Clinical Psychology Chair, Moscow State University of Medicine and Dentistry named after A. I. Evdokimov, Moscow, Russia
Fear of disease progression is one of the most common sources of psychological distress in patients suffering from chronic diseases. Fear of disease progression is a situationspecific and fully discernible (reportable) emotion based on personal experience of a life-threatening disease. This article presents the results of a study of cancer patients’ coping behavior according to the levels of fear of disease progression experienced. The presence of pronounced fear of disease progression reflects a negative cognitive-affective response to one’s expectations for one’s own future; this response is related to a decrease in adaptive capacity. To determine the particular characteristics of coping strategies and coping resources in women with reproductive-system cancers according to the level of fear of disease progression. A total of 177 women with reproductive-system cancers were examined, among them 59 with breast cancer and 118 with gynecological cancers. Women with reproductive-system cancers have varying sets of coping strategies and coping resources according to their level of fear of disease progression. For each of the differentiated groups, specific characteristics of the strategies of coping with difficult life situations are described, along with cognitive self-regulation strategies specific to the illness and to coping resources. The women exhibiting moderate fear of disease progression significantly more often adhered to problem-oriented strategies of coping with difficult life situations and illness and had an internal locus of control regarding treatment. Patients with a low level of fear of disease progression tended to use strategies of positive reinterpretation of difficult life situations and illness; an external locus of control regarding treatment prevailed in this group. Patients found to have a dysfunctional level of fear of disease progression displayed significantly higher rates of using cognitive-regulation strategies focused on negative aspects of illness, as well as strategies for avoiding difficult life situations. Fear of disease progression is a psychological problem in women with reproductive-system cancers. Higher levels of fear of disease progression are associated with a decrease in the psychosocial adaptation of women suffering from reproductivesystem cancers.
Keywords: female reproductive-system cancers, fear of disease progression, cognitive strategies for self-regulation in illness, locus of control in illness, self-efficacy in illness and treatment
Background. Academic success in a higher education institution requires the ability to process large amounts of information in a relatively short period of time, including having proficiency at a high level of basic knowledge, and an ability to cope with stress. Continual study overload, a competitive environment, and ethical dilemmas (e.g. “How should I deal with human suffering?”, “How should I convey the diagnosis?”, “How should I tell someone that palliative treatment is the only option?”, “What if I make a mistake?”) can all result in anxiety and depression. Research has shown that students who show signs of anxiety and depression may have maladaptive cognitive strategies for processing their emotional experiences. In the medical community, the rules concerning one’s own emotions are, on one hand, determined by specific ethical standards (e.g., the idea that physicians should not show their emotions), and on the other, by the stressful situation itself, which requires taking responsibility for another person’s life. The additional stress point is the need for constant study, which requires a pro-active attitude and learning more and more skills. A significant number of physicians tend to ignore their own emotional experiences, or suppress them. The present study deals with indications of anxiety and depression on the basis of such emotional schemas, which we suggest play the key role in the development of emotional maladaptation in medical students.
Objective. In this study we observe signs of anxiety and depression in medical students and their dependence upon the intensity of dysfunctional emotional schemas.
Design. The number of participants was 400, comprised of students from general medicine (n = 300) and dentistry (n = 100) at the Moscow State University of Medicine and Dentistry.
Methods. We took from the Symptom Check List-90-Revised (Russian version, N.V. Tarabrina N.V.) the subscales related to affective and anxiety disorders: anxiety, depression, interpersonal sensitivity, obsessive-compulsiveness, somatization, and phobic anxiety. We also used 28 items from the Leahy Emotional Schema Scale II (the Russian version, adapted by the authors and Y.A. Kochetkov).
Results. The medical students fell into two groups: those with low and those with high intensity of the dysfunctional schemas. The groups were distinguished by which of Leahy’s basic emotional regulation strategies, either normalizing or pathologizing, they used. The pathologizing students followed strict, maladaptive rules concerning their emotional experiences. Students with intense dysfunctional schemas also demonstrated signs of anxiety, depression, obsessive-compulsiveness, and somatization. The students who saw their emotions as normal demonstrated lower levels of dysfunctional emotional schemas. As stated in Leahy’s emotional schemas theory, such students tend to see their emotions as a normal, important, and meaningful part of their daily lives. Analysis has shown that these types of students exhibit lower levels of anxiety, depression, obsessive- compulsiveness, somatization, and interpersonal sensitivity. Regression analysis demonstrated that emotional schemas are significantly related to emotional maladaptation in students. The analysis also allowed us to determine the association of different emotional schemas with the development of anxiety, obsessive-compulsiveness, somatization, and interpersonal sensitivity. Adoption of emotional schemas correlated with the symptoms of depressive and anxiety disorders.
Keywords: emotional schemas, anxiety, depression, medical students, emotional self-regulation