted (OR=.962, 95% CI=.938, .986) even after adjustment for the interaction between PA and NA, and after additional adjustment for prior medical conditions, functional status and self-rated health.

CONCLUSIONS

In congruence with positive psychology, PA proved to be an independent protective factor regardless of variations in NA, which did not seem to be a mortality risk factor.

Variation in narrative identity is associated with trajectories of mental health over several years

This article presents 2 longitudinal studies designed to assess the relationship between variability in narrative identity and trajectories of mental health over several years. In Study 1, core scenes from 89 late-mid-life adults' life stories were assessed for several narrative themes. Participants' mental health and physical health were assessed concurrently with the narratives and annually for the subsequent 4 years. Concurrent analyses indicated that the themes of agency, redemption, and contamination were significantly associated with mental health. Longitudinal analyses indicated that these same 3 themes were significantly associated with participants' trajectories of mental health over the course of 4 years. Exploratory analyses indicated that narratives of challenging experiences may be central to this pattern of results. In Study 2, similar longitudinal analyses were conducted on a sample of 27 late-mid-life adults who received a major physical illness diagnosis between the baseline assessment and 6 months later and a matched sample of 27 control participants who remained healthy throughout the study. Participants' mental health and physical health were assessed every 6 months for 2 years. In this study, the themes of agency, communion, redemption, and contamination in participants' life narratives collected at baseline (before any participant became sick) were significantly associated with mental health in the group of participants who went on to receive a medical diagnosis, but not in the control group. Taken together, the results of these 2 studies indicate that the way an individual constructs personal narratives may impact his or her trajectory of mental health over time.

As long as you've got your health: Longitudinal relationships between positive affect and functional health in old age

OBJECTIVE

Reciprocal relationships between positive affect (PA) and health are now subject of a heuristic debate in psychology and behavioral medicine. Two radically opposed approaches address the link between subjective well being (SWB) and physical health: top-down (i.e., psychosomatic hypothesis) and bottom-up (i.e., disability/ability hypothesis) approaches. The aim of the present study was to test these two approaches by investigating thirteen-year longitudinal relationships between PA, as an affective dimension of SWB, and functional health in older people.

METHODS

The study included 3754 participants aged 62-101 years assessed 6 times over a thirteen-year period. PA was measured by the mean of the positive affect subscale of the CES-D scale. Functional health was assessed by four composite items: a single-item self-rating of hearing impairment, a single-item self-rating of vision impairment, the number of medically prescribed drugs, and a single-item self-rating of dyspnoea. We used cross-lagged modeling with latent variables, which is appropriate for testing specific theories. Mean arterial pressure, diabetes mellitus and hypercholesterolemia status, sequelae of stroke, gender, level of education, and age at baseline were use as control variables in the models.

RESULTS

Results indicated that good health significantly predicted subsequent levels of PA (average β = -0.58, p < 0.001), but PA did not predict subsequent levels of good health (β = 0.01, ns).

CONCLUSION

This finding, obtained from a sample of older people, is in keeping with the bottom-up approach, and supports the popular adage "As long as you've got your health". Limitations of this finding are reviewed and discussed. Models including longitudinal mediators, such as biomarkers and life style patterns, are needed to clarify the nature of the link between these constructs.

Positive psychology group intervention for breast cancer patients: a randomised trial

This study assessed the effects of a psychological group intervention based on positive psychology in women with breast cancer. 175 women were randomly assigned either to an experimental group, receiving the 14-session intervention (n = 87), or to a wait list group (n = 88) that did not receive any type of intervention. For treatment, a group intervention was applied, based on improving psychological strengths and enhancing positive psychology-based styles of coping. Strength-related outcomes, self-esteem, well-being, and happiness were assessed before and after the intervention. The experimental group showed higher scores on all of the study variables after the intervention. Participants reported improved self-esteem, emotional intelligence-related abilities, resilience, and optimism, as well as positive affectivity, well-being, and happiness. The results show a beneficial effect of this psychological intervention based on positive psychology on female breast cancer patients' psychological health.

Thinking about trauma: the unique contributions of event centrality and posttraumatic cognitions in predicting PTSD and posttraumatic growth

Researchers have been investigating possible pathways to negative (posttraumatic stress disorder [PTSD]) and positive (posttraumatic growth [PTG]) reactions to trauma in recent decades. Two cognitive constructs, event centrality and posttraumatic cognitions, have been implicated to uniquely predict PTSD symptoms in an undergraduate sample. The current pair of studies attempted to (a) replicate this finding in an undergraduate sample, (b) replicate this finding in a treatment-seeking sample, and (c) explore whether these 2 cognitive constructs uniquely predict PTG. The first study consisted of 500 undergraduate students, whereas the second study consisted of 53 treatment-seeking clients. Results indicated both posttraumatic cognitions and event centrality uniquely predicted PTSD in the undergraduate (R(2) = .46) and treatment-seeking samples (R(2) = .46). These 2 cognitive constructs also predicted PTG in the undergraduate sample (R(2) = .37), but only posttraumatic cognitions predicted PTG in the treatment-seeking sample (R(2) = .17). The relationships between PTG varied, depending on whether PTG for high or low event-centrality events were assessed. The original model was supported within both populations for PTSD symptoms, and its extension to PTG was supported within the treatment-seeking sample. These results underscore cognitive and narrative factors in the progression of trauma.

Development and validation of the positive affect and well-being scale for the neurology quality of life (Neuro-QOL) measurement system

PURPOSE

To develop and validate an item-response theory-based patient-reported outcomes assessment tool of positive affect and well-being (PAW). This is part of a larger NINDS-funded study to develop a health-related quality of life measurement system across major neurological disorders, called Neuro-QOL.

METHODS

Informed by a literature review and qualitative input from clinicians and patients, item pools were created to assess PAW concepts. Items were administered to a general population sample (N = 513) and a group of individuals with a variety of neurologic conditions (N = 581) for calibration and validation purposes, respectively.

RESULTS

A 23-item calibrated bank and a 9-item short form of PAW was developed, reflecting components of positive affect, life satisfaction, or an overall sense of purpose and meaning. The Neuro-QOL PAW measure demonstrated sufficient unidimensionality and displayed good internal consistency, test-retest reliability, model fit, convergent and discriminant validity, and responsiveness.

CONCLUSION

The Neuro-QOL PAW measure was designed to aid clinicians and researchers to better evaluate and understand the potential role of positive health processes for individuals with chronic neurological conditions. Further psychometric testing within and between neurological conditions, as well as testing in non-neurologic chronic diseases, will help evaluate the generalizability of this new tool.

A longitudinal investigation of posttraumatic growth in adult patients undergoing treatment for acute leukemia

An acute leukemia diagnosis can be an extremely stressful experience for most patients. Posttraumatic growth (PTG) is positive psychological change experienced following a struggle with highly challenging life circumstances. The current study is the first longitudinal investigation of predictors of PTG and distress in adult acute leukemia patients undergoing induction chemotherapy. Findings suggest that these patients report PTG, and levels of PTG appear to increase over the weeks following leukemia diagnosis and induction chemotherapy. Variables associated with higher total PTG scores over time included greater number of days from baseline, younger age, and greater challenge to core beliefs. Variables associated with higher distress included greater number of days from baseline, greater perceived cancer threat, higher symptom severity, and lower spiritual well-being. Results underscore the critical role that examination of one's core beliefs may play in the development of PTG over time.

Sense of coherence, depressive symptoms, cardiovascular diseases, and all-cause mortality

OBJECTIVE

There is increasing interest in whether positive and negative psychological constructs are bipolar opposites of the same phenomenon. We examine whether a positive construct--sense of coherence (SOC)--has independent predictive power over and above depressive symptoms for cardiovascular disease (CVD) and all-cause mortality.

METHODS

Participants included 3850 men and 4083 women aged 25 to 74 years who had participated in risk factor surveys conducted in 1992 or 1997. Antonovsky's 13-item SOC scale was used to measure SOC, and had a correlation of -0.60 with the Beck Depression Inventory.

RESULTS

During a mean follow-up time of 14.2 years, there were 670 deaths and 487 nonfatal and fatal CVD events. Higher SOC scores were associated with a lower risk of all-cause mortality (relative risk [RR] = 0.90, 95% confidence interval [CI] = 0.84-0.97 per unit), especially among men, but this association became nonsignificant after adjustment for depressive symptoms (RR = 0.99, 95% CI = 0.90-1.08). Among participants without a history of CVD, higher SOC scores were related to a lower risk for CVD (RR = 0.90, 95% CI = 0.83-0.98), but this association disappeared after adjustment for cardiovascular risk factors. Depressive symptoms remained significant predictors of CVD among women in a model including also SOC (RR = 1.24, 95% CI = 1.06-1.46).

CONCLUSIONS

SOC was related to all-cause mortality among men; the association with CVD events was modest. Measures for SOC and depressive symptoms were significantly correlated, which might result in overlap in their associations with adverse disease and mortality outcomes.

Review of the application of positive psychology to substance use, addiction, and recovery research

Advances in positive psychology have grown exponentially over the past decade. The addictions field has experienced its own growth in a positive direction, embodied by the recovery movement. Despite parallel developments, and great momentum on both sides, there has been little crosspollination. This article introduces positive psychology and the recovery movement, describes the research on positive psychology in the addictions, and discusses future avenues of theory, research, and intervention based on a positive-psychology framework. A systematic review of positive psychology applied to substance use, addiction, and recovery found nine studies which are discussed according to the following themes: theoretical propositions, character strengths and drinking, positive psychology and recovery, positive interventions, and addiction: feeling good and feeling bad. The current scholarship is scant, but diverse, covering a wide range of populations (adults, adolescents, those in and out of treatment), topics (character strengths, recovery, positive affect), and addictive behaviors (work addiction, cigarette smoking, and alcohol use disorders). There is diversity, too, in country of origin, with work originating in the U.S., U.K., Poland, and Spain. The rigorous application of the lens, tools, and approaches of positive psychology to addiction research generally, and to the aims of the recovery movement specifically, has potential for the development of theory and innovation in prevention and intervention. Further, because the work in positive psychology has primarily focused on microsystems, it may be primed to make contributions to the predominantly macrosystems focus of the recovery movement. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Predicting positive and negative impacts of cancer among long-term endometrial cancer survivors

OBJECTIVE

Although the survival outcomes among women diagnosed with endometrial cancer are very favorable, little is known about the long-term impact of their cancer experience. This study identifies the extent of positive and negative impacts of cancer and factors associated with this, amongst long-term survivors of endometrial cancer.

METHODS

Australian women diagnosed with endometrial cancer (N=632) were sent questionnaires at the time of diagnosis and 3-5 years later. Hierarchical multiple regression models were used to examine whether a range of variables at diagnosis/treatment predicted subsequent scores on the Impact of Cancer Scale, which examines positive (e.g. health awareness) and negative (e.g. appearance concerns) impacts amongst cancer survivors.

RESULTS

Overall, women had a higher mean score for the positive than negative impact scales (M=3.5 versus M=2.5, respectively). An intermediate grade of endometrial cancer, a prior diagnosis of cancer and lower levels of education were significant, but weak, predictors of higher scores on the positive impact scale. Higher scores on the negative impact scale were predicted by a higher grade of cancer, poor physical and mental health, a younger age, being single or having lower levels of education.

CONCLUSIONS

The study demonstrates that factors that predict positive impact in cancer survivors differ to those that predict negative impact, suggesting that interventions to optimize cancer survivors' quality of life will need to be multi-dimensional, and this supports the need for tailored intervention.

Posttraumatic growth in women one year after diagnosis for gynecologic cancer or benign conditions

The authors sought to examine levels and predictors of posttraumatic growth over one year after surgery in women diagnosed with gynecologic cancer or benign conditions necessitating surgical intervention. Women with advanced-stage cancer (n = 16), early-stage cancer (n = 18), benign gynecologic disease (n = 21), and no disease (n = 14; postannual pelvic exam) completed questionnaires (Perceived Threat, PTSD Checklist [PCL]) 1 week prior to surgery and completed the Posttraumatic Growth Inventory (PTGI) 16 months postsurgery. The four groups' scores varied significantly on the PTGI. The three disease groups reported higher levels of posttraumatic growth than the no disease group. Higher PCL score presurgery and greater disease severity were positively related to posttraumatic growth, and higher income level was negatively related to posttraumatic growth. Women with gynecologic cancer, regardless of stage, and women with benign gynecologic conditions experience posttraumatic growth.

Posttraumatic growth in combat veterans

Combat veterans and their families face significant challenges not only to their abilities to cope, but often to their fundamental belief systems. Traumatic events represent assaults on core beliefs, yet at times, produce cognitive processing that can ultimately result in personal transformations called posttraumatic growth (PTG). Clinicians can utilize a systematic therapeutic approach to facilitate PTG as they carry out a relationship of expert companionship. PTG in service members is described in this article, as well as the approach to facilitation of PTG.

Posttraumatic growth in combat veterans

Combat veterans and their families face significant challenges not only to their abilities to cope, but often to their fundamental belief systems. Traumatic events represent assaults on core beliefs, yet at times, produce cognitive processing that can ultimately result in personal transformations called posttraumatic growth (PTG). Clinicians can utilize a systematic therapeutic approach to facilitate PTG as they carry out a relationship of expert companionship. PTG in service members is described in this article, as well as the approach to facilitation of PTG.

Theory, measurement, and controversy in positive psychology, health psychology, and cancer: basics and next steps

The aims of this commentary are two-fold: First, to amplify some of the points that Aspinwall, Tedeschi, Coyne, Tennen, and Ranchor have raised, noting the importance of a return to basics. Second, to posit next steps in theory development and methods at the intersection of health psychology, positive psychology, and cancer. Additional theory development, more applications of large prospective studies, and instrument refinements are warranted to understand the effects of positive constructs on health outcomes and adaptation to cancer. This area of research would be strengthened by studies that incorporate survival, health-related quality of life, and well-being outcome measures, using cancer registries and/or multiple raters. More observational studies are necessary. Attention to social justice questions is suggested in future studies at the intersection of these fields.

Introduction to special series: The great debate--evaluating the health implications of positive psychology

BACKGROUND

In recent years, investigators have focused increased attention on positive psychology constructs and their associations with health outcomes, such as morbidity, mortality, and adaptation to illness. The database regarding some of these concepts and models has grown appreciably, but work in this area has been subject to controversy.

PURPOSE

This special series of papers offers contrasting perspectives regarding research on positive psychology and health. Both proponents and critics were invited to review recent developments concerning a number of positive constructs that have been evaluated in the oncology literature and in health research, more generally.

METHODS

Papers are presented in the format of a debate. Significant advances are reviewed by one set of investigators, Drs, Lisa G. Aspinwall and Richard G. Tedeschi, while shortcomings and concerns are highlighted by another set of investigators, Drs. James C. Coyne and Howard Tennen. Each of these review papers is followed by a rebuttal by the opposing side. A commentary on the exchange is provided by Dr. Sherri Sheinfeld Gorin.

RESULTS

These papers address a range of important considerations regarding conceptualization of constructs, methodological rigor, dissemination of findings, and implications for practice.

CONCLUSION

The critiques and recommendations offered in these papers may help inform future efforts in this area, as the field continues to evolve.