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Features of post-traumatic stress disorder, resilience and attitude to the disease in patients of different groups (on the example of oncological and cardiovascular diseases)

Tulitbaeva Galina Fanilevna

ORCID: 0000-0002-3754-9473

PhD in Psychology

Associate Professor, Department of Psychological Support and Clinical Psychology, Ufa University of Science and Technology

3/4 Karl Marx str., Ufa, Republic of Bashkortostan, 450000, Russia

tulitbaevagf@rambler.ru
Other publications by this author
 

 
Politika Oksana Ivanovna

ORCID: 0000-0002-5538-7711

PhD in Psychology

Associate Professor, Department of Psychological Support and Clinical Psychology, Ufa University of Science and Technology

450,000, Russia, Republic of Bashkortostan, Ufa, Karl Marx str., 3/1

okcanapolitika@yandex.ru
Shafigullina Liliya Rashidovna

ORCID: 0009-0003-9555-8380

Assistant, Department of Psychological Support and Clinical Psychology, Ufa University of Science and Technology

45000, Russia, Republic of Bashkortostan, Ufa, Karl Marx str., 3/1

tulitbaevagf@rambler.ru
Bozhko Aigul' Anasovna

ORCID: 0000-0000-0000-0000

Master's degree, Department of Psychological Support and Clinical Psychology, Ufa University of Science and Technology

45000, Russia, Republic of Bashkortostan, Ufa, Karl Marx str., 3/1

tulitbaevagf@rambler.ru

DOI:

10.25136/2409-8701.2023.5.44091

EDN:

ERURQS

Received:

21-09-2023


Published:

06-11-2023


Abstract: There is a steady increase in oncological diseases all over the world. Malignant tumors are one of the most frequent causes of death in the population of developed countries. The article presents the results of an empirical study aimed at studying the features of post-traumatic stress disorder, resilience and attitude to the disease in patients with oncological and cardiovascular diseases. The study sample consisted of 80 people aged 40 to 73 years. The average age is 58 years. The sample included 40 patients with cancer and 40 patients with diseases of the cardiovascular system. The study involved able-bodied men and women who are fluent in Russian, without cognitive disorders. Statistically significant differences were found between the groups. Patients with cancer are more likely to relive what happened when reminded of a traumatic event, the orientation of the personality is characterized by avoiding everything that reminds of a traumatic experience, post-traumatic stress disorder is expressed. The feeling of self-safety is more typical for patients with cardiovascular diseases than for cancer patients. The latter are more characterized by oppressive uncertainty. If we talk about the types of response to the disease, then among cancer patients there is more often post-sleep anxiety, they think about complications; there is excessive concentration on subjective painful and other unpleasant sensations; behavior like "irritable weakness"; dejection, therefore disbelief in the possibility of recovery and improvement of the condition, as well as in general on the effectiveness of treatment, pessimistic a look at everything around; vulnerability. Exposing experiences and sufferings to relatives and others prevails in cancer patients in comparison with patients of the cardiovascular group.


Keywords:

stress, stress disorder, after injury, resilience, relationship, disease, a patient, oncological disease, cardiovascular disease, attitude to the disease

This article is automatically translated.

The relevance of research. There is a steady increase in oncological diseases all over the world. Malignant tumors are one of the most common causes of death in the population of developed countries. In itself, the fact of having a severe somatic disease is a powerful mental and physiological stress for the patient [5; 6; 3; 1].

It is known that the internal picture of the disease in cancer correlates with the concepts of "suffering", "pain", "death" and acquires exceptional significance for a person. The diagnosis of this disease is one of the most powerful stressful factors leading to disruption of all adaptive mechanisms, depletion of psychological resources and the patient's health. The diagnosis of cancer and information about the upcoming treatment triggers a number of experiences and causes severe psychological distress in every person, which, with a lack of coping mechanisms, can lead to the development of concomitant mental disorders.

Personal characteristics, features of the psychological state of patients with oncological diseases have repeatedly become objects of psychological research (Nepomnyashchaya N.I., Ivashkina M.G., Vasilyeva A.V., Kazennaya E.V., etc.). The least studied among the mental features of concomitant malignant neoplasms are post-traumatic stress disorder (PTSD) and resilience. Post-traumatic stress disorder is a complex of mental and physical symptoms that develop as part of a reaction to a traumatic situation and persist for more than one month [5]. For the development of post-traumatic stress disorder, it is not so much the type of stressor that is important, as its characteristics. The disease develops after events that are extreme in nature, go beyond ordinary human experiences and cause intense fear for their lives, horror and a sense of helplessness. Important characteristics of a severe traumatic factor are surprise, the rapid development of a catastrophic event and the duration of exposure. Knowledge about cancer meets these criteria and can cause post-traumatic stress disorder.

The aim of the study is to study the features of post-traumatic stress disorder, resilience and attitude to the disease in patients with oncological and cardiovascular diseases.

The hypothesis of the study: post-traumatic stress disorder, resilience, attitude to the disease in cancer patients has its own characteristics in dealing with patients with cardiovascular diseases.

To solve the tasks and test the hypothesis, the following methods were used: "Scale of assessment of the impact of a traumatic event" (M. Horowitz et al.), "Test of resilience" (S. Maddi, adaptation by D.A. Leontiev, E.I. Rasskazova), "Scale of psychological stress" (Lemura–Tessier–Fillion), "Questionnaire diagnostics of types of attitude to the disease" (V.M. Bekhterev Research Psychoneurological Institute).

Quantitative data analysis was performed using a nonparametric criterion U-Mann–Whitney criterion. All calculations are performed in the SPSS software (version 17.0)

The empirical basis of the study was the department of antitumor drug therapy of the Republican Clinical Oncological Dispensary of the Ministry of Health of the Republic of Bashkortostan, Oktyabrsky; the oncological department of the State Budgetary Healthcare Institution of the Republic of Bashkortostan City Hospital No. 1. October.

The study sample consisted of 80 people aged 40 to 73 years. The average age is 58 years. The sample included 40 patients with cancer and 40 patients with diseases of the cardiovascular system. The study involved able-bodied men and women who are fluent in Russian, without cognitive disorders.

Table 1 shows the revealed statistically significant differences in the groups with oncological diseases and with cardiovascular diseases in twelve variables.

Table 1

Differences in indicators in groups of patients with oncological and cardiovascular diseases, average

Variables

Patients with oncological diseases

Patients with cardiovascular diseases

Mann-Whitney U-criterion

The level of differences

"A scale for assessing the impact of a traumatic event" (M. Horowitz et al.)

invasion

14,70

9,5

103,0

0,008a

avoidance

17,35

8,85

61,5

0,000a

excitability

14,20

11,55

153,5

0,211a

the amount

46,25

29,9

92,0

0,003a

"The Test of resilience" (S. Maddi, adaptation by D.A. Leontiev, E.I. Rasskazova)

engagement

22,80

23,4

187,0

0,738a

control

15,20

18,1

127,0

0,049a

risk taking

10,40

13,1

136,0

0,086a

the amount

48,40

54,6

142,0

0,121a

0

"Questionnaire for the diagnosis of types of attitudes to the disease"

(V.M. Bekhterev Psychoneurological Research Institute)

harmonious

16,6

13,95

198,0

0,968a

ergopathic

24,7

23,85

183,5

0,659a

anosognosic

11,95

12,75

176,0

0,529a

anxious

13,9

5,6

125,0

0,043a

hypochiondrial

14,2

6,8

97,50

0,005a

neurasthenic

15

7,55

120,5

0,030a

melancholic

8

1,55

112,5

0,017a

apathetic

6,55

1,85

120,0

0,030a

sensitive

21,75

7,0

44,0

0,000a

egocentric

11,4

4,65

62,0

0,000a

paranoid

6,65

4,45

138,0

0,096a

dysphoric

6,75

4,3

181,0

0,620a

"Scale of psychological stress" (Lemur–Tessier–Fillion)

PSM – 25

95

81

125,5

0,043a

Note: significant differences at the 0.05 level are highlighted in bold

                                                                    

The analysis of the available statistically significant differences between the samples for the presented variables showed the following. When studying the effect of a traumatic event on a person, statistically significant differences were found in the invasion indicator (14.70; 9.5; p=0.008). Thus, patients with cancer are more likely to relive what happened when reminded of a traumatic event, they often have unexpected feelings of a direct return to a traumatic situation than patients with the musculoskeletal group.

Significant differences in the avoidance criterion were obtained (17.35; 8.85; p=0.000). The orientation of the personality to avoid everything that reminds of a traumatic experience is more characteristic for patients with cancer than for patients with cardiovascular diseases. They are also more prone to internal tension, irritability, alertness.

In addition, statistically significant differences were obtained in the sum of points according to the method (46.25; 29.9; p=0.003), which indicates that post-traumatic stress disorder is more pronounced in patients with oncological diseases, traumatization is more pronounced.

The study of resilience showed the presence of statistically significant differences on the control scale (15.20; 18.1; p= 0.049). Accordingly, control, control of the situation is given to patients with cancer easier and simpler, there is a certainty that the struggle allows you to influence the outcome of what is happening, at the same time, a sense of self-safety is more characteristic of patients with cardiovascular diseases than for cancer patients. The latter are more characterized by oppressive uncertainty.

A study of the types of attitudes to the disease in both groups showed the following differences in the samples.

This type of response to the disease as "alarming" is more typical for cancer patients (13.9; 5.6; p=0.043) than for patients with cardiovascular diseases. This means that they are experiencing restless anxiety, thinking about constant complications.

Hypochondriacal type is also more typical for cancer patients (14.2; 6.8; p= 0.005), which shows excessive concentration on subjective painful and other unpleasant sensations, the desire to discuss this problem in society, to exaggerate suffering.

Behavior of the type of "irritable weakness", active outbursts of irritability in case of failures, adverse sensations, pain, impatience, i.e. the neurasthenic type of attitude to the disease is generally more characteristic for patients with cancer than for patients of the second group (15; 7.55; p=0.030).

At the same time, cancer patients are more likely to feel dejected by the disease, they do not believe in the effect of treatment, there is a pessimistic view of everything around them, which shows the prevailing melancholic type of attitude towards the disease (8; 1.55; p=0.017).

The presence of an apathetic type (6.55; 1.85; p = 0.030) indicates a loss of interest in life, lethargy, complete indifference, which contributes to the increased manifestation of post-traumatic stress disorder, which is also more pronounced in cancer patients.

Oncological patients have excessive vulnerability and vulnerability, at the same time, fear of becoming a burden for loved ones (a sensitive type of attitude to the disease) (21.75; 7.0; p = 0.000).

Note that this type of attitude to the disease as egocentric (11.4; 4.65; p=0.000), which is characterized by the fact that experiences and sufferings are displayed to relatives and others, prevails in cancer patients than in patients of the cardiovascular group.

The study of the types of attitudes to the disease as a whole shows a picture in which it is clearly seen that cancer patients are more characterized by the predominance of maladaptive behavior disorder and usually a violation of social adaptation.

The data of the psychological stress scale indicate that the stress response in patients with cancer is more pronounced than in patients with cardiovascular diseases (95; 81; p=0.043), but at the same time it has a low, adaptive level of severity in both groups.

No statistically significant differences were found in the other studied parameters in the two samples. Thus, excitability as a symptom of post-traumatic stress is inherent in both groups and has a low level of severity (14.20; 11.55; p=0.211). Such indicators of resilience as engagement (22.80; 23.4; p=0.738), risk acceptance (10.40; 13.1; p= 0.086) have the same severity in both groups. Resilience, according to many authors, is formed at the dawn of youth and, therefore, the disease that develops in adulthood cannot greatly affect these characterological features of a person.

The study of the types of attitude to the disease revealed no differences on the presented scales: harmonious (16.6; 13.95; p=0.968), ergopathic (24.7; 23.85; p= 0.659), anosognosic (11.95; 12.75; at p= 0.529). Types of attitude to the disease are characterized by the absence of mental maladaptation in patients.

Thus, statistically significant differences were found between the two study groups. Thus, patients with cancer are more likely to relive what happened when reminded of a traumatic event, the orientation of the personality is characterized by avoidance of everything that reminds of a traumatic experience, post-traumatic stress disorder is expressed. The feeling of self-safety is more typical for patients with cardiovascular diseases than for cancer patients. The latter are more characterized by oppressive uncertainty. If we talk about the types of response to the disease, then among cancer patients there is more often post-sleep anxiety, they think about complications; there is excessive concentration on subjective painful and other unpleasant sensations; behavior like "irritable weakness"; dejection, therefore disbelief in the possibility of recovery and improvement of the condition, as well as in general on the effectiveness of treatment, pessimistic a look at everything around; vulnerability. Exposing experiences and sufferings to relatives and others prevails in cancer patients in comparison with patients of the cardiovascular group.

As we can see, statistically significant differences were found in the studied groups on most scales. In the future, to study the structure of the relationship of variables, a correlation analysis will be performed separately for both groups and presented in the following publications of the authors.

References
1. Vasilyeva, A.V., Karavaeva, T.A., Mizinova, E.B., & Lukoshkina, E.P. (2020). Targets of psychotherapy in comorbid post-traumatic stress disorder in cancer patients. Bulletin of the St. Petersburg University. Psychology, 10, 402-416.
2. Kazennaya, E.V. (2020). Modern foreign studies of post-traumatic stress disorder and its treatment by effective psychotherapeutic methods in adults. Modern foreign psychology, 9, 110-119.
3. Karpova, E.B. (2007). Oncological disease as a psychological crisis. In: Materials of the scientific and practical conference "Ananiev readings-2007". St. Petersburg, Publishing House of St. Petersburg State University, 556-557.
4. Tarabrina, N.V. (2010). Oncopsychology: post-traumatic stress in breast cancer patients. Moscow: Publishing house Institute of Psychology of the Russian Academy of Sciences.
5. Akhmedova, X.B. (2004). Post-traumatic personality changes in civilians who have experienced a threat to life. Questions of psychology, 3, 93-102.
6. Biktina, N.N., Kekk, A.N. (2015) Personality traits and role positions of cancer patients. Modern problems of science and education. Retrieved from https://science-education.ru
7. Volodin, B.Yu. (2009). Possibilities of psychotherapy in an oncological clinic. Russian Oncological journal: scientific and practical journal, 1, 43-45.
8. Ivashkina, M.G. (1998). Psychological features of the personality of cancer patients: abstract of the dissertation of the candidate. Moscow.
9. Nepomnyashchaya, N.I. (1998). On the psychological aspect of oncological diseases. Psychological Journal, 4, 132-145.
10. Andrykowski, M. A. (1998). Posttraumatic stress disorder after treatment for breast cancer: Prevalence of diagnosis and use of the PTSD Checklist–Civilian Version (PCL–C) as a screening instrument/ M. A. Andrykowski, M. J.Cordova, J. L. Studts et al, 66, 586-590.

First Peer Review

Peer reviewers' evaluations remain confidential and are not disclosed to the public. Only external reviews, authorized for publication by the article's author(s), are made public. Typically, these final reviews are conducted after the manuscript's revision. Adhering to our double-blind review policy, the reviewer's identity is kept confidential.
The list of publisher reviewers can be found here.

The identification of personal characteristics of the response to cancer has long and repeatedly been the subject of scientific research by clinical psychologists. This is important because the attending physicians must take into account this kind of reaction in the treatment process. It is this circumstance that has a traditional relevance for research on this topic. And not what the author points out, referring to the literature and indicating that "there is a steady increase in oncological diseases all over the world. Malignant tumors are one of the most common causes of death in the population of developed countries. The very fact of having a severe somatic disease is a powerful mental and physiological stress for the patient." Such links have no direct relation to substantiating the relevance of the stated topic. It is necessary to pay more attention to the justification of this particular research topic. Questions also arise about the research topic. It is formulated unnecessarily cumbersome and if you focus on such a formulation, then the study should be much larger than the one submitted to the reviewer. In addition, the original intention of the author is unclear. Why are cancer patients compared with patients with cardiovascular pathology? What kind of pathology is this? Cardiovascular pathology is very different and the author's logic is unclear. There is no explanation in the text and nothing is noted at all about patients with cardiovascular diseases. Why not with patients with gastrointestinal pathology? Or respiratory diseases? The author writes that the diagnosis of cancer and information about the upcoming treatment triggers a number of experiences and causes severe psychological distress in every person, which, with a lack of coping mechanisms, can lead to the development of concomitant mental disorders. Yes, this is true and one can only agree with the author's opinion. There are no formulations of the subject of the study in the text of the article. It is noticeable in the text. By the way, the text is perceived as pointless. The scientific novelty is not substantiated and there is no information about the research methodology. These shortcomings require revision of the text, as they negatively affect its content. The style of presentation is superficial and inconsistent. There are a large number of typos in the text, indicating the author's careless attitude to the work and distorting the meaning. There is even a mistake in the title of the article. But the main thing is that there is no logic of presentation. The author proceeds from the fact that before the diagnosis, the personality of all the subjects was harmonious and the very fact of detecting oncological pathology triggered the mechanism of PTSD, as a result of which personality patterns were formed. That's not so. The type of response depends on a very large number of factors. The individual psychological characteristics of the patient's personality also relate to them and they determine the orientation, severity and specificity of personal response to the disease. According to the content of the work, it is clear that the author has only theoretical ideas about the psychology of cancer patients. For example, attention is not paid to the age of the patients who were examined. It is indicated that there were people from 40 to 73 years old. How can such a large age gap be allowed for the subjects? The deployment of coping mechanisms in the case of cancer detection is very dependent on the age of patients. The diagnoses of cancer patients are also not taken into account, namely they are also of decisive importance. Cancers are different, they have a different prognosis. Many are being treated. Therefore, it is important to detail the results of the study for greater persuasiveness and, especially, their practical significance. Despite the shortcomings, it should be noted that the author received important, interesting and useful information on the types of attitude to the disease. Thus, the study of resilience showed the presence of statistically significant differences on the control scale (15.20; 18.1; p=0.049). Accordingly, control and control of the situation is given to patients with cancer easier and simpler. They have a conviction that the struggle for life allows them to influence the outcome of what is happening. But such patients are characterized by oppressive uncertainty. This circumstance is of practical importance, since in the case of a diagnosis with an extremely unfavorable prognosis, it is important to be able to provide palliative psychological care to such patients. The author draws attention to this type of attitude to the disease as egocentric, which is characterized by the fact that experiences and sufferings are exposed to relatives and others. Such experiences are prevalent in cancer patients. It is also of practical importance if psychological counseling of relatives, for example, dying patients, is necessary. This need often arises. By the way, such information is also important for attending physicians, since it is to them, and not to psychologists, that relatives turn for advice. The structure of the article also needs to be improved. In addition to the above remarks, the article, for example, lacks conclusions. The conclusion is available and, in the opinion of the reviewer, it is written correctly. The bibliographic list consists of sources on the research topic. Despite the presence of a large number of critical comments, it should be noted that they can be eliminated with appropriate revision of the text. Therefore, after finalizing the text of the article, it can be recommended for publication in a scientific journal.

Second Peer Review

Peer reviewers' evaluations remain confidential and are not disclosed to the public. Only external reviews, authorized for publication by the article's author(s), are made public. Typically, these final reviews are conducted after the manuscript's revision. Adhering to our double-blind review policy, the reviewer's identity is kept confidential.
The list of publisher reviewers can be found here.

The paper "Features of post-traumatic stress disorder, resilience and attitude to the disease in patients of different groups (using the example of oncological and cardiovascular diseases)" is presented for review. The subject of the study. The work is aimed at studying the features of post-traumatic stress disorder, resilience and attitude to the disease in patients with oncological and cardiovascular diseases. As a result of the study, the author was able to identify the presence of differences in the designated groups. The research methodology is determined by the highlighted relevance, the set goal and objectives. However, there is a shortage of research devoted to the study of this problem. The relevance of the study is determined by the fact that it is necessary to timely identify personal characteristics, features of the psychological state of patients with oncological and cardiovascular diseases. The scientific novelty of the research. The study made it possible to identify indicators of the characteristics of post-traumatic stress disorder, resilience and attitude to the disease in patients with oncological and cardiovascular diseases. The author relied on the methods used to identify the study criteria. As a result, the following indicators were determined: intrusion, avoidance, excitability, involvement, control, risk taking, types of attitude to the disease (harmonious, ergopathic, anosognosic, anxious, hypochondriacal, neurasthenic, melancholic, apathetic, sensitive, egocentric, paranoid, dysphoric). Style, structure, content. The style of presentation corresponds to publications of this level. The language of the work is scientific. The structure of the work is clearly traced, the author highlights the main semantic parts. The introductory part of the article indicates the relevance of the problem raised. The author highlights some of the problems of the conducted research, the empirical base and the sample. The paper defines the purpose and hypothesis of the research, the corresponding methods and methods of processing the results obtained. The next section is devoted to the description of the results obtained. The author presented the revealed statistically significant differences in the groups with oncological diseases and with cardiovascular diseases in twelve variables. In conclusion, the final summary conclusions are formulated. The author notes the following: - statistically significant differences were found between the two study groups (with oncological diseases and with cardiovascular diseases) on the selected scales; - the prospects for further research of the affected problem are highlighted. Bibliography. The bibliography of the article includes 10 domestic and foreign sources, a small part of which has been published in the last three years. The list contains mainly articles and abstracts. In addition, the bibliography contains monographs, an abstract and online sources. The sources are mostly designed correctly and uniformly. Appeal to opponents. Recommendations: - to conduct a more in-depth theoretical analysis of modern scientific sources on the subject; - to achieve this goal and form conclusions, to present in this paper a correlation analysis of data separately for both groups. Conclusions. The problems of the article are of undoubted relevance, theoretical and practical value; it will be of interest to specialists who deal with issues of psychological support for patients with oncological and cardiovascular diseases. It is important to identify the features of their post-traumatic stress disorder, resilience and attitude to the disease. The article can be recommended for publication taking into account the highlighted recommendations.