Lung cancer-related emotional growth : the role of coping styles and prior trauma.

The objective of this study was to explore the relationship of prior traumatic history, coping styles, and post-traumatic emotional growth in participants diagnosed with lung cancer. Participants (n = 40) completed baseline questionnaire packets as part of their initial entry into the ongoing study “Understanding the Prognostic Significance of Circadian Disruption in Lung Cancer.” Linear hierarchal regressions adjusted age at diagnosis, stage, and household income. Analyses revealed no relationship between traumatic history and post-traumatic emotional growth. However, lung cancer patients who endorsed active coping styles were significantly more likely to report post-traumatic emotional growth. Secondary analyses revealed this relationship appeared to be driven by data from subjects of male gender. The encouraging nature of this finding has potential clinical implications, including contributing to the knowledge that coping styles have a relationship with potential emotional growth in a traumatic event and promotion of active coping in therapeutic settings. LUNG CANCER-RELATED EMOTIONAL GROWTH 3 Lung Cancer-Related Emotional Growth: The Role of Coping Styles and Prior Trauma Current statistics from the American Cancer Society state that lung cancer is the second most common cancer for both men and women. Lung cancer accounts for approximately 27% of all cancer deaths and is the leading cause of cancer death among both men and women. Each year, more people die of lung cancer than of colon, breast, and prostate cancers combined. Survival rates vary greatly among the different stages of lung cancer from 49% for stage IA to 1% for stage IV (American Cancer Society, 2015). Given the traumatic nature of a lung cancer diagnosis and acknowledgement that quantity of life may be shorter, quality of life becomes even more important. It becomes essential to look at the psychological well-being and quality of life of the patient and the potential for emotional growth post-diagnosis and during treatment. The intent of this study was to explore the relationship between prior traumatic history, coping styles, and post-traumatic growth in participants in the ongoing study “Understanding the Prognostic Significance of Circadian Disruption in Lung Cancer and Piloting an Intervention.” This thesis will explore the cancer-related emotional growth as defined by the Post-Traumatic Growth Inventory (PTGI). This inquiry explores the notion that the person’s coping style could be related to emotional growth, related to the cancer experience. Coping styles are defined as a person’s responsive approach toward stressful information (Roth and Cohen, 1986). This finding is important in this study as the person’s style or approach toward a traumatic event has been shown to have implications in latent emotional growth following a stressor. A study by Pineles et al. (2011) found that “individuals who are relatively highly reliant on avoidant coping strategies and relatively highly reactive to trauma reminders may be at greatest risk of maintaining or potentially increasing their PTSD symptoms within the LUNG CANCER-RELATED EMOTIONAL GROWTH 4 first few months following the trauma” (Pineles et al., 2011). This study emphasizes the importance of the style of coping an individual uses facing trauma and its aftermath. The Post-Traumatic Growth Inventory (PTGI) is a pencil-and-paper measure of growth and is based on five factors: relating to others, new possibilities, personal strength, spiritual change, and appreciation of life. According to a study on breast cancer patients using the English version of the PTGI scale translated into Chinese (CPTGI), M. W. Chan states that, “Findings showed that negative cancer-related rumination partially mediated the relationship between negative attentional bias and PTSD symptoms, while positive cancer-related rumination partially mediated the relationship between positive attentional bias and PTG” (M.W. Chan, 2011). This study highlights the importance of positive thoughts regarding the cancer. This suggests that cancer provides an opportunity for modification of thought processes that may result in emotional growth. By focusing on the latent potential positive outcomes, and taking an active coping style in their approach to thought patterns, the focus may allow for emotional growth. Current research suggests that self-reported patient coping styles play a role in potential psychological growth following a traumatic incident (Tedeschi, R. G., & Calhoun, L. G., 2004). Additionally, a study by Schroevers, M. J. and Teo, I. found that “greater use of the coping strategies, instrumental support, positive reframing, and humor was associated with more posttraumatic growth” (Schroevers, M. J. and Teo, I. 2008). As a lung cancer diagnosis can be considered a traumatic event due to the often grim prognosis. A study on those diagnosed with lung, neck and throat cancer found that 53% of participants (n=63) met the diagnostic criteria for Post-Traumatic Stress Disorder six months following lung cancer diagnosis (Kangas, M., Henry, J. L., Bryant, R. A., 2005). This diagnosis also carries a stigma attached due to the negative LUNG CANCER-RELATED EMOTIONAL GROWTH 5 connotation with smoking that may add to the additional stress of the diagnosis (Chapple, A., Ziebland, S., & McPherson, A., 2004). Because of the traumatic nature, it stands to reason that a patient’s active coping style could play a role in post-diagnosis emotional growth. There is currently a growing body of research, in the context of breast cancer, exploring the role of prior trauma and the effect such previous incidents have on the potential post-traumatic growth (Antoni, M.H. et al., 2001; Carver, C. S., Antoni, M. H., 2004; Tomich, P. L.; Helgeson, V. S., 2004; Sears, S.R., Stanton, A. L., Danoff-Burg, S., 2003). However, little research has been done on these measures specific to lung cancer patients. In a study focused on benefit finding as a predictor of better long-term adjustment among breast cancer patients during the first year after diagnosis, Carver and Antoni state that finding benefit was related to higher stage of diagnosis and higher age (Carver C.S., Antoni M. H., 2004). Benefit finding in a traumatic situation might be considered an active coping strategy, in that it requires positive reframing in a distressing situation, which could be considered a constructive action. Tomich and Helgeson’s study, also on women breast-cancer patients, state that there is a growing body of research that suggest that the more trauma someone experiences in their life, the more value they may find in the diagnosis. The study states that this may be because their life experiences have provided the opportunity and allowed the person to initiate and develop better coping skills (Tomich, P.L., Helgeson, V. S., 2004). Interestingly, R.G. Tedeschi and L.G Calhoun (2004) state that there are multiple distressing outcomes when individuals face trauma and, because of that, the focus of much of the research is on the potential negative outcomes. However, empirical evidence highlights the LUNG CANCER-RELATED EMOTIONAL GROWTH 6 potential of positive changes in perspective due to an individual’s willingness and ability to find meaning and adapt during a trauma. Thornton et al. (2012) found that higher self-reported levels of trauma also yielded higher levels of perceived benefit. Also, Thornton et al. suggests that there are predictive factors in emotional growth following a traumatic experience (Thornton et al., 2012). According to this study, benefit finding is positively related to how much impact a traumatic event produces. Reports of benefit finding after lung cancer were higher in patients who experienced more intrusive stress symptoms related to their cancer. The measure of intrusive stress symptoms that was used may also be indicative of cognitive processing, which may be consistent with the theory suggesting that benefit finding arises as a result of engaging with a highly stressful event. This study also found that lower levels of perceived stress were related to higher levels of benefit finding (Thornton et al., 2012). This seemingly paradoxical pattern of outcomes is consistent with Tedeschi and Calhoun's (2004) trauma theory that trauma is necessary to experience post-traumatic emotional growth and highlights the complexity of psychological response to a life-threatening illness like lung cancer. Andrykowski et al. elaborates on Tedeschi and Calhoun’s findings, stating that trauma is needed to trigger post-traumatic emotional growth and that greater growth was found consistently with greater negative stress (Andrykowski et al., 2015). An article by Zoellner & Maercker (2006) repeats this finding. They emphasize that patients may report that, without the trauma they are experiencing, they would not have been forced to live in a better way (Zoellner, Maercker, 2006). Highlighting the role of the participant’s appraisal of the cancer diagnosis, M.J. Cordova and colleagues (2007) studied participants with breast cancer states, finding that demographics LUNG CANCER-RELATED EMOTIONAL GROWTH 7 such as age and perception of cancer were associated with greater growth. Additionally, the authors suggest that, “Psychosocial interventions should be sensitive to the potential for PTG, both in treatment design and in assessment of outcomes” (Cordova et. al, 2007).