Background : Methods of treatment for patients with complex regional pain syndrome (CRPS) have not been established, and therefore psychological support is an essential dimension for improving their quality of life. The purpose of this study was to reveal how pain catastrophizing influences online information-seeking behavior when they gain medical information. Method : Semi-structured interviews of 4 patients with CRPS (age of range : 29-46, female : 3, non-binary : 1) were conducted to clarify the psychological process related to pain catastrophizing during information gathering. Results : The results of analysis by SCAT (Steps for Cording and Theorization) and data organization of pain acceptance processes and pain catastrophization during online information-seeking showed that the data were classified into 3 categories of rumination and 1 category of magnification. Remarks related to helplessness were not identified. Given that the characteristic psychological processes during online information-seeking behavior were rumination and magnification, it is important to note that an interaction between the two can lead to a vicious cycle of addiction. Conclusion : Reducing the pain catastrophic degree and having social support during online information-seeking will help patients be objective while consuming pain-related information online without pain catastrophizing. Thus, patients with CRPS might break the cycle of online information-seeking that can be both negative and addictive.

Messages to promote health behavior are essential when considering health promotion, disease prevention, and healthy life expectancy. The present study aimed to examine whether (1) positive and negative goal-framing messages affect message memory and behavioral intention differently in younger, middle-aged, and older adults, (2) framing effects are mediated by interest in health (health promotion and disease prevention) and emotion regulation (cognitive reappraisal and expressive suppression), and (3) mediation effects differ between positive and negative frames. Participants (N = 1248) aged 20 to 70 years were divided into positive and negative frame conditions. Framing demonstrated interactive effects on message memory; all age groups showed higher recognition accuracy in the positive than the negative frame. The accuracy of younger adults was higher than that of older adults in the negative frame, while older adults showed higher accuracy than younger adults in the positive frame. Additionally, recognition accuracy was higher in the positive frame, as participants had higher interest in health promotion and used cognitive reappraisal more frequently. Contrariwise, emotion regulation and interest in health promotion did not have significant effects on memory in negative frames. Moreover, regardless of the message valence, age did not influence behavioral intention directly but was mediated by interest in health and emotion regulation, while the older the participants were, the higher their interest in health, resulting in higher intention. For emotion regulation, intention increased with higher reappraisal scores and decreased with increasing suppression. Our results suggest that interest in health and emotion regulation should be considered when examining the relationship between age and goal-framing for health messages.

<p>Objectives: This study aimed to describe the experiences of bereaved family members of cancer patients in terms of regret in relation to ending terminal treatment for the patient. Methods: We conducted a semi-structured qualitative interview of 37 bereaved family members regarding their decision-making and their psychological adjustment from the time they made the decision to terminate treatment. Interviews were analyzed using qualitative content analysis. Results: Approximately 40% of bereaved family members reported that they had some regrets about their decision. Regret contents were classified into 8 categories and diversified from 4 categories at the time of decision-making to 7 categories after the death. The reasons for regret were classified into 43 categories. Common factors that minimized regret included situations at the time when they made the decision, such as patient- and family-specific factors and relationship with the medical staff. In comparison, the common reasons for regret centered on factors related to the approach for decision-making, such as the process, options, as well as psychological coping and relationships with medical staff. Conclusion: The results suggest that regret in the bereaved could be modified by understanding the relationship between regret characteristics and psychological coping.</p>

Purpose： The aim of this study was to create a list of psycho-social problems and solutions for patients with pancreatic cancer by applying the social problem-solving process. Methods： A semi-structured interview of approximately 1 hour was conducted on two occasions. The participants were 17 patients with pancreatic cancer. Results： Psycho-social problems were divided into two themes: "facing the future uncertainty" and "facing the effects of treatment received". A list of problems and solutions was created for each problem theme. Realistic goals for "facing the future uncertainty" were 'maintaining this living condition （n=7）', 'preparing for changes to the environment （n=5）', 'keeping a sense of control over my own life （n=5）' and 'dealing with anxiety （n=3）'. Realistic goals for "facing the effects of treatment received" were 'restoring the self of pre-illness（n=2）'. Conclusion： For seemingly unsolvable problems, patients can formulate realistic goals that they want to have clarified, and then the problems can be recaptured as solvable problems.

Breast cancer is the most common cancer in Japanese women. As patients with breast cancer have a lower level of mental health than healthy individuals, it is most important that they have the support of their partners to adapt to everyday life. However, 3 years after diagnosis the mental health of partners of breast cancer patients is lower than that of the patients. Few studies have examined the difficulties partners may have after their wife has been diagnosed as breast cancer. The aims of this study on partners of breast cancer patients were to investigate (l) the percentage of partners who needed information and advice services, and sympathetic support, (2) difficulties in marital communication regarding the illness, and (3) the relationship between the characteristics and difficulties in marital communication about the illness. The partners completed self-administered questionnaires (n=368). The results showed more than one-half of the partners needed support on information services (67.1 %), advice services (63.9 %), and sympathetic support (56.5%). At the time of diagnosis 66.6% of the partners had trouble grasping what his wife wanted and what he could do for her. These difficulties declined over time, however, 10-30% of partners had continuing problems regarding marital communication about the illness. Difficulties in marital communication about the illness were shown to be associated with recurrence of breast cancer, use of anticancer drug therapy, and a partner's previous experience with cancer. It is therefore necessary to provide partners who have these characteristics with information regarding marital communication about breast cancer.

The purpose of this study was to examine the differences between regret over actions taken versus regret over inaction vis-a-vis bereaved family. The focal points of the study were as follows: 1) to explore the nature of unreversed regret in the bereaved; 2) to examine the association between the number and intensity of regrets and mental health and grief; and 3) to examine the effect of action and inaction on mental health and grief. Using a mail-in questionnaire, we surveyed and analyzed the results of 89 bereaved respondents. The results showed that participants had more lifetime regrets over inaction than over action taken. The number and intensity of regrets also correlated with mental health and grief. Bereaved participants who expressed regret over inaction had poorer mental health and stronger feelings of grief than those with no regrets over inaction. We discuss the implications of unreversed regret and examine regret prevention for the bereaved.

The objective of this study was to identify the roles of clinical psychologists in palliative care teams by conducting focus group interviews. The participants were 7 physicians and nurses of highly active palliative care teams. Results from the qualitative analysis of interview content revealed that the most important knowledges needed by psychologists in palliative care is fundamental and specialized psychological knowledges and skills. The second most important was general and psychiatric medical knowledges regarding cancer. Otherwise, psychologists were expected to understand the roles of other staff members and the medical system, and provide mental and emotional support to medical staff. Our results clarified that psychologists require a broad understanding of medical care for cancer, good communication skills for interacting with other staff members, and the ability to actively utilize their psychiatric specialty to provide psychological support to patients, families and medical workers. Palliat Care Res 2009; 4(2): 228-234

The purpose of this study was to investigate the effects of adopted coping strategies on relationship between dispositions of spouse and state of psychological stress in spouse with cancer patient. The dispositions of spouse were evaluated using three variables, which were age of spouse, cancer stage of the patient, and the years after surgical operation of the patient. State of psychological stress was evaluated usingindices for mental health and subjective burden. Subjects were 57 female spouses (age 64.8±6.0) of gastric cancer patients who were operated after having informed cancer (year after surgical operation : 1.9±1.1). In this study, Tn-axial Coping Scale (TAC-24), Subjective Burden Scale (SBS), General Health Question-naire (GHQ) and Face sheet were used. The answers for questionnaires were obtained through a mail survey. Result of structural equation modeling analysis, this model revealed best fitting (Chi^2=5.60,p=0.69 ; GFI=0.97 ; CFI=1.00). According to this model, it was revealed that the longer time passed after surgical operation, the more families of patients adopted coping strategies of problem-avoidance. As a result, state of psychological stress was evaluated to be getting worse. Furthermore, the older they grew, the more they adopted coping strategies of emotional control. In conclusion, it is very important to support the spouse who has taken care of cancer patient after surgical operation for a long time. Furthermore, these results suggested that the effective support for spouse of cancer patient could be achieved if one could find a way to prevent the tendency of the spouse to use coping strategies of problem-avoidance. Results of this study were discussed from the viewpoint of support system for spouse with cancer patient.

The purpose of this study is to investigate quality of life (QOL) and psychological distress in Japanese breast cancer patients. A total of 112 post-operation patients participated in this study. The correlation between QOL and other psychological distress factors was analyzed by multiple regression analysis. Depression (HADS) and both positive and problematic support (ISSS) had a significant impact on physical QOL. Anxiety (HADS) and depressive coping (DWI) had a significant impact on mental QOL. This result indicated that control of depression and anxiety might contribute to the improvement of both physical and mental QOL in Japanese breast cancer patients.

人の思考は合理的ではなく，選択や判断の際には認知バイアス(非合理的な選択の偏り)が生じる。特に高齢期では加齢に伴い合理的判 断の基盤となる認知機 能が低下するため，どれだけ客観的・合理的な情報であっても認知バイアスを考慮した情報提示でなければ，適切な判断や行動に結びつかない。しかしながら， 高齢者の自律支援において，どのような情報提示のあり方が最適なのかついて，十分な検討がなされておらず，確立された手法も存在しない。本研究の目的は， 1)認知機能の低下の影響を受けにくい情報提示方法，2)満足でき後悔しない選択のための情報提示方法，3)過剰な影響を排除し自律を阻害しない情報提示方法 の3つを検討することである。 本年度は，20歳から70歳代の421名を対象とし，商品の購買の際に、白紙の状態からほしいオプションを追加する方法（加法条件）に比べ、すべて選択されている状態から必要ないオプションを削除する方法（減法条件）のほうが、数多くオプションを選択するオプションフレーミング効果に影響する要因及び，熟考を促すことによりオプションフレーミング効果を抑制することが可能か検討した。 その結果，性格特性と選択するオプション数に関連性がみられ減法条件では，神経症傾向が高いほどオプション選択数が多かった。また，最高の選択がしたいという動悸が高い人ほど減法条件においてオプション選択の困難度評価が高かった。オプションフレーミング効果の抑制については，熟考を促してもオプション選択数に違いがみられなかった。このことは，オプションフレーミング効果が自動的・無意識的な処理に依存し頑健な効果であることを示唆している。

A series of experiments and surveys suggested that the use of emotion regulation strategies in older age is less affected by age-related decline in cognitive function in the healthy range, and that the quality of information processed (positive or negative information) affects emotion regulation and emotions more than cognitive performance. It was also suggested that the type of emotion regulation strategy used was related to social connectedness and loneliness. On the other hand, the use of others for emotion regulation decreased with age, and emotion regulation used by spouses who had lived together for a long time did not predict their own mental health, suggesting that emotion regulation strategies in old age may be completed within the individual.

A series of studies confirmed the importance of culturally and socially appropriate emotion regulation in the face of death in order to avoid regret during end-of-life decision making. Emotional regulation through acceptance, based on the Yin-Yang philosophy, was shown to be effective for minimizing/preventing regret when facing death among Japanese. In addition, we had developed the “Life Value Orientation Scale”and had shown that valuing life may lead to acceptance of life and a reduction in regret. Based on these results, we proposed the need to develop a decision-making support program. This specific program can promote effective emotion regulation strategies, after confirming the path toward the ideal emotional state, by confronting the value of one’s life through life value orientation.

The purpose of this research is to clarify the characteristics of decision-making biases in elderly people and to find methods of decision-making support that are suitable for elderly people. We conducted research on age-based changes in cognitive biases (such as framing, anchoring effects, sunk-cost fallacy, and so on) in daily decision making in the elderly, as well as satisfaction and regret about choices (e.g., surrogated decision making among the families of dementia patients.). These research showed that the decision of the elderly adults is not necessarily inferior to the young adults. For example, elderly adults make decisions that emphasize positive information. Therefore, the tendency of loss aversion is smaller than younger adults, which leads to rational judgment of elderly adults.

A series of studies were conducted on general elderly people and elderly bereaved families with patients who survived cancer, to formulate a proposal to provide psychological support for elderly cancer patients and their families so that they did not regret terminal treatment choices. Studies on the characteristics of the regrets of the bereaved families were also examined to explain individual differences in sensitivity. These findings suggested that in order to minimize regret it is important to intentionally change the reference point so that it matches the situation at the time the decision was made. Studies on general elderly people suggested that it was important to build relationships without the fear of dealing with emotions expressed in daily conversation in order to face family-related decisions made at the final stage of life.

In order to obtain basic knowledge for developing a psychological support program for cancer patients and their families when the patient chooses treatment in the end-of-life stage, we conducted an awareness survey of ordinary adults and an interview survey of families of cancer patients. The results showed when we apply the conventional decision-making model to the choice of end-of life treatment, it is necessary to pay attention to the following three points: First, the future time perspective of the patient and his or her family affect the framework of the decision; Second, their belief towards life-sustaining treatment encourages intuitive decision-making; Third, the convincing criteria for decision-making are different between the patient and his or her family. In the future, we need to examine the decision-making model for the end of life empirically and continue to improve to make it suit the current conditions.

本年度は、乳がん患者に対する縦断的質問紙調査を引き続き行ったことに加え、乳がん患者の配偶者に対する質問紙調査を行い、結果をまとめた。 まず、乳がん患者に対する縦断的調査の7時点のうち、入院時(T1;N=201)、1ヶ月後(T2;N=196)、半年後(T3;N=196)のデータを用いて、解析を行った。親しい他者からのネガティブサポートの中で、過剰関与と問題回避は時間の経過に従って減少するサポートであり、過小評価は変化しないサポートであることが示された。また、各時点でのネガティブサポートが心理的適応に及ぼす影響を検討したところ、3時点ともに問題回避のみが有意な影響を及ぼしていた(T1:β=0.27,p<0.01;T2:β=0.34,p<0.01;T3:β=0.27,p<0.01)。親しい他者が問題回避していると報告している患者には、NEOによる性格傾向に特徴はなかったが、感情抑制傾向が強いことがわかった(r=0.27,p<0.01)。このことから、二者間の問題回避は、どちらか片方ではなく両者のダイナミズムの問題として捉える必要があることが示唆された。 そのため、乳がん患者の配偶者(N=368)を対象に、どの程度患者に対して問題回避を行っているのか、また、問題回避を行う配偶者の特徴を調べることを目的に質問紙調査を行った。その結果、ときどきよりも頻回に問題回避をしている配偶者が、診断直後では約半数、また現在(術後平均2.4年)でも約35%いることが明らかになった。また、配偶者自身の問題回避と患者がとっていると認識している問題回避との相関は強かった(r=0.62,p<0.01)。問題回避をとる配偶者の特徴として、がんに対する脅威性が高い、侵入想起症状が強いという特徴が明らかとなり、問題回避をとることには、配偶者の性格傾向や家族機能ではなく、配偶者自身の心理的不適応が背景にあることが明らかとなった。 これらの結果から、患者と配偶者の両者の視点にたった心理支援ツールを開発し、乳腺外科のある病院やクリニックの外来、ホームページなどで情報発信する準備を進めている。

本研究では、乳がん患者が配偶者との日常生活において、配偶者が良かれと思って行っているであろうサポート態度が、患者にとってサポートとならない場合について着目している。先に行った乳がん患者に対する半構造化面接で得られた、患者にとって「ありがた迷惑」、「大きなお世話」といった配偶者からのネガティブサポート態度に関する15項目を用いて、手術前と手術後においてどのような変化が見られるかを縦断的に明らかにした。 手術前と術後1ヶ月に質問紙調査を行ったところ、ネガティブサポート態度に関して欠損値がなかった乳がん患者63名(平均年齢:49.3±8.9歳)を分析対象とした。半構造化面接で得られた15項目は、比較的頻度の高いもの(早く元通りになるようにとあなたを励ます・あなたの病気や治療のことは、全て医師にまかせるものとして関与しない・自分のことよりも、常にあなたのことを優先する)、比較的頻度の低いもの(あなたと病気についての話をすることを避ける・あなたを病人として、はれものに触るように大事にする)が含まれていた。また、これら15項目は探索的因子分析と検証的因子分析を経て、3下位因子によって説明された。その3つの下位因子は、「過剰関与」、「問題回避」、「過小評価」と命名されている。 術前と術後に変化が見られるかどうかを繰り返しのある分散分析で検討したところ、「過剰関与(F(1,62)=6.19,p<0.05)」と「問題回避(F(1,62)=10.35,p<0.01)」において有意な差がみられた。このことから、配偶者からのネガティブサポート態度は、術前・術後といった治療経過の中で出現頻度の認知に変化がみられるものであることが示唆された。今後、この変化が、実際に変化しているものなのか、患者のサポートニードが変化したものなのか、患者の個人的特性や状況などの変数を加えて詳細に検討していく必要がある。