Cancer has long been a prevalent illness in Hong Kong which caused tremendous stress on patients and their families. This study examined the cognitive process and behavioral efforts which related to cancer patients’ subjective well-being. Three hypotheses were proposed. First, higher internal locus of control over the cause of illness was hypothesized to relate to poorer subjective well-being through maladaptive coping. Second, higher internal locus of control over the course of illness may result in better subjective well-being through adaptive coping. Third, higher levels of hope may relate to better subjective well-being through adaptive coping. Ninety-eight patients with different types of cancers were recruited in this study. The results showed that internal locus of control over the cause of illness was not directly related to subjective well-being. The relationship between internal locus of control over the course of illness and social/family well-being was fully mediated by adaptive cognitive-behavioral coping and social and activity-engagement coping respectively in two separate mediation analyses. The relationship between levels of hope and social/family well-being was partially mediated by social and activity-engagement coping, while levels of hope significantly associated with social/family, emotional, functional and overall well-being. The study findings enhance understanding of close relationship between cognitive process and behavioral efforts in enhancing cancer patients’ adjustment to the illness. / published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

Comorbid chronic insomnia was found highly prevalent in breast cancer patients. It also persisted through survivorship. Negative emotions upon diagnosis and during the course of cancer treatment might complicate the underlying mediating factors between stress and insomnia found in non-cancer population. Cognitive Behavioural Therapy (CBT) has been evidenced in improving insomnia. With the appreciation of Mindfulness training in improving cognitive flexibility and rumination, a novel treatment approach integrating CBT and mindfulness—Mind-Body Intervention (MBI) was developed. 　　　There were three objectives in the research. Firstly, prevalence data on insomnia and clinical profile of Hong Kong Chinese breast cancer survivors were obtained. Secondly, the mediating roles of negative emotions, hyperarousal, pre-sleep arousals in the relationship between perceived stress and insomnia were examined. Thirdly, the effects of CBT and MBI for breast cancer survivors with insomnia were investigated. 　　　In the first study, 1049 women who survived from non-metastatic breast cancer were invited to complete a survey on stress, mental health, arousals and insomnia. Those who met psychophysiological insomnia were invited to participate in the second study, which was a multisite randomized controlled trial. The 73 participants were allocated to CBT (n=24), MBI (n=27) or waiting list control, WLC (n=22). Both treatments were five weekly-session group therapies. Outcomes on insomnia, mental health, arousals, dysfunctional beliefs, quality of life and mindfulness, were obtained on baseline, post-treatment, 3-month and 6-month follow-ups. 　　　Results of the first study revealed 34.6% of the participants suffered from clinical insomnia, while 15.1%, 27.4% and 12.8% endorsed moderate to extremely severe depression, anxiety and stress respectively. Duration of insomnia was correlated with insomnia severity. Hyperarousal was found moderating cognitive ore-sleep arousal and anxiety, these in turn, together with depression mediated the relationship between perceived stress and insomnia severity. Results of the second study supported the hypothesis both CBT and MBI improved insomnia and other psychological symptoms, while WLC did not. After treatment, significant decreases of 59 and 67 minutes of total wake time per night were found for CBT and MBI respectively. Sleep efficiency values significantly increased in CBT (12.2%) and MBI (12.7%). Moderate to large effect sizes and clinically significant differences were found in most sleep and psychological variables. Generally, CBT produced larger effect sizes than MBI on post-treatment. The therapeutic gains were found sustaining through 3-month to 6-month follow-ups in both treatments. However, the effect sizes of CBT were on the declining trend, while those of MBI were more stable. 　　　The results suggested that insomnia and anxiety were frequently experienced in breast cancer even after completing the medical treatments. The longer the survivors suffered from insomnia, the higher the severity was found. In additional to the cognitive pre-sleep arousal, the important mediating roles of depression and anxiety imply that insomnia treatments should incorporate strategies designed to help in decreasing rumination/worry before bedtime and improving mental health conditions. The findings also provided initial evidence for the efficacy of MBI as a viable treatment for insomnia. More vigorous randomized controlled trial and the long-term efficacy could be further studied. / published_or_final_version / Clinical Psychology / Doctoral / Doctor of Psychology

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

published_or_final_version / Clinical Psychology / Master / Master of Social Sciences

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

This study offers a brief review of the literature on resilience. The review served as a basis for designing a qualitative study to observe how resilience develops in survivors of breast cancer. Survivors are those who lead productive, satisfying and/or inspirational lives, after their treatment has ended. By using qualitative data collection methods and post hoc data analysis, a purposive sampling of 11 women, in the Midwest, resilient survivors of breast cancer were studied. These women were asked to write brief autobiographies, detailing the important factors and contexts that were evidence of the development of resilience in themselves. Tape recorded interviews allowed participants to add to or delete from their autobiographies.The findings showed the eleven participants shared six common characteristics: (1) making a spiritual connection; (2) having meaningful work; (3) engaging in social activism; (4) being a self-directed learner; (5) living a healthy lifestyle; and (6) expressing a wide range of feelings. In addition, the taped interviews revealed the importance of creativity and authentic relationships. A resilience wheel illustrates the definition of resilience, i.e., as a positive attitude about one's body, mind, spirit and emotions, manifested by living a healthy lifestyle; engaging in meaningful work; forming and maintaining authentic relationships; and-expressing a wide range of feelings appropriately. The study demonstrated resilience is more than effective coping. It is observed and characterized by others as a zest for life.Among these participants, resilience/zest for life was found to have developed in their youth, when they identified with a positive role model/s, who modeled resilient attitudes/values. As children they internalized these values, acting on them in small ways, until adulthood when a life event triggered a shift. As adults they, then, claimed these internalized values as "my own philosophy."Although there was not sufficient evidence to discuss resilience as a developmental process in adulthood, the ages of the participants (40-77) imply the process of learning and growing continues throughout the life span.Suggestions for teaching resilience are offered along with recommendations for future research. / Department of Educational Leadership

Educational programs covering the technical, treatment and emotional aspects of a cancer diagnosis have been shown to reduce anxiety levels, boost compliance with treatment regimens and improve survival rates. This study was designed to evaluate whether newly diagnosed cancer patients, after reviewing an educational intervention, felt they experienced decreased stress levels and more informed decision making ability. A descriptive, evaluative study was designed. Seventy-five newly diagnosed cancer patient's evaluation forms were examined. Responses were reviewed to see if these patients placed an important versus unimportant value on the individual components of an educational packet. Their responses were tallied and the results showed that an overwhelming majority of the patients felt that the packet components were important in helping them feel decreased stress levels and more informed in their decision making regarding their diagnosis of cancer. It was also determined that the majority of patients felt that the packet components were easy to understand. / Department of Physiology and Health Science

published_or_final_version / abstract / Psychology / Master / Master of Philosophy

published_or_final_version / Social Work and Social Administration / Doctoral / Doctor of Philosophy

published_or_final_version / Social Work and Social Administration / Master / Master of Philosophy