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BACKGROUNDA recent Pew Charitable Trust study found that 52,000,000 individuals used the Internet to obtain health/medical information. Clinical trials of face‐to‐face breast carcinoma support groups show evidence of 1) improvement in quality of life, 2) reduction of psychologic symptoms, 3) improvement in coping responses, and 4) a reduction in pain. To the authors' knowledge, a few studies published to date have investigated Internet‐delivered electronic support groups (ESGs) for cancer. The most sophisticated is the Comprehensive Health Enhancement Support System (CHESS) program, which provides integrated information, referral, and a newsgroup‐based social support program. However, to the authors' knowledge, no studies published to date have examined the impact of a breast carcinoma ESG in a clinical trial.METHODSSixty‐seven women completed the initial baseline questionnaires, 32 of whom accepted the authors' invitation and began the groups. With regard to geographic location, 49% lived in rural/small towns, 41% lived in medium‐sized cities, and 10% lived in large cities. Diagnostic stages of disease were: Stage I, 22%; Stage II, 56%; Stage III, 12%; and other forms, 10%. There were 4 intervention groups, of which 8 participants led by trained Wellness Community (TWC) (a national agency) leaders met for 1.5 hours once a week for 16 weeks. Student t tests for paired outcome data were computed using baseline and postgroup scores.RESULTSThe results of the current study indicated that breast carcinoma patients significantly reduced depression (Center for Epidemiologic Studies‐Depression [CES‐D] scale) and Reactions to Pain. They also demonstrated a trend toward increases on The Posttraumatic Growth Inventory (PTGI) in two subscales: New Possibilities and Spirituality. Counterintuitively, breast carcinoma patients appeared to demonstrate an increase in emotional suppression. Postinterview results indicated that approximately 67% of patients found the group to be beneficial. Those who withdrew from the groups (20%) demonstrated low scores in their ability to contain anxiety and appeared to be more likely to suppress their thoughts and feelings regarding their illness.CONCLUSIONSThe findings of the current study are encouraging, particularly because it was conducted through TWC, a national agency willing to make this type of intervention readily available at no cost. A limitation of the current study was the lack of randomization and a control group comparison. Although the authors were not able to demonstrate effectiveness without the addition of a control condition, the analysis of pregroup and postgroup outcomes suggests that a randomized trial is worthwhile. Women with a devastating disease will join and commit themselves to an online support group. In addition, because a large percentage of these women were from rural locations, this type of intervention may hold promise for those who have limited access to support groups. Cancer 2003;97:920–5. © 2003 American Cancer Society.DOI 10.1002/cncr.11145

The repression/suppression of negative emotions has long been considered detrimental for breast cancer (BC) patients, leading to poor coping, progression of symptoms, and general lower quality of life. Therapies have focused on encouraging the expression of negative emotions. While group therapies have proven to be successful for BC patients, no study has looked at the role of expressing negative emotions during the therapeutic interaction. We examined written expressed emotions by women participating in a common form of psychosocial support, Internet based bulletin boards (BBs). Fifty-two new members to BC BBs were studied. They completed measures of quality of life and depression. After 6 months the measures were again assessed and messages during that time were collected and analyzed for emotional content. For the 52 women, results showed that greater expression of anger was associated with higher quality of life and lower depression, while the expression of fear and anxiety was associated with lower quality of life and higher depression. The expression of sadness was unrelated to change scores. Our results serve to challenge the commonly held belief that the expression of all negative emotions are beneficial for BC patients. Instead, expressing specific negative emotions are beneficial, while others are not.

Examined is the impact of dementia on the physical and mental health of all family members caring for an ill parent/spouse. The sample included 97 spouses of patients diagnosed with either Alzheimer's disease or vascular dementia, 186 offspring, and 97 offspring spouses or "in-laws." Multiple regression tested the association between severity of the illness and family member health and well-being. Severity was significantly associated with health and well-being for spouses, offspring, and in-laws, regardless of the amount of caregiving, demonstrating the potential cascading effect of the illness through the family. Use of services displayed no direct association with spouse health and well-being, but service utilization interacted with illness severity. The relationship between severity of illness and spouse health was lower under conditions of high service utilization than under conditions of low service utilization.

"Ask not for whom the bells toll; they toll for thee." John Donne's admonition, though written 350 years ago, endures with astonishing freshness; it speaks to something self-evident, to a truth that is well known to many who have experienced bereavement--that the death of a significant other has the potential to hurl the survivor into a confrontation with his/her own death. A confrontation with death--should we seek it? There is evidence in the clinical literature that in terminally ill patients such a confrontation may lead to pronounced positive psychological changes. Research (Yalom 1980) has documented that terminally ill patients may undergo a series of positive personal changes; they communicate more openly with family and close friends, they experience fewer fears, they rearrange their life priorities, they are less preoccupied with the trivialities of life, they live life more immediately rather than postpone experience and pleasure into the future. Does spousal bereavement in our culture confront individuals with their own personal death? Does it cause some widow/widowers to regard their existence in a different manner? If so, might it be possible that those bereaved individuals who examine their life deeply may have a different course of bereavement than those who do not look within? Might it even be possible that bereavement, for some individuals, results in psychological shifts analogous to the positive changes reported by terminally ill patients? These are the basic questions of our research inquiry. We designed a project which would allow us to determine, in a nonclinical sample of bereaved spouses, differences in the degree of existential awareness and the consequences of such awareness on the course of bereavement. We also attempted to determine which subjects were more likely to develop heightened existential awareness. The participants studied were part of an intervention project on bereavement in which we studied a sample of widows and widowers in the first few months of bereavement and then offered them an opportunity to participate in an eight-meeting support group. Reports of the clinical issues emerging in our short-term bereavement groups and of the efficacy of these groups were published elsewhere (Yalom and Vinogradov 1988; Lieberman and Yalom 1991).