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Journal of Behavioral Medicine

, Volume 38, Issue 1, pp 171–182 | Cite as

Deconstructing therapeutic mechanisms in cancer support groups: do we express more emotion when we tell stories or talk directly to each other?

  • Rie Tamagawa
  • Yong Li
  • Theo Gravity
  • Karen Altree Piemme
  • Sue DiMiceli
  • Kate Collie
  • Janine Giese-Davis
Article

Abstract

Studies indicate that story-telling and emotional expression may be important therapeutic mechanisms. This study examined how they work together over 1 year of supportive-expressive group therapy (SET). Participants were 41 women randomized to SET. We coded emotional expression and story types (story vs. non-story) at the initial session, 4, 8, and 12 months. Women engaged in more storytelling in their initial than later sessions. In later sessions, women expressed significantly more emotion, specifically compassion and high-arousal positive affect. Direct communication (non-story) allowed more positive but also more defensive expression as women supported and challenged each other. Greater hostility in non-story and greater constrained anger during story were associated with increasing depression. Greater high-arousal positive affect in non-story and greater primary negative affect in story were associated with increasing social network size. These results inform clinicians about cues they might use to improve the effectiveness of cancer support groups.

Keywords

Metastatic breast cancer Emotional expression Storytelling Supportive-expressive group therapy Narratives 

Notes

Acknowledgments

We thank the principal investigator for the parent study, David Spiegel, and acknowledge The John D. and Catherine T. MacArthur Foundation Mind/Body Network, and National Institute of Mental Health Grant MH47226 and MH47226-11 with additional funding from The National Cancer Institute and the Fetzer Institute, Kalamazoo, Mich. Breast Cancer Research Program of California #9IB-0191, and the Kozmetsky Global Collaboratory also supported analysis. Preparation of this article was supported by the Alberta Innovates—Health Solutions Fellowship and the Psychosocial Oncology Research Training Post-doctoral Fellowship awarded to Dr. Rie Tamagawa. Salary support for Janine Giese-Davis is from the Enbridge Chair for Psychosocial Oncology Research held by Linda E. Carlson. This project started as an undergraduate honors project conducted by Caroline J. Perry under the mentorship of J. Giese-Davis, and was awarded Stanford University’s Firestone Medal and a citation at the Annual meeting of the Society for Behavioral Medicine, Washington, D.C., April 2002. The Emotion Coding Labs—Stanford and Calgary completed the project. We presented the current study at the Canadian Association of Psychosocial Oncology (CAPO), Vancouver, BC. April 25-28, 2012. We also gratefully acknowledge Helena C. Kraemer, biostatistician; coders Jennifer Boyce-McNeille, Diana Edwards, Sanjay Chakrapani, Barbara Symons, Casey Alt, Caryn Bernstein, David Weibel, Wendy Ellis, Suzanne Twirbutt, and Maya Yutsis; and the therapists and women who participated in this study.

Conflict of interest

All authors, Rie Tamagawa, Yong Li, Theo Gravity, Karen Altree Piemme, Sue DiMiceli, Kate Collie, and Janine Giese-Davis, declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

References

  1. Angus, L. (2012). Toward an integrative understanding of narrative and emotion processes in emotion-focused therapy of depression: Implications for theory, research and practice. Psychotherapy Research, 22(4), 367–380.PubMedCrossRefGoogle Scholar
  2. Arrington, M. I. (2010). Theorizing about social support and health communication in a prostate cancer support group. Journal of Psychosocial Oncology, 28(3), 260–268.PubMedCrossRefGoogle Scholar
  3. Baumeister, R. F., & Newman, L. S. (1994). How stories make sense of personal experiences: Motives that shape autobiographical narratives. Personality and Social Psychology Bulletin, 20(6), 676–690.CrossRefGoogle Scholar
  4. Bell, K., Lee, J., Foran, S., Kwong, S., & Christopherson, J. (2010). Is there an “ideal cancer” support group? Key findings from a qualitative study of three groups. Journal of Psychosocial Oncology, 28(4), 432–449.PubMedCrossRefGoogle Scholar
  5. Blake, R. L., & McKay, D. A. (1986). A single-item measure of social supports as a predictor of morbidity. The Journal of Family Practice, 22(1), 82–84.PubMedGoogle Scholar
  6. Bohart, A. C., & Greenberg, L. S. (1997). Empathy reconsidered: New directions in psychotherapy. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  7. Boritz, T. Z., Angus, L., Monette, G., Hollis-Walker, L., & Warwar, S. (2011). Narrative and emotion integration in psychotherapy: Investigating the relationship between autobiographical memory specificity and expressed emotional arousal in brief emotion-focused and client-centred treatments of depression. Psychotherapy Research, 21(1), 16–26.PubMedCrossRefGoogle Scholar
  8. Butler, L. D., Koopman, C., Neri, E., Giese-Davis, J., Palesh, O., ThorneYocam, K. A., et al. (2009). Effects of supportive-expressive group therapy on pain in women with metastatic breast cancer. Health Psychology, 28(5), 579–587.PubMedCrossRefGoogle Scholar
  9. Cameron, L. D., & Jago, L. (2008). Emotion regulation interventions: A common-sense model approach. British Journal of Health Psychology, 13(2), 215–221.PubMedCrossRefGoogle Scholar
  10. Campbell, A., & Muncer, S. (2008). Intent to harm or injure? Gender and the expression of anger. Aggressive Behavior, 34(3), 282–293.PubMedCrossRefGoogle Scholar
  11. Carryer, J. R., & Greenberg, L. S. (2010). Optimal levels of emotional arousal in experiential therapy of depression. Journal of Consulting and Clinical Psychology, 78(2), 190–199.PubMedCrossRefGoogle Scholar
  12. Classen, C., Butler, L. D., Koopman, C., Miller, E., DiMiceli, S., Giese-Davis, J., et al. (2001). Supportive-expressive group therapy and distress in patients with metastatic breast cancer: A randomized clinical intervention trial. Archives of General Psychiatry, 58(5), 494–501.PubMedCrossRefGoogle Scholar
  13. Coreil, J., Wilke, J., & Pintado, I. (2004). Cultural models of illness and recovery in breast cancer support groups. Qualitative Health Research, 14(7), 905–923.PubMedCrossRefGoogle Scholar
  14. Fleiss, J. L. (1971). Measuring nominal scale agreement among many raters. Psychological Bulletin, 76(5), 378–382.CrossRefGoogle Scholar
  15. Gerrig, R. J. (1994). Narrative thought? Personality and Social Psychology Bulletin, 20(6), 712–715.CrossRefGoogle Scholar
  16. Gibbons, R. D., Hedeker, D. R., Elkin, I., Waternaux, C., Kraemer, H. C., Greenhouse, J. B., et al. (1993). Some conceptual and statistical issues in analysis of longitudinal psychiatric data: Application to the NIMH treatment of depression collaborative research program dataset. Archives of General Psychiatry, 50(9), 739–750.PubMedCrossRefGoogle Scholar
  17. Giese-Davis, J., Collie, K., Rancourt, K. M., Neri, E., Kraemer, H. C., & Spiegel, D. (2011). Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: A secondary analysis. Journal of Clinical Oncology, 29(4), 413–420.PubMedCentralPubMedCrossRefGoogle Scholar
  18. Giese-Davis, J., DiMiceli, S., Sephton, S., & Spiegel, D. (2006). Emotional expression and diurnal cortisol slope in women with metastatic breast cancer in supportive-expressive group therapy: A preliminary study. Biological Psychology, 73(2), 190–198.PubMedCrossRefGoogle Scholar
  19. Giese-Davis, J., Koopman, C., Butler, L. D., Classen, C., Cordova, M., Fobair, P., et al. (2002). Change in emotion-regulation strategy for women with metastatic breast cancer following supportive-expressive group therapy. Journal of Consulting and Clinical Psychology, 70(4), 916–925.PubMedCrossRefGoogle Scholar
  20. Giese-Davis, J., Piemme, K. A., Dillon, C., & Twirbutt, S. (2005). Macro-variables in affective expression in women with breast cancer participating in support groups. In J. A. Harrigan, R. Rosenthal, & K. R. Scherer (Eds.), Nonverbal behavior in the affective sciences: A handbook of research methods (pp. 399–445). Oxford: Oxford University Press.Google Scholar
  21. Goodwin, P. J., Leszcz, M., Ennis, M., Koopmans, J., Vincent, L., Guther, H., et al. (2001). The effect of group psychosocial support on survival in metastatic breast cancer. New England Journal of Medicine, 345(24), 1719–1726.PubMedCrossRefGoogle Scholar
  22. Gottman, J. M. (1995). What predicts divorce: The measures. Hillsdale, NJ: Lawrence Erlbaum Assoc.Google Scholar
  23. Hoybye, M. T., Johansen, C., & Tjornhoj-Thomsen, T. (2005). Online interaction. Effects of storytelling in an internet breast cancer support group. Psycho-Oncology, 14(3), 211–220.PubMedCrossRefGoogle Scholar
  24. Kemeny, M. E., Foltz, C., Cavanagh, J. F., Cullen, M., Giese-Davis, J., Jennings, P., et al. (2012). Contemplative/emotion training reduces negative emotional behavior and promotes prosocial responses. Emotion, 12(2), 338–350.PubMedCrossRefGoogle Scholar
  25. Kissane, D. W., Grabsch, B., Clarke, D. M., Christie, G., Clifton, D., Gold, S., et al. (2004). Supportive-expressive group therapy: The transformation of existential ambivalence into creative living while enhancing adherence to anti-cancer therapies. Psycho-Oncology, 13(11), 755–768.PubMedCrossRefGoogle Scholar
  26. Kreuter, M. W., Green, M. C., Cappella, J. N., Slater, M. D., Wise, M. E., Storey, D., et al. (2007). Narrative communication in cancer prevention and control: A framework to guide research and application. Annals of Behavioral Medicine, 33(3), 221–235.PubMedCrossRefGoogle Scholar
  27. Leszcz, M., & Goodwin, P. J. (1998). The rationale and foundations of group psychotherapy for women with metastatic breast cancer. International Journal of Group Psychotherapy, 48(2), 245–273.PubMedGoogle Scholar
  28. Lieberman, M. A., & Goldstein, B. A. (2006). Not all negative emotions are equal: The role of emotional expression in online support groups for women with breast cancer. Psycho-Oncology, 15(2), 160–168.PubMedCrossRefGoogle Scholar
  29. Matsunaga, D. S., & Gotay, C. C. (2004). Characteristics contributing to an enduring prostate cancer support group in an Asian and Pacific Islander community. Journal of Psychosocial Oncology, 22(4), 1–30.CrossRefGoogle Scholar
  30. Mustafa, M., Carson Stevens, A., Gillespie, D., & Edwards, A. G. K. (2013). Psychological interventions for women with metastatic breast cancer. Cochrane Database of Systematic Reviews, 6, CD004253–CD004253.PubMedGoogle Scholar
  31. Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401.CrossRefGoogle Scholar
  32. Sandaunet, A. (2008). The challenge of fitting in: Non-participation and withdrawal from an online self-help group for breast cancer patients. Sociology of Health & Illness, 30(1), 131–144.CrossRefGoogle Scholar
  33. Shim, M., Cappella, J. N., & Han, J. Y. (2011). How does insightful and emotional disclosure bring potential health benefits? Study based on online support groups for women with breast cancer. Journal of Communication, 61(3), 432–454.PubMedCentralPubMedCrossRefGoogle Scholar
  34. Spiegel, D., Butler, L. D., Giese-Davis, J., Koopman, C., Miller, E., DiMiceli, S., et al. (2007). Effects of supportive-expressive group therapy on survival of patients with metastatic breast cancer: A randomized prospective trial. Cancer, 110(5), 1130–1138.PubMedCrossRefGoogle Scholar
  35. Spiegel, D., & Classen, C. (2000). Group therapy for cancer patients. A research-based handbook of psychosocial care. New York: Basic.Google Scholar
  36. Turner-Cobb, J. M., Sephton, S. E., Koopman, C., BlakeMortimer, J., & Spiegel, D. (2000). Social support and salivary cortisol in women with metastatic breast cancer. Psychosomatic Medicine, 62(3), 337–345.PubMedCrossRefGoogle Scholar
  37. Ussher, J. M., Kirsten, L., Butow, P., & Sandoval, M. (2008). A qualitative analysis of reasons for leaving, or not attending, a cancer support group. Social Work in Health Care, 47(1), 14–29.PubMedCrossRefGoogle Scholar
  38. Walker, L. M., Bischoff, T. F., & Robinson, J. W. (2010). Supportive expressive group therapy for women with advanced ovarian cancer. International Journal of Group Psychotherapy, 60(3), 407–427.PubMedCrossRefGoogle Scholar
  39. Yalom, I. D. (1980). Existential psychotherapy. New York: Basic Books.Google Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Rie Tamagawa
    • 1
    • 2
  • Yong Li
    • 2
  • Theo Gravity
    • 3
  • Karen Altree Piemme
    • 3
  • Sue DiMiceli
    • 3
  • Kate Collie
    • 4
    • 5
    • 6
  • Janine Giese-Davis
    • 1
    • 2
  1. 1.Department of Oncology, Faculty of MedicineUniversity of CalgaryCalgaryCanada
  2. 2.Department of Psychosocial ResourcesTom Baker Cancer CentreCalgaryCanada
  3. 3.Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordUSA
  4. 4.Cross Cancer InstituteEdmontonCanada
  5. 5.University of AlbertaEdmontonCanada
  6. 6.EdmontonCanada

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