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Development of psychological interventions delivered via the Internet is a rapidly growing field with the potential to make vital services more accessible. However, there is a corresponding need for careful examination of factors that contribute to effectiveness of Internet-delivered interventions, especially given the observed high dropout rates relative to traditional in-person (IP) interventions. Research has found that the involvement of an online therapist in a Web-based intervention reduces treatment dropout. However, the role of such online therapists is seldom well articulated and varies considerably across programs making it difficult to discern processes that are important for online therapist involvement.In this paper, we introduce the concept of “therapeutic facilitation” to describe the role of the online therapist that was developed and further refined in the context of a Web-based, asynchronous psychosocial intervention for couples affected by breast cancer called Couplelinks. Couplelinks is structured into 6 dyadic learning modules designed to be completed on a weekly basis in consultation with a facilitator through regular, asynchronous, online text-based communication.Principles of therapeutic facilitation derived from a combination of theory underlying the intervention and pilot-testing of the first iteration of the program are described. Case examples to illustrate these principles as well as commonly encountered challenges to online facilitation are presented. Guidelines and principles for therapeutic facilitation hold relevance for professionally delivered online programs more broadly, beyond interventions for couples and cancer.

Despite growing evidence in support of mindfulness as an underlying mechanism of mindfulness-based interventions (MBIs), it has been suggested that nonspecific therapeutic factors, such as the experience of social support, may contribute to the positive effects of MBIs. In the present study, we examined whether change in mindfulness and/or social support mediated the effect of Mindfulness-Based Cancer Recovery (MBCR) compared to another active intervention (i.e. Supportive Expressive Group Therapy (SET)), on change in mood disturbance, stress symptoms and quality of life. A secondary analysis was conducted of a multi-site randomized clinical trial investigating the impacts of MBCR and SET on distressed breast cancer survivors (MINDSET). We applied the causal steps approach with bootstrapping to test mediation, using pre- and post-intervention questionnaire data of the participants who were randomised to MBCR (n = 69) or SET (n = 70). MBCR participants improved significantly more on mood disturbance, stress symptoms and social support, but not on quality of life or mindfulness, compared to SET participants. Increased social support partially mediated the impact of MBCR versus SET on mood disturbance and stress symptoms. Because no group differences on mindfulness and quality of life were observed, no mediation analyses were performed on these variables. Findings showed that increased social support was related to more improvement in mood and stress after MBCR compared to support groups, whereas changes in mindfulness were not. This suggests a more important role for social support in enhancing outcomes in MBCR than previously thought., Author(s): Melanie. P. J. Schellekens [sup.1] , Rie Tamagawa [sup.2] [sup.3] , Laura E. Labelle [sup.2] [sup.3] , Michael Speca [sup.2] [sup.3] , Joanne Stephen [sup.4] , Elaine Drysdale [sup.4] [...]

Examined significance of instrumental versus experiential orientation and of formistic versus dialectical thinking in identity research. Among 60 college students, those in identity status characterized by formation and maintenance of structure (Foreclosure) were instrumentally oriented whereas those characterized by openness to change and revision (Moratorium) were experientially oriented. Similarly, more Moratoriums that other statuses were high in dialectical thinking. (Author/NB)

A considerable amount of research has investigated symptoms of posttraumatic stress in cancer patients while the occurrence and correlates of secondary traumatic stress on patients' intimate partners has yet to [...]

Objective: Young women with breast cancer and their partners are more distressed than couples who are affected later in life. While dyadic interventions in the context of cancer are promising, there are access barriers, particularly for younger couples. This study evaluated Couplelinks, a professionally facilitated, web‐based program designed to help couples improve their conjoint coping. Method: This randomised controlled trial employed a waitlist control evaluation of the program. Outcomes included dyadic coping, relationship adjustment, depression, and anxiety. Results: Seventy‐five couples consented to participate and were randomised. The final analysis included 31 couples in the treatment group and 36 couples in the waitlist group. Modest improvements were found in positive dyadic coping but effects were not maintained at 3‐month follow‐up. No effect was seen on overall relationship adjustment. Conclusions: Our findings inform the rapidly expanding field of online programming for couples in general, and those affected by BC in particular. Intervention timing, 'dose', low overall relational distress, and the mainly enrichment rather than problem‐focus of Couplelinks may help explain the lack of change on relationship adjustment. [ABSTRACT FROM AUTHOR]

Sixty university students with a mean age of 25 years were measured on instrumental and experiential orientations and formistic-dialectical reasoning. Results show that students having a formation and maintenance of structure identity status were instrumentally oriented while those having an identity status characterized by openness to change and revision were experientially-oriented. The latter were also high in dialectic thinking.

Synchronous online support groups (OSGs) represent a promising psychosocial resource, as they offer many of the same therapeutic factors as face-to-face groups as well as unique benefits (e.g., anonymity, convenience). Despite their advantages, OSGs also present challenges to participation, including lack of visual cues, disjointed text communication, and rapid pace, which render the presence of a professional facilitator especially important. This study involved an in-depth qualitative analysis of 38 sessions of four time-limited OSGs for informal caregivers (i.e., family) of patients with advanced-stage cancer. Results depict the ways in which four trained facilitators maximized the utility of their respective online groups—namely, by structuring and guiding, actively scanning, and modulating experiencing. These findings expand our limited understanding of the facilitative processes that take place in OSGs and may be clinically informative to professionals with an interest in this relatively novel group modality. [ABSTRACT FROM AUTHOR]

Objective This study sought to identify relationships between trait mindfulness, repressive, and suppressive emotional styles, and the relative importance of these traits in their association with self-reported psychological health among women with breast cancer. Method Of the 277 women with breast cancer accrued in the study, 227 (81.9%) completed a set of questionnaires assessing personality traits, stress symptoms, and mood. Results High levels of mindfulness were associated with fewer stress-related symptoms and less mood disturbance, while high levels of suppression were associated with poorer self-reported health. Conclusion Individuals' dispositional ways to manage negative emotions were associated with the experience of symptoms and aversive moods. Helping patients cultivate mindful insights and reduce deliberate emotional inhibition may be a useful focus for psycho-oncological interventions. [ABSTRACT FROM AUTHOR]

Background Professional-led cancer support groups can improve quality of life and address unmet needs, but most Canadians affected by cancer do not have access to or do not make use of cancer support groups. A collaborative interdisciplinary team developed, oper- ated, and evaluated Internet-based, professional-led, live-chat support groups (osGs) for cancer patients, caregivers, and survivors across Canada. Objective Our study aimed to report participant and participation characteristics in the pan-Canadian initiative known as CancerChatCanada, and to understand participant perspectives about the quality of communication and professional facilitation, overall satisfaction, and psychosocial benefits and outcomes. Methods Participants in OSGS provided informed consent. Participant and participation characteristics were gathered from program data collection tools and are described using frequencies, means, and chi-squares. Patient, survivor, and caregiver perspectives were derived from 102 telephone interviews conducted after OSG completion and subjected to a directed qualitative content analysis. Results The 55 professional-led OSGS enrolled 351 participants from 9 provinces. More than half the participants came from rural or semirural areas, and more than 84% had no received previous cancer support. The attendance rate was 75%, the dropout rate was 26%, and 80% of participants were satisfied or very satisfied. The convenience and privacy of OSGS were benefits. Meaningful communication about important and difficult topics, kinship and bonding with others, and improved mood and self-care were perceived outcomes. [ABSTRACT FROM AUTHOR]

Canada is a pioneer in remote cancer care delivery to underserved populations; however, it is trailing behind on policies that would support clinicians in providing care using distance technologies. The current policy framework is disjointed, and discussions by professional boards about online jurisprudence associated with licensure appear to be regressive. We hope that by addressing the discrepancies in interjurisdictional practice and focusing on the key issue of "where therapy resides," we will be able to nudge dialogue and thinking closer toward the reasoning and recommendations of national telehealth organizations. We present this discussion of jurisdictional issues and e-health practice in the context of a pan-Canadian online support program developed for cancer patients and family members. Although the present paper uses online support groups as a springboard to advocate for e-health, it ultimately addresses a broader audience: that of all Canadian health care stakeholders. [ABSTRACT FROM AUTHOR]

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Expression of emotion has been linked to numerous critical and beneficial aspects of human functioning. Accurately capturing emotional expression in text grows in relevance as people continue to spend more time in an online environment. The Linguistic Inquiry and Word Count (LIWC) is a commonly used program for the identification of many constructs, including emotional expression. In an earlier study (Bantum & Owen, 2009) LIWC was demonstrated to have good sensitivity yet poor positive predictive value. The goal of the current study was to create an automated machine learning technique to mimic manual coding. The sample included online support groups, cancer discussion boards, and transcripts from an expressive writing study, which resulted in 39,367 sentence-level coding decisions. In examining the entire sample the machine learning approach outperformed LIWC, in all categories outside of Sensitivity for negative emotion (LIWC Sensitivity = .85; Machine Learning Sensitivity = .41), although LIWC does not take into consideration prosocial emotion, such as affection, interest, and validation. LIWC performed significantly better than the machine learning approach when removing the prosocial emotions ( p = <.0001). The sample over-represented examples of emotion that fit into the overarching category of positive emotion. Remaining work is needed to create more effective machine learning features for codes that are thought to be important emotionally but were not well represented in the sample (e.g., frustration, contempt, and belligerence), and Machine Learning could be a fruitful method for continued exploration.

Background: Mindfulness-based cancer recovery (MBCR) and supportive-expressive therapy (SET) are well-validated psycho-oncological interventions, and we have previously reported health benefits of both programs. However, little is known about patients' characteristics or program preferences that may influence outcomes. Therefore, this study examined moderators of the effects of MBCR and SET on psychological well-being among breast cancer survivors., Methods: A multi-site randomized controlled trial was conducted between 2007 and 2012 in two Canadian cities (Calgary and Vancouver). A total of 271 distressed stage I-III breast cancer survivors were randomized into MBCR, SET or a 1-day stress management seminar (SMS). Baseline measures of moderator variables included program preference, personality traits, emotional suppression, and repressive coping. Outcome measures of mood, stress symptoms, quality of life, spiritual well-being, post-traumatic growth, social support, and salivary cortisol were measured pre- and post intervention. Hierarchical regression analyses were used to assess moderator effects on outcomes., Results: The most preferred program was MBCR (55%). Those who were randomized to their preference improved more over time on quality of life and spiritual well-being post-intervention regardless of the actual intervention type received. Women with greater psychological morbidity at baseline showed greater improvement in stress symptoms and quality of life if they received their preferred versus nonpreferred program., Conclusions: Patients' program preference and baseline psychological functioning, rather than personality, were predictive of program benefits. These results suggest incorporating program preference can maximize the efficacy of integrative oncology interventions, and emphasize the methodological importance of assessing and accommodating for preferences when conducting mind-body clinical trials., (© The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)