Personality traits and coping mechanisms in the cancer patients ...

Personality traits and coping mechanisms in the cancer
patients and non-cancer

Ashraf Sadat Giti Ghoreishi

Lecturer of Islamic Azad University, Roudhen branch



Abstract:

Present research is a study of coping mechanisms and
personality characteristics in the cancer patients and it’s
comparison with non-cancer individuals. In this study we have
measured coping mechanisms; depression; anxiety and
aggression in 80 men and women- 40 with cancer and the
other without cancer-. We have observed significant
differences in the emotional and psychosomatic dimensions;
depression and anxiety indicators. But in the aggression
indicators no significant difference has been seen.


Introduction:

Relation between psycho – social factors and cancer disease is a problem
that in the recent decades is related to psychosomatic diseases by many of
the researches. In attention to increase in the cancer disease rate in different
societies, seem that other factors with the exception of physical factors,
genetic tendency, physical stimuli, chemical materials effects and viral
effects and etc. to be effective in appearance and increase of cancer. It is
believed that there are some personality traits in some cancer patients in
common. These traits are coping mechanisms employed in response to
environmental stimuli and sometime special personality type is considered
relation to this disease presented occasionally as type. Other studies have
believed that among all of psycho–social variables, this behavior pattern
have stranger relation with cancer disease production and progress. Briefly,
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personality C type characteristics include kind, traditional, hard trying and
sociable people.
Coping refers to the attitudes and behaviors that you use to maintain your
emotional well being and to adjust to the stresses caused by cancer.
Different people cope in different ways, and some ways of coping are more
successful in promoting a person's emotional well being and psychological
adjustment than others. Currently, you might be coping with treatments and
their side effects. Perhaps you are also coping with a recurrence of your
cancer or with pain and disability. Your life has been disrupted and perhaps
altered by your illness, and you are dealing with the effect on your loved
ones of all that is happening to you.
Clinicians have long touted the benefits of working through emotions
attendant on stressful or traumatic experiences (e.g., Horowitz, 1976;
Kübler-Ross, 1969). Spiegel (1993), for example, in addressing adaptive
resolution for individuals confronting life-threatening illness, suggested that
"the best way for you, your family, and your friends to cope with illness is
to do the hard emotional work of recognizing and feeling what those losses
might mean". Such recommendations stand in contrast to conclusions from
the empirical literature on coping with stressful encounters, which often
indicate that emotion-focused coping is maladaptive (e.g., Kohn, 1996 ;
Moos & Schaefer, 1993). However, conceptual and methodological
problems in that literature may call such conclusions into question. In a
longitudinal design, we used recently developed coping measures to test the
utility of coping through actively processing and expressing emotion in
psychological and physical adjustment to breast cancer. Further, we
investigated the relations of emotional approach coping, dispositional hope,
and perceived social context receptivity in predicting adjustment.
Three lines of evidence suggest that coping through emotional approach
(i.e., coping through actively processing and expressing emotion; Stanton,
Danoff-Burg, Cameron, & Ellis, 1994; Stanton, Kirk, Cameron, & Danoff-
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Burg, 2000) may enhance adjustment in cancer patients. First, randomized,
controlled studies of psychological interventions, in which one intervention
component is the facilitation of emotional expression, provide evidence that
these interventions can enhance psychological adjustment (Fawzy, Cousins,
et al., 1990 ; Spiegel, Bloom, & Yalom, 1981), improve immune function
(Fawzy, Kemeny, et al., 1990), and perhaps promote longer survival
(Fawzy et al., 1993 ; Spiegel, Bloom, Kraemer, & Gottheil, 1989 ) in groups
with cancers such as metastatic breast cancer and malignant melanoma.
Because these were multicomponent interventions, however, we cannot
conclude that emotional expression was the effective ingredient.
Second, studies of adjustment to cancer indicate that coping through
cognitive and behavioral avoidance is detrimental to adjustment (e.g.,
Carver et al., 1993 ; Friedman, Nelson, Baer, Lane, & Smith, 1990 ; Stanton
& Snider, 1993 ) and perhaps to health status ( Epping-Jordan, Compas, &
Howell, 1994 ; Jensen, 1987 ). Given these findings, one would expect that
the opposing strategy of actively approaching the stressor through
processing and expressing emotion would be beneficial. However, studies
with breast cancer patients have not used adequate measures of emotional
approach coping.
Although not yet extended to cancer patients, experimental investigations
provide the most convincing evidence to date that emotional processing and
expression are related causally to positive outcomes. A series of studies by
Pennebaker and colleagues, as well as investigations conducted in other labs
(Pennebaker, Mayne, & Francis, 1997 ; Smyth, 1998), have revealed that
experimentally inducing individuals to write or talk about stressful
experiences over several sessions can enhance physical and psychological
health as well as important behavioral outcomes.
Recent research has continued to confirm the role of psychological
factors in heart disease. John Hopkins University has confirmed that
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medical students who (a) expressed or concealed their anger, (b) were
irritable, and (3) griped a lot were 3 times more likely to develop early heart
disease and 5 times more likely to have a heart attack than their calmer class
mates. Likewise, another study at University of North Carolina (Williams,
2001) found that people with high anger scores (quick tempered with
frequent, intense rages and urges to hit people, etc.) were three times more
likely to have a heart attack or cardiac death. Early measures of hostility
(mistrust, aggression, cynicism) are good predictors years later of heart
disease so early intervention is possible. High stress reactions have been
shown to trigger a heart attack. Depression increases the likelihood of death
from heart disease. It seems likely that heart patients might benefit from
anger, depression, and/or stress management. Several publications have
already suggested that more complete psycho educational programs would
be beneficial and a couple of major studies of extensive psychological
treatment are now underway (Research to the Heart of the Matter). It seems
likely that self-help efforts to reduce the major emotions of Anxiety,
Depression, and Anger could have significant impact on your future health.
And don't forget exercise, a healthy diet, no smoking, and a good social life.
As we discussed above, stress and certain emotions can contribute to the
development of certain physical problems, like heart problems, but in other
disorders stress is not a cause but a result of having certain physical
problems. Breast and prostate cancers are cases in point. Being told you
have breast cancer or prostate cancer would set off a near panic reaction in
most of us. Many people still believe they will die when they are told they
have cancer. That is probably a misunderstanding of the diagnosis. During
the course of cancer, patients report having continuing emotional distress,
fatigue, lack of energy, fears, depression, and interpersonal difficulties, in
addition to added financial, health insurance, and employment problems.
Holland(1989) describes cancer cases in which the patient feels
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especially hopeless because they just can't get optimistic, even though their
cancer treatment is going well or has been successful. Because the self-help
books say you must be positive, they feel afraid and worried because they
don't have the "right" attitude. Sadness and fear do not make tumors grow.
No one is going to die because they can't keep a positive attitude. Self-help
book writers should realize their positive message, while helpful in some
cases, can also encourage blaming the victim. Some people are so into the
positive thinking thing that they actually blame people for having a brain
tumor or cancer of some internal organ. That is stupid and cruel. But
humans, always hoping they have a solution, are prone to think this way,
e.g. before bacterial infections were found to be responsible for tuberculosis
and for ulcers, it was thought that personality traits and high stress were the
causes. Cancer can't be caused or controlled by your positive or negative
thoughts, but optimism can perhaps help you cope with the growing cells.
That being said, most cancer patients behave in ways reminiscent of
posttraumatic stress disorder. Comparative data suggest that cancer patients
react in the same fashion as sexual assault victims. The resulting depression
is similar in nature, and is worse when faced alone. The ranks of the
depressed grow from a general population baseline of 3%, to 6% among
cancer outpatients, to 12% among cancer inpatients. Major depression
characterized 1 of every 5 terminal ill patients, and 60% of individuals who
requested assisted suicide are suffering from major clinical depression. The
latter finding raises the provocative question of whether physicians ought to
be treating the depression instead of supporting physician-assisted suicide.
While numerous individual and group psychosocial treatment models
exist, Dr. Spiegel (2001) focused on the group supportive expressive
treatment model, which he employs almost exclusively in managing cancer
patients. This model is predicated upon building social bonds, allowing for
the discussion of common problems. Patients collectively view their
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reactions as normal and learn to find meaning in their own tragedies.
Patients often choose to overcome the social isolation of illness by helping
others to feel better through the sharing of their own experiences. This
model encourages emotional expression, rather than attempting to suppress
or channel it.

Method:
In this research independent variable consists of personality traits and
coping mechanisms and dependent variable is cancer disease. In the
research control variables consists: age variable (over 30), sex variable
(male/female), disease kind (cancer). In this study samples are considered
randomly means of available groups that composition of samples is made
before hand and dependent variable has occurred formerly.
In these research two independent groups are patients, independent
groups (cancer) and dependent group (non-cancer) have examined.
Individual of sample group affected by cancer are in over 30 years age 40
individuals that have referred to Masih-Daneshvary hospital and cancer
institute of the Imam-Khomeini hospital. In this study with use of SCL90R
test and behaviors of coping questioner of Lazarus, test group and reference
groups have examined. These tests have been done individually and the time
is so minutes for doing these tests.

Hypotheses:
In this research we examine following hypotheses:
1. There is significant difference between dimension scales of different
coping mechanism in the cancer patients and non-cancer individuals.
2. There is significant difference between cancer patients and non-cancer
individuals in their depression indicator.
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3. There is significant difference between cancer patients and non-cancer
individuals in their anxiety indicator.
4. There is significant difference between cancer patients and non-cancer
individuals in their aggressiveness indicator.

Research plan:

In this experimental study there are two groups, one with cancer and
other without cancer. In this plan 80 subjects in two groups (with and
without cancer) each of them composed of men and women. Research
societies used in this study are cancer institute of Imam-Khomeini hospital
and Masih-Danshvary hospital. They have different cancers.

Sample:

The sample group consists of 80 men and women- 40 one with cancer
and the other without cancer-.

Instruments:

In this study we applied two tests: Coping behaviors test, and SCL90R
test. Coping behaviors questionnaire is planned to measure coping behavior.
Based on presented systems in studying coping ways with stresses we have
used Lazarus and Folkman methods (combination of the other methods).
This test has four different ways of coping including cognitive behavior,
problem solving, emotional control and seeking social support. Each test
contained 32 multiple-choice questions.
SCL90R test is used to differentiate a group with special psychological
problem from the one without problem. It has include 90 questions to
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evaluate symptoms that are reported by subject and for the first time is used
to indicate different psychological aspects of physical and psychic patient.
This test is an objective one with multiple choice questions that are
answered directly by the subjects. 90 items includes 9 different dimensions
are physical complaints, obsession and compulsion, sensitivity in interactive
relation, depression, anxiety, aggressiveness and hostility, phobia, paranoid
thoughts and psychosis.

Data analysis:
In this study for analyze the data and relationships between cancer and
coping mechanism and personality traits were investigated using descriptive
and deductive in which for comparison of averages T- test for independent
groups are used. In all tables frequency distribution of X1 is the study
groups and X2 is representative of comparison group.


Description Data :


Table (1) – Frequency distribution in relation to education in two groups.


Group/Education Illiterate
Under
literate
Literate
Total

Study
Frequency
12 20 8
40

Percent
30 50 20
100
Comparison
Frequency
10 21 9
40

Percent
25 52/5 22/5
100



Table (2) – Frequency distribution with age: 10



Group/Age
30 – 39
40-49
50-59
60 - 69
Total

Study
Frequency
7 16
12 5 40

Percent
17/5 40 30 12/5 100
Comparison
Frequency
8 15
10 7 40

Percent
20 37/5 25 17/5 100



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Table (3) – Statistical indicators in coping behaviors score in the women of
comparison groups:

Group
Study ( 20person )
Comparison ( 20 person)

Indicators/Dimensions Mean Standard Mean Standard

deviation
deviation

Cognitive
1/584
0/342
1/221
0/41

Emotive
1/746
0/758
1/001
0/326
Problem solving
1/96
0/68
1/65
0/542
Social support
0/782
0/526
0/498
0/418
Psycho - somatic
0/921
0/325
0/213
0/856







Table (4) – Statistical indicators in coping behaviors score in the men of study and
comp
arison groups:


Group
Study ( 20person )
Comparison ( 20 person)

Indicators/Dimensions Mean Standard Mean Standard

deviation
deviation
Cognitive
1/316
0/561
1/302
0/412
Emotive
1/436
0/478
1/241
0/536

Problem solving
1/62
0/64
1/59
0/53

Social support
0/514
0/521
0/781
0/491
Psycho - somatic
0/814
0/651
0/316
0/46







Table (5) – Statistical indicators in coping behaviors score in both groups:



Group
Study ( 20person )
Comparison ( 20 person)

Indicators/Dimensions Mean Standard Mean Standard

deviation
deviation

Cognitive
1/45
0/451
1/261
0/411
Emotive
1/591
0/618
1/125
0/426
Problem solving
1/77
0/66
1/62
0/536
Social support
0/781
0/508
0/506
0/469
Psycho - somatic
0/867
0/488
0/264
0/658










Table (6) – Calculation table of statistical indicators in sample women’s depression:

Study Group
Comparison Group
X S n X S n
1/25 0/197 20 2/3 0/747 20
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Table (7) – Calculation table of statistical indicators in sample means' depression:



Study Group
Comparison Group

X S n X S n


1/35 0/45 20 2/4 0/778 20
12






Table (8) – Calculation table of statistical indicators in the depression of both study

and comparison groups:


Study Group
Comparison Group

X S n X S n


1/3 0/317 40 2/35 0/746 40






Table (9) – Calculation table of statistical indicators in sample women’s' anxiety :


Study Group
Comparison Group

X S N X S n


1/3 0/22 20 2 0/526 20








Table (10) – Calculation table of statistical indicators in sample men’s' anxiety :



Study Group
Comparison Group

X S n X S n


1/45 0/52 20 2/05
0/471 20
12



Table (11) – Calculation table of statistical indicators in both groups' anxiety:

Study Group
Comparison Group
X S n X S n
10

1/375
0/394 40 2/025
0/486 40

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