Combining subjective and objective appraisals of cognitive dysfunction in patients with cancer: a deeper understanding of meaning and impact on suffering?

PURPOSE

Patients with advanced cancer often experience cognitive dysfunction, which may influence decision making, self-perception, and existential well-being. However, there is little evidence regarding this issue. This study analysed associations between objective neuropsychological measures and patients' self-report of cognitive dysfunction interfering with everyday life, general well-being, and sense of existential value.

METHODS

A mixed method study assessed 13 adult patients with advanced cancer with validated neuropsychological tests, which assessed sustained attention, psychomotor speed, memory/attention, mental flexibility, and a measure of global cognitive function. These were followed by semi-structured interviews focusing on subjective experiences of cognitive dysfunction. Agreement between subjective and objective measures were analysed by Cohen's Kappa (k). Thematic analysis explored associations with cognitive deficits.

RESULTS

Poor cognitive performance on the neuropsychological tests was observed regarding sustained attention (n = 8), psychomotor speed (n = 1), memory/attention (n = 2), mental flexibility (n = 9), and global cognitive function (n = 3). Almost all patients (n = 12) had complaints of cognitive dysfunction. However, the agreement between the two assessments was weak (k ≤ 0.264). Cognitive dysfunction challenged the patients with regard to practice everyday life including their existential values related to meaning of life and well-being. Adjustment of the sense of living according to one's existential values and changes of self-perception were also related positively and negatively to existential well-being.

CONCLUSION

Despite the weak agreement between objective and subjective measures of cognitive function, many of the patients reported experiences of cognitive dysfunction that had an impact on their daily life and existential well-being, adding to the suffering experienced.

An existential support program for people with cancer: Development and qualitative evaluation

PURPOSE

To describe the development process of an existential support program and to explore participants' evaluation of supportive/unsupportive processes of change.

METHOD

A five-day existential support program called "Energy for life" was designed including three main elements: 1. existential group counseling, 2. art therapy and 3. interaction with nature and aesthetic surroundings. The program was implemented at two different study sites. Focus group interviews were conducted to evaluate the program.

RESULTS

40 subjects were recruited (20 for each one of the two study sites) and 36 completed the study (31 women, five men) in the age range from 31 to 76 years and living with cancer across all stages and types. The program resulted in supportive processes of "existential sharing". The existential group counseling included a sharing process which led to an increased awareness and acceptance of one's existential situation and a preparation for the next steps in one's life. Art therapy offered a respite from the illness or the opportunity to express and share difficult thoughts and feelings connected to the illness experience. The interaction with nature/surroundings induced feelings of calmness and peace, increasing self-worth and spiritual belonging. Unsupportive processes of change related to the organization of the existential counseling groups, feelings of discomfort with creative engagement and feelings of distress provoked by a hospital environment.

CONCLUSION

Through "Energy for life" existential concerns and distress were shared, contained and transformed. Knowledge has been gained about how an existential support program can be designed that explicitly focuses on alleviating patients' existential distress.

Impact of Spirituality/Religiousness on Cyber Bullying and Victimization in University Students: Mediating Effect of Emotional Intelligence

The aim of the study was to explore the relationship between spirituality/religiousness with cyber bullying and victimization amongst Indian University students and whether emotional intelligence mediates the relationship. Data were collected from 490 University students studying in undergraduate and postgraduate courses across India. IBM AMOS was used to find reliability and validity of instruments and PROCESS macro for IBM SPSS by Preacher and Hayes (Behav Res Methods 36(4): 717-731, 2004) was used for conducting mediation analyses. Both spiritual and existential well-being were found negatively related with cyber bullying and victimization. As far as mediation goes, the negative relationships between spiritual and existential well-being with that of cyber bullying and victimization were significantly mediated by Appraisal of Self-Emotions, Appraisal of Other's Emotions and Regulation and control of Emotions dimensions of emotional intelligence. Implication and future directions are also discussed.

Suicidal ideation and hopelessness in PTSD: spiritual well-being mediates outcomes over time

Background There is an increased interest in understanding the mechanisms through which post-traumatic stress disorder (PTSD) relates with hopelessness and suicidal ideation. Spiritual well-being could help explain the link between PTSD and both hopelessness and suicidal ideation in African Americans. However, no study has examined the mediational role of existential and religious well-being among these variables. Objectives To examine if initial levels of existential and religious well-being mediated the relation between levels of PTSD symptoms and prospective levels of hopelessness and suicidal ideation in a sample of African American females. Design The study used a longitudinal design with a 10-week time interval. Methods The sample comprised of 113 disadvantaged African American women survivors of a recent suicide attempt recruited from a southern hospital. Self-report measures of PTSD symptoms, hopelessness, suicidal ideation, and spiritual well-being were administered to examine the variables of interest. Bootstrapping techniques were used to test the mediational models. Results Existential, but not religious well-being, mediated the relationship between levels of PTSD symptoms severity and both levels of hopelessness and suicidal ideation over time. Conclusions Existential well-being appears to play a promising protective role against the negative effects of PTSD on both hopelessness and suicidal ideation.

Evaluation of the Spiritual Well-Being Scale in a Sample of Korean Adults

This study explored the psychometric qualities and construct validity of the Spiritual Well-Being Scale (SWBS; Ellison in J Psychol Theol 11:330-340, 1983) using a sample of 470 Korean adults. Two factor analyses, exploratory factor analysis and confirmatory factor analysis, were conducted in order to test the validity of the SWBS. The results of the factor analyses supported the original two-dimensional structure of the SWBS-religious well-being (RWB) and existential well-being (EWB) with method effects associated with negatively worded items. By controlling for method effects, the evaluation of the two-factor structure of SWBS is confirmed with clarity. Further, the differential pattern and magnitude of correlations between the SWB subscales and the religious and psychological variables suggested that two factors of the SWBS were valid for Protestant, Catholic, and religiously unaffiliated groups except Buddhists. The Protestant group scored higher in RWB compared to the Buddhist, Catholic, and unaffiliated groups. The Protestant group scored higher in EWB compared to the unaffiliated groups. Future studies may need to include more Buddhist samples to gain solid evidence for validity of the SWBS on a non-Western religious tradition.

Meaning-centered dream work with hospice patients: A pilot study

OBJECTIVE

Hospice patients often struggle with loss of meaning, while many experience meaningful dreams. The purpose of this study was to conduct a preliminary exploration into the process and therapeutic outcomes of meaning-centered dream work with hospice patients.

METHOD

A meaning-centered variation of the cognitive-experiential model of dream work (Hill, 1996; 2004) was tested with participants. This variation was influenced by the tenets of meaning-centered psychotherapy (Breitbart et al., 2012). A total of 12 dream-work sessions were conducted with 7 hospice patients (5 women), and session transcripts were analyzed using the consensual qualitative research (CQR) method (Hill, 2012). Participants also completed measures of gains from dream interpretation in terms of existential well-being and quality of life.

RESULTS

Participants' dreams generally featured familiar settings and living family and friends. Reported images from dreams were usually connected to feelings, relationships, and the concerns of waking life. Participants typically interpreted their dreams as meaning that they needed to change their way of thinking, address legacy concerns, or complete unfinished business. Generally, participants developed and implemented action plans based on these interpretations, despite their physical limitations. Participants described dream-work sessions as meaningful, comforting, and helpful. High scores on a measure of gains from dream interpretation were reported, consistent with qualitative findings. No adverse effects were reported or indicated by assessments.

SIGNIFICANCE OF RESULTS

Our results provided initial support for the feasibility and helpfulness of dream work in this population. Implications for counseling with the dying and directions for future research were also explored.

Mediators of the childhood emotional abuse-hopelessness association in African American women

Although there is an association between experiencing childhood emotional abuse and feeling hopeless as an adult, it is critical to understand the factors that may be protective in this relationship. The goal of this study was to determine if two protective factors, namely spiritual well-being, including both religious and existential well-being, and positive self-esteem, served to mediate the association between childhood emotional abuse and adult hopelessness. The sample for this investigation was low-income African American women suicide attempters who were abused by a partner in the prior year (N=121). A path analysis revealed that in this sample, the childhood emotional abuse-hopelessness link was mediated by existential well-being and positive self-esteem, as well as by the two-mediator path of emotional abuse on existential well-being on self-esteem on hopelessness. Results suggested that existential well-being may be a more salient protective factor for hopelessness than religious well-being among abused, suicidal African American women who experienced childhood emotional abuse. Findings highlight the value of culturally relevant strategies for enhancing existential well-being and self-esteem in this at-risk population to reduce their vulnerability to feelings of hopelessness.