10.2190/GE85-J31W-XJV7-LB9L GE85J31WXJV7LB9L 219 COMPARISONS: PROFESSIONALLY-DIRECTED AND SELF-DIRECTED INTERNET GROUPS FOR WOMEN WITH BREAST CANCER 219 235 20050316 20050316 20050316 20050316 GE85J31WXJV7LB9L.pdf http://baywood.metapress.com/link.asp?target=contribution&id=GE85J31WXJV7LB9L 3 MORTON A. LIEBERMAN PH.D. MITCH GOLANT PH.D. ANDREW WINZELBERG PH.D. FIONA MCTAVISH MA DAVID H. GUSTAFSON PH.D. University of California, San Francisco The Wellness Community Stanford University University of Wisconsin <P>Psychological interventions for women coping with breast cancer (BC) have embraced the idea that the open expression of negative emotions is beneficial. This study asks if there is a difference in the amount of negative emotions expressed by members of professional-led compared to self-directed on-line support groups. To answer this question we examined the support group messages written by participants of 11 Internet delivered BC support groups. Seven were facilitated by professionals and four were self-directed. We used two text analysis software programs, LWIC and PCAD, to categorize the interaction. Groups conducted by professionals expressed significantly more negative emotions, anxiety, hostility, and depression and fewer positive emotions than self-directed groups. These differences suggest what leaders encourage, reinforce, model, and may influence members' behaviors. Professionals encourage the further expression of such emotions, whereas lay leaders more often respond with support and reassurance to members who express painful emotions.</P> Classen, C., Diamond, S., Soleman, A., Fobair, P., Spira, J., & Spiegel, D. (1993). Brief supportive-expressive group therapy for women with primary breast cancer: A treatment manual. Stanford, CA: Stanford University School of Medicine. Daldrup, R. J., Beutler, L. E., Engle, D., & Greenberg, L. S. (1988). Focused expressive psychotherapy: Freeing the overcontrolled patient. New York: Guilford. Davison, K. P., & Pennebaker, J. W. (1997). Virtual narratives: Illness representations in online support groups. In Perceptions of health and illness: Current research and applications (pp. 463-486). Derogatis, L. R., Abeloff, M. D., & Melisaratos, N. (1979). Psychological coping mechanisms and survival time in metastatic breast cancer. Journal of the American Medical Association, 242(14), 1504-1508. Ekman & Lieber, M. A. (1992). Unpublished Emotional Dictionary. Fawzy, F. I., Fawzy, N. W., Arndt, L. A., & Pasnau, R. O. (1995). Critical review of psychosocial interventions in cancer care. Archives of General Psychiatry, 52(2), 100-113. Fox, S. (2000, November). Pew Internet & American Life Project [on-line]. Available at http://www.pewinternet.org. Fox, S. (2004). Preliminary psychometric testing of the Fox Simple Quality-of-Life Scale. Journal of Neuroscience Nursing, 36(3): 157-166. Erratum in: Journal of Neuroscience Nursing, 35(5): 288, 2004. Freud, A. (1966). The ego and the mechanisms of defense. New York: International Universities Press, Inc. Frijda, N. H. (1986). The emotions. Cambridge, England: Cambridge University Press. Goodwin, P. J., Leszcz, M., Koopmana, J., Arnold, A., Doll, R., Chochinov, H., Nsvarro, M., Butler, K., & Pritchard, K. I. (1996). Randomized trial of group psychosocial support in metastatic breast cancer; the BEST (Breast-Expressive Supportive Therapy) study. Cancer Treatment, 22(Suppl A), 91-96. Gottschalk, L. A. (2000). The application of computerized content analysis of natural language in psychotherapy research now and in the future. American Journal of Psychotherapy, 54, 305-311. Gottschalk, L. A., & Bechtel, R. J. (1989). Artificial intelligence and the computerization of the content analysis of natural language. Artificial Intelligence in Medicine, 1, 131-137. Greer, S. (1991). Psychological response to cancer and survival. Psychology and Medicine, 21(1), 43-49. Greer, S., & Morris, T. (1975). Psychological attributes of women who develop breast cancer: A controlled study. Journal of Psychosomatic Research, 19(2), 147-153. Greer, S., Morris, T., & Pettingale, K. W. (1979). Psychological response to breast cancer: Effect on outcome. Lancet, 2(8146), 785-787. Greer, S., Morris, T., Pettingale, K. W., & Haybittle, J. L. (1990). Psychological response to breast cancer and 15-year outcome. Lancet, 335(8680), 49-50. Gross, J. (1989). Emotional expression in cancer onset and progression. Social Science and Medicine, 28(12), 1239-1248. Gustafson, D. H., Hawkins, R. P., Boberg, E. W., Mctavish, F., Owens, B., Wise, M., Berhe, H., & Pingree, S. (2001). CHESS: Ten years of research and development in consumer health informatics for broad populations, including the underserved. Medinfo, 10(Pt 2), 1459-1563. Gustafson, D. H., McTavish, F., Hawkins, R., Pingree, S., Arora, N., Mendenhall, J., & Simmons, G. E. R. (1998). Computer support for elderly women with breast cancer. Journal of the American Medical Association, 280(15), 1305. Horowitz, M., & Wilner, N. (1976). Stress films, emotion, and cognitive response. Archives of General Psychiatry, 33(11): 1339-1344. PMID: 985045 Kessler, R. C., Mickelson, K. D., & Zhao, S. (1997). Patterns and correlates of self-help group membership in the United States. Social Policy, 27, 27-46. Kneier, A. W., & Temoshok, L. (1984). Repressive coping reactions in patients with malignant melanoma as compared to cardiovascular disease patients. Journal of Psychosomatic Research, 28(2) 145-155. Kreshka, M. A., & Graddy, K. (1997). One in eight: Women speaking to women, a breast cancer workbook-journal. Sierra Nevada Cancer Center-Stanford University School of Medicine. Lieberman, M. A., Golant, M., Giese-Davis, J., Winzlenberg, A., Benjamin, H., Humphreys, K., Kronenwetter, C., Russo, S., & Spiegel, D. (2003). Electronic support groups for breast carcinoma. Cancer, 97, 920-925. Lieberman, M. A., & Goldstein, B. (2005). Self help online: An outcome evaluation of breast cancer bulletin boards. Under review. Journal of Health Psychology. McKenna, M. C., Zevon, M. A., Corn, B., & Rounds, J. (1999). Psychosocial factors and the development of breast cancer: A meta-analysis. Health Psychology, 18(5), 520-531. Pennebaker, J. W. (1997). Writing about emotional experiences as a therapeutic process. Psychological Science, 8(3), 162-166. Pennebaker, J. W., Mayne, T. J., & Francis, M. E. (1997). Linguistic predictors of adaptive bereavement. Journal of Personality and Social Psychology, 72, 863-871. Perls, F., Hefferline, R. F., & Goodman, P. (1951). Gestalt therapy. New York: Dell. Pettingale, K. W., Morris, T., Gerer, S., & Haybittle, J. L. (1985). Mental attitudes to cancer: An additional prognostic factor. Lancet, 1(8431), 750. Reich, W. (1949). Character-analysis (3rd ed.). Oxford, England: Orgone Institute Press. Roberts, C. W., & Popping, R. (1993). Computer-supported content analysis: Some recent developments. Social Science Computer Review, 11(3), 283-291. McTavish, F. M., Gustafson, D. H., Owens, B. H., Hawkins, R. P., Pingree, S., Wise, M., Taylor, J. O., Apantaku, F. M. (1995). CHESS (Comprehensive Health Enhacement Support System): An interactive computer system for women with breast cancer piloted with an underserved population. Journal of Ambulatory Care Management, 18(3), 35-41. Rogers, C. R. (1959). A theory of therapy, personality and interpersonal relationships as developed in the client centered framework. In S. Koch (Ed.), Psychology: A study of science: Formulations of the person and the social context (pp. 184-256). New York: McGraw-Hill. Shaw, A. (2001). Health on the Internet. Journal of Research of Social Health, 121(3), 145. Spiegel, D. (1999). Healing words: Emotional expression and disease outcome. Journal of the American Medical Association, 281, 1328-1329. Spiegel, D., Bloom, J. R., Kraemer, H. C., & Gottheil, E. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. Lancet, 2(8668), 888-891. Spiegel, D., & Classen, C. (2000). Group therapy for cancer patients. New York: Basic Books. Spiegel, D., & Kato, P. (1996). Psychosocial influences on cancer incidence and progression. Harvard Review of Psychiatry, 4, 10-26. Spiegel, D., & Yalom, I. (1978). A support group for dying patients. International Journal of Group Psychotherapy, 28, 233-245. Stanton, A. L., Danoff-Burg, S., Lepore, S. J., & Smyth, J. M. (Eds.). (2002). The writing cure: How expressive writing promotes health and emotional well-being (pp. 31-51). Washington, DC: U.S. American Psychological. Weinberg, N., Schmale, J., Uken, J., & Wessel, K. (1996). Online help: Cancer patients participate in a computer mediated support group. Health & Social Work, 21(1), 24-29. Pelletier, K. R. (1992). Mind-body health: Research, clinical, and policy applications. American Journal of Health Promotion, 6(5), 345-358. Winzelberg, A. J., Classen, C., Alpers, G. W., Roberts, H., Koopman, C., Adams, R. E., Ernst, H., Dev, P., & Taylor, C. B. (2003). Evaluation of an Internet support group for women with primary breast cancer. Cancer, 97, 1164-1173. Stanton, A. L., Danoff-Burg, S., Sworowski, C. A.., Branstetter, A. R. H., Kirk, S. B., & Austenfeld, J. L. (2002). Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients. Journal of Clinical Oncology, 20, 4160-4168. Temoshok, L., Heller, B. W., Sagebiel, R. W., Blois, M. S., Sweet, D. M., DiClemente, R. J., & Gold, M. L. (1985). The relationship of psychosocial factors to prognostic indicators in cutaneous malignant melanoma. Journal of Psychosomatic Research, 29(2), 139-153.