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« 27. Healthy emotional adjustment to cancer screening »

Summarised by Rachel Green. Director, The Emotional Intelligence Institute. Author of "How to develop emotional resilience and manage your emotions".

This article describes a research paper: "Identifying and describing feelings and psychological flexibility predict mental health in men with HIV", written by Jodie M. B. Landstra, Joseph Ciarrochi, Frank P. Deane and Richard J. Hillman; and published in the "British Journal of Health Psychology, 18, 844–857, (2013).

Does psychological flexibility and the ability to describe one's own feelings predict a healthy emotional adjustment to the results of cancer screening in men with HIV?

It was hypothesised that the ability to identify and describe feelings (DIDF) and the presence of psychological flexibility (PF) may help people to cope with the waiting and uncertainty of cancer screening.

Similarly, that difficulty in identifying and describing one's own feelings (sometimes called Alexithymia) and psychological inflexibility would put men undergoing cancer screening at risk of poor adjustment.

Psychological flexibility (PF) is the ability to be in the present moment and to behave in ways that are adaptable and that will achieve a person’s values.

Three possible links between the ability to identify and describe feelings (DIDF) and psychological flexibility (PF), and a cancer screening procedure and emotional adjustment were tested.

1. Do the medical results, rather than DIDF or PF determine the type of emotional response after screening?

2. Does the effect of the medical results depend on how much DIDF or PF the participant displays?

3. Does DIDF and PF determine and predict an emotionally healthy response, regardless of medical results?

The researchers also compared models that presume DIDF is the mediator between PF and emotional adjustment, with models that assume PF is the mediator between DIDF and mental health.

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Emotional intelligence study background

 I am including significant background to this study as much of it relates to the importance of emotional intelligence in relation to health and well-being, and may not be known to readers.

The ability to accurately identify how you are feeling is an important component of emotional intelligence and the first dimension on the Genos emotional intelligence model, and this is a key focus of the study.

Here are some excerpts from the previous research quoted by the authors.

  1. The intense experiencing of emotions is not necessarily maladaptive as long as these emotions are adequately processed.
  2. Men tend to be poorer at identifying and describing emotions than women and so DIDF and PF may be of particular importance in the male population.
  3. The ability to recognise and describe emotions may help people to cope with health problems.
  4. The ability to identify and describe one’s feelings has been found helpful in studies related to alcohol consumption and treatment. In a study of underage drinking, Kashdan, Ferssizidis, Collins, and Muraven (2010) found that the number of drinks per session was related to the ability to differentiate between emotions. Moreover, in the presence of high negative emotion intensity, those with better skills at differentiating emotions had fewer drinks than those who were less able to differentiate them.
  5. Better alcohol treatment outcomes have also been found to be significantly related to lower Alexithymia scores. These studies illustrate that it is not the situation or particular emotion that is important, but the individual’s ability to process them.
  6. Psychological flexibility has been shown to improve many aspects of well-being. In a meta-analysis of 32 studies, higher PF was consistently associated with better quality of life (QOL) and other psychological outcomes.
  7. When people lack psychological flexibility they are more vulnerable to emotional difficulties.
  8. Individuals who had higher PF in their coping efforts were better adjusted, and had less anxiety and fewer depressive symptoms.
  9. Karekla and Panayiotou (2011) found that individuals with low PF used avoidant coping methods such as denial, emotional support, behavioural disengagement, venting and self-blame, to a greater extent.
  10. Psychological flexibility involves being willing to experience unpleasant emotions without needing to change them. If an individual is low in PF, this means they are more likely to avoid, distract or ignore negative emotions. Such a tendency to avoid may limit their opportunities for identifying and clearly labelling emotions.
  11. It is not clear from previous research whether it is learning to be aware of and to describe emotions that allows one to be more flexible, which in turn improves functioning, or whether it is learning to be flexible with one’s private experiences that facilitates improved identification and description of emotions, which, in turn, improves functioning.

Emotional intelligence study subjects

271 men agreed to participate, 187 completed both assessments, (called Completers).

  • Completers had a mean age of 51 years (SD = 9, range = 28-73 years).
  • 49% were in an ongoing relationship, and of those, 76% had been in that relationship for longer than 5 years.
  • 64% had finished tertiary education.
  • 51% were in full-time employment.
  • 9% were taking antidepressant medication.
  • 29% were current smokers.
  • 85% were current alcohol drinkers.
  • 49% had used illicit drugs in the last 2 years.
  • All lived in Sydney, Australia.

All were HIV-infected.

  • Fifteen years was the average time since diagnosis of HIV infection (SD = 8, range = 1-28).
  • 91% were taking HIV medications, with an average of 10 years on medications ( SD = 6, range = 1-22).
  • All had sex with men.
  • All were undergoing anal cytological screening.

Emotional intelligence study methods

This was a longitudinal, self-report survey.

Each Completer had anal cancer screening at two time points over 14 weeks.

Psychological flexibility (PF) was assessed by the Acceptance and Action Questionnaire II. The AAQ-II measures the tendency to control thoughts and feelings and the ability to act in the presence of difficult thoughts or feelings. Each item is rated on a 7-point Likert scale, e.g. "I worry about not being able to control my worries and feelings" and "My painful memories prevent me from having a fulfilling life".

The ability to identify and describe feelings (DIDF) was assessed by subscales of the Toronto Alexithymia Scale-20. The TAS-20 is a self-report scale that is comprised of 20 items rated on a 5-point Likert scale. The scale includes items such as, "When I am upset, I don’t know if I am sad, frightened, or angry" and "It is difficult for me to find the right words for my feeling".

  1. Subjects were also assessed for depression, anxiety, stress using the The Depression Anxiety Stress Scale (DASS). Items such as "I felt scared without any good reason" are rated on a 4-point Likert scale.
  2. The Medical Outcomes Study Short Form Health Survey (SF-12) was used to measure health related quality of life. Two summary scales of physical (PCS) and mental (MCS) well-being were used.
  3. Data were collected at baseline with questionnaire pack one given at the initial interview, to be completed that day and mailed back. Another questionnaire pack was mailed in the week following the date the participant received their cytology and histology results, 12 - 14 weeks after baseline.

Emotional intelligence study results

The results show that lower Alexithymia scores and a higher ability to identify and describe feelings (DIDF) predicted less depression, anxiety and stress and higher levels of mental and physical quality of life (QOL).

  1. Both DIDF and PF were reliable predictors of mental health.
  2. The link between PF and mental health is entirely mediated by DIDF in this medical screening context.
  3. Greater health threat did not predict changes in mental health.
  4. The ability to identify and describe feelings and the presence of psychological flexibility help men with HIV to experience positive changes in mental health over time.

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Emotional intelligence study conclusions & the future

The ability to correctly identify and differentiate between one's own feelings is important and influences the ability of people to cope with difficult health situations such as medical screening for cancer. This adds further support to the benefit of having emotional intelligence skills.

This study relied on self-report measures.

The use of additional, more objective, measures may be beneficial in future studies.

As the authors state: "Emotion-related skills are protective against a variety of poor psychological outcomes".

Key point about emotional adjustment & emotional intelligence

Emotional intelligence skills matter and help people adjust in an emotionally healthy way at times of potential medically related distress. 

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