The Effectiveness of Cognitive-Analytic Therapy in Women Diagnosed with Breast Cancer and Post-Traumatic Stress Disorder

Chapter 2 Local control in young women 2.1 Are breast conservation and mastectomy equally effective in the treatment of young women with early breast cancer? Long-term results of a population-based cohort of 1451 patients aged 40 years. 2.2 Local recurrence following breast-conserving therapy in women aged 40 years or younger: Trends in risk and the impact on prognosis in a cohort of 1143 patients. 2.3 Detection of local recurrence following breast-conserving therapy in young women with early breast cancer: Optimization of long-term follow-up strategies. Chapter 3 Local control in lobular breast cancer 3.1 Margin status and the risk of local recurrence after breastconserving therapy of lobular breast cancer. 3.2 The impact of postmastectomy radiotherapy on local control in patients with invasive lobular breast cancer. Chapter 4 Prognosis following local relapse 4.1 The prognosis of patients with local recurrence more than five years after breast-conserving therapy for invasive breast carcinoma. 4.2 Prognosis following local recurrence after breast-conserving therapy in young women with early breast cancer. Chapter 5 Regional relapse 5.1 Diagnosis, treatment and prognosis of internal mammary lymph node recurrence in breast cancer patients. 5.2 Detection, treatment, and outcome of isolated supraclavicular recurrence in 42 patients with invasive breast carcinoma. Chapter 6 General discussion and future perspectives Summary Nederlandse samenvatting Abbreviations List of publications Dankwoord Curriculum Vitae Chapter 1 10 1

Posttraumatic Stress Disorder Among Military Returnees From Afghanistan and Iraq

BackgroundTraumatic experiences, such as natural disasters, produce multiple and serious impacts on people. Despite the traditional focus on negative consequences, in many cases there are also positive consequences, such as posttraumatic growth. Tedeschi and Calhoun proposed a model of posttraumatic growth that emphasizes the role of rumination after the basic beliefs breakdown due to the occurrence of a traumatic experience.MethodA total of 238 volunteers affected by two major earthquakes and tsunami alerts in northern Chile on April 1 and 2, 2014, responded to an online survey measuring subjective severity, basic beliefs change, social share of emotion, rumination, posttraumatic stress, and posttraumatic growth.ResultsPath analyses reveal that posttraumatic stress goes through a negative change in basic beliefs, intrusive rumination, and deliberated rumination, meanwhile posttraumatic growth is only achieved directly from a positive change in basic beliefs and deliberated rumination.DiscussionThe model is consistent with the empirical model obtained in Chilean people affected by the earthquake and tsunami that occurred on 27 February, 2010, but it is slightly different and in a form that is more consistent with Tedeschi and Calhoun’s theoretical model. Both models remark on the role of deliberated rumination in posttraumatic growth and failure to progress from intrusive to deliberated rumination in posttraumatic stress, but the proposed one is more parsimonious and assumes subjective severity as an antecedent to basic belief changes. These conclusions must be considered in light of limitations that a cross-sectional design and the correlational nature of the statistical analysis carried out impose.Highlights of the articleRole of subjective severity, change of basic beliefs, social sharing of emotion, and rumination on posttraumatic stress and growth were modeled from responses of people affected by the April 1–2, 2014, northern Chilean earthquakes.Posttraumatic stress goes through negative changes in basic beliefs, intrusive rumination, and deliberated rumination.Posttraumatic growth is achieved from positive changes in basic beliefs and deliberated rumination.Deliberated rumination and moving from intrusive to deliberated rumination appear as cornerstones in posttraumatic processing.

LAY SUMMARY Posttraumatic stress disorder (PTSD) is a common, debilitating mental illness with a substantial burden on individuals and society. The authors aimed to compare the effects of cognitive analytic therapy and compassion-focused therapy on Veterans with PTSD. This study showed that a 12-session program of cognitive analytic therapy or an 8-session program of compassion-focused therapy was effective for treating PTSD. The interventions controlled re-experiencing, avoidance, and hyperarousal in PTSD. Also, they decreased depression, anxiety, and numbness in patients with PTSD. Compassion-focused therapy was more effective in controlling avoidance and depression than cognitive analytic therapy.

Background Post-traumatic stress disorder represents a multifaceted clinical entity with a profound impact on mental health. This study was conducted to evaluate the effects of cognitive analytic therapy on the manifestations of post-traumatic stress disorder. Materials and methods From May 21, 2023, to July 7, 2023, we conducted a randomized control trial in the outpatient clinic of a psychiatry Hospital. Participants were Iran-Iraq war veterans (N = 40) with a confirmed diagnosis of post-traumatic stress disorder. They were randomly allocated to cognitive analytic therapy and control groups. The primary outcome was re-experiencing, and the secondary outcomes included avoidance, hyperarousal, depression, anxiety, and numbness scores measured by appropriate questionnaires before and after the interventions. The cognitive analytic therapy group received a weekly program totaling 12 sessions of therapy adjunct to pharmacotherapy, each session lasting 90 min, and the control group received only pharmacotherapy. Results Within-group analysis showed that cognitive analytic therapy (N = 19) decreased all symptom scores (all p < 0.001), while the control group (N = 20) showed a decrease in hyper-arousal, depression, and anxiety (p < 0.001) scores. Between-group analysis implied that cognitive analytic therapy was more successful than usual pharmacotherapy in decreasing all outcome scores (all p < 0.001) Conclusion A 12-session program of cognitive analytic therapy was effective in alleviating re-experiencing, avoidance, hyper-arousal, depression, anxiety, and numbness in post-traumatic stress disorder. It was safe and acceptable by participants reflected by a high retention rate. We recommend the incorporation of cognitive analytic therapy to the treatment of post-traumatic stress disorder.

The study has three aims: (1) to compare the effect of the Qassam attacks in two types of communities: development town and kibbutz; (2) to examine the relationship between posttraumatic stress (PTS) and posttraumatic growth (PTG); and (3) to examine the contribution that level of exposure, cognitive appraisal, and sense of belonging to the country make to PTS and PTG. The sample consisted of 134 residents, 67 living on two kibbutzim and 67 living in the development town of Sderot. Results revealed that the development town residents reported more PTS symptoms and more PTG than did the kibbutz residents, and the association between PTS and PTG was positive. In addition, the findings show that most of the predictors contribute to either PTS or PTG, or predicted them differently. The discussion examines the results in light of the current literature on PTS and PTG.

Given that more than one third of some cohorts of cancer survivors exhibit post-traumatic stress disorder (PTSD) symptomatology, this study examines how trauma outcomes might relate to quality of life (QOL). Eight hundred thirty survivors of adult lymphoma were assessed for PTSD, post-traumatic growth (PTG) and QOL. Structural equation modeling revealed that QOL was best explained by the model in which stressors (e.g., co-morbidities) were mediated by PTSD and PTG. Trauma outcomes mediated the relationship between specific stressors and QOL. These findings support using PTSD and PTG as a diagnostic framework in understanding symptomatology in survivors.

The protective role of maternal post-traumatic growth and cognitive trauma processing in Palestinian mothers and infants: a longitudinal study

AimsPrevious studies have reported inconsistent findings regarding the association between post-traumatic stress (PTS) and post-traumatic growth (PTG). Three major issues could account for this inconsistency: (1) the lack of information about mental health problems before the disaster, (2) the concept of PTG is still under scrutiny for potentially being an illusionary perception of personal growth and (3) the overlooking of PTS comorbidities as time-dependent confounding factors. To address these issues, we explored the associations of PTS and PTG with trauma-related diseases and examined the association between PTS and PTG using marginal structural models to address time-dependent confounding, considering pre-disaster covariates, among older survivors of the 2011 Japan Earthquake and Tsunami.MethodsSeven months before the disaster, the baseline survey was implemented to ask older adults about their health in a city located 80 km west of the epicentre. After the disaster, we implemented follow-up surveys approximately every 3 years to collect information about PTS and comorbidities (depressive symptoms, smoking and drinking). We asked respondents about their PTG in the 2022 survey (n = 1,489 in the five-wave panel data).ResultsPTG was protectively associated with functional disability (coefficient −0.47, 95% confidence interval (CI) −0.82, −0.12, P < 0.01) and cognitive decline assessed by trained investigators (coefficient −0.07, 95% CI −0.11, −0.03, P < 0.01) and physicians (coefficient −0.06, 95% CI −0.11, −0.02, P < 0.01), while PTS was not significantly associated with them. Severely affected PTS (binary variable) was associated with higher PTG scores, even after adjusting for depressive symptoms, smoking and drinking as time-dependent confounders (coefficient 0.35, 95% CI 0.24, 0.46, P < 0.01). We also found that an ordinal variable of the PTS score had an inverse U-shaped association with PTG.ConclusionPTG and PTS were differentially associated with functional and cognitive disabilities. Thus, PTG might not simply be a cognitive bias among survivors with severe PTS. The results also indicated that the number of symptoms in PTS had an inverse U-shaped association with PTG. Our findings provided robust support for the theory of PTG, suggesting that moderate levels of psychological struggles (i.e., PTS) are essential for achieving PTG, whereas intense PTS may hinder the attainment of PTG. From a clinical perspective, interventions that encourage social support could be beneficial in achieving PTG by facilitating deliberate rumination.

ABSTRACTThe study examined psychosocial factors (quality of life, depression, anxiety, optimism, coping, and social support) in relation to symptoms of posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) in 108 women diagnosed with ovarian cancer. Canonical correlational analysis showed that both PTSD and PTG were related to poorer quality of life, lack of social supports, and avoidant coping styles. However, higher PTG was also associated with the use of meaning and social support to cope with their experience. The findings highlight both negative and positive posttraumatic outcomes but longitudinal studies are now needed to more fully evaluate these relationships.

We previously found deteriorations in working memory and attention with aromatase inhibitor (AI) therapy in postmenopausal women with breast cancer and that, compared to matched-controls, women with breast cancer have poorer executive function before adjuvant therapy (AI +/-chemotherapy) that persists through the first 18 months of therapy.However, the trajectory of cognitive function through the 5-year AI therapy course has not been documented, nor is it clear whether cognitive function recovers post-therapy.The purpose of this study was to determine the long term effect of AI therapy on objectively-measured cognitive function in postmenopausal women with early stage breast cancer and whether cognitive function recovers 1 year post-therapy relative to pre-therapy and the last assessment while on therapy.Using a comprehensive, objective battery, cognitive function was assessed before therapy, semiannually years 1 and 2 of therapy, annually years 3 through 5 of therapy and one year post-therapy in 83 postmenopausal women with breast cancer and matched controls.Data were analyzed using linear mixed modeling; covariates including age, IQ (National Adult Reading Test-R), depression (Beck Depression Inventory-II), anxiety (Profile of Mood States (POMS) Tension/Anxiety), fatigue (POMS Fatigue/Inertia) and pain (Brief Pain Inventory) were assessed concurrently with cognitive function.Relative to pre-therapy, women who received AIs alone had poorer concentration (p=.02) and psychomotor speed (p=.004) one year post-therapy and poorer concentration relative to the last assessment during therapy (p=.02).No covariates were associated with performance in these cognitive domains.In contrast, women with breast cancer and controls had improved executive function, attention, working memory and verbal memory at therapy completion relative to pre-therapy and at one year post-therapy relative to pre-therapy (p=.05 to <.001).Deficits in concentration and psychomotor speed may persist after completion of AI therapy in women with breast cancer.Improvements in performance in other cognitive domains likely represent practice effects.While these results need to be verified in a larger sample, they point to a need for interventions to help women compensate for persistent cognitive changes they may experience after AI therapy.This is the first known study to examine cognitive function through the full, 5-year trajectory of AI therapy and to examine whether cognitive function recovers post-therapy in women with breast cancer.

Comparing the nature of grief and growth in bereaved, divorced, and unemployed individuals

Secular Mindfulness-Based Interventions: Efficacy and Neurobiology.

Routine axillary lymph node dissection (ALND) for elderly women with invasive breast cancer has been questioned because it rarely alters therapy yet carries a significant morbidity rate. Sentinel lymphadenectomy (SLND) improves axillary staging and alters therapy in women with T1 breast cancer, but it is not clear whether SLND alters therapy in elderly women with breast cancer. A prospective breast cancer data base was used to identify women 70 years old and older who underwent SLND for axillary staging of invasive breast cancer between 1991 and 1998. There were 75 invasive breast cancers in 73 women. The mean patient age was 74.5 years (range, 70-90 years). Median tumor size was 1.4 cm (range, 0.1-6.2 cm). Of the 75 tumors, 42 (56%) had favorable primary characteristics; the remaining tumors had unfavorable characteristics. SLND was performed alone in 17 cases (23%) and was followed by completion ALND in 58 cases (77%). Positive lymph nodes were identified in 32 cases (43%); 26 (81.3%) were detected by hematoxylin and eosin stains, and 6 (18.7%) were detected by immunohistochemistry alone. Five patients (6.9%) received adjuvant chemotherapy. Seven patients (9.6%) received axillary/supraclavicular radiation for positive nodes. Ten (13.7%) of 73 patients had obvious alterations in therapy because of axillary nodal status. As a result of SLND, 3 (13.6%) of 22 patients with tumors 1.0 cm or smaller received tamoxifen, and 7 (15%) of 46 patients with tumors between 1.0 and 3.0 cm in size had changes in therapy. When patient and tumor characteristics were analyzed to determine relationships to therapeutic decision-making, nodal status was the variable most significantly associated with changes in therapy (P = .0001). SLND improves axillary staging in elderly women with invasive breast cancer. Results of immunohistochemistry do not alter therapy in this group of individuals (P = .6367). In patients with small primary tumors, SLND alters therapy by increasing the number of patients receiving tamoxifen. In addition, SLND affects adjuvant systemic chemotherapy and regional radiotherapy in a significant number of patients with larger tumors, particularly tumors between 1.0 and 3.0 cm.

Background: Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) are known psychological outcomes that can co-occur in the aftermath of a traumatic event. However, it is less clear how these outcomes interact – particularly for female survivors of conflict-related sexual violence (CRSV) – and to what extent intermediary factors play a role in this relationship.&lt;br/&gt; Methods: In a sample of 192 war survivors from Bosnia &amp; Herzegovina (n = 104 experienced CRSV, n = 88 did not), a structural equation model (LISREL 8.8) tested CRSV as a traumatic event, 'positive reinterpretation' (as a strategy of approach coping) and 'behavioural disengagement' (as a strategy of avoidance coping), and PTSD and PTG as psychosocial outcomes. A difference in the mechanisms by which PTG and PTSD interact in the two subgroups was hypothesised, given the differences in the nature of the trauma they experienced.&lt;br/&gt; Results: Through multiple indirect relationships, results showed that CRSV survivors respond to their trauma with both PTSD and PTG, suggesting a dual PTSDPTG mechanism. As for coping strategies, positive reinterpretation predicted greater PTG, and behavioural disengagement predicted greater PTSD. In the sample of nonsexual violence survivors, positive reinterpretation also remained a significant predictor of PTG.&lt;br/&gt; Conclusions: Positive reinterpretation as a coping strategy appears to be a stable characteristic that independently predicts PTG, irrespective of trauma type. Mental health professionals should take into account this mechanism when addressing the needs of CRSV survivors, but also war survivors more generally. Reframing traumatic events and post-trauma sequalae during treatment could lead to PTG and enhance recovery.