Mood disturbance in community cancer support groups: The role of emotional suppression and fighting spirit.
Cordova MJ, Giese-Davis J, Golant M, Kronnenwetter C, Chang V, McFarlin S and Spiegel D;
Commented by , 21 Nov 2003
Background
Emotional suppression, “the attempt to control expression of negative affect”, has been associated with emotional distress in cancer patients. Conversely, fighting sprit, “an attitude of optimism in the face of a realistic appraisal of the illness”, has been associated with lower emotional distress. Yet, important demographic and medical variables have not been accounted for in previous research.
Purpose
Evaluate whether emotional suppression and fighting spirit were associated with mood disturbance in cancer patients participating in community cancer support groups, accounting for demographic, medical and group variables.
Methods
Participants were recruited from two California community agencies providing cancer support groups. Please refer to original article for details of the groups. Of 245 eligible participants, 121 (49%) returned questionnaires; 71% female.
Measures included: demographic, disease and treatment variables; a measure of perceived group support developed by the authors; emotional suppression was measured by the Courtauld Emotional Control Scale (CECS); fighting spirit, cognitive avoidance and fatalism by the Mini-Mental Adjustment to Cancer Scale (Mini-MAC); and mood using the Profile of Mood States (POMS).
Simultaneous multiple regression analyses tested the relative contributions of emotional suppression, fighting spirit, demographic, medical and group support variables on mood; with POMS as the dependent variable.
Results
Intercorrelations among the independent variables revealed an inverse correlation between emotional suppression and fighting spirit. Regression analyses revealed lower mood disturbance was associated with lower emotional suppression, greater fighting spirit, older age and higher income. While other demographic, coping (cognitive avoidance, fatalism), medical and group support variables were not associated with mood disturbance.
Discussion
Several limitations bear review. Most importantly, the cross-sectional design and correlational data limit causal inference and predicting the direction of the relationships. In addition, patients who decide to participate in support groups may not be reflective of the wider population of cancer patients, and may represent a biased sample Even amongst support group patients, a response bias is possible in the 49% who elected to respond to the questionnaire.
Finally, while the authors’ advanced this area of research by accounting for important confounding variables, they omitted the influence of perceived family and social support; an important parameter in the quality of life of cancer patients (1), shown to be associated with better emotional adjustment (2).
Notwithstanding these limitations, the authors provide an important contribution in our understanding of the determinants of health in cancer patients. In addition to their attention to important confounds, what separates this from previous research is drawing the sample from naturalistic community support groups as opposed to university-based research settings, strengthening the generalizability of the findings.
The study’s finding that emotional suppression was associated with more depression and the adoption of fighting spirit with less depression has important implications for individual and group therapists. Particularly, as these styles of emotional regulation have been shown to be mutable through group interventions, rather than stable temperamental or personality traits (3,4). Implications extend beyond therapists, as training other health care providers to develop skills related to adaptive emotional communication may lead to improved quality of life in cancer patients (5).
References
1. Baider L, Ever-Hadini P, Goldzweig G, et al. Is perceived family support a relevant variable in psychological distress? A sample of prostate and breastcancer couples. Journal of Psychosomatic research 2003; 55:453-460
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2. Akechi T, Kugaya A, Okamura H, et al. Predictive factors for psychological distress in ambulatory lung cancer patients. Support Care Cancer 1998; 6:281-286
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3. Giese-Davis J, Koopman C, Butler LD, et al. Change in emotion-regulation strategy for women with metastatic breast cancer following supportive-expressive group therapy. Journal of consulting and clinical psychology 2002; 70:916-925.
4. Fukui S, Kugaya A, Okamura H, et al. A psychosocial group intervention for Japanese women with primary breast carcinoma. Cancer. 2000; 89(5):1026-36
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5. Mcguire P, Pitceathly C. Improving the psychological care of cancer patients and their relatives: the role of specialist nurses. Journal of Psychosomatic research 2003; 55:469-474
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