Self-Compassion and Physical Health-Related Quality of Life in Cancer: Mediating Effects of Control Beliefs and Treatment Adherence

Among the 14 million persons living in the United States with current or remitted cancer, poor physical health-related quality of life (HRQL) is a significant concern. However, self-compassion (i.e., common humanity, mindfulness, self-kindness) may be a protective factor, either directly or indirectly, by allowing for a sense of empowerment and control over illness, and in turn, facilitating engagement in treatment and positive perceptions of health. Serial mediation analyses among persons living with current (n = 67) or remitted (n = 168) cancer lend support for a positive, direct association between self-compassion and physical HRQL, as well as indirect effects via internal perceived control and, to a lesser degree, treatment adherence. Mixed findings, especially among cancer patients, highlight limitations of resiliency traits while also supporting the notion that self-compassion interventions (e.g., Mindful Self-Compassion Training) may have positive implications for health-related control beliefs, behaviors, and quality of life in the cancer population

Optimism and Physical Health-Related Quality of Life in Chronic Illness: Mediating Effects of Control Beliefs and Health Behaviors

Among persons living with, or recovering from, chronic illness, poor physical health-related quality of life is a concern, as current and residual illness symptoms and treatment side effects may deleteriously impact physical functioning and fulfillment of daily roles. Numerous cognitive, emotional, and behavioral factors may impact perceptions of health status. Optimism, for example, is conceptualized as belief in the occurrence of positive future outcomes, and is beneficially associated with physical health-related quality of life. Further, optimism may contribute to enhanced perceptions of control and efficacy over disease symptoms and general health, manifesting as proactive health behaviors (e.g., wellness behaviors; treatment adherence) and, in turn, improved health-related quality of life. Across independent samples of persons living with remitted cancer (N = 164) or fibromyalgia (N = 508), we examined the serial mediating effects of health-related self-efficacy and proactive health behaviors in the relation between dispositional optimism and physical health-related quality of life. Participants completed online self-report measures, including the Life Orientation Test – Revised, Control Beliefs Inventory, Multidimensional Health Profile – Health Functioning Index, Wellness Behaviors Inventory, Medical Outcomes Study General Treatment Adherence Scale, and the Short-Form Health Survey. Significant serial mediation was observed across samples; higher dispositional optimism was associated with greater health-related self-efficacy and, in turn, greater engagement in proactive health behaviors and better physical health-related quality of life. For persons with remitted cancer, absence of other specific indirect effects indicates a need to consider the potential impact of unique aspects of disease, such as late effects of treatment or fear of recurrence, that may limit the beneficial effects of optimism exclusively through health-related self-efficacy or wellness behaviors. For persons with fibromyalgia, we found specific indirect effects through each mediating variable, lending support for the decoupling of cognitive and behavioral factors, consistent with pathophysiological and psychosomatic explanations of illness symptoms and approaches to treatment. Interventions designed to enhance optimism (e.g., cognitive-behavioral therapy; best possible self exercise) or self-efficacy (e.g., exercise skills training) may have positive downstream effects on health behavior engagement and perceptions of physical health-related quality of life among individuals living with remitted cancer or fibromyalgia

The Impact of Time in Doctor-Patient Encounters on Perceived Health Status of Children with Diabetes: Potential Mediating Roles of Shared Decision Making and Resilient Parents

In 2019, diabetes affected approximately 283,000 individuals, aged 20 years or younger, in the U.S. Due to illness symptoms (e.g., hypo/hyperglycemia) and disease-related complications (e.g., nephropathy), individuals report poor health-related quality of life. However, individual-level, family-oriented, and health care system factors may affect perceptions of a child’s overall health status. For example, beliefs of having spent enough time with the doctor may predict proactive health behaviors and perceptions of health. Overall health status may also be indirectly related to time spent in medical conversations. For instance, perceptions of shared decision-making (e.g., exploring pros and cons of treatments together) between families and providers may, in turn, foster family empowerment and resiliency (i.e., ability to adapt, cope, and overcome challenges) in the context of caring for a child with a chronic illness, with positive implications for perceived health status of their child. This study aims to examine the relationships of these variables. At the bivariate level, it was hypothesized that time spent in visits, shared decision making, family resilience, and perceived health status of the child would all be positively related. At the multivariate level, it was hypothesized that doctors working collaboratively with parents and family resilience would serially mediate the relation between time spent in medical visits and perceived health, such that more time spent with the doctor would be associated with perception of collaborative decision making and, in turn, higher levels of resiliency and better overall health status from parents’ perspectives. Utilizing data from the National Survey of Child and Adolescent Health from 2020-2021, this study examined survey responses from 369 parents of children with a reported diabetes diagnosis. Responses were extracted from a larger survey for questions related to time spent with providers in prevention focused visits, collaborative decision-making, family resilience, and health status of the child. Bivariate correlations and serial mediation analyses, per Hayes (2013), were conducted, covarying age, sex, ethnicity of child, health insurance, family structure, income, and education level of parents. Bivariate analyses showed some variables were significantly related in hypothesized directions (p \u3c .05). In serial mediation analyses (10,000 bootstrapped samples), the total effect of time spent with the doctor on overall health status was nonsignificant (t = 0.7767, p = 0.4383), and the direct effect was also nonsignificant when mediators (i.e., collaborative decision making, family resilience) were added (t = 0.805 CI= -0.0044, 0.0122), indicating no serial mediation. Controlling for the effects of the other mediator, a significant indirect effect was found through collaborative decision making (t= 1.9181 CI = 0.0015-0.0940) but not family resilience (t = 0.9565 CI=-0.0059-0.478). This study demonstrates that collaborative decision making with parents mediates the relationship between time spent in preventative health care visits and overall health status. Changes such as policies that incentivize quality of care rather than number of billable visits, or establishment of patient centered medical homes, could support appointments of sufficient length that would allow for collaboration and, in turn, better perceived health status for those affected by diabetes

Self-Continuity and Depression in Cancer: Does Coping Help to Explain the Association?

In the United States, approximately two million new cancer diagnoses will emerge in 2020, and more than 16 million persons are cancer survivors. Poor mental health is a significant concern among individuals with current or remitted cancer. Approximately 15%-25% of persons in the cancer population experience depression, perhaps attributable to the physical burden of illness and recovery (e.g., treatment side effects), and threat of mortality. Risk for distress may vary relative to the cohesiveness of one’s sense of self across time. Self-continuity, or perceived congruence of how one views their past, current, and future self (e.g., personality; values) may be disrupted by the illness experience but, when present, may promote psychosocial adjustment throughout the illness trajectory. Specifically, stable self-concept may promote engagement in adaptive coping mechanisms (e.g., problem-solving; seeking support), whereas self-discontinuity may deleteriously impact coping (e.g., interpersonal dysfunction; emotion dysregulation). In turn, it is well-established that effective coping is linked to less psychological distress. However, the role of self-continuity in this process has not been previously examined in the context of chronic illness. At the bivariate level, we hypothesized that self-continuity would be positively associated with adaptive coping and negatively related to depressive symptoms, with opposite patterns of correlations for self-discontinuity. At the multivariate level, we hypothesized that adaptive coping would mediate the associations between self-perception type and depressive symptoms; self-continuity would be associated with adaptive coping and, sequentially, to fewer depressive symptoms. Conversely, self-discontinuity would be linked to poorer coping and, in turn, to more depressive symptoms. Our U.S. national sample of persons with current or remitted cancer was recruited online (N=235). Most were female (n=152; 64.4%) and White (n=216; 91.5%). Participants completed self-reported measures including the Self-Continuity Scale and Multidimensional Health Profile-Psychological (coping and depression subscales). Bivariate correlations and mediation analyses, per Hayes (2013), were conducted, covarying age, sex, and ethnicity. At the bivariate level, all variables were significantly (pt=-2.6289, SE=.3389, pt=-1.4125, SE=.3124, p=.159, CI [-1.0579, .1755]), indicating mediation. Coping was also a significant mediator of the relation between self-discontinuity and depressive symptoms; the total effect was significant (t=5.15, SE=.3098, p=.000, CI [.9849, 2.208]), and the direct effect reduced in significance when coping was added to the model (t=3.5539, SE=.2997, p In our sample of persons with or recovering from cancer, self-continuity was associated with better coping and, in turn, to fewer depressive symptoms. Conversely, self-discontinuity was linked to poorer coping and consequent depression. To stabilize temporal self-perception, intervention strategies such as cognitive defusion (e.g., “leaves on a stream” mindfulness) or distress tolerance skills (e.g., sensory grounding) may promote acceptance of uncontrollable situations or inner experiences that threaten self-concept. Encouraging self-continuity (e.g., via nostalgia journaling) and adaptive coping (e.g., problem solving, relaxation may have beneficial effects on mental health throughout the diagnosis, treatment and survivorship phases of the cancer experience

Positive Future Time Perspective, PTSD, and Insomnia in Veterans: Do Anger and Shame Keep You Awake?

There is heightened risk for physical and mental health concerns among U.S. veterans. For instance, 26% of veterans experience insomnia (i.e., chronic difficulty initiating or maintaining sleep), compared to 15% of the general population. This may be due, in part, to the presence of post-traumatic stress disorder (PTSD) symptoms, as veterans are twice as likely to be diagnosed with PTSD. Rumination or flashbacks focused on traumatic events (e.g., witnessing death) may contribute to problems with the onset and quality of sleep. However, not all veterans experience insomnia or PTSD symptoms, perhaps due to a positive future orientation (FO). Adaptive, goal-directed thinking may lessen risk for rumination about past actions or experiences (e.g., combat exposure), with consequent beneficial effects on sleep quality. Yet, to the extent that other negative emotions remain in the presence of FO, potential benefits may be thwarted. Specifically, feelings of shame (i.e., judging self as intolerable or defective) or anger may arise from discrepancies between military actions taken or witnessed and one’s moral beliefs. In turn, this may limit future-oriented coping abilities, with negative implications for PTSD symptoms and insomnia. At the bivariate level, we hypothesized that PTSD symptoms, insomnia, shame, and anger would be positively related, and that these variables would be negatively related to FO. At the multivariate level, we hypothesized that PTSD symptoms would mediate the relation between FO and insomnia, such that greater FO would be associated with fewer PTSD symptoms and, in turn, to fewer insomnia symptoms. Further, we hypothesized that shame and anger would moderate these linkages, reducing beneficial effects and exacerbating risk. Our sample of U.S. veterans (n=551) was recruited online from national organizations and social media groups and was primarily white (n=469; 85.1%) and male (n=382; 69.3%). Participants completed self-report measures, including the Zimbardo Time Perspective Inventory - Brief (future subscale), PTSD Checklist - Military Version, Insomnia Severity Index, and Differential Emotions Scale (shame and anger subscales). Bivariate correlations and moderated-mediation analyses, per Hayes (2013), were conducted, covarying age, sex, and ethnicity. In bivariate analyses, all variables were significantly related in hypothesized directions (p\u3c.01). In mediation analyses, the total effect of FO on insomnia was significant (t=-5.336, p\u3c.001), and the direct effect was nonsignificant when PTSD was added (t=-1.840, p=.07), indicating mediation. In moderated-mediation analyses, the PTSD-insomnia linkage was strengthened by shame (b2=-.011, t=-2.451, p=.015, CI=[-.019, -.002])and anger (b2=-.012,t=-3.1, p=.002, CI=[-.020, -.005]), in separate models. In our veteran sample, to the extent one is future-oriented, PTSD symptoms may be ameliorated, with consequent beneficial impact on sleep quantity and quality. Yet, shame and anger may exacerbate the linkage between PTSD symptoms and insomnia, suggesting that therapeutic interventions to reduce shame (e.g., Acceptance and Commitment Therapy) and anger (e.g., cognitive reframing) may promote better sleep. Clinical strategies to promote positive future-oriented thinking (e.g., Cognitive Processing Therapy) may also help to alleviate PTSD symptoms and associated insomnia within the veteran population

Shame, Guilt, and Suicide Risk Among Veterans: Self-compassion as a Moderator

Among the 19.3 million veterans residing in the U.S., suicide is a primary mental health concern, with risk for suicide among veterans being 21% higher than for the general population. Increased suicide risk for veterans may be linked to strong negative emotions associated with the requirements of being in the military. For instance, many veterans describe feelings of guilt, defined as remorse or responsibility for one\u27s actions, such as for experiences during combat exposure (e.g., having to kill someone). Shame, or the belief that there is something inherently wrong or defective with the self, often occurs following a violation of personal values or morals (e.g. participation in violence, missing important family events during deployment), and frequently coexists with feelings of guilt. As well, many members of the military experience sexual trauma, which may induce shame. For some veterans, suicide may become a viable alternative to these overwhelming negative feelings. However, not all veterans are at risk for suicide, perhaps due to individual-level protective factors. One such factor is self-compassion, which is composed of self-kindness, community, and mindfulness. Positive emotions (i.e. selfcompassion) may buffer against negative feelings about the self or one\u27s actions (i.e. guilt and shame), thereby decreasing suicide risk. Our study aimed to test these associations in the context of moderation analyses. At the bivariate level, we hypothesized that guilt and shame would be negatively related to self-compassion and positively related to suicide risk. Also, we hypothesized that self-compassion would be negatively related to suicide risk. At the multivariate level, we hypothesized that self-compassion would moderate the relations between guilt and suicide risk, and between shame and suicide risk, weakening both associations. Our sample of veterans (N=422) was primarily white (n=366) and male (n=291). Participants completed self-report measures including the Differential Emotions Scale-IV, Self-Compassion Scale Short-Form, and Suicide Behaviors Questionnaire-Revised. Bivariate correlations and multivariate analyses, per Hayes (2013), were conducted covarying age, sex, and ethnicity. In bivariate correlations, guilt and shame were positively related to suicide risk (

“I Forgive Myself and God:” Coping and Distress Among Parents of Children with Disabilities

Approximately 22% of households in the U.S. have at least one child living with a disability. Due, in part, to being overwhelmed by caregiving challenges, parents may report experiencing a deep and unbearable psychological pain (i.e., psychache), characterized by despair, anguish, and hopelessness. Yet, risk for distress may be lessened by seeking and accepting social support (e.g., parenting advice). Spiritual coping (e.g., prayer) may also be beneficial, encouraging meaning-making and better psychological adjustment. Availability of social and religious support may also indirectly affect distress by encouraging self-forgiveness. For example, social feedback and support could minimize self-blame for a child’s diagnosis or self-criticism for perceived parental shortcomings. Through spiritual connections, forgiveness of God may manifest, promoting perception of the child as a “blessing” or opportunity for growth, rather than a punishment (e.g., “why me?”). As such, we examined the potential mediating effect of forgiveness in the association of coping styles and psychache among parents of children with disabilities. At the bivariate level, we hypothesized that coping styles (i.e., social and spiritual support) and types of forgiveness (i.e., of God and self) would be positively related, and that all would be negatively related to psychache. At the multivariate level, we hypothesized that types of forgiveness (included in same model) would mediate the associations of coping styles and psychache, such that higher levels of seeking social or spiritual support would be associated with greater forgiveness of the self and God and, in turn, less psychache. Parents raising children with physical or developmental disabilities (n=253) were recruited from support groups and organizations, and social media websites. Our sample was predominantly mothers (n=203; 80.2%), White (n=186; 73.5%), and married (n=172; 68%). Participants completed self-report measures including: Family Crisis Oriented Personal Scales, Fetzer Multidimensional Measurement of Religiousness/Spirituality, a one-item measure of forgiveness of God, and the Psychache Scale. Bivariate correlations and mediation analyses, per Hayes (2013), were conducted, covarying age, race, and type of guardian (e.g., mother or father). At the bivariate level, hypotheses were supported; all variables were significantly related to one another in the hypothesized directions (p \u3c .05). Multivariate hypotheses were also supported; there was a significant total effect between seeking social support and psychache (t=-3.13, p=.002; 95% CI[-.533, -.121]) and a nonsignificant direct effect (t=-1.35, p=.18; 95% CI[-.302, .057]) when types of forgiveness were added to the model, indicating mediation. Additionally, there was a significant total effect for the association of spiritual coping and psychache (t=-3.24, p=.002; 95% CI[-.813, -.197]), and the direct effect fell out of significance when forgiveness was accounted for (t=-1.13, p=.26; 95% CI[-.448, .121]), indicating mediation. In sum, coping through pursuit of both social and spiritual support was associated with greater self-forgiveness and forgiveness of God and, in turn, to lower risk for psychache. Therapeutic interventions may include community support groups (e.g., health information from providers; connect to other families) or collaborations between psychologists and spiritual leaders. Existential therapy and self-forgiveness activities (e.g., loving-kindness meditation) may also be beneficial for alleviating distress among parents raising children with disabilities

Social Support and Psychological Distress in Cancer: Stress as a Mediator

Cancer affects nearly 15 million Americans, and is the second leading cause of death in the U.S. Persons with cancer, including those in recovery, are at increased risk for mental health difficulties; 15% - 25% experience clinically significant depressive symptoms and approximately 12% meet criteria for an anxiety disorder. Poor mental health may be due to heightened levels of stress related to the illness experience, such as uncertainty about the course of disease or adapting to functional impairments (e.g., cleaning, walking) and illness symptoms (e.g., pain). Lack of predictability regarding symptoms and physical limitations may lead to negative mood states, such as fear, worry, or sadness. However, not all persons living with or recovering from cancer, experience psychological distress, perhaps due to individual-level factors, such as social support. An available network of persons (e.g., friends, family) who can provide emotional (e.g., empathy), instrumental (e.g., health advice), or tangible (e.g., assistance with chores) support may lower levels of perceived stress and, in turn, may reduce the likelihood of experiencing psychological distress. Based on this, we examined the linkage between social support and symptoms of psychopathology, and the mediating role of perceived stress. At the bivariate level, we hypothesized that social support would be negatively related to stress and symptoms of depression and anxiety, and that stress would be positively related to both depressive and anxiety symptoms. At the multivariate level, we hypothesized that stress would mediate the relations between social support and symptoms of anxiety and depression, such that higher levels of social support would be associated with lower levels of perceived stress and, in turn, to fewer symptoms of depression and anxiety. Our sample of persons living with, or in remission from, cancer (N = 236) was primarily White (91.5%; n = 216) and female (64.4%; n = 152). Participants completed self-report measures including the Modified Social Support Survey, Perceived Stress Scale, and Multidimensional Health Profile – Psychosocial Functioning. Bivariate correlations and multivariate analyses, per Hayes (2013), were conducted covarying age, sex, and ethnicity. In bivariate correlations, all variables were significantly related to one another in the hypothesized directions (p \u3c .01). In serial mediation analyses, the total effect of social support on depressive symptoms was significant (t = -5.22, p \u3c .001), and the direct effect was nonsignificant when stress was added to the model (t = -1.72, p = .09), indicating mediation. In the second model, stress also mediated the relation between social support and anxiety symptoms; the total effect was significant (t = -4.56, p \u3c .001), and the direct effect was nonsignificant (t = -1.73, p = .09). Supporting hypotheses, our results suggest that to the extent one has available social support, illness-related stress may be lessened and, in turn, cancer-affected persons may experience fewer symptoms of depression and anxiety. Therapeutic interventions focused on enhancing one’s social support network (e.g., cancer support groups) or lowering perceived stress (e.g., Mindfulness Based Stress Reduction) may reduce experiences of psychological distress among persons living with, or in remission from, cancer

Psychache and Suicide Risk in the LGBTQ Community: Considering the Role of Time Perspective

In the United States, approximately 45,000 persons die by suicide annually. Members of the LGBTQ community experience heightened suicide risk; for example, suicide attempts are four times higher among gay and bisexual men, and twice as common in lesbian and bisexual women, compared to heterosexual counterparts. Experiences of stigma and discrimination may constrict one’s view of a positive future (e.g., hopelessness), thereby contributing to the development of psychache, or unbearable psychological pain and negative emotionality, and heightened risk for suicide. However, individual-level resiliency traits, such as a positive view of the future (e.g., future orientation) may contribute to reduced levels of psychological pain and suicidality. That is, whereas future orientation may ameliorate psychological pain and suicide risk, hopelessness may exacerbate such risks; yet, a comparison of the effects of these temporal constructs on psychache has not been previously examined in an LGBTQ sample. At the bivariate level, we hypothesized that hopelessness would be positively related to psychache and suicide risk, and that psychache would be positively related to suicide risk. In addition, we hypothesized that future orientation would be negatively related to hopelessness, psychache and suicide risk. At the multivariate level, we hypothesized that psychache would mediate the associations between hopelessness and suicide risk, and between positive future orientation and suicide risk. In other words, greater positive future orientation would be associated with less psychache and, in turn, to reduced suicide risk, and greater hopelessness would be linked to more psychache and suicide risk. Recruited locally, nationally, and internationally from advocacy organizations and support groups, our sample of LGBTQ individuals (N = 496) was primarily White (81.7%; n = 365), female (44.8%; n = 201), and either lesbian or gay (46.8%, n = 209). Participants completed online self-report measures, including: Beck Hopelessness Scale, Future Orientation Scale, Psychache Scale, and the Suicidal Behaviors Questionnaire-Revised. Bivariate correlations, and multivariate analyses per Hayes (2013), were conducted, covarying age, birth sex, and race/ethnicity. In bivariate correlations, all variables were significantly related in hypothesized directions (p \u3c .01). In serial mediation analyses, the total effect of future orientation on suicide risk was significant (t = -2.17, p \u3c .05), and the direct effect was nonsignificant when psychache was added to the model (t = -.879, p = .381), indicating mediation. In the second model, psychache mediated the relation between hopefulness and suicide risk; the total effect was significant (t = 3.56, p \u3c .05), and the direct effect was nonsignificant (t = 1.35, p = .181). Supporting hypotheses, our results suggest that LGBTQ individuals with a positive future orientation experience less psychache and, in turn, reduced suicide risk. On the other hand, LGBTQ persons with greater hopelessness experience greater psychache and, in turn, greater suicide risk. Therapeutic interventions designed to encourage an adaptive, positive view of the future (e.g. Future Directed Therapy), rather than a hopeless view of the future, may help to counteract the often-present stressors and distress experienced by LGBTQ persons, thereby ameliorating suicide risk