Karen L Weihs

Interests

Teaching

Physician patient relationshipsPsychoOncologyMentalization based Psychotherapy

Research

Mind Body processes as they affect patients with chronic and life threatening illnessPsychotherapeutic processes, especially related to emotion regulation

Courses

Scholarly Contributions

Books

• Weihs, K. L., Alberts, D. S., Lluria-Prevatt, M. D., & Ka, S. (2016). Supportive Cancer Care. Cham, Switzerland: Springer International Publishing.
• Weihs, K. L., Alberts, D., Lluria-Prevatt, M., & Ka, S. (2015). Supportive Cancer Care. Switzerland: Springer.
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  This textbook provides a highly coordinated, interdisciplinary model for future clinical cancer supportive care programs in National Cancer Institute (NCI)-designated Clinical and Comprehensive Cancer Centers and NCI Community Oncology Research Programs (NCORPs). At the same time, it is intended to serve as an up-to-date resource for oncologists and primary care providers that addresses the many aspects of supportive care associated with cancer survivorship. Accordingly, the book covers a wide range of areas and topics, including but not limited to psychosocial oncology, patient and familyeducation, lifestyle change counseling, palliative care, symptom management (eg. Pain control), cancer risk and genetic counseling, financial planning, and patient navigation.

Chapters

• Weihs, K. (2016). Psychosocial oncology. In Supportive Cancer Care(pp 45-55). Springer International Publishing. doi:10.1007/978-3-319-24814-1_3
• Weihs, K. L. (2015).

  Psychosocial Oncology

  . In Supportive Cancer Care. Cham, Switzerland: Springer International Publishing.
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  This textbook provides a highly coordinated, interdisciplinary model for future clinical cancer supportive care programs in National Cancer Institute (NCI)-designated Clinical and Comprehensive Cancer Centers and NCI Community Oncology Research Programs (NCORPs). At the same time, it is intended to serve as an up-to-date resource for oncologists and primary care providers that addresses the many aspects of supportive care associated with cancer survivorship. Accordingly, the book covers a wide range of areas and topics, including but not limited to psychosocial oncology, patient and family education, lifestyle change counseling, palliative care, symptom management (eg. Pain control), cancer risk and genetic counseling, financial planning, and patient navigation.
• Weihs, K. L., & Politi, M. C. (2006). Family development in the face of cancer. In Cancer and the Family(pp 3-30). Chichester, England: John Wiley & Sons, Ltd..SAGE Publications Inc. doi:10.4135/9781452231631.N1
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  he National Cancer Institutereported that 8.9 million Americanswho have had cancer were alive in1999 (American Cancer Society, 2003). Thenumber of cancer cases has increased whilethe incidence of cancer mortality has declinedfrom 1973 to 1999 (Edwards et al., 2002). Asa result, patients and families must learn tolive with the chronic physical and psychoso-cial adjustments of a cancer diagnosis.The majority of families mount a resilientresponse over time, despite the suffering thatis universal for those living with cancer(Arpin, Fitch, Browne, & Corey, 1990;Grassi & Rosti, 1996; Skerrett, 1998). Theyreport feeling closer to one another after mar-shaling resources to fight the disease (Lewis,Woods, Hough, & Bensley, 1989; Skerrett,1998). Although many families report thispositive response, the physical and emotionalpressures during the different stages of cancercan strain family relationships, even amongfamilies who cope well with the diagnosis andits effects (Carlson, Bultz, Speca, & St.-Pierre,2000; Halford, Scott, & Smythe, 2000;Veach & Nicholas, 1998).Furthermore, some families of cancerpatients express psychological distress asmuch as, if not more than, the patients(Ferrell, Ervin, Smith, Marek, & Melancon,2002; Northouse, Mood, Templin, Mellon,& George, 2000; Omne-Ponten, Holmberg,Bergstrom, Sjoden, & Burns, 1993). Research-ers have reported that one third to one half ofcancer patients meet the diagnostic criteria fora wide range of disorders, including adjust-ment disorders, affective disorders, and anxi-ety disorders (Derogatis et al., 1983; Grassi& Rosti, 1996). In addition to the directeffects of cancer on families, these negativepsychological changes in the patient can influ-ence the quality of the family environmentand family adjustment to cancer (Baider,Koch, Esacson, & Kaplan-DeNour, 1998;Ben-Zur, 2001; Omne-Ponten et al., 1993),resulting in decreased closeness in family rela-tionships (Ell, Nishimoto, Morvay, Mantell,& Hamovitch, 1989).Family environments can affect thelevel of the patient’s and family members’distress. Cohesive family environmentswith low conflict include family members
• Weihs, K. L., Menehan, K., Politi, M. C., & Lincoln, J. (2005). Chapter 38 – Needs of Breast Cancer Patients and Their Families: Psychosocial Adaptation. In Breast Cancer(pp 637-651). Churchill, London: Elsevier Inc. doi:10.1016/B978-0-443-06634-4.50041-8
• Weihs, K. L., & Reiss, D. (1996). Family reorganization in response to cancer: A developmental perspective.. In Cancer and the Family(pp 3-30). John Wiley & Sons.
• Weihs, K. L., & Kingsolver, K. (1987). Systems-oriented Counseling. In The Family In Medical Practice: A Family Systems Primer(pp 140-174.). New York, NY: Springer, New York, NY. doi:10.1007/978-1-4612-4642-8_7
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  When a factory worker complains to his/her family physician of a sore throat, back pain, and irritability at home, the physician can choose to work up the sore throat and the back pain, using a straightforward biomedical approach. Alternatively, in addition to biomedical problems, the clinician can consider broader diagnoses such as job stress, marital discord, and depression. When a patient with well-controlled chronic heart failure presents with trouble sleeping and crying spells, without dyspnea, ankle edema, or chest pain, the physician can reassure the patient that his/her chronic disease is under control and leave it at that, or he/she can address the way these symptoms are part of more generalized distress in the patient’s life.

Journals/Publications

• Goldman, C. M., Chuning, A. E., Lane, R. D., Smith, R., & Weihs, K. L. (2025). Emotional awareness amplifies affective sensitivity to social support for women with breast cancer. Journal of health psychology, 30(13), 3803-3819.
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  Emotional awareness (EA) is thought to facilitate psychological health by aiding emotion regulation in oneself and garnering social support from others. This study tested these potential relationships within a one-year longitudinal study of 460 women (age 23-91 years, mean 56.4 years) recently diagnosed with breast cancer (i.e., within four months). The women completed measures of emotional awareness, social support, social stress, affective symptoms, and well-being. Linear models tested EA as a moderator of social support and stress on affective symptoms and well-being. In those with higher EA, low social support was associated with greater depression and lower optimism. There was some evidence that higher EA predicted greater depression at baseline but lower depression at nine-month follow-up. These results support the idea that EA increases sensitivity to available social support and facilitates emotional adjustment over time, suggesting that assessment of EA could help guide clinicians in identifying those at greatest risk of adverse mental health outcomes in this population.
• Harel, K., Czamanski-Cohen, J., Cohen, M., Caspi, O., & Weihs, K. L. (2025). Coping, Emotional Processing, and Cancer-Related Symptoms in Breast Cancer Survivors: Cross-Sectional Secondary Analysis of the REPAT Study. Psycho-oncology, 34(2), e70094.
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  As survival rates from breast cancer increase, the post-treatment period poses several challenges, including a high burden of cancer-related symptoms that interfere with quality of life. This study aims to provide a better understanding of the relationship between coping (approach and avoidance), emotional processing (emotional awareness and acceptance of emotions), and cancer-related symptoms.
• Harel, K., Czamanski-Cohen, J., Cohen, M., Lane, R. D., Allen, J. J., Caspi, O., & Weihs, K. L. (2025). Cardiac Vagal Control and Emotional Awareness Associated With Pain Among Breast Cancer Survivors. Psychophysiology, 62(6), e70086.
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  Pain is the most common symptom reported by breast cancer survivors (BCS), and it significantly affects their quality of life. Higher vagally mediated heart rate variability (vmHRV) is associated with higher emotional awareness (EA) and lower pain. This study examines the moderating role of vmHRV in the association between EA and pain among BCS, which, to our knowledge, has not previously been explored. The study is a cross-sectional secondary analysis of baseline data from an existing study exploring mental health outcomes after art therapy. Participants were 156 female BCS 14 months after cancer diagnosis. We measured vmHRV indexed by the root mean square of successive differences (RMSSD) at rest via electrocardiogram recordings, levels of EA via a performance measure, and how much pain interferes with daily life activities and the intensity of pain in one's daily activities through questionnaires. A negative association was found between RMSSD and pain intensity but not pain interference or EA. At high but not low RMSSD, EA was negatively associated with pain intensity. High EA supports implicit-to-explicit emotional processing, increased vmHRV supports top-down modulation of the nervous system, and both are relevant to pain. Further research is needed to explore the impacts of EA and vmHRV on pain management and psychotherapy interventions.
• Harel, K., Czamanski-Cohen, J., Cohen, M., Lane, R. D., Allen, J. J., Caspi, O., & Weihs, K. L. (2025). Cardiac Vagal Control and Emotional Awareness Associated With Pain Among Breast Cancer Survivors. Psychophysiology, 62(Issue 6). doi:10.1111/psyp.70086
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  Pain is the most common symptom reported by breast cancer survivors (BCS), and it significantly affects their quality of life. Higher vagally mediated heart rate variability (vmHRV) is associated with higher emotional awareness (EA) and lower pain. This study examines the moderating role of vmHRV in the association between EA and pain among BCS, which, to our knowledge, has not previously been explored. The study is a cross-sectional secondary analysis of baseline data from an existing study exploring mental health outcomes after art therapy. Participants were 156 female BCS 14 months after cancer diagnosis. We measured vmHRV indexed by the root mean square of successive differences (RMSSD) at rest via electrocardiogram recordings, levels of EA via a performance measure, and how much pain interferes with daily life activities and the intensity of pain in one's daily activities through questionnaires. A negative association was found between RMSSD and pain intensity but not pain interference or EA. At high but not low RMSSD, EA was negatively associated with pain intensity. High EA supports implicit-to-explicit emotional processing, increased vmHRV supports top–down modulation of the nervous system, and both are relevant to pain. Further research is needed to explore the impacts of EA and vmHRV on pain management and psychotherapy interventions.
• Harel, K., Czamanski-Cohen, J., Cohen, M., Lane, R. D., Dines, M., Caspi, O., & Weihs, K. L. (2025). Differences in Emotional Awareness Moderate Cytokine-Symptom Associations Among Breast Cancer Survivors. Brain, Behavior, and Immunity, 124(Issue). doi:10.1016/j.bbi.2024.12.005
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  Cancer survivors have elevated levels of proinflammatory cytokines, which could be associated with cancer-related symptoms. Given that proinflammatory cytokines heighten negative affect by directly affecting the brain, we explored these direct associations and whether differences in levels of emotional awareness moderate the associations between proinflammatory cytokines and cancer-related symptoms. This cross-sectional, secondary analysis of baseline data was collected from 162 female breast cancer survivors (aged 36–70 years), who were enrolled 6 ± 4 months after completing cancer treatment. We tested cytokines in serum (IL-1β, IL-6, IL-8, TNF-α, IL-4, IL-10, and TGF-β) and assessed depression, cancer-related fatigue, pain intensity, and pain interference. Emotional awareness was assessed using a performance measure, the Levels of Emotional Awareness Scale. In participants with high but not average or low levels of emotional awareness, positive associations were found for IL-1β, IL-6, and TNF-α with depression and between IL-6 and TNF-α with pain intensity. In addition, IL-6 had a positive association with pain intensity at average levels of emotional awareness. These results suggest that women with high or in some cases average, but not low, emotional awareness reported depression and pain as being positively associated with their cytokine levels. By using emotional awareness as a cognitive resource to promote emotion regulation and distress transformation, interventions may be able to counteract heightened sensitivity to the mood-altering effects of cytokines.
• Harel, K., Czamanski-Cohen, J., Cohen, M., Lane, R. D., Dines, M., Caspi, O., & Weihs, K. L. (2025). Differences in Emotional Awareness Moderate Cytokine-Symptom Associations Among Breast Cancer Survivors. Brain, behavior, and immunity, 124, 387-396.
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  Cancer survivors have elevated levels of proinflammatory cytokines, which could be associated with cancer-related symptoms. Given that proinflammatory cytokines heighten negative affect by directly affecting the brain, we explored these direct associations and whether differences in levels of emotional awareness moderate the associations between proinflammatory cytokines and cancer-related symptoms. This cross-sectional, secondary analysis of baseline data was collected from 162 female breast cancer survivors (aged 36-70 years), who were enrolled 6 ± 4 months after completing cancer treatment. We tested cytokines in serum (IL-1β, IL-6, IL-8, TNF-α, IL-4, IL-10, and TGF-β) and assessed depression, cancer-related fatigue, pain intensity, and pain interference. Emotional awareness was assessed using a performance measure, the Levels of Emotional Awareness Scale. In participants with high but not average or low levels of emotional awareness, positive associations were found for IL-1β, IL-6, and TNF-α with depression and between IL-6 and TNF-α with pain intensity. In addition, IL-6 had a positive association with pain intensity at average levels of emotional awareness. These results suggest that women with high or in some cases average, but not low, emotional awareness reported depression and pain as being positively associated with their cytokine levels. By using emotional awareness as a cognitive resource to promote emotion regulation and distress transformation, interventions may be able to counteract heightened sensitivity to the mood-altering effects of cytokines.
• Larkey, L. K., James, D. L., Han, S. Y., Weihs, K., Jahnke, R., Oh, B., Kim, S. W., Huberty, J., Petrov, M. E., Martin, D., Howe, N., Hook, J., Soltero, E., Rao, S., & Northfelt, D. (2025). Randomized controlled trial testing Tai Chi Easy/Qigong and Sham Qigong on breast cancer survivors’ fatigue and associated symptoms.. Complementary Therapies in Clinical Practice, 61(Issue). doi:10.1016/j.ctcp.2025.102014
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  Background and purpose: Fatigue is the most frequently reported symptom among breast cancer survivors (BCSs). Interventions using Tai Chi and Qigong improve fatigue and related symptoms for BCSs when compared to controls; less is known about sham Qigong (i.e., gentle exercise without meditative state or breath focus). Materials and methods: Fatigued BCSs
• Larkey, L. K., James, D. L., Han, S., Weihs, K., Jahnke, R., Oh, B., Kim, S. W., Huberty, J., Petrov, M. E., Martin, D., Howe, N., Hook, J., Soltero, E., Rao, S., & Northfelt, D. (2025). Randomized controlled trial testing Tai Chi Easy/Qigong and Sham Qigong on breast cancer survivors' fatigue and associated symptoms. Complementary therapies in clinical practice, 61, 102014.
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  Fatigue is the most frequently reported symptom among breast cancer survivors (BCSs). Interventions using Tai Chi and Qigong improve fatigue and related symptoms for BCSs when compared to controls; less is known about sham Qigong (i.e., gentle exercise without meditative state or breath focus).
• Nicholas, T., Hamann, H. A., Price, S. N., & Weihs, K. (2025). Coping strategies and changes in depressive symptoms: Insights from a collaborative care intervention for individuals facing cancer in underserved communities. Journal of Psychosocial Oncology. doi:10.1080/07347332.2025.2542451
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  Objective: Coping trajectories are important predictors of depressive symptoms among individuals with cancer. However, less is understood about the relationship between coping and depression within the context of psychosocial interventions, especially among minoritized (i.e. “underserved”) populations. The current study addresses this gap by investigating the relationship between coping strategies and changes in depression severity among underserved cancer patients participating in the Collaborative Oncology Project to Enhance Depression Care (COPE-D), a 12-week collaborative care depression management intervention for patients with cancer. Methods: The sample comprised 137 participants who completed both baseline and 12-week follow-up measures. Coping strategies were measured using a shortened version of the adapted Coping Orientation to Problems Experienced (COPE) Inventory, and depression severity was assessed using the Patient Health Questionnaire-9 (PHQ-9). Pre-intervention coping strategies were investigated as predictors of change in depression severity over the intervention, and changes in coping were investigated as moderators of the association between pre- and post-intervention depression severity. Results: Participants reported significant increases in approach-oriented coping over the course of the intervention (t = 6.57, df = 140, p < 0.001). Conversely, participants exhibited a statistically significant decrease in avoidance-oriented coping (t = −2.76, df = 192, p = 0.006). Neither the degree of approach nor avoidant baseline coping strategies significantly predicted changes in depression severity over the course of the intervention. Changes in avoidance-oriented coping were associated with changes in depression severity (β = 0.2662, p = 0.0304) such that those who maintained or increased avoidant coping over time were less likely to report decreases in depressive symptoms. Conclusions: Baseline coping did not predict changes in depression severity during the intervention. However, increases in avoidance-oriented coping were associated with greater increases in depression severity over time. These findings underscore the importance of considering coping strategies in depression management interventions for cancer patients.
• Nicholas, T., Hamann, H. A., Price, S. N., & Weihs, K. (2025). Coping strategies and changes in depressive symptoms: Insights from a collaborative care intervention for individuals facing cancer in underserved communities. Journal of psychosocial oncology, 1-14.
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  Coping trajectories are important predictors of depressive symptoms among individuals with cancer. However, less is understood about the relationship between coping and depression within the context of psychosocial interventions, especially among minoritized (i.e. "underserved") populations. The current study addresses this gap by investigating the relationship between coping strategies and changes in depression severity among underserved cancer patients participating in the Collaborative Oncology Project to Enhance Depression Care (COPE-D), a 12-week collaborative care depression management intervention for patients with cancer.
• Schmitz-Riol, S., Fuchshuber, J., Herpertz, J., Buchheim, A., Hörz-Sagstetter, S., Rentrop, M., Fischer-Kern, M., Buchheim, P., Taylor, J., Tmej, A., Weihs, K. L., Lane, R. D., & Doering, S. (2025). Emotion word repertoire in the adult attachment interview predicts a reduction of non-suicidal self-injury in the psychotherapy of borderline personality disorder. BMC Psychiatry, 25(Issue 1). doi:10.1186/s12888-025-07300-6
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  Background: Borderline personality disorder (BPD) is characterized by mental representation deficits and emotion dysregulation, with non-suicidal self-injury (NSSI) often occurring as a maladaptive regulation strategy. The ability to verbally express emotions might be advantageous for coping with emotion dysregulation and benefiting from psychotherapy. Methods: In the present study, we used a novel text-based measure of emotional awareness to examine whether a greater emotion word repertoire (EWR) predicts improvement in psychotherapy for patients with BPD regarding NSSI, suicide attempts, attachment representations, mentalization, and personality organization. We conducted a secondary analysis of a randomized controlled trial comparing the efficacy of Transference-Focused Psychotherapy (TFP) vs. treatment as usual over one year in a sample of female BPD outpatients. The German electronic Levels of Emotional Awareness Scale (eLEAS) scoring system was applied to Adult Attachment Interviews (AAI) administered at baseline (n = 87; Mage = 27.4, SDage = 7.4) and upon treatment termination (n = 52; Mage = 28.6, SDage = 7.2). Results: In both treatment groups, EWR at baseline was positively correlated with a reduction of NSSI after one year of psychotherapy (r =.46, p
• Wallace, R., Smith, I., Day, D., Alexander, M., Weihs, K. L., & Wiley, J. F. (2025). A Randomized Controlled Trial: Evaluating Whether a Cognitive Behavioral Internet-Delivered Intervention Targeting Emotion Regulation Improves Health-Related Quality of Life in Cancer Survivors. Health Psychology. doi:10.1037/hea0001497
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  Objective: Cancer survivors experience reduced overall health-related quality of life (HRQoL) compared to the general population. This research assesses and compares the efficacy of an emotion-focused (CanCopeMind [CM]) and lifestyle (CanCopeLifestyle [CL]) intervention to improve HRQoL among cancer survivors. Method: This 8-week, internet-delivered, randomized controlled trial compared CM (n = 110) and CL (n = 114) on self-reported HRQoL (range −0.022 = indicating a state akin to dead to 1.0 representing perfect health) at baseline, postintervention, and 3-month follow-up. CM, adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, targeted core emotion regulation skills (understanding emotions, mindfulness, flexible thinking, and changing behaviors). CL, the active control, targeted healthy lifestyle domains (diet, exercise, relaxation, and sleep). Results: HRQoL increased in both groups from baseline to postintervention (CM, p,.001, SMDmedian = 0.54; CL, p,.001, SMDmedian = 0.40), and these improvements were sustained at follow-up (CM, p,.001, SMDmedian = 0.52; CL, p =.005, SMDmedian = 0.33). The difference between each group was not significant at either postintervention (p =.095, SMDmedian = 0.19) or follow-up (p =.081, SMDmedian = 0.23). Subgroup analyses revealed no moderation by cancer stage, treatment type, months since treatment, cancer type or sex. Conclusion: The findings indicate that an accessible, internet-delivered emotion-focused and lifestyle interventions hold promise for improving HRQoL among cancer survivors.
• Wallace, R., Smith, I., Day, D., Alexander, M., Weihs, K. L., & Wiley, J. F. (2025). A randomized controlled trial: Evaluating whether a cognitive behavioral internet-delivered intervention targeting emotion regulation improves health-related quality of life in cancer survivors. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 44(10), 909-921.
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  Cancer survivors experience reduced overall health-related quality of life (HRQoL) compared to the general population. This research assesses and compares the efficacy of an emotion-focused (CanCopeMind [CM]) and lifestyle (CanCopeLifestyle [CL]) intervention to improve HRQoL among cancer survivors.
• Weinfeld-Yehoudayan, A., Czamanski-Cohen, J., Weihs, K. L., & Cohen, M. (2025). Development and Validation of Drawing-Based Emotional Processing Scale (DRAWEP) for Art Therapists. Art Therapy, 42(Issue). doi:10.1080/07421656.2024.2412435
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  This study developed and evaluated the Drawing-Based Emotional Processing Scale for Art Therapists (DRAWEP) for measuring emotional processing. We collected 120 drawings from participants (aged 18–87). The study was conducted in two phases: (a) tool development through expert focus group discussions of 20 drawings, content validity and interrater reliability assessment; (b) assessment of 100 drawings for construct validity (factor structure, convergent and discriminant validity). In Phase 1 The DRAWEP tool was constructed. In Phase 2, four emotional processing factors were identified: art creation, making sense, organizing, and embodiment. Convergent and discriminant validity and reliability were satisfactory. DRAWEP may provide art therapists with a tool for evaluating latent contents of emotional processing. Further testing with clinical populations is needed.
• Weinfeld-Yehoudayan, A., Czamanski-Cohen, J., Weihs, K. L., & Cohen, M. (2025). Using Drawings to Measure Emotional Processing in Breast Cancer Survivors and Its Association With Depression, Pain, and Fatigue. Psycho-Oncology, 34(Issue 2). doi:10.1002/pon.70099
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  Background: Conscious and unconscious emotional processing (EP) may be related to breast cancer survivors' (BCS) response to the stress of dealing with cancer and its treatment, and often entails myriad psychological and physical symptoms. Aims: To examine the relationship between EP expressed by BCS in drawings made during art therapy and its relationship with depression, pain, and fatigue. Methods: This cross-sectional secondary analysis used data from the Role of Emotional Processing in Art Therapy study. BCS (N = 81) answered self-report questionnaires measuring depression, pain, and fatigue at baseline. Their drawings were coded for EP using the Drawing-Based Emotional Processing Scale (DRAWEP). Results: Levels of depression, pain intensity and interference, and fatigue, were high, and a substantial percentage of participants were beyond the cutoff scores for severe symptoms. Controlling for background variables, EP subscales of making sense and organization were negatively associated with pain intensity, pain interference, and depression, but not with fatigue. These relationships are demonstrated with selected drawings. Conclusions: Since drawing involves embodied processes and has the potential to capture latent aspects of EP, examining drawings can provide a means of investigating EP among BCS and its relationship to depression and pain and learn more about the emotional experiences of BCS. Implications for Practice: The DRAWEP can assist art therapists in increasing their awareness of EP, which may benefit their ability to identify women at risk. Moreover, this article can contribute to the development and enhancement of art therapists' awareness of EP.
• Weinfeld-Yehoudayan, A., Czamanski-Cohen, J., Weihs, K. L., & Cohen, M. (2025). Using Drawings to Measure Emotional Processing in Breast Cancer Survivors and Its Association With Depression, Pain, and Fatigue. Psycho-oncology, 34(2), e70099.
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  Conscious and unconscious emotional processing (EP) may be related to breast cancer survivors' (BCS) response to the stress of dealing with cancer and its treatment, and often entails myriad psychological and physical symptoms.
• Cloonan, S., Ault, L., Weihs, K. L., & Lane, R. D. (2024). Development and Preliminary Validation of the Lovebird Scale. Behavioral sciences (Basel, Switzerland), 14(9).
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  The term "lovebirds" is often used to describe the loving behaviors and interactions between two romantic partners, but what specific processes distinguish these flourishing lovebird relationships from other committed but "numbed" relationships? The present study aimed to address this knowledge gap through the development and preliminary validation of the Lovebird Scale. The Lovebird Scale describes the thoughts, feelings, behaviors, and habits that constitute and maintain relationship flourishing, which in turn could promote aspects of individual flourishing such as positive affect. We conducted three studies using data collected from 996 English-speaking U.S. adults (64.2% Female, = 39.2 years old) who reported being in a romantic relationship for at least six months ( = 11.2 years). In Study 1, we conducted an exploratory factor analysis to determine the underlying factor structure. In Study 2, confirmatory factor analyses revealed a three-factor model nested within a higher-order factor representing lovebird relationships. In Study 3, we cross-validated the higher-order structure, examined the construct validity of the scale, and explored associations between the Lovebird Scale and affective state. Finally, we discuss how the Lovebird Scale contributes to the growing field of positive relationship science as well as conceptual and clinical implications of the scale.
• Cloonan, S., Ault, L., Weihs, K., & Lane, R. (2024). Development and Preliminary Validation of the Lovebird Scale. Behavioral Sciences, 14(9). doi:10.3390/bs14090747
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  The term “lovebirds” is often used to describe the loving behaviors and interactions between two romantic partners, but what specific processes distinguish these flourishing lovebird relationships from other committed but “numbed” relationships? The present study aimed to address this knowledge gap through the development and preliminary validation of the Lovebird Scale. The Lovebird Scale describes the thoughts, feelings, behaviors, and habits that constitute and maintain relationship flourishing, which in turn could promote aspects of individual flourishing such as positive affect. We conducted three studies using data collected from 996 English-speaking U.S. adults (64.2% Female, M = 39.2 years old) who reported being in a romantic relationship for at least six months (M = 11.2 years). In Study 1, we conducted an exploratory factor analysis to determine the underlying factor structure. In Study 2, confirmatory factor analyses revealed a three-factor model nested within a higher-order factor representing lovebird relationships. In Study 3, we cross-validated the higher-order structure, examined the construct validity of the scale, and explored associations between the Lovebird Scale and affective state. Finally, we discuss how the Lovebird Scale contributes to the growing field of positive relationship science as well as conceptual and clinical implications of the scale.
• Fuchshuber, J., Doering, S., Schmitz-Riol, S., Herpertz, J., Buchheim, A., Rentrop, M., Fischer-Kern, M., Buchheim, P., Taylor, J., Tmej, A., Weihs, K., Lane, R., & Hörz-Sagstetter, S. (2024). Emotion word repertoire in the adult attachment interview is linked to reduced suicide attempts in patients with borderline personality disorder. Heliyon, 10(17). doi:10.1016/j.heliyon.2024.e36907
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  Background: This study explored the association between emotion word repertoire (EWR), attachment, reflective functioning and personality organization (PO) and suicidal behavior in borderline personality disorder (BPD) patients. Methods: The current study performed a secondary data analysis from a randomized control trial for BPD patients (all female; n = 87; age: m = 27; SD = 7.42). EWR was assessed via machine-scoring transcripts of Adult Attachment Interviews (AAI) for affective words using the VETA electronic scoring software for the Levels of Emotional Awareness Scale (LEAS). Generated scores were related to impairments in PO (Structured Interview for Personality Organization; STIPO), attachment organization (AAI) and mentalization (Reflective Functioning Scale), general symptom severity (Brief Symptom Inventory; BSI-53), self-harm and suicidal behavior. Independent effects of the investigated predictors were studied using Bayesian path analysis. Results: Corrected for education, findings in Bayesian path analysis suggest an independent negative association between EWR and suicide attempts (BE = −.32; 95 % CI [-.51, −.12]) and positive associations of deficits in PO with psychiatric symptoms (BE = .23; 95 % CI [.01, .44]) as well as suicide attempts (BE = .30; 95 % CI [.08, .49]). Discussion: The findings underscore the potential role of high EWR and PO as a protective factor for suicidal behavior in individuals with BPD.
• Goldman, C. M., Chuning, A. E., Lane, R. D., Smith, R., & Weihs, K. L. (2024). Emotional awareness amplifies affective sensitivity to social support for women with breast cancer. Journal of Health Psychology. doi:10.1177/13591053241291018
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  Emotional awareness (EA) is thought to facilitate psychological health by aiding emotion regulation in oneself and garnering social support from others. This study tested these potential relationships within a one-year longitudinal study of 460 women (age 23–91 years, mean 56.4 years) recently diagnosed with breast cancer (i.e., within four months). The women completed measures of emotional awareness, social support, social stress, affective symptoms, and well-being. Linear models tested EA as a moderator of social support and stress on affective symptoms and well-being. In those with higher EA, low social support was associated with greater depression and lower optimism. There was some evidence that higher EA predicted greater depression at baseline but lower depression at nine-month follow-up. These results support the idea that EA increases sensitivity to available social support and facilitates emotional adjustment over time, suggesting that assessment of EA could help guide clinicians in identifying those at greatest risk of adverse mental health outcomes in this population.
• Hebi, M., Hebi, M., Czamanski-Cohen, J., Czamanski-Cohen, J., Azaiza, F., Azaiza, F., Weihs, K. L., & Weihs, K. L. (2024). Art and emotion processing among arab breast cancer survivors: An exploratory study. Arts in Psychotherapy, 87(Issue). doi:10.1016/j.aip.2024.102123
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  Art therapy (AT) has demonstrated potential for improving the well-being of breast cancer (BC) survivors, but limited research exists on emotion processing (EP) of Arab women in this context. Thus, this study delves into the relationship between EP and the art-making of Arab BC survivors in an AT group intervention to provide an in-depth understanding of their unique experience. We hypothesized that openly expressing emotions in the face of life-threatening events, such as BC, might be difficult for individuals from collective cultures with a strong emphasis on social harmony. We conducted a mixed-methods exploratory study (N = 62) with a visual analysis of 22 drawings and a textual analysis of reports from five art therapists. Positive correlations were observed between conservation values, acceptance of emotions, values, and artistic elements. Acceptance of emotions correlated negatively with space in drawing. Textual analysis of therapist reports revealed two themes—coping strategies and mixed emotions—corresponding to phenomena observed in the drawings. The women reported that art-making in a group facilitated access to their inner emotions, reinforced personal boundaries, and provided a safe space for addressing complex experiences. The AT group also offered socialization with women in similar circumstances. We conclude that AT provided these Arab BC survivors a culturally sensitive means of safely processing emotions through creative visual expression. Further research is needed to examine if AT is also helpful to BC survivors from other collectivist ethno-cultures.
• Pfeifer, V. A., Weihs, K. L., & Lai, V. T. (2024). Narratives about Cancer: What Metaphors can tell us about Depressive Symptoms in Breast Cancer Patients. Health communication, 39(9), 1888-1898.
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  Metaphors are pervasive in cancer discourse. However, little is known about how metaphor use develops over time within the same patient, and how metaphor use and its content relate to the mental health of the patient. Here, we analyzed metaphor use in personal essays written by breast cancer patients shortly after the time of diagnosis and nine months later, in relation to their depressive symptoms at both time points. Results show that metaphor use can provide important insight into a patient's current mental state. Specifically, patients who had no change in their depressive symptom levels used metaphors more densely after nine months. In addition, metaphor valence in the later essay was associated with depressive symptoms at study entry and nine months after. Lastly, we observed a shift in metaphor reference pattern for different symptom trajectories, such that those who recovered from initially elevated depressive symptoms used fewer self-referencing metaphors and more cancer-referencing metaphors in their later essay. Our work suggests that metaphor use reflects how a patient is coping with their diagnosis.
• Price, S., Hamann, H. A., Halaby, L., Trejo, J., Rogers, F. C., & Weihs, K. (2024). Collaborative depression care sensitive to the needs of underserved patients with cancer: Feasibility, acceptability and outcomes. Journal of Psychosocial Oncology, 42(Issue 1). doi:10.1080/07347332.2023.2224314
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  Purpose: A single-arm trial evaluated the feasibility, acceptability, and outcomes of COPE-D, a collaborative care intervention for underserved cancer patients with depression. Methods: Bilingual (Spanish and English) care managers provided counseling and/or medication management in consultation with physicians. Outcomes were treatment improvement (≥ 5-point reduction in PHQ-9), treatment response (≥ 50% reduction in PHQ-9), suicidal ideation resolution, and changes in depression (PHQ-9), anxiety (GAD-2), sleep disturbance (PSQI), global mental and physical health (PROMIS), social isolation (PROMIS), and qualitative feedback. Results: 193 patients consented to participate. 165 initiated and 141 completed treatment, with 65% and 56% achieving treatment improvement and response, respectively. Outcomes did not differ by ethnicity (31% Hispanic), cancer stage (71% stages III-IV), income, or education. Suicidal ideation, depression, anxiety, sleep disturbance, and social isolation also improved. Qualitative feedback was largely positive. Conclusion: COPE-D improved depression and quality of life among underserved patients, with acceptable retention rates.
• Price, S., Hamann, H. A., Halaby, L., Trejo, J., Rogers, F. C., & Weihs, K. (2024). Collaborative depression care sensitive to the needs of underserved patients with cancer: Feasibility, acceptability and outcomes. Journal of psychosocial oncology, 42(1), 90-112.
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  A single-arm trial evaluated the feasibility, acceptability, and outcomes of COPE-D, a collaborative care intervention for underserved cancer patients with depression.
• Smith, R., Persich, M. R., Chuning, A. E., Cloonan, S., Woods-Lubert, R., Skalamera, J., Berryhill, S. M., Weihs, K. L., Lane, R. D., Allen, J. J., Dailey, N. S., Alkozei, A., Vanuk, J. R., & Killgore, W. D. (2024). Improvements in Mindfulness, Interoceptive and Emotional Awareness, Emotion Regulation, and Interpersonal Emotion Management Following Completion of an Online Emotional Skills Training Program. Emotion, 24(Issue 2). doi:10.1037/emo0001237
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  Socioemotional skills, such as the ability to recognize, understand, and regulate the emotions of self and others, are associated with both physical and emotional health. The present study tested the effectiveness of a recently validated online training program for increasing these emotional skills in adults. In this study, 448 participants (323 female) were randomly assigned to complete this training program or a placebo control program. Among those who completed the training program or placebo (N = 326), the training program led to improved scores post-training on measures of interoceptive and emotional awareness, mindfulness, emotion recognition, and emotion regulation strategies (e.g., reduced emotion suppression and greater impulse control) relative to placebo. In a smaller group of participants who also completed a 6-month follow-up visit (N = 94), sustained improvements were observed on several measures in those who completed the training program, while the placebo group instead showed decreased performance. This suggested a potentially protective effect against emotional challenges associated with the COVID-19 pandemic occurring during this time. These results suggest that this online training program shows promise in improving emotional skills relevant to adaptive social and emotional functioning, and that it might be useful as an intervention within at-risk populations and those with emotional disorders associated with reduced application of these skills.
• Smith, R., Persich, M. R., Chuning, A. E., Cloonan, S., Woods-Lubert, R., Skalamera, J., Berryhill, S. M., Weihs, K. L., Lane, R. D., Allen, J. J., Dailey, N. S., Alkozei, A., Vanuk, J. R., & Killgore, W. D. (2024). Improvements in mindfulness, interoceptive and emotional awareness, emotion regulation, and interpersonal emotion management following completion of an online emotional skills training program. Emotion (Washington, D.C.), 24(2), 431-450.
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  Socioemotional skills, such as the ability to recognize, understand, and regulate the emotions of self and others, are associated with both physical and emotional health. The present study tested the effectiveness of a recently validated online training program for increasing these emotional skills in adults. In this study, 448 participants (323 female) were randomly assigned to complete this training program or a placebo control program. Among those who completed the training program or placebo ( = 326), the training program led to improved scores post-training on measures of interoceptive and emotional awareness, mindfulness, emotion recognition, and emotion regulation strategies (e.g., reduced emotion suppression and greater impulse control) relative to placebo. In a smaller group of participants who also completed a 6-month follow-up visit ( = 94), sustained improvements were observed on several measures in those who completed the training program, while the placebo group instead showed decreased performance. This suggested a potentially protective effect against emotional challenges associated with the COVID-19 pandemic occurring during this time. These results suggest that this online training program shows promise in improving emotional skills relevant to adaptive social and emotional functioning, and that it might be useful as an intervention within at-risk populations and those with emotional disorders associated with reduced application of these skills. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
• Smith, R., Versluis, A., Chuning, A. E., Allen, J. J., Weihs, K. L., Brosschot, J. F., Verkuil, B., Allam, A., & Lane, R. D. (2024). Early adversity and emotional awareness: A partial confirmation and extension of their relationship. Journal of Family Trauma, Child Custody and Child Development, 21(Issue 3). doi:10.1080/26904586.2023.2216695
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  Early adversity has been consistently linked to mental health outcomes, but the underlying pathways remain unclear. One previous study found an association between early adversity and trait emotional awareness (EA), which has itself been linked to health outcomes, but links to mental health were not explicitly examined. The aim of the current study was to test the hypothesis that the association between early adversity and health can be partially accounted for by differences in EA within a large student sample (n = 196). Participants completed measures of early adversity, EA, and current emotional functioning (i.e., depression, anxiety, somatization, positive/negative affect). Bayesian analyses found the most evidence for models with an interaction between sex and early adversity in predicting emotional functioning—revealing the expected negative relationship between early adversity and EA in females, but a positive relationship in males. Early adversity, but not EA, was associated with depression, anxiety, and implicit negative affect. Only explicit positive affect was associated with both early adversity and EA, and EA partially mediated the negative association between early adversity and positive affect. These results provide limited support for EA as a mediating pathway for the effects of early adversity on mental health.
• Smith, R., Versluis, A., Chuning, A. E., Allen, J. J., Weihs, K. L., Brosschot, J. F., Verkuil, B., Allam, A., & Lane, R. D. (2024). Early adversity and emotional awareness: A partial confirmation and extension of their relationship. Journal of family trauma, child custody & child development, 21(3), 320-340.
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  Early adversity has been consistently linked to mental health outcomes, but the underlying pathways remain unclear. One previous study found an association between early adversity and trait emotional awareness (EA), which has itself been linked to health outcomes, but links to mental health were not explicitly examined. The aim of the current study was to test the hypothesis that the association between early adversity and health can be partially accounted for by differences in EA within a large student sample (n = 196). Participants completed measures of early adversity, EA, and current emotional functioning (i.e., depression, anxiety, somatization, positive/negative affect). Bayesian analyses found the most evidence for models with an interaction between sex and early adversity in predicting emotional functioning - revealing the expected negative relationship between early adversity and EA in females, but a positive relationship in males. Early adversity, but not EA, was associated with depression, anxiety, and implicit negative affect. Only explicit positive affect was associated with both early adversity and EA, and EA partially mediated the negative association between early adversity and positive affect. These results provide limited support for EA as a mediating pathway for the effects of early adversity on mental health.
• Weinfeld-Yehoudayan, A., Czamanski-Cohen, J., Cohen, M., & Weihs, K. L. (2024). A Theoretical Model of Emotional Processing in Visual Artmaking and Art Therapy. The Arts in psychotherapy, 90.
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  Current theoretical models of emotional processing rely mainly on detecting emotional processing through verbal, conscious, and cognitive processes. However, artmaking can potentially reveal embodied and implicit processes that may otherwise remain hidden in verbal expression. This paper attempts to close the scholarly gap by introducing a novel art-based emotional processing model that integrates emotional processing and art therapy literature, incorporating emotional meaning-making, awareness, acceptance, and memory consolidation. The art-based EP model explains the processes through which art creation may benefit emotional processing. It also elucidates the ways in which art therapy can be used to enhance therapeutic outcomes.
• Weinfeld-Yehoudayan, A., Weinfeld-Yehoudayan, A., Czamanski-Cohen, J., Czamanski-Cohen, J., Cohen, M., Cohen, M., Weihs, K., & Weihs, K. (2024). A theoretical model of emotional processing in visual artmaking and art therapy. Arts in Psychotherapy, 90(Issue). doi:10.1016/j.aip.2024.102196
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  Current theoretical models of emotional processing rely mainly on detecting emotional processing through verbal, conscious, and cognitive processes. However, artmaking can potentially reveal embodied and implicit processes that may otherwise remain hidden in verbal expression. This paper attempts to close the scholarly gap by introducing a novel art-based emotional processing model that integrates emotional processing and art therapy literature, incorporating emotional meaning-making, awareness, acceptance, and memory consolidation. The art-based EP model explains the processes through which art creation may benefit emotional processing. It also elucidates the ways in which art therapy can be used to enhance therapeutic outcomes.
• Arizmendi, B. J., Seeley, S. H., Allen, J. J., Killgore, W. D., Andrews-Hanna, J., Weihs, K., & O'Connor, M. F. (2023). A pull to be close: The differentiating effects of oxytocin and grief stimulus type on approach behavior in complicated grief. European Journal of Trauma and Dissociation, 7(Issue 3). doi:10.1016/j.ejtd.2023.100339
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  Theoretical models of complicated grief (CG) suggest that maladaptive motivational tendencies (e.g., perseverative proximity-seeking of the deceased; excessive avoidance of reminders) interfere with a person's ability to recover from their loved one's death. Due in part to conflicting evidence, little mechanistic understanding of how these behaviors develop in grief exists. We sought to (1) identify behavioral differences between CG and non-CG groups based on approach/avoidance bias for grief-, deceased-, and social-related stimuli, and (2) test the role of the neuropeptide oxytocin in shaping approach/avoidance bias. Widowed older adults with (n = 17) and without (n = 22) CG completed an approach/avoidance task measuring implicit bias for both personalized and non-specific grief-related stimuli (among other stimuli). In a double-blinded, randomized, counterbalanced design, each participant attended both an intranasal oxytocin session and a placebo session. Aims were to (1) identify differential effects of CG and stimulus type on implicit approach/avoidance bias [placebo session], and (2) investigate interactive effects of CG, stimulus type, and oxytocin vs. placebo on approach/avoidance bias [both sessions]. In the placebo session, participants in the non-CG group demonstrated an approach bias across all stimuli. Intranasal oxytocin had an overall slowing effect on the CG group's response times. Further, oxytocin decreased avoidance bias in response to photos of the deceased spouse in the CG group only. Findings support the hypothesis that oxytocin has a differential effect on motivational tendency in CG compared to non-CG, strengthening evidence for its role in CG. Findings also emphasize the need to consider differences in personalized vs. generic stimuli when designing grief-relevant tasks.
• Arizmendi, B. J., Seeley, S. H., Allen, J. J., Killgore, W. D., Andrews-Hanna, J., Weihs, K., & O'Connor, M. F. (2023). A pull to be close: The differentiating effects of oxytocin and grief stimulus type on approach behavior in complicated grief. European journal of trauma & dissociation = Revue europeenne du trauma et de la dissociation, 7(3).
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  Theoretical models of complicated grief (CG) suggest that maladaptive motivational tendencies (e.g., perseverative proximity-seeking of the deceased; excessive avoidance of reminders) interfere with a person's ability to recover from their loved one's death. Due in part to conflicting evidence, little mechanistic understanding of how these behaviors develop in grief exists. We sought to (1) identify behavioral differences between CG and non-CG groups based on approach/avoidance bias for grief-, deceased-, and social-related stimuli, and (2) test the role of the neuropeptide oxytocin in shaping approach/avoidance bias. Widowed older adults with ( 17) and without ( 22) CG completed an approach/avoidance task measuring implicit bias for both personalized and non-specific grief-related stimuli (among other stimuli). In a double-blinded, randomized, counterbalanced design, each participant attended both an intranasal oxytocin session and a placebo session. Aims were to (1) identify differential effects of CG and stimulus type on implicit approach/avoidance bias [placebo session], and (2) investigate interactive effects of CG, stimulus type, and oxytocin vs. placebo on approach/avoidance bias [both sessions]. In the placebo session, participants in the non-CG group demonstrated an approach bias across all stimuli. Intranasal oxytocin had an overall slowing effect on the CG group's response times. Further, oxytocin decreased avoidance bias in response to photos of the deceased spouse in the CG group only. Findings support the hypothesis that oxytocin has a differential effect on motivational tendency in CG compared to non-CG, strengthening evidence for its role in CG. Findings also emphasize the need to consider differences in personalized vs. generic stimuli when designing grief-relevant tasks.
• Czamanski-Cohen, J., & Weihs, K. L. (2023). The role of emotion processing in art therapy (REPAT) intervention protocol. Frontiers in Psychology, 14(Issue). doi:10.3389/fpsyg.2023.1208901
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  Psychological and physical health are known to improve with emotion processing, which is becoming aware of bodily sensations, accepting them as information that can be translated into emotion concepts and expressing them symbolically and linguistically as emotions. Art therapy utilizes the visual arts for processing emotions to facilitate self-expression and communication with the goal of improving psychological wellbeing. The mental health of individuals coping with and recovering from cancer is known to benefit from art therapy. The purpose of this paper is to describe the development of the role of emotion processing in art therapy (REPAT) intervention, which is an 8 week, one and a half hour art therapy intervention created to target emotion processing as a primary mechanism of change, through which art therapy has the potential to reduce symptoms (i.e., depression, pain and fatigue) of women coping with breast cancer. To obtain this goal we used template for intervention description and replication (TIDieR) and GUIDance for the rEporting of intervention Development (GUIDED) guidelines for intervention development description, with the goal of ensuring successful implementation for clinical and research use.
• Czamanski-Cohen, J., & Weihs, K. L. (2023). The role of emotion processing in art therapy (REPAT) intervention protocol. Frontiers in psychology, 14, 1208901.
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  Psychological and physical health are known to improve with emotion processing, which is becoming aware of bodily sensations, accepting them as information that can be translated into emotion concepts and expressing them symbolically and linguistically as emotions. Art therapy utilizes the visual arts for processing emotions to facilitate self-expression and communication with the goal of improving psychological wellbeing. The mental health of individuals coping with and recovering from cancer is known to benefit from art therapy. The purpose of this paper is to describe the development of the role of emotion processing in art therapy (REPAT) intervention, which is an 8 week, one and a half hour art therapy intervention created to target emotion processing as a primary mechanism of change, through which art therapy has the potential to reduce symptoms (i.e., depression, pain and fatigue) of women coping with breast cancer. To obtain this goal we used template for intervention description and replication (TIDieR) and GUIDance for the rEporting of intervention Development (GUIDED) guidelines for intervention development description, with the goal of ensuring successful implementation for clinical and research use.
• Durham, M. R., Smith, R., Cloonan, S., Hildebrand, L. L., Woods-Lubert, R., Skalamera, J., Berryhill, S. M., Weihs, K. L., Lane, R. D., Allen, J. J., Dailey, N. S., Alkozei, A., Vanuk, J. R., & Killgore, W. D. (2023). Development and validation of an online emotional intelligence training program. Frontiers in Psychology, 14. doi:10.3389/fpsyg.2023.1221817
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  Introduction: Emotional intelligence (EI) is associated with a range of positive health, wellbeing, and behavioral outcomes. The present article describes the development and validation of an online training program for increasing EI abilities in adults. The training program was based on theoretical models of emotional functioning and empirical literature on successful approaches for training socioemotional skills and resilience. Methods: After an initial design, programming, and refinement process, the completed online program was tested for efficacy in a sample of 326 participants (72% female) from the general population. Participants were randomly assigned to complete either the EI training program (n = 168) or a matched placebo control training program (n = 158). Each program involved 10-12 hours of engaging online content and was completed during either a 1-week (n = 175) or 3-week (n = 151) period. Results: Participants who completed the EI training program showed increased scores from pre- to post-training on standard self-report (i.e., trait) measures of EI (relative to placebo), indicating self-perceived improvements in recognizing emotions, understanding emotions, and managing the emotions of others. Moreover, those in the EI training also showed increased scores in standard performance-based (i.e., ability) EI measures, demonstrating an increased ability to strategically use and manage emotions relative to placebo. Improvements to performance measures also remained significantly higher than baseline when measured six months after completing the training. The training was also well-received and described as helpful and engaging. Discussion: Following a rigorous iterative development process, we created a comprehensive and empirically based online training program that is well-received and engaging. The program reliably improves both trait and ability EI outcomes and gains are sustained up to six months post-training. This program could provide an easy and scalable method for building emotional intelligence in a variety of settings.
• Durham, M. R., Smith, R., Cloonan, S., Hildebrand, L. L., Woods-Lubert, R., Skalamera, J., Berryhill, S. M., Weihs, K. L., Lane, R. D., Allen, J. J., Dailey, N. S., Alkozei, A., Vanuk, J. R., & Killgore, W. D. (2023). Development and validation of an online emotional intelligence training program. Frontiers in psychology, 14, 1221817.
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  Emotional intelligence (EI) is associated with a range of positive health, wellbeing, and behavioral outcomes. The present article describes the development and validation of an online training program for increasing EI abilities in adults. The training program was based on theoretical models of emotional functioning and empirical literature on successful approaches for training socioemotional skills and resilience.
• Harel, K., Czamanski-Cohen, J., Cohen, M., & Weihs, K. L. (2023). Emotional Processing, Coping, and Cancer-Related Sickness Symptoms in Breast Cancer Survivors: Cross- Sectional Secondary Analysis of the REPAT Study. Research square.
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  The study aims to provide a better understanding of the relationship between emotional processing, coping, and cancer-related sickness symptoms.
• Hebi, M., Czamanski-Cohen, J., Azaiza, F., & Weihs, K. L. (2023). Values and their relationship with emotion processing and physical and psychological symptoms among Jewish and Arab breast cancer survivors. Frontiers in Psychology, 14(Issue). doi:10.3389/fpsyg.2023.1297377
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  Introduction: Individuals from different cultures differ in their values, which encompass belief systems that individuals develop based on their culture, and play a pivotal role in shaping their perspectives. These values may affect emotion processing (EP): the recognition, interpretation, expression and response to bodily sensations, translated as emotions. These varying values may contribute to distinct emotional experiences, impacting physical and psychological symptoms in breast cancer (BC) survivors. Methods: This cross-sectional study investigated how EP including acceptance, expression (avoidance and approach coping), and awareness, may mediate the relationship between conservation values and symptoms of pain, fatigue, and depression among Arab (n = 62) and Jewish (n = 179) women BC survivors in Israel. Conservation values include tradition, conformity, and security. Results: Depression and fatigue were negatively correlated with acceptance of emotions, and positively correlated with avoidance and conservation levels. Emotion processing mediated the relationship between conservation and fatigue and depression. Arab women reported higher levels of various values, emotional acceptance, pain, fatigue, and depression symptoms compared to Jewish women. Conservation was higher in Arab women and correlated with both approach and avoidance coping which was not the case in Jewish women. Avoidance coping had a positive relationship with fatigue in the Jewish, but not the Arab women. Similarly, approach coping was negatively related to depression in Jewish, but not in Arab women. Discussion: Cultural differences are important for understanding the experience of cancer in individuals from different cultures. Future interventions for more conservative BC survivors should take culture into account.
• Hebi, M., Czamanski-Cohen, J., Azaiza, F., & Weihs, K. L. (2023). Values and their relationship with emotion processing and physical and psychological symptoms among Jewish and Arab breast cancer survivors. Frontiers in psychology, 14, 1297377.
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  Individuals from different cultures differ in their values, which encompass belief systems that individuals develop based on their culture, and play a pivotal role in shaping their perspectives. These values may affect emotion processing (EP): the recognition, interpretation, expression and response to bodily sensations, translated as emotions. These varying values may contribute to distinct emotional experiences, impacting physical and psychological symptoms in breast cancer (BC) survivors.
• Kim, S. W., Langer, S., Ahern, M., Larkey, L., Todd, M., Martin, D., Weihs, K., & Khera, N. (2023). Hematopoietic Cell Transplantation Patient-Caregiver Dyad Perspectives on Participation in a Digital Storytelling Intervention: A Qualitative Approach. Transplantation and Cellular Therapy, 29(Issue 8). doi:10.1016/j.jtct.2023.04.021
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  Storytelling has long been considered an effective means of communication, allowing the teller to process their emotions in light of particular life challenges. Effects on the listener also have been demonstrated to be beneficial, especially if the listener is faced with a similar life challenge. Less is known regarding the potential effects of storytelling on listening dyads and opportunities for joint processing following exposure to relevant stories. We sought to study these phenomena in the context of hematopoietic cell transplantation (HCT), a demanding medical procedure requiring intensive informal caregiving and thus great patient-caregiver entwinement. The purpose of this qualitative descriptive study was to explore participants’ perceptions of a 4-week web-based digital storytelling (DST) intervention using both quantitative ratings of acceptability and qualitative coding of interviews conducted after intervention completion. A total of 202 participants (101 HCT patient-caregiver dyads) were recruited from the Mayo Clinic Arizona and randomized into either a DST arm or an Information Control (IC) arm. Participants in the DST arm rated the acceptability of the intervention and were asked to participate in a 30-minute phone interview to discuss their experience with the DST intervention. All interviews were recorded and transcribed verbatim and imported into NVivo 12 for coding and analysis, using a combination of deductive and inductive approaches to organize the data, create categories, and develop themes and subthemes. A total of 38 participants (19 HCT patient-caregiver dyads) completed the post-intervention interviews. Patients were 63% male and 82% White, 68% received allogeneic HCT, and their mean age was 55 years. The median time from HCT was 25 days (range, 6 to 56 days). Caregivers were mostly patients’ spouses (73%) and female (69%), with a mean age of 56 years. In general, the 4-week web-based DST intervention was well accepted and liked by both patients and caregivers regarding the duration, dyadic participation, and convenience of participating in the intervention at home. Patients and caregivers who completed the DST intervention indicated that they were satisfied with the intervention (mean score, 4.5 of 5), were likely to recommend it to others (mean score, 4.4), would watch more stories (mean score, 4.1), and that the experience was worth their time (mean score, 4.6). Major themes that emerged from the qualitative analysis included (1) building communal connection through engaging with the stories; (2) positive emotional growth after HCT; (3) value of gaining the other's perspective; and (4) impact of open communication on the patient-caregiver relationship. A web-based DST intervention provides an attractive format through which to deliver a nonpharmacologic psychosocial intervention to HCT patient-caregiver dyads. Watching the emotional content in digital stories may help patients and caregivers cope with psychoemotional challenges together and provide an opportunity for emotional disclosure. Further work on determining optimal paths to disclosure is warranted.
• Kim, S. W., Langer, S., Ahern, M., Larkey, L., Todd, M., Martin, D., Weihs, K., & Khera, N. (2023). Hematopoietic Cell Transplantation Patient-Caregiver Dyad Perspectives on Participation in a Digital Storytelling Intervention: A Qualitative Approach. Transplantation and cellular therapy, 29(8), 520.e1-520.e7.
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  Storytelling has long been considered an effective means of communication, allowing the teller to process their emotions in light of particular life challenges. Effects on the listener also have been demonstrated to be beneficial, especially if the listener is faced with a similar life challenge. Less is known regarding the potential effects of storytelling on listening dyads and opportunities for joint processing following exposure to relevant stories. We sought to study these phenomena in the context of hematopoietic cell transplantation (HCT), a demanding medical procedure requiring intensive informal caregiving and thus great patient-caregiver entwinement. The purpose of this qualitative descriptive study was to explore participants' perceptions of a 4-week web-based digital storytelling (DST) intervention using both quantitative ratings of acceptability and qualitative coding of interviews conducted after intervention completion. A total of 202 participants (101 HCT patient-caregiver dyads) were recruited from the Mayo Clinic Arizona and randomized into either a DST arm or an Information Control (IC) arm. Participants in the DST arm rated the acceptability of the intervention and were asked to participate in a 30-minute phone interview to discuss their experience with the DST intervention. All interviews were recorded and transcribed verbatim and imported into NVivo 12 for coding and analysis, using a combination of deductive and inductive approaches to organize the data, create categories, and develop themes and subthemes. A total of 38 participants (19 HCT patient-caregiver dyads) completed the post-intervention interviews. Patients were 63% male and 82% White, 68% received allogeneic HCT, and their mean age was 55 years. The median time from HCT was 25 days (range, 6 to 56 days). Caregivers were mostly patients' spouses (73%) and female (69%), with a mean age of 56 years. In general, the 4-week web-based DST intervention was well accepted and liked by both patients and caregivers regarding the duration, dyadic participation, and convenience of participating in the intervention at home. Patients and caregivers who completed the DST intervention indicated that they were satisfied with the intervention (mean score, 4.5 of 5), were likely to recommend it to others (mean score, 4.4), would watch more stories (mean score, 4.1), and that the experience was worth their time (mean score, 4.6). Major themes that emerged from the qualitative analysis included (1) building communal connection through engaging with the stories; (2) positive emotional growth after HCT; (3) value of gaining the other's perspective; and (4) impact of open communication on the patient-caregiver relationship. A web-based DST intervention provides an attractive format through which to deliver a nonpharmacologic psychosocial intervention to HCT patient-caregiver dyads. Watching the emotional content in digital stories may help patients and caregivers cope with psychoemotional challenges together and provide an opportunity for emotional disclosure. Further work on determining optimal paths to disclosure is warranted.
• Pfeifer, V. A., Weihs, K. L., & Lai, V. T. (2023). Narratives about Cancer: What Metaphors can tell us about Depressive Symptoms in Breast Cancer Patients. Health Communication, 39(9), 1-11. doi:10.1080/10410236.2023.2245989
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  Metaphors are pervasive in cancer discourse. However, little is known about how metaphor use develops over time within the same patient, and how metaphor use and its content relate to the mental health of the patient. Here, we analyzed metaphor use in personal essays written by breast cancer patients shortly after the time of diagnosis and nine months later, in relation to their depressive symptoms at both time points. Results show that metaphor use can provide important insight into a patient's current mental state. Specifically, patients who had no change in their depressive symptom levels used metaphors more densely after nine months. In addition, metaphor valence in the later essay was associated with depressive symptoms at study entry and nine months after. Lastly, we observed a shift in metaphor reference pattern for different symptom trajectories, such that those who recovered from initially elevated depressive symptoms used fewer self-referencing metaphors and more cancer-referencing metaphors in their later essay. Our work suggests that metaphor use reflects how a patient is coping with their diagnosis.
• Price, S. N., Hamann, H. A., Halaby, L., Trejo, J. I., Corella, F., & Weihs, K. L. (2023). Poor Subjective Sleep Quality Among Patients with Cancer and Comorbid Depression: An Opportunity to Inform Screening and Intervention. Behavioral Sleep Medicine, 21(Issue 1). doi:10.1080/15402002.2022.2033243
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  Objective: Sleep disturbances are under-identified and under-treated in oncology settings, especially for underserved populations and those with psychiatric comorbidities. This study examined the prevalence and correlates of poor subjective sleep quality as well as clinical sleep recommendations among a socioeconomically and ethnically diverse population of patients with cancer referred for depression management. Methods: Participants were 140 adults with cancer who screened positive for depression through routine, practice-based assessment with the Patient Health Questionnaire (PHQ-9 ≥ 8) and were referred to a study of collaborative care for depression. Demographics, clinical characteristics, subjective sleep quality, and sleep recommendations received were self-reported by patients prior to intervention. Sleep quality was measured using the Pittsburgh Sleep Quality Index (PSQI), general health status was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10, and depressive symptoms were measured using the PHQ-9. Results: Of 138 patients with complete data, 123 (89.1%) reported poor sleep quality, and 87 (63%) met the threshold for possible insomnia. The strongest correlates of poor subjective sleep were female gender (β = 0.19, p = .02), greater depressive symptom severity (β = 0.28, p = .001), and worse physical health (β = −0.19, p = .04). Of 118 patients reporting problems with sleep since their cancer diagnosis, 95 discussed the issue with a medical provider; medications were recommended most often (37; 38.9%); only 9 (9.5%) received recommendations for cognitive-behavioral therapy for insomnia (CBT-I) or other CBT. Conclusions: Patients with cancer seeking treatment for depression report very high rates of poor subjective sleep quality and insomnia, underscoring the importance of providing and referring to guideline-concordant sleep interventions in oncology supportive care contexts.
• Price, S. N., Hamann, H. A., Halaby, L., Trejo, J. I., Corella, F., & Weihs, K. L. (2023). Poor Subjective Sleep Quality Among Patients with Cancer and Comorbid Depression: An Opportunity to Inform Screening and Intervention. Behavioral sleep medicine, 21(1), 45-60.
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  Sleep disturbances are under-identified and under-treated in oncology settings, especially for underserved populations and those with psychiatric comorbidities. This study examined the prevalence and correlates of poor subjective sleep quality as well as clinical sleep recommendations among a socioeconomically and ethnically diverse population of patients with cancer referred for depression management.
• Smith, I. S., Bind, M. A., Weihs, K. L., Bei, B., & Wiley, J. F. (2023). Targeting emotional regulation using an Internet-delivered psychological intervention for cancer survivors: A randomized controlled trial. British Journal of Health Psychology, 28(Issue 4). doi:10.1111/bjhp.12679
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  Objectives: This trial assessed the efficacy of an emotion-focused, modular, Internet-delivered adaptation of the Unified Protocol (UP) in improving cancer survivors' emotion regulation strategies. Design: A two-arm randomized controlled trial (1:1) was used to compare the efficacy of two Internet-based interventions: UP-adapted CanCope Mind (CM) and lifestyle-focused active control CanCope Lifestyle (CL). Methods: N = 224 cancer survivors randomized to CM or CL were assessed at baseline, between-modules, at post-intervention and 3-month follow-up on emotion regulation outcomes targeted by each CM module (Module 1: beliefs about emotions; Module 2: mindfulness; Module 3: cognitive reappraisal skills, catastrophizing, refocus on planning; Module 4: experiential avoidance). Primary analyses were intention-to-treat linear regressions using Fisher randomization tests for p-values and intervals were used to compare groups with standardized mean difference (SMD) effect sizes. Results: CanCope Mind participants (n = 61 completers) experienced moderate-to-large improvements (SMDs from.44–.88) across all outcomes at post-intervention. CM's effects were larger than CL's (n = 75 completers) immediately post-intervention and at 3-month follow-up for beliefs about emotions, mindfulness, cognitive reappraisals and experiential avoidance (all p's
• Smith, I. S., Bind, M. A., Weihs, K. L., Bei, B., & Wiley, J. F. (2023). Targeting emotional regulation using an Internet-delivered psychological intervention for cancer survivors: A randomized controlled trial. British journal of health psychology, 28(4), 1185-1205.
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  This trial assessed the efficacy of an emotion-focused, modular, Internet-delivered adaptation of the Unified Protocol (UP) in improving cancer survivors' emotion regulation strategies.
• Weihs, K. L. (2022).

  Poor Subjective Sleep Quality Among Patients with Cancer and Comorbid Depression: An Opportunity to Inform Screening and Intervention

  . Behavioral Sleep Medicine.
• Smith, I. S., Wallace, R., Wellecke, C., Bind, M. A., Weihs, K. L., Bei, B., & Wiley, J. F. (2022). Assessing an Internet-Delivered, Emotion-Focused Intervention Compared With a Healthy Lifestyle Active Control Intervention in Improving Mental Health in Cancer Survivors: Protocol for a Randomized Controlled Trial. JMIR Research Protocols, 11(Issue 7). doi:10.2196/36658
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  Background: Cancer survivors are vulnerable to experiencing symptoms of anxiety and depression and may benefit from accessible interventions focused on improving emotion regulation. CanCope Mind (CM) was developed as an internet-delivered intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors. Objective: This protocol aims to provide an outline of the CanCope Study, a trial comparing the efficacy of a Unified Protocol-adapted internet-delivered intervention (CM) designed for cancer survivors compared with an active control condition-an internet-delivered healthy lifestyle intervention, CanCope Lifestyle (CL). The primary aim is to assess and compare the efficacy of both interventions in improving emotion regulation, anxiety and depressive symptoms, and quality of life. The secondary aims involve assessing the mechanisms of the CM intervention. Methods: This trial is a 2-arm randomized controlled trial that allocates cancer survivors to either CM or CL. Both interventions comprise 4 web-based modules and are expected to take participants at least 8 weeks to complete. Participants' mental and physical health will be assessed via self-reported surveys at baseline (T0), between each module (T1, T2, and T3), immediately after the intervention (T4), and at 3-month follow-up (T5). The study aims to recruit 110 participants who have completed T4. Results: The CanCope study began recruitment in September 2020. A total of 224 participants have been randomized to the CM (n=110, 49.1%) and CL (n=114, 50.9%) groups. Conclusions: This is one of the first trials to develop and investigate the efficacy of a web-based intervention for cancer survivors that specifically targets emotion regulation.
• Smith, I. S., Wallace, R., Wellecke, C., Bind, M. A., Weihs, K. L., Bei, B., & Wiley, J. F. (2022). Assessing an Internet-Delivered, Emotion-Focused Intervention Compared With a Healthy Lifestyle Active Control Intervention in Improving Mental Health in Cancer Survivors: Protocol for a Randomized Controlled Trial. JMIR research protocols, 11(7), e36658.
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  Cancer survivors are vulnerable to experiencing symptoms of anxiety and depression and may benefit from accessible interventions focused on improving emotion regulation. CanCope Mind (CM) was developed as an internet-delivered intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors.
• Smith, I. S., Wellecke, C., Weihs, K. L., Bei, B., & Wiley, J. F. (2022). Piloting CanCope: An internet-delivered transdiagnostic intervention to improve mental health in cancer survivors. Psycho-oncology, 31(1), 107-115.
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  CanCope is an internet-delivered, cognitive-behavioural intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors. Four separate pilot studies evaluated each of CanCope's modules for (1) feasibility and participant satisfaction, and changes in (2) module-specific outcomes, and (3) global measures of emotion dysregulation and anxiety and depressive symptoms, from pre-to-post module delivery.
• Weihs, K. L. (2022). Lower emotional awareness is associated with greater early adversity and faster life history strategy. Evolutionary Behavioral Science.
• Bean, H. R., Diggens, J., Ftanou, M., Weihs, K. L., Stanton, A. L., & Wiley, J. F. (2021). Insomnia and Fatigue Symptom Trajectories in Breast Cancer: A Longitudinal Cohort Study. Behavioral Sleep Medicine, 19(Issue 6). doi:10.1080/15402002.2020.1869005
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  Objective: Insomnia and fatigue are common, although not inevitable, during breast cancer. This study is one of the first aiming to describe distinct trajectory classes of insomnia and fatigue symptoms, and their correlates, from diagnosis through treatment. Methods: This longitudinal cohort study was conducted at a comprehensive cancer center and community oncology practices. Participants (N = 460) were women diagnosed with any stage of breast cancer in the previous 4 months. Primary outcomes for this ancillary study of the existing cohort were self-reported insomnia and fatigue symptoms assessed repeatedly across 12 months. Results: Four distinct classes of insomnia symptoms emerged: persistently very high, clinically elevated symptoms (13.7%); high, clinically elevated symptoms (65.9%); stable low (17.2%) or very low (2.6%) symptoms. Five fatigue symptom classes included high, increasing fatigue (9.6%), two recovery classes starting at high (26.3%), or moderate (18.0%) severity at diagnosis, stable low (33.3%) or very low (12.2%) classes. In multivariate analyses, higher depressive symptoms, anxiety, and chronic life stress were associated with being in the very high insomnia class versus the low symptom class. Oncologic factors were not associated with insomnia class membership. Receiving chemotherapy was linked significantly to high and recovery fatigue symptom classes versus the low class. Higher chronic life stress was associated with more persistent fatigue symptoms. Conclusions: Distinct classes of insomnia and fatigue symptoms were evident; 79.6% of the women had clinically elevated, persistent insomnia symptoms, 53.9% had elevated fatigue. A substantial minority evidenced low symptoms, suggesting targeted or stepped-care approaches to symptom management.
• Bean, H. R., Diggens, J., Ftanou, M., Weihs, K. L., Stanton, A. L., & Wiley, J. F. (2021). Insomnia and Fatigue Symptom Trajectories in Breast Cancer: A Longitudinal Cohort Study. Behavioral sleep medicine, 1-14.
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  : Insomnia and fatigue are common, although not inevitable, during breast cancer. This study is one of the first aiming to describe distinct trajectory classes of insomnia and fatigue symptoms, and their correlates, from diagnosis through treatment. : This longitudinal cohort study was conducted at a comprehensive cancer center and community oncology practices. Participants ( = 460) were women diagnosed with any stage of breast cancer in the previous 4 months. Primary outcomes for this ancillary study of the existing cohort were self-reported insomnia and fatigue symptoms assessed repeatedly across 12 months. : Four distinct classes of insomnia symptoms emerged: persistently very high, clinically elevated symptoms (13.7%); high, clinically elevated symptoms (65.9%); stable low (17.2%) or very low (2.6%) symptoms. Five fatigue symptom classes included high, increasing fatigue (9.6%), two recovery classes starting at high (26.3%), or moderate (18.0%) severity at diagnosis, stable low (33.3%) or very low (12.2%) classes. In multivariate analyses, higher depressive symptoms, anxiety, and chronic life stress were associated with being in the very high insomnia class versus the low symptom class. Oncologic factors were not associated with insomnia class membership. Receiving chemotherapy was linked significantly to high and recovery fatigue symptom classes versus the low class. Higher chronic life stress was associated with more persistent fatigue symptoms. : Distinct classes of insomnia and fatigue symptoms were evident; 79.6% of the women had clinically elevated, persistent insomnia symptoms, 53.9% had elevated fatigue. A substantial minority evidenced low symptoms, suggesting targeted or stepped-care approaches to symptom management.
• Bei, B., Smith, I. S., Weihs, K. L., Wellecke, C., & Wiley, J. F. (2021). Piloting CanCope: An internet‐delivered transdiagnostic intervention to improve mental health in cancer survivors. Psycho-Oncology, 31(1), 107-115. doi:10.1002/pon.5787
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  CanCope is an internet-delivered, cognitive-behavioural intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors. Four separate pilot studies evaluated each of CanCope's modules for (1) feasibility and participant satisfaction, and changes in (2) module-specific outcomes, and (3) global measures of emotion dysregulation and anxiety and depressive symptoms, from pre-to-post module delivery.Eligible cancer survivors self-selected into one two-week online module designed to improve a specific aspect of emotion regulation ([1] understanding emotions, [2] mindfulness of emotions, [3] cognitive reappraisals, [4] challenging emotion-driven behaviours).Across modules, post-intervention surveys were completed by 17-19 participants, (58.1%-90.5% completion rate for participants who received the intervention). Each module was feasible and participants reported high satisfaction. Moderate-to-large pre-to-post effect sizes in mean differences were observed in module-specific target outcomes (p's < 0.05). Emotion dysregulation significantly decreased across modules 1 to 3 (p's < 0.05) with a non-significant decrease for module 4 (p = 0.13). Anxiety symptoms significantly decreased across all modules (p's < 0.05). Depressive symptoms significantly decreased across modules 1 and 3 (p's < 0.05), with non-significant decreases across modules 2 (p = 0.08) and 4 (p = 0.06).Each CanCope module demonstrated promise in targeting emotion regulation skills and supporting the mental health of cancer survivors. Randomised controlled trials are required to test the efficacy of CanCope as an intervention in its entirety.
• Kim, J. H., Bright, E. E., Williamson, T. J., Krull, J. L., Weihs, K. L., & Stanton, A. L. (2021). Transitions in coping profiles after breast cancer diagnosis: implications for depressive and physical symptoms. Journal of behavioral medicine, 44(1), 1-17.
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  The objective of this study was to determine whether: (a) cancer-related coping profiles change across time; (b) coping profile transition types predict changes in depressive and physical symptoms. Latent transition analysis was conducted with repeated measures of seven cancer-related coping processes from 460 women recently diagnosed with breast cancer. In multilevel models, coping profile transition groups were entered as predictors of symptoms across 12 months. Three coping profiles emerged at study entry, with two profiles at later assessments. Forty-eight percent of women maintained high-moderate approach-oriented coping over time. Specific factors (e.g., age, acceptance of emotions) differentiated the transition groups. Women who increased and then maintained high-moderate approach-oriented coping had relatively high initial depressive symptoms that declined steeply. When cancer-related acceptance predominated, women experienced increasing physical symptoms. Distinct cancer-related coping patterns are related to the level of and change in depressive and physical symptoms longitudinally. Early intervention to increase approach-oriented coping strategies could yield favorable outcomes.
• Lane, R. D., Solms, M., Weihs, K. L., Hishaw, A., & Smith, R. (2021). Is the concept of affective agnosia a useful addition to the alexithymia literature?. Neuroscience and biobehavioral reviews, 127, 747-748.
• Marshall, C. A., Trejo, M. J., Trejo, J. I., Armin, J. S., Badger, T. A., & Weihs, K. L. (2021). Implementation of Un Abrazo Para La FamiliaTM in southern Arizona with extension to survivors and assessment of effects on distress. Families, systems & health : the journal of collaborative family healthcare, 39(2), 269-281.
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  [Embracing the Family] (Abrazo) is a 3-hr psychoeducational intervention designed for low-income informal caregivers who are cosurvivors of cancer. A rehabilitation-informed preventive intervention, Abrazo reflects the importance of family, culture, and socioeconomic background. A pilot study was conducted to inform a larger geographic implementation of Abrazo. The aims were to determine if previous outcomes of increased cancer knowledge and self-efficacy could be replicated and to investigate intervention effects on distress. A pretest-posttest design was used to assess changes in cancer knowledge, self-efficacy, and distress for Abrazo participants. Distress was measured with the American Medical Association's Caregiver Assessment (Epstein-Lubow et al., 2010) and the National Comprehensive Cancer Network Distress Thermometer (Donovan et al., 2014; Forsythe et al., 2013; Fulcher & Gosselin-Acomb, 2007). The Patient Health Questionnaire-4 (PHQ-4) (Kroenke et al., 2009) measured symptoms of anxiety and depression. Both survivors ( = 37) and cosurvivors ( = 103) increased in cancer knowledge and self-efficacy after completing Abrazo. Mean levels of distress and symptoms decreased for cosurvivors, but not for survivors. At study entry, 19% of cosurvivors and 12% of survivors scored ≥6/12 on the PHQ-4, the standard cutoff for clinically significant symptoms. Only 13% of cosurvivors, but 30% of survivors exceeded this threshold at three-month follow-up. Elevated symptoms persisted in 12% of survivors from baseline to follow-up; in 18% of survivors, symptoms rose between baseline and follow-up. Increased cancer knowledge and self-efficacy in participants replicates evidence of Abrazo's effectiveness. The result of decreased distress in cosurvivors extends our understanding of Abrazo's effectiveness with this population. The increase in distress in cancer survivors warrants further attention to their intervention needs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
• Weihs, K. L. (2021). Marshall C, Trejo MJ, Trejo, Armin JS, Badger TA, Weihs KL. (2021) Implementation of Un Abrazo Para La Familia™ in Southern Arizona with Extension to Survivors and Assessment of Effects on Distress.. Families, Systems, & Health, 39(2), 269-281.
• Weihs, K. L., Stanton, A. L., Kim, J. H., & Cole, S. W. (2021). Abstract PD12-02: Chronic interpersonal stress predicts depressive outcomes in the first year of invasive breast cancer: Moderation by the serotonin-transporter polymorphism. Cancer Research. doi:10.1158/1538-7445.sabcs20-pd12-02
• Badger, T. A., Segrin, C., Sikorskii, A., Pasvogel, A., Weihs, K., Lopez, A. M., & Chalasani, P. (2020). Randomized controlled trial of supportive care interventions to manage psychological distress and symptoms in Latinas with breast cancer and their informal caregivers. Psychology & health, 35(1), 87-106.
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  The purpose of this study was to test two 2-month psychosocial interventions (Telephone Interpersonal Counseling [TIPC] and Supportive Health Education [SHE]) to improve quality of life (QOL) outcomes for Latinas with breast cancer and their informal caregivers. Two hundred and forty-one Latinas with breast cancer and their caregivers were assessed at baseline, immediately after the 2-month intervention, at 4 and 6 months after baseline. QOL outcomes were psychological distress, symptoms and social support. Linear mixed effects models showed that for cancer survivors at 2 months, TIPC produced lower adjusted mean depression scores compared to SHE. At 4 months, SHE had reduced total number of symptoms, global symptom distress, and social isolation compared to TIPC. Only total number of symptoms was lower in SHE than in TIPC at 6 months. Among caregivers at 2 months, total number of symptoms, global symptom distress, and anxiety were lower, and self-efficacy for symptom management was higher in SHE compared to TIPC. Caregiver depression was lower in TIPC compared to SHE at 4 months. These telephone delivered interventions improved different outcomes. TIPC demonstrated superior benefits for depression management and SHE was more successful in anxiety and cancer-related symptom management.
• Czamanski-Cohen, J., Wiley, J., & Weihs, K. L. (2020). Protocol for the REPAT study: role of emotional processing in art therapy for breast cancer palliative care patients. BMJ open, 10(11), e037521.
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  Patients with breast cancer (BC) cope with depression which is linked to functional limitations in survivorship and to physical symptoms. Pain and fatigue are prominent symptoms that affect the well-being of cancer survivors. Emotional processing has been associated with improved physical and psychological health in survivors. Art therapy is a form of psychotherapy that involves the use of visual art-making for expression and communication. It encourages emotional processing and has been linked to symptom reduction in patients with cancer. This protocol is designed to examine two mechanistic changes: emotional processing (awareness, expression and acceptance) and cholinergic anti-inflammatory processes (heart rate variability and cytokine expression) through which an art therapy intervention may reduce depression, pain and fatigue. In addition, we will examine ethnocultural differences in the effect of art therapy in women from different ethnocultural backgrounds.
• Smith, R., Steklis, H. D., Steklis, N. G., Weihs, K. L., & Lane, R. D. (2020). The evolution and development of the uniquely human capacity for emotional awareness: A synthesis of comparative anatomical, cognitive, neurocomputational, and evolutionary psychological perspectives. Biological psychology, 154, 107925.
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  We offer an interdisciplinary framework for understanding the expanded capacity for emotional awareness (EA) in humans relative to other animals, synthesizing work within computational neuroscience, evolutionary psychology, and comparative anatomy. We argue that disproportionate cortical expansion during human evolution reflects additional hierarchical levels of computational processing, allowing representation of multimodal regularities over longer timescales - affording abstract concept learning, internal simulation of distal future outcomes, and expanded working memory capacity. This allows for the ability to simulate emotions, learn emotion concepts, and manipulate them in working memory when deciding how to act. We also draw on the construct of life history strategy within evolutionary psychology to argue that individual differences in EA within humans can be understood as the result of tuning particular computational parameters to the predictability of long timescale socioemotional regularities of the local environment. We conclude by discussing the implications and testable hypotheses offered by our proposed framework.
• Weihs, K. L., Lane, R. D., Weihs, K. L., Solms, M., Smith, R., Lane, R. D., & Hishaw, A. (2020). Affective agnosia: a core affective processing deficit in the alexithymia spectrum. Biopsychosocial Medicine, 14(1), 1-14. doi:10.1186/s13030-020-00184-w
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  Affective agnosia, an impairment in knowing how one feels emotionally, has been described as an extreme deficit in the experience and expression of emotion that may confer heightened risk for adverse medical outcomes. Alexithymia, by contrast, has been proposed as an over-arching construct that includes a spectrum of deficits of varying severity, including affective agnosia at the more severe end. This perspective has been challenged by Taylor and colleagues, who argue that the concept of affective agnosia is unnecessary. We compare these two perspectives by highlighting areas of agreement, reasons for asserting the importance of the affective agnosia concept, errors in Taylor and colleagues’ critique, and measurement issues. The need for performance-based measures of the ability to mentally represent emotional states in addition to metacognitive measures is emphasized. We then draw on a previously proposed three-process model of emotional awareness that distinguishes affective response generation, conceptualization and cognitive control processes which interact to produce a variety of emotional awareness and alexithymia phenotypes - including affective agnosia. The tools for measuring these three processes, their neural substrates, the mechanisms of brain-body interactions that confer heightened risk for adverse medical outcomes, and the differential treatment implications for different kinds of deficits are described. By conceptualizing alexithymia as a spectrum of deficits, the opportunity to match specific deficit mechanisms with personalized treatment for patients will be enhanced.
• Weihs, K. L., Segrin, C. G., Badger, T. A., Sikorskii, A., Chalasani, P., Pasvogel, A., & Lopez, A. M. (2020). Longitudinal dyadic interdependence in psychological distress among Latinas with breast cancer and their caregivers. Supportive Care in Cancer, 28(6), 2735-2743.
• Alkozei, A., Killgore, W. D., Lane, R. D., Smith, R., & Weihs, K. L. (2019).

  An Embodied Neurocomputational Framework for Organically Integrating Biopsychosocial Processes: An Application to the Role of Social Support in Health and Disease

  . Psychosomatic Medicine. doi:10.1097/psy.0000000000000661
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  ABSTRACT Objective Two distinct perspectives—typically referred to as the biopsychosocial and biomedical models—currently guide clinical practice. Although the role of psychosocial factors in contributing to physical and mental health outcomes is widely recognized, the biomedical model remains dominant. This is due in part to ( a ) the largely nonmechanistic focus of biopsychosocial research and ( b ) the lack of specificity it currently offers in guiding clinicians to focus on social, psychological, and/or biological factors in individual cases. In this article, our objective is to provide an evidence-based and theoretically sophisticated mechanistic model capable of organically integrating biopsychosocial processes. Methods To construct this model, we provide a narrative review of recent advances in embodied cognition and predictive processing within computational neuroscience, which offer mechanisms for understanding individual differences in social perceptions, visceral responses, health-related behaviors, and their interactions. We also review current evidence for bidirectional influences between social support and health as a detailed illustration of the novel conceptual resources offered by our model. Results When integrated, these advances highlight multiple mechanistic causal pathways between psychosocial and biological variables. Conclusions By highlighting these pathways, the resulting model has important implications motivating a more psychologically sophisticated, person-specific approach to future research and clinical application in the biopsychosocial domain. It also highlights the potential for quantitative computational modeling and the design of novel interventions. Finally, it should aid in guiding future research in a manner capable of addressing the current criticisms/limitations of the biopsychosocial model and may therefore represent an important step in bridging the gap between it and the biomedical perspective.
• Badger, T. A., Chalasani, P., Lopez, A. M., Pasvogel, A., Segrin, C., Sikorskii, A., & Weihs, K. (2019). Randomized controlled trial of supportive care interventions to manage psychological distress and symptoms in Latinas with breast cancer and their informal caregivers. Psychology & Health, 35(1), 87-106. doi:10.1080/08870446.2019.1626395
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  Objective: The purpose of this study was to test two 2-month psychosocial interventions (Telephone Interpersonal Counseling [TIPC] and Supportive Health Education [SHE]) to improve quality of life (QOL) outcomes for Latinas with breast cancer and their informal caregivers. Methods: Two hundred and forty-one Latinas with breast cancer and their caregivers were assessed at baseline, immediately after the 2-month intervention, at 4 and 6 months after baseline. QOL outcomes were psychological distress, symptoms and social support. Results: Linear mixed effects models showed that for cancer survivors at 2 months, TIPC produced lower adjusted mean depression scores compared to SHE. At 4 months, SHE had reduced total number of symptoms, global symptom distress, and social isolation compared to TIPC. Only total number of symptoms was lower in SHE than in TIPC at 6 months. Among caregivers at 2 months, total number of symptoms, global symptom distress, and anxiety were lower, and self-efficacy for symptom management was higher in SHE compared to TIPC. Caregiver depression was lower in TIPC compared to SHE at 4 months. Conclusions: These telephone delivered interventions improved different outcomes. TIPC demonstrated superior benefits for depression management and SHE was more successful in anxiety and cancer-related symptom management.
• Boland, R. J., Weihs, K. L., & Gündel, H. (2019). Introducing a New Special Series: Clinical Applications in Psychosomatic Medicine. Psychosomatic medicine, 81(2), 112-113.
• Czamanski-Cohen, J., Wiley, J. F., Sela, N., Caspi, O., & Weihs, K. (2019). The role of emotional processing in art therapy (REPAT) for breast cancer patients. Journal of psychosocial oncology, 37(5), 586-598.
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  Emotional awareness and acceptance of emotion are associated with improved health in breast cancer (BC) patients. Art therapy (AT) uses visual art-making for expression and communication and has been shown to reduce psychological and physical symptoms in individuals with cancer. A major objective of AT is to encourage increases in emotion processing; however, few studies examine these changes. To examine the effect of an eight-week AT group on emotion processing as a mechanism of symptom reduction in women with BC. Randomized clinical trial. Twenty women diagnosed with breast cancer whom had completed primary treatment. Participants were randomized to participate in eight-weeks of AT or sham AT, which was a mandala coloring group. Participants answered questionnaires before and after the intervention. We used a Cohen's D calculator for effect sizes and a t-test to examine group differences. Statistically significant between-group differences in emotional awareness and acceptance of emotion were found after the intervention. We found large effect sizes between groups and over time in acceptance of emotion, emotional awareness and depressive symptoms. We conclude that emotion processing in AT may be a potential mechanism reducing depression and somatic symptoms in cancer patients. Art Therapy is a feasible intervention to increase emotional processing. A larger study is required to further examine its effect on psychological and physical symptoms in breast cancer patients.
• Robbins, M. L., Wright, R. C., María López, A., & Weihs, K. (2019). Interpersonal positive reframing in the daily lives of couples coping with breast cancer. Journal of psychosocial oncology, 37(2), 160-177.
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  This study examined word use as an indicator of interpersonal positive reframing in daily conversations of couples coping with breast cancer and as a predictor of stress.
• Segrin, C., Badger, T. A., Sikorskii, A., Pasvogel, A., Weihs, K., Lopez, A. M., & Chalasani, P. (2019). Longitudinal dyadic interdependence in psychological distress among Latinas with breast cancer and their caregivers. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer.
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  Cancer diagnosis and treatment can generate substantial distress for both survivors and their family caregivers. The primary aim of this investigation is to test a model of dyadic interdependence in distress experienced by cancer survivors and their caregivers to determine if each influences the other.
• Smith, R., Weihs, K. L., Alkozei, A., Killgore, W. D., & Lane, R. D. (2019). An Embodied Neurocomputational Framework for Organically Integrating Biopsychosocial Processes: An Application to the Role of Social Support in Health and Disease. Psychosomatic medicine, 81(2), 125-145.
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  Two distinct perspectives-typically referred to as the biopsychosocial and biomedical models-currently guide clinical practice. Although the role of psychosocial factors in contributing to physical and mental health outcomes is widely recognized, the biomedical model remains dominant. This is due in part to (a) the largely nonmechanistic focus of biopsychosocial research and (b) the lack of specificity it currently offers in guiding clinicians to focus on social, psychological, and/or biological factors in individual cases. In this article, our objective is to provide an evidence-based and theoretically sophisticated mechanistic model capable of organically integrating biopsychosocial processes.
• Smith, T. W., & Weihs, K. (2019). Emotion, Social Relationships, and Physical Health: Concepts, Methods, and Evidence for an Integrative Perspective. Psychosomatic Medicine, 81(Issue 8). doi:10.1097/psy.0000000000000739
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  Emotional characteristics and processes are robust predictors of the development and course of major medical illnesses and premature mortality, as are a variety of indicators of the presence and quality of personal relationships. Despite clear evidence of close interconnection between these two domains of risk and protection, affective characteristics and relationships have largely been studied separately as influences on health. After a recent conference on integrative perspectives on emotions, relationships and health co-sponsored by the American Psychosomatic Society and the Society for Affective Science, the present review builds on prior calls for integration, related theory, and current research to outline what is known about the interconnection of these domains as it specifically relates to their overlapping influences on health. Areas of interest include the following: their interconnected roles over the course of development, which may inform current efforts to understand the influence of early life events on adult health; the parallel positive and negative factors in both domains that could have distinct influences on health; the role of emotion regulation in relationship contexts; and measurement, design, and analysis approaches to capture the dyadic and dynamic aspects of these interconnected influences on health. We conclude with a discussion of an emerging research agenda that includes the following: common biological foundations of affective and relationship processes, the cultural embeddedness of affective and relationship processes, the potential contribution of affective-relational processes to health disparities, and implications for intervention research.
• Smith, T. W., & Weihs, K. (2019). Emotion, Social Relationships, and Physical Health: Concepts, Methods, and Evidence for an Integrative Perspective. Psychosomatic medicine, 81(8), 681-693.
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  Emotional characteristics and processes are robust predictors of the development and course of major medical illnesses and premature mortality, as are a variety of indicators of the presence and quality of personal relationships. Despite clear evidence of close interconnection between these two domains of risk and protection, affective characteristics and relationships have largely been studied separately as influences on health. After a recent conference on integrative perspectives on emotions, relationships and health co-sponsored by the American Psychosomatic Society and the Society for Affective Science, the present review builds on prior calls for integration, related theory, and current research to outline what is known about the interconnection of these domains as it specifically relates to their overlapping influences on health. Areas of interest include the following: their interconnected roles over the course of development, which may inform current efforts to understand the influence of early life events on adult health; the parallel positive and negative factors in both domains that could have distinct influences on health; the role of emotion regulation in relationship contexts; and measurement, design, and analysis approaches to capture the dyadic and dynamic aspects of these interconnected influences on health. We conclude with a discussion of an emerging research agenda that includes the following: common biological foundations of affective and relationship processes, the cultural embeddedness of affective and relationship processes, the potential contribution of affective-relational processes to health disparities, and implications for intervention research.
• Stinesen Kolberg, K., Wiley, J., Ross, K. M., Alexandra, J., Hammen, C., Weihs, K. L., & Stanton, A. (2019). Chronic stress in vocational and intimate partner domains as predictors of depressive symptoms after breast cancer diagnosis. Annals of Behavioral Medicine.
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  Karin Stinesen Kollberg1,5, Joshua F. Wiley2, Kharah M. Ross1, Alexandra Jorge1,4, Constance Hammen1, Karen L. Weihs3, Annette L. Stanton
• Stinesen Kollberg, K., Wiley, J. F., Ross, K. M., Jorge-Miller, A., Hammen, C., Weihs, K. L., & Stanton, A. L. (2019). Chronic Stress in Vocational and Intimate Partner Domains as Predictors of Depressive Symptoms After Breast Cancer Diagnosis. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 53(4), 333-344.
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  After cancer diagnosis, depressive symptoms are elevated on average and decline over time, but substantial variability is apparent. Few studies have examined to what extent chronic stress in distinct life domains affects depressive symptoms.
• Weihs, K. L., Kogan, A. V., Wiley, J. F., & Stanton, A. L. (2019).

  Cardiac Vagal Control and Coping Strategies as Predictors of Depression in Breast Cancer

  . Psychosomatic Medicine.
• Weihs, K. L., McConnell, M. H., Wiley, J. F., Crespi, C. M., Sauer-Zavala, S., & Stanton, A. L. (2019). A preventive intervention to modify depression risk targets after breast cancer diagnosis: Design and single-arm pilot study. Psycho-oncology, 28(4), 880-887.
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  Apply the National Institutes of Health (NIH) Stage Model to design and test an intervention to prevent depression in breast cancer patients at risk for depression.
• Weihs, K. L., Wajsbrot, D. B., Chiles, D., Ramaker, S., & Chappell, P. (2019). Re: "Desvenlafaxine Versus Placebo in a Fluoxetine-Referenced Study of Children and Adolescents with Major Depressive Disorder: Design, Definitions, and Ongoing Challenges for Child and Adolescent Psychopharmacology Research" by Strawn JR and Croarkin PE (J Child Adolesc Psychopharmacol 2018;28:(5)363). Journal of child and adolescent psychopharmacology, 29(3), 245-246.
• Fisher, L., Hessler, D., Polonsky, W. H., Masharani, U., Guzman, S., Bowyer, V., Strycker, L., Ahmann, A., Basina, M., Blumer, I., Chloe, C., Kim, S., Peters, A. L., Shumway, M., Weihs, K., & Wu, P. (2018). T1-REDEEM: A Randomized Controlled Trial to Reduce Diabetes Distress Among Adults With Type 1 Diabetes. Diabetes care, 41(9), 1862-1869.
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  To compare the effectiveness of two interventions to reduce diabetes distress (DD) and improve glycemic control among adults with type 1 diabetes (T1D).
• Marshall, C. A., Curran, M. A., Brownmiller, G., Solarte, A., Armin, J., Hamann, H. A., Crist, J. D., Niemelä, M., Badger, T. A., & Weihs, K. L. (2018). Oregon's Familias en Acción replicates benefits for underserved cancer co-survivors through Un Abrazo Para la Familia. Psycho-oncology, 27(10), 2405-2411.
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  Our goal in this study was to determine if we could replicate initial findings when providing the intervention, Un Abrazo Para La Familia ("Abrazo"). Abrazo is a community-focused psychoeducational preventive intervention addressing the cancer information and coping needs of low-income, underserved family members of cancer survivors, developed and first implemented in Tucson, Arizona.
• Robbins, M. L., Karan, A., López, A. M., & Weihs, K. L. (2018). Naturalistically observing noncancer conversations among couples coping with breast cancer. Psycho-oncology, 27(9), 2206-2213.
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  This study revealed the landscape of noncancer conversations, identifying topics and types of everyday conversation, and examined links to psychological adjustment among couples coping with breast cancer.
• Stanton, A. L., Wiley, J. F., Krull, J. L., Crespi, C. M., & Weihs, K. L. (2018). Cancer-related coping processes as predictors of depressive symptoms, trajectories, and episodes. Journal of consulting and clinical psychology, 86(10), 820-830.
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  Although numerous studies address the relationships of depression with coping processes directed toward approaching or avoiding stressful experiences, the large majority are cross-sectional in design, assess coping processes at only one timepoint, or solely include prediction of the linear slope of depressive symptoms. In this research, coping processes were investigated as predictors of depressive symptoms, symptom trajectory classes (consistently high, recovery, consistently low), and major depressive episodes (MDEs) over 12 months in the cancer context.
• Weihs, K. L., Abbas, R., Chiles, D., England, R. D., Ramaker, S., Wajsbrot, D. B., & Murphy, W. R. (2018). Desvenlafaxine Versus Placebo in a Fluoxetine-Referenced Study of Children and Adolescents with Major Depressive Disorder.. Journal of child and adolescent psychopharmacology, 28(1), 36-46. doi:10.1089/cap.2017.0100
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  To evaluate the short-term efficacy and safety of desvenlafaxine (25-50 mg/d) compared with placebo in children and adolescents with major depressive disorder (MDD)..Outpatient children (7-11 years) and adolescents (12-17 years) who met DSM-IV-TR criteria for MDD and had screening and baseline Children's Depression Rating Scale-Revised (CDRS-R) total scores >40 were randomly assigned to 8-week treatment with placebo, desvenlafaxine (25, 35, or 50 mg/d based on baseline weight), or fluoxetine (20 mg/d). The primary efficacy endpoint was change from baseline in CDRS-R total score at week 8, analyzed using a mixed-effects model for repeated measures. Secondary efficacy endpoints included week 8 Clinical Global Impressions-Severity, Clinical Global Impressions-Improvement (CGI-I), and response (CGI-I ≤ 2). Safety assessments included adverse events, physical and vital sign measurements, laboratory evaluations, electrocardiogram, and the Columbia-Suicide Severity Rating Scale..The safety population included 339 patients (children, n = 130; adolescents, n = 209). The primary endpoint, change from baseline in CDRS-R total score at week 8, did not statistically separate from placebo, for either desvenlafaxine (adjusted mean [standard error] change, -22.6 [1.17]) or fluoxetine (-24.8 [1.17]; placebo, -23.1 [1.18]). Week 8 CGI-I response rates were significantly greater for fluoxetine (78.2%; p = 0.017) than for placebo (62.6%); desvenlafaxine (68.7%) did not differ from placebo. Other secondary outcomes were consistent with those obtained with CDRS-R. Rates of treatment-emergent adverse events were comparable among treatment groups (desvenlafaxine, 60.0%; placebo, 70.5%; and fluoxetine, 64.3%)..Desvenlafaxine did not demonstrate efficacy for treating MDD in children and adolescents in this trial. Because neither desvenlafaxine nor the reference medication, fluoxetine, demonstrated a statistically significant difference from placebo on the primary endpoint, this was considered a failed trial and no efficacy conclusions can be drawn. Desvenlafaxine 25-50 mg/d was generally safe and well tolerated in children and adolescents in this study.
• Badger, T., Segrin, C., Swiatkowski, P., McNelis, M., Weihs, K., & Lopez, A. M. (2017). Why Latinas With Breast Cancer Select Specific Informal Caregivers to Participate With Them in Psychosocial Interventions. Journal of Transcultural Nursing, 28(Issue 4). doi:10.1177/1043659616656391
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  The purpose of this study is to describe the reasons 88 Latinas with breast cancer selected specific supportive others to participate in an 8-week psychosocial intervention. Participants were asked one open-ended question during the baseline assessment for a larger clinical trial: “Could you tell me more about why you selected [insert name] to participate in the study with you?” A content analysis of the responses found three thematic categories: source of informational or emotional support, concern for the informal caregiver’s welfare, and special characteristics or qualities of the informal caregiver. These findings reflected both the cultural value of familism, the woman’s role as caregiver to the family (marianismo), and the man’s role of provider (machismo). Findings provide support for including the supportive person identified by the patient during a health crisis rather than the provider suggesting who that should be. Psychosocial services designed and implemented through such a cultural lens are more likely to be successful.
• Badger, T., Segrin, C., Swiatkowski, P., McNelis, M., Weihs, K., & Lopez, A. M. (2017). Why Latinas With Breast Cancer Select Specific Informal Caregivers to Participate With Them in Psychosocial Interventions. Journal of transcultural nursing : official journal of the Transcultural Nursing Society, 28(4), 391-397.
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  The purpose of this study is to describe the reasons 88 Latinas with breast cancer selected specific supportive others to participate in an 8-week psychosocial intervention. Participants were asked one open-ended question during the baseline assessment for a larger clinical trial: "Could you tell me more about why you selected [insert name] to participate in the study with you?" A content analysis of the responses found three thematic categories: source of informational or emotional support, concern for the informal caregiver's welfare, and special characteristics or qualities of the informal caregiver. These findings reflected both the cultural value of familism, the woman's role as caregiver to the family ( marianismo), and the man's role of provider ( machismo). Findings provide support for including the supportive person identified by the patient during a health crisis rather than the provider suggesting who that should be. Psychosocial services designed and implemented through such a cultural lens are more likely to be successful.
• Bauer, M. R., Wiley, J. F., Weihs, K. L., & Stanton, A. L. (2017). Stuck in the spin cycle: Avoidance and intrusions following breast cancer diagnosis. British journal of health psychology, 22(3), 609-626.
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  Theories and research regarding cognitive and emotional processing during the experience of profound stressors suggest that the presence of intrusive thoughts and feelings predicts greater use of avoidance and that the use of avoidance paradoxically predicts more intrusions. However, empirical investigations of their purported bidirectional relationship are limited.
• Harris, L. N., Bauer, M. R., Wiley, J. F., Hammen, C., Krull, J. L., Crespi, C. M., Weihs, K. L., & Stanton, A. L. (2017). Chronic and episodic stress predict physical symptom bother following breast cancer diagnosis. Journal of Behavioral Medicine, 40(Issue 6). doi:10.1007/s10865-017-9855-x
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  Breast cancer patients often experience adverse physical side effects of medical treatments. According to the biobehavioral model of cancer stress and disease, life stress during diagnosis and treatment may negatively influence the trajectory of women’s physical health-related adjustment to breast cancer. This longitudinal study examined chronic and episodic stress as predictors of bothersome physical symptoms during the year after breast cancer diagnosis. Women diagnosed with breast cancer in the previous 4 months (N = 460) completed a life stress interview for contextual assessment of chronic and episodic stress severity at study entry and 9 months later. Physical symptom bother (e.g., pain, fatigue) was measured at study entry, every 6 weeks through 6 months, and at nine and 12 months. In multilevel structural equation modeling (MSEM) analyses, both chronic stress and episodic stress occurring shortly after diagnosis predicted greater physical symptom bother over the study period. Episodic stress reported to have occurred prior to diagnosis did not predict symptom bother in MSEM analyses, and the interaction between chronic and episodic stress on symptom bother was not significant. Results suggest that ongoing chronic stress and episodic stress occurring shortly after breast cancer diagnosis are important predictors of bothersome symptoms during and after cancer treatment. Screening for chronic stress and recent stressful life events in the months following diagnosis may help to identify breast cancer patients at risk for persistent and bothersome physical symptoms. Interventions to prevent or ameliorate treatment-related physical symptoms may confer added benefit by addressing ongoing non-cancer-related stress in women’s lives.
• Harris, L. N., Bauer, M. R., Wiley, J. F., Hammen, C., Krull, J. L., Crespi, C. M., Weihs, K. L., & Stanton, A. L. (2017). Chronic and episodic stress predict physical symptom bother following breast cancer diagnosis. Journal of behavioral medicine, 40(6), 875-885.
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  Breast cancer patients often experience adverse physical side effects of medical treatments. According to the biobehavioral model of cancer stress and disease, life stress during diagnosis and treatment may negatively influence the trajectory of women's physical health-related adjustment to breast cancer. This longitudinal study examined chronic and episodic stress as predictors of bothersome physical symptoms during the year after breast cancer diagnosis. Women diagnosed with breast cancer in the previous 4 months (N = 460) completed a life stress interview for contextual assessment of chronic and episodic stress severity at study entry and 9 months later. Physical symptom bother (e.g., pain, fatigue) was measured at study entry, every 6 weeks through 6 months, and at nine and 12 months. In multilevel structural equation modeling (MSEM) analyses, both chronic stress and episodic stress occurring shortly after diagnosis predicted greater physical symptom bother over the study period. Episodic stress reported to have occurred prior to diagnosis did not predict symptom bother in MSEM analyses, and the interaction between chronic and episodic stress on symptom bother was not significant. Results suggest that ongoing chronic stress and episodic stress occurring shortly after breast cancer diagnosis are important predictors of bothersome symptoms during and after cancer treatment. Screening for chronic stress and recent stressful life events in the months following diagnosis may help to identify breast cancer patients at risk for persistent and bothersome physical symptoms. Interventions to prevent or ameliorate treatment-related physical symptoms may confer added benefit by addressing ongoing non-cancer-related stress in women's lives.
• Howe, G. W., Selzer, R., Cimporescu, M., Neiderhiser, J., Moreno, F., & Weihs, K. L. (2017). Combining stress exposure and stress generation: Does neuroticism alter the dynamic interplay of stress, depression and anxiety following job loss?. Journal of Personality, 85(4), 553-564. doi:10.1111/jopy.12260
• Weihs, K. L., Murphy, W., Abbas, R., Chiles, D., England, R. D., Ramaker, S., & Wajsbrot, D. B. (2017). Desvenlafaxine Versus Placebo in a Fluoxetine-Referenced Study of Children and Adolescents with Major Depressive Disorder. Journal of child and adolescent psychopharmacology.
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  To evaluate the short-term efficacy and safety of desvenlafaxine (25-50 mg/d) compared with placebo in children and adolescents with major depressive disorder (MDD).
• Weihs, K. L., Wiley, J. F., Crespi, C. M., Krull, J. L., & Stanton, A. L. (2017). Predicting future major depression and persistent depressive symptoms: Development of a prognostic screener and PHQ-4 cutoffs in breast cancer patients. Psycho-oncology.
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  Create a brief, self-report screener for recently diagnosed breast cancer patients to identify patients at risk of future depression.
• Bauer, M. R., Harris, L. N., Wiley, J. F., Crespi, C. M., Krull, J. L., Weihs, K. L., & Stanton, A. L. (2016). Dispositional and Situational Avoidance and Approach as Predictors of Physical Symptom Bother Following Breast Cancer Diagnosis. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine.
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  Few studies examine whether dispositional approach and avoidance coping and stressor-specific coping strategies differentially predict physical adjustment to cancer-related stress.
• Czamanski-Cohen, J., & Weihs, K. L. (2016). The Bodymind Model: A platform for studying the mechanisms of change induced by art therapy. The Arts in psychotherapy, 51, 63-71.
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  This paper introduces the Bodymind model of Art Therapy and delineates the processes through which it has salutary effects on individuals coping with a variety of health related challenges. The goal of this model is to articulate how activation, reorganization, growth and reintegration of the self can emerge from bodymind processes activated by art therapy. It provides a framework for the conduct of research that will test the key theoretical mechanisms through which art therapy benefits clients. We expect this model to be a spring board for discussion, debate and development of the profession of art therapy. Furthermore, we hope readers can use this model to conduct sound mechanistic studies. This paper can inform social scientists and medical professionals on the manner in which art making can contribute to health.
• Howe, G. W., Cimporescu, M., Seltzer, R., Neiderhiser, J., Moreno, F., & Weihs, K. (2016). Combining stress exposure and stress generation: Does neuroticism alter the dynamic interplay of stress, depression, and anxiety following job loss?. Journal of personality.
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  Emerging models of stress point to a dynamic formulation where stressors and internalizing symptoms reciprocally influence each other. This study tested whether this dynamic interplay is the result of a general internalizing process underlying both depression and anxiety, and whether it varies with neuroticism.
• Larkey, L., Huberty, J., Pedersen, M., & Weihs, K. (2016). Qigong/Tai Chi Easy for fatigue in breast cancer survivors: Rationale and design of a randomized clinical trial. Contemporary clinical trials, 50, 222-8.
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  Breast cancer survivors (BCSs) often report fatigue that persists for years following treatment. Despite a growing body of evidence for meditative movement practices to improve symptoms among BCSs, few studies have explored using Qigong/Tai Chi to reduce fatigue. Additionally, few have examined the biological mechanisms through which fatigue may be reduced using Qigong/Tai Chi.
• Marroquín, B., Czamanski-Cohen, J., Weihs, K. L., & Stanton, A. L. (2016). Implicit loneliness, emotion regulation, and depressive symptoms in breast cancer survivors. Journal of behavioral medicine, 39(5), 832-44.
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  Among individuals coping with cancer, emotional approach coping-expressing and processing emotions following negative events-has been identified as a potentially adaptive form of emotion regulation. However, its mental health benefits may depend on social-cognitive factors and on how it is implemented. This study examined loneliness as a determinant of emotion regulation associations with depressive symptoms in women with breast cancer. Loneliness was examined as an implicit social-cognitive phenomenon (i.e., automatic views of oneself as lonely), and emotional expression and processing were examined as both explicit and implicit processes. Approximately 11 months after diagnosis, 390 women completed explicit measures of coping through cancer-related emotional expression and processing; an implicit measure of expression and processing (an essay-writing task submitted to linguistic analysis); and an implicit association test measuring loneliness. Depressive symptoms were assessed 3 months later. Regardless of implicit loneliness, self-reported emotional expression (but not emotional processing) predicted fewer depressive symptoms, whereas implicit expression of negative emotion during essay-writing predicted more symptoms. Only among women high in implicit loneliness, less positive emotional expression and more causal processing during the writing task predicted more depressive symptoms. Results suggest that explicit and implicit breast cancer-related emotion regulation have distinct relations with depressive symptoms, and implicit loneliness moderates effects of implicit emotional approach. Findings support implicit processes as influential mechanisms of emotion regulation and suggest targets for intervention among breast cancer survivors.
• Reed, R. G., Weihs, K. L., Sbarra, D. A., Breen, E. C., Irwin, M. R., & Butler, E. A. (2016). Emotional acceptance, inflammation, and sickness symptoms across the first two years following breast cancer diagnosis. Brain, behavior, and immunity, 56, 165-74.
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  Breast cancer diagnosis and treatment are associated with increased inflammatory activity, which can induce sickness symptoms. We examined whether emotional acceptance moderates the association between proinflammatory cytokines and self-reported sickness symptoms in women recently diagnosed with breast cancer.
• Dodds, S. E., Pace, T. W., Bell, M. L., Fiero, M., Negi, L. T., Raison, C. L., & Weihs, K. L. (2015). Erratum to: Feasibility of Cognitively-Based Compassion Training (CBCT) for breast cancer survivors: a randomized, wait list controlled pilot study. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 23(12), 3609-11.
• Dodds, S. E., Pace, T. W., Bell, M. L., Fiero, M., Negi, L. T., Raison, C. L., & Weihs, K. L. (2015). Feasibility of Cognitively-Based Compassion Training (CBCT) for breast cancer survivors: a randomized, wait list controlled pilot study. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 23(12), 3599-608.
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  This study assessed the feasibility of a meditation-based program called Cognitively-Based Compassion Training (CBCT) with breast cancer survivors. Enrollment and participant satisfaction with a novel intervention, adherence to program requirements, and differences between the intervention group and wait list controls on self-report measures were also assessed. Additionally, cortisol, a stress-related endocrine biomarker, was assessed.
• Herring, A. M., Hishaw, A., Lane, R. D., Smith, R., & Weihs, K. L. (2015).

  Affective agnosia: Expansion of the alexithymia construct and a new opportunity to integrate and extend Freud's legacy

  . Neuroscience & Biobehavioral Reviews. doi:10.1016/j.neubiorev.2015.06.007
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  We describe a new type of consisting of an impairment in the ability to mentally represent or know what one is feeling. Freud the neurologist coined the term in 1891 before creating psychoanalysis in 1895 but the term has not been previously applied to the domain of processing. We propose that the concept of affective agnosia advances the theory, measurement and treatment of what is now called alexithymia, meaning lack of words for emotion. We trace the origin of the alexithymia construct and discuss the strengths and limitations of extant research. We review evidence that the ability to represent and put emotions into words is a developmental achievement that strongly influences one's ability to experience, recognize, understand and use one's own emotional responses. We describe the neural substrates of emotional awareness and and compare and contrast these with related conditions. We then describe how this expansion of the conceptualization and measurement of processing deficits has important implications for basic emotion research and clinical practice.
• Howe, G. W., Monfort, S. S., Nettles, C. D., & Weihs, K. L. (2015).

  A longitudinal examination of re-employment quality on internalizing symptoms and job-search intentions.

  . Journal of Occupational Health Psychology. doi:10.1037/a0037753
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  Underemployed workers-those receiving less pay, working fewer hours, or using fewer skills than they would prefer-appear to experience negative mental health outcomes similar to the unemployed. Prior cross-sectional research provides mixed empirical evidence for this conclusion, however. The current study sought to clarify the impact of underemployment longitudinally, assessing mental health 5 times over 8 months after job loss. In addition to the commonly used indicators of underemployment, we designed a measure of cognitive complexity using the Occupational Information Network (O*NET), an extensive government database used to organize and categorize occupational information. Replicating past research, we found concurrent associations between all indexes of reemployment job quality and internalizing symptoms in the period immediately after reemployment. However, when controlling for quality of prior employment, all indicators except our measure for cognitive complexity became nonsignificant. As participants transitioned from unemployment to reemployment, only reductions in cognitive complexity were associated with sustained general internalizing symptoms. We also found that although changes in cognitive complexity had an immediate impact on the well-being of the recently reemployed, only the number of available weekly hours (full-time vs. part-time status) was relevant 6 to 12 weeks later. Our longitudinal model thus provides significant nuance to the current understanding of underemployment and mental health.
• Lane, R. D., Weihs, K. L., Herring, A., Hishaw, A., & Smith, R. (2015). Affective agnosia: Expansion of the alexithymia construct and a new opportunity to integrate and extend Freud's legacy. Neuroscience and biobehavioral reviews, 55, 594-611.
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  We describe a new type of agnosia consisting of an impairment in the ability to mentally represent or know what one is feeling. Freud the neurologist coined the term "agnosia" in 1891 before creating psychoanalysis in 1895 but the term has not been previously applied to the domain of affective processing. We propose that the concept of "affective agnosia" advances the theory, measurement and treatment of what is now called "alexithymia," meaning "lack of words for emotion." We trace the origin of the alexithymia construct and discuss the strengths and limitations of extant research. We review evidence that the ability to represent and put emotions into words is a developmental achievement that strongly influences one's ability to experience, recognize, understand and use one's own emotional responses. We describe the neural substrates of emotional awareness and affective agnosia and compare and contrast these with related conditions. We then describe how this expansion of the conceptualization and measurement of affective processing deficits has important implications for basic emotion research and clinical practice.
• Larkey, L. K., Roe, D. J., Weihs, K. L., Jahnke, R., Lopez, A. M., Rogers, C. E., Oh, B., & Guillen-Rodriguez, J. (2015). Randomized controlled trial of Qigong/Tai Chi Easy on cancer-related fatigue in breast cancer survivors. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 49(2), 165-76.
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  Many breast cancer survivors experience fatigue, mood, and sleep disturbances.
• Monfort, S. S., Howe, G. W., Nettles, C. D., & Weihs, K. L. (2015). A longitudinal examination of re-employment quality on internalizing symptoms and job-search intentions. Journal of occupational health psychology, 20(1), 50-61.
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  Underemployed workers-those receiving less pay, working fewer hours, or using fewer skills than they would prefer-appear to experience negative mental health outcomes similar to the unemployed. Prior cross-sectional research provides mixed empirical evidence for this conclusion, however. The current study sought to clarify the impact of underemployment longitudinally, assessing mental health 5 times over 8 months after job loss. In addition to the commonly used indicators of underemployment, we designed a measure of cognitive complexity using the Occupational Information Network (O*NET), an extensive government database used to organize and categorize occupational information. Replicating past research, we found concurrent associations between all indexes of reemployment job quality and internalizing symptoms in the period immediately after reemployment. However, when controlling for quality of prior employment, all indicators except our measure for cognitive complexity became nonsignificant. As participants transitioned from unemployment to reemployment, only reductions in cognitive complexity were associated with sustained general internalizing symptoms. We also found that although changes in cognitive complexity had an immediate impact on the well-being of the recently reemployed, only the number of available weekly hours (full-time vs. part-time status) was relevant 6 to 12 weeks later. Our longitudinal model thus provides significant nuance to the current understanding of underemployment and mental health.
• Stanton, A. L., Wiley, J. F., Krull, J. L., Crespi, C. M., Hammen, C., Allen, J. J., Barrón, M. L., Jorge, A., & Weihs, K. L. (2015). Depressive episodes, symptoms, and trajectories in women recently diagnosed with breast cancer. Breast cancer research and treatment, 154(1), 105-15.
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  Depression carries serious psychosocial, physical, and economic consequences for cancer survivors. Study goals were to characterize patterns and predictors of depressive symptoms and major depressive episodes in recently diagnosed breast cancer patients. Consecutively recruited women (N = 460) completed a validated interview (CIDI) and questionnaire measure (CES-D) of depression within 4 months after invasive breast cancer diagnosis and at six additional assessments across 12 months. Outcomes were major depressive episodes, continuous symptom scores, and latent symptom trajectory classes. Across 12 months, 16.6 % of women met criteria for a major depressive episode. Unemployment predicted depressive episodes after other correlates were controlled. Distinct trajectory classes were apparent: an estimated 38 % of women had chronically elevated symptoms (High trajectory), 20 % recovered from elevated symptoms (Recovery), and 43 % had lower symptoms (Low and Very Low trajectories). Although 96 % of episodes occurred in the High or Recovery classes, 66 % of women in the High trajectory did not have an episode. Women in the Low (vs High) trajectory were more likely to be older, retired, more affluent, and have fewer comorbid diseases and briefer oncologic treatment. Women in the Recovery trajectory (vs High) were more likely to be married and more affluent and have fewer comorbid diseases. Assuming available therapeutic resources, assessment of both depressive symptoms and episodes over several months after diagnosis is important. Identification of patients at risk for persistently high depressive symptoms (e.g., younger, longer treatment course) opens targeted opportunities to prevent and promote rapid recovery from depression.
• Stanton, A. L., Wiley, J., Krull, J., Crespi, C., & Weihs, K. L. (2017). Cancer-Related Coping Processes Predict Depressive Symptoms, Trajectories, and Episodes across One Year. Journal of Consulting and Clinical Psychology.
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  The Role of Coping Processes in Predicting Depression after Breast Cancer Diagnosis ORCancer-Related Coping Processes Predict Depressive Symptoms, Trajectories, and Episodes across One YearAnnette L. Stanton1,2,3, Joshua F. Wiley4, Jennifer L. Krull1, Catherine M. Crespi2,5, & Karen L. Weihs,6,7
• Groysman, M. J., Ogwaro, K., Fort, C., Weihs, K. L., & Lane, R. D. (2014). HIGHER EMOTIONAL AWARENESS ASSOCIATED WITH BETTER PHYSICAL HEALTH IN UNDERGRADUATES. Psychosomatic Medicine, 76(3), A32.
• Menzl, I., Lebeau, L., Pandey, R., Hassounah, N. B., Li, F. W., Nagle, R., Weihs, K., & McDermott, K. M. (2014). Loss of primary cilia occurs early in breast cancer development. Cilia, 3, 7.
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  Primary cilia are microtubule-based organelles that protrude from the cell surface. Primary cilia play a critical role in development and disease through regulation of signaling pathways including the Hedgehog pathway. Recent mouse models have also linked ciliary dysfunction to cancer. However, little is known about the role of primary cilia in breast cancer development. Primary cilia expression was characterized in cancer cells as well as their surrounding stromal cells from 86 breast cancer patients by counting cilia and measuring cilia length. In addition, we examined cilia expression in normal epithelial and stromal cells from reduction mammoplasties as well as histologically normal adjacent tissue for comparison.
• Robbins, M. L., López, A. M., Weihs, K. L., & Mehl, M. R. (2014). Cancer conversations in context: naturalistic observation of couples coping with breast cancer. Journal of family psychology : JFP : journal of the Division of Family Psychology of the American Psychological Association (Division 43), 28(3), 380-90.
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  This study explored the feasibility and potentials of a naturalistic observation approach to studying dyadic coping in everyday life. Specifically, it examined the natural context and content of the spontaneous cancer conversations of couples coping with cancer, and how they relate to patients' and spouses' psychological adjustment. Women with breast cancer (N = 56) and their spouses wore the electronically activated recorder (EAR), an unobtrusive observation method that periodically records snippets of ambient sounds, over one weekend to observe the couples' cancer conversations in their natural context. Both patients and spouses completed self-reported measures of psychological adjustment at baseline and at a 2-month follow-up. Cancer was a topic of approximately 5% of couples' conversations. Cancer conversations occurred more often within the couple than with friends and family, and they were more often informational than emotional or supportive. Consistent with research on the social cognitive processing model (Lepore & Revenson, 2007), spouses' engagement in emotional disclosure and informational conversation with patients predicted better patient adjustment. This first naturalistic observation study of dyadic coping revealed that the EAR method can be implemented with high compliance and relatively low obtrusiveness within the sensitive context of couples coping with cancer, and having a spouse who discussed cancer in an emotional or informational way predicted better patient adjustment. As a complement to in-lab and other momentary assessment methods, a naturalistic observation approach with a method such as the EAR can contribute to a more comprehensive understanding of the role that communication processes play in coping with cancer.
• Varga, C. M., Nettles, C. D., Whitesel, A. L., Howe, G. W., & Weihs, K. L. (2014). The Interplay of Stress and Attachment in Individuals Weathering Loss of Employment. Journal of research in personality, 50, 23-32.
• Varga, C. M., Nettles, C. D., Whitesel, A. L., Howe, G. W., & Weihs, K. L. (2014). The interplay of stress and attachment in individuals weathering loss of employment. Journal of Research in Personality, 50(Issue 1). doi:10.1016/j.jrp.2014.02.002
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  This study addressed two questions concerning the interplay between adult romantic attachment and exposure to stressful circumstances: do stressful events predict fluctuation in romantic attachment during a period of unemployment, and does attachment measured at one point predict later changes in stressors? Stressors and attachment were measured over a six month period following involuntary job loss for a sample of 426 adults. Autoregressive models found evidence for both the stress-effects and stress-generation hypotheses, with more stressors associated with prospective decreases in attachment, and lower attachment associated with prospective increases in stressors. These findings support a more dynamic formulation of the interplay between attachment and exposure to stressors over the months following job loss. © 2014 Elsevier Inc.
• Weihs, K. L., Reiss, D., & Jongil, Y. (2014). 부모의 우울증, 가족환경, 청소년 자녀의내재화 및 외현화 증상. Korean Journal of Youth Studies, 21(10), 53-74.
• Marshall, C. A., Curran, M. A., Koerner, S. S., Weihs, K. L., Hickman, A. C., & García, F. A. (2013). Information and support for co-survivors during or after cancer treatment: Consideration of Un Abrazo Para la Familia as a model for family-focused intervention in cancer rehabilitation. Work (Reading, Mass.), 46(4), 395-405.
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  The development and evaluation of Un Abrazo Para La Familia, [A Hug for the Family] is described. Un Abrazo is discussed as an effective model of education, information-sharing, and skill-building for use with low-income co-survivors of cancer.
• Marshall, C. A., Koerner, S. S., Weihs, K. L., Garcia, F. A., Weihs, K. L., Verdugo, L., Marshall, C. A., Larkey, L. K., Koerner, S. S., Garcia, F. A., Curran, M. A., & Badger, T. A. (2013). Un Abrazo Para La Familia: providing low-income Hispanics with education and skills in coping with breast cancer and caregiving.. Psycho-oncology, 22(2), 470-4. doi:10.1002/pon.2108
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  Un Abrazo Para La Familia (A Hug for the Family) is an intervention designed to increase the accessibility of cancer information to low-income and medically underserved co-survivors of cancer. Co-survivors are family members or friends of an individual diagnosed with cancer. Our goal was to increase socio-emotional support for these co-survivors and improve skills in coping with cancer. The purpose of our pilot study was to explore the effectiveness of the intervention in increasing cancer knowledge and self-efficacy among co-survivors..Un Abrazo consisted of three one-hour sessions, in either Spanish or English. Sessions were delivered by a trained promotora (community health worker), in partnership with a counselor. Sixty participants completed measures of cancer knowledge and self-efficacy preceding (pre-test) and following the intervention (post-test)..From pre-test to post-test, the percentage of questions answered correctly about cancer knowledge increased (p < 0.001), as did ratings of self-efficacy (p < 0.001). Decreases were seen in 'Do not know' responses for cancer knowledge (p < 0.01), with a negative correlation between number of 'Do not knows' on cancer knowledge at pre-test and ratings of self-efficacy at pre-test (r = -0.47, p < 0.01)..When provided an accessible format, co-survivors of cancer from underserved populations increase their cancer knowledge and self-efficacy. This is notable because research indicates that family members and friends with increased cancer knowledge assume more active involvement in the cancer care of their loved ones.
• Weihs, K. L., Weihs, K. L., Segrin, C., Pasvogel, A., Lopez, A. M., Hepworth, J. T., & Badger, T. A. (2013). Telephone-delivered health education and interpersonal counseling improve quality of life for Latinas with breast cancer and their supportive partners.. Psycho-oncology, 22(5), 1035-42. doi:10.1002/pon.3101
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  This study aims to test two telephone-delivered interventions for their efficacy in improving quality of life (QOL) (psychological, physical, social, and spiritual) among Latinas with breast cancer and their family members or friends (labeled supportive partners in this study)..Latinas with breast cancer and their supportive partners (SPs) were randomly assigned to one of two telephone delivered 8-week interventions: (i) telephone interpersonal counseling (TIP-C) or (ii) telephone health education (THE). QOL assessments were made at baseline, immediately after the 8-week interventions ended, and at an 8-week follow-up. Seventy Latinas and their 70 SPs completed all assessments (36 in health education and 34 in counseling) and were included in the final analysis..Both Latinas with breast cancer and their SPs had significant improvements in virtually all dimensions of QOL over the 16 weeks of the investigation. However, there was no evidence documenting the superiority of either intervention for improving QOL. Preliminary cost analysis found that the counseling intervention cost about $164.68 for one dyad compared with $107.03 for health education. The majority of participants reported benefit from the intervention and liked that the intervention was in Spanish, included SPs, and was delivered by telephone..The results of this study show that relatively brief, culturally appropriate, and highly accessible telephone-delivered interventions that provide emotional and information support can bring about substantial improvements in QOL for both Latinas with breast cancer and their SPs.
• Weihs, K. L., Weihs, K. L., Smith, H. L., Robbins, M. L., & Mehl, M. R. (2013). Linguistic indicators of patient, couple, and family adjustment following breast cancer.. Psycho-oncology, 22(7), 1501-8. doi:10.1002/pon.3161
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  This study examined how language reflective of emotional and social processes during a cancer-related discussion relates to patient, couple, and family adjustment after breast cancer. It investigated whether emotional expression or relational focus, manifested in language use, indicates healthy family coping following breast cancer..Family members each completed measures of adjustment (Family Environment Scale, Dyadic Adjustment Scale, and patient Profile of Mood States) and engaged in a 15-min family discussion about how they have coped with breast cancer. Transcripts from the discussion were submitted to a text-analysis software program to obtain frequency of positive and negative emotion words, and personal pronouns spoken by each family member. The relationship between self-reports of adjustment and frequency of language use during the family discussion was analyzed with regression models..Partners' positive emotion words were indicative of better family adjustment, patients' negative emotion words indicated greater family conflict, and sons' and daughters' anger words indicated poorer adjustment, whereas their anxiety words indicated better family adjustment. Partner we-talk was related to better dyadic adjustment, and couples' 'you' was somewhat related to worse adjustment at all levels..Important information about how a family copes with breast cancer can be obtained by attending to families' emotional and relational language. This study suggests that clinicians and members of families' support networks can gauge how well a family has adapted after the breast cancer experience by attending to the type of words that each family member uses to describe how they coped with breast cancer.
• Yuh, J., Reiss, D., & Weihs, K. L. (2013). Parent-adolescent Discrepancies Regarding Adolescent Psychopathology and its Relation to Parental Characteristics in a Clinical Sample. International journal of human ecology, 14(2), 15-24. doi:10.6115/ijhe.2013.14.2.15
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  This study investigated the differences between adolescents` own perceptions of their psychopathology and perceptions by clinically depressed parents of their adolescents` psychopathology. The study also examined parental characteristics that accounted for discrepancies between parents and adolescents. The clinical sample consisted of 61 adolescents and their parents who were diagnosed with a major depressive disorder. The adolescents and parents evaluated the adolescents` psychopathology in separate interviews with the Child Behavior Checklist (CBCL) and the Youth Self- Report (YSR). Parents reported on current depressive symptoms and parenting practices using questionnaires. The results revealed that parent-adolescent discrepancies were greater in regard to affective and anxiety problems compared to oppositional defiant and conduct problems. Parental rejection was associated with differences in scores for affective problems after controlling for parents` current depressive symptoms and adolescents` age and gender. The findings highlight the importance of considering adolescents` affective and anxiety problems when treating depressed parents. Furthermore, the findings suggest that parental rejection may play a pivotal role when interpreting the discrepancy concerning adolescents` affective problems.
• Howe, G. W., Hornberger, A. P., Neiderhiser, J. M., Weihs, K. L., & Moreno, F. A. (2012). Higher-order structure in the trajectories of depression and anxiety following sudden involuntary unemployment.. Journal of abnormal psychology, 121(2), 325-38. doi:10.1037/a0026243
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  Recent work on comorbidity finds evidence for hierarchical structure of mood and anxiety disorders and symptoms. This study tests whether a higher-order internalizing factor accounts for variation in depression and anxiety symptom severity and change over time in a sample experiencing a period of major life stress. Data on symptoms of depression, chronic worry, and social anxiety were collected five times across seven months from 426 individuals who had recently lost jobs. Growth models for each type of symptom found significant variation in individual trajectories. Slopes were highly correlated across symptom type, as were intercepts. Multilevel confirmatory factor analyses found evidence for a higher-order internalizing factor for both slopes and intercepts, reflective of comorbidity of depression and anxiety, with the internalizing factor accounting for 54% to 91% of the variance in slopes and intercepts of specific symptom sets, providing evidence for both a general common factor and domain-specific factors characterizing level and change in symptoms. Loadings on the higher order factors differed modestly for men and women, and when comparing African American and White participants, but did not differ by age, education, or history of depression. More distal factors including gender and history of depression were strongly associated with internalizing in the early weeks after job loss, but rates of change in internalizing were associated most strongly with reemployment. Findings suggest that stressors may contribute in different ways to the common internalizing factor as compared to variance in anxiety and depression that is independent of that factor.
• Iannone, M., Pennick, L., Tom, A., Cui, H., Gilbert, M., Stopeck, A. T., & Weihs, K. L. (2012). Prevalence of depression in adults with haemophilia.. Haemophilia : the official journal of the World Federation of Hemophilia, 18(6), 868-74. doi:10.1111/j.1365-2516.2012.02863.x
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  Multiple factors place adults with haemophilia at risk for depression. Health outcomes can be compromised in depressed patients secondary to increased risk taking behaviour and poor compliance with treatment recommendations. To assess the prevalence and risk factors associated with depression in adult patients with haemophilia treated at a haemophilia treatment centre. Adults with haemophilia were screened for depression during their annual clinic visit using the Patient Health Questionnaire 9 (PHQ-9), a validated tool for depression screening in adults. Depression was defined as a PHQ-9 score ≥ 5. Risk factors associated with depression were collected by chart review and correlated with depression scores. A total of 41 adult patients consented to the study and 37% met criteria for depression. Fifty-three per cent of patients with depression reported moderate to severe symptoms of depression (PHQ-9 score >10). Seventy-six per cent of patients with depression reported suffering functional impairment due to their depressive symptoms. Lack of social support and unemployment were significantly associated with higher PHQ-9 scores (P = 0.04 and P = 0.01 respectively). Adult patients with haemophilia have a high prevalence of depression. The addition of depression screening to the comprehensive care of adults with haemophilia may result in improved overall health outcomes and treatment adherence.
• Kogan, A. V., Weihs, K. L., Weihs, K. L., Kogan, A. V., & Allen, J. J. (2012). Cardiac vagal control as a prospective predictor of anxiety in women diagnosed with breast cancer.. Biological psychology, 90(1), 105-11. doi:10.1016/j.biopsycho.2012.02.019
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  Low cardiac vagal control (CVC) has been associated with state and trait anxiety and anxiety spectrum disorders. Studies indicate that diagnosis and treatments for breast cancer may be associated with anxiety. The current study examined whether CVC prospectively predicted a trajectory of change in anxiety following breast cancer diagnosis. Forty-three women diagnosed with non-metastatic breast cancer completed the Taylor Manifest Anxiety Scale and the Perceived Stress Scale, and a 5-min resting electrocardiographic (ECG) segment was recorded. Self-report measures were completed approximately every 3 months for a year. Respiratory sinus arrhythmia (RSA) significantly predicted the trajectory of change in anxiety over the follow-up period: participants with higher baseline RSA evidenced decreasing anxiety, whereas those with lower baseline RSA had increasing anxiety. These results are consistent with the hypothesis that CVC facilitates the modulation of anxiety in women coping with significant stressors of breast cancer diagnosis and treatment.
• Marshall, C. A., Weihs, K. L., Armin, J., Garcia, F. A., Weihs, K. L., Marshall, C. A., Larkey, L. K., Garcia, F. A., Curran, M. A., Badger, T. A., & Armin, J. (2011). Considerations of culture and social class for families facing cancer: the need for a new model for health promotion and psychosocial intervention.. Families, systems & health : the journal of collaborative family healthcare, 29(2), 81-94. doi:10.1037/a0023975
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  Cancer is a family experience, and family members often have as much, or more, difficulty in coping with cancer as does the person diagnosed with cancer. Using both family systems and sociocultural frameworks, we call for a new model of health promotion and psychosocial intervention that builds on the current understanding that family members, as well as the individuals diagnosed with cancer, are themselves survivors of cancer. We argue that considering culture, or the values, beliefs, and customs of the family, including their choice of language, is necessary to understand fully a family's response to cancer. Likewise, acknowledging social class is necessary to understand how access to, and understanding of, otherwise available interventions for families facing cancer can be limited. Components of the model as conceptualized are discussed and provide guidance for psychosocial cancer health disparities research and the development of family-focused, strength-based, interventions.
• Marshall, C. A., Weihs, K. L., Koerner, S. S., Garcia, F. A., Weihs, K. L., Pedroza, R., Marshall, C. A., Larkey, L. K., Koerner, S. S., Garcia, F. A., Curran, M. A., & Badger, T. A. (2011). "Like a Mexican wedding": psychosocial intervention needs of predominately Hispanic low-income female co-survivors of cancer.. Journal of family nursing, 17(3), 380-402. doi:10.1177/1074840711416119
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  Although recent work has recognized that the influence and consequences of cancer extend beyond the individual receiving the diagnosis, no studies have focused on the specific psychosocial intervention needs of female co-survivors in low-income populations. In this qualitative study, the co-survivors, 16 women, representing 10 low-income families and predominately Hispanic, were interviewed about their experience of having someone in their family diagnosed with cancer. Several themes emerged from the data, including family stress, lack of skill in coping with the effects of cancer (e.g., depression of their loved one), a need for financial help, a willingness to share with others, and reliance on faith to see them through the cancer experience. Whereas no agreement existed as to where and how to provide an intervention, participants reported that tailoring an intervention to family needs and delivering it in a way that was accessible to them was important.
• Michael, Y. L., Carlson, N. E., Bowen, D. J., Ritenbaugh, C., Chlebowski, R. T., Weihs, K. L., & Ockene, J. K. (2011). Re: "Invited commentary: personality as a causal factor in cancer risk and mortality--time to retire a hypothesis?".. American journal of epidemiology, 173(6), 716; author reply 716-7. doi:10.1093/aje/kwq448
• Weihs, K. L., Weihs, K. L., Robbins, M. L., Mehl, M. R., Lopez, A. M., Kasle, S., & Focella, E. S. (2011). Naturalistically observed swearing, emotional support, and depressive symptoms in women coping with illness.. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 30(6), 789-92. doi:10.1037/a0023431
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  The goal of this study was to explore the intra- and interpersonal consequences of swearing. Specifically, it investigated what implications swearing has for coping with and adjustment to illness..The present project combined data from two pilot studies of 13 women with rheumatoid arthritis and 21 women with breast cancer. Participants wore the Electronically Activated Recorder, an unobtrusive observation sampling method that periodically records snippets of ambient sounds, on weekends to track spontaneous swearing in their daily interactions, and completed self-reported measures of depressive symptoms and emotional support..Naturalistically observed swearing in the presence of others, but not alone, was related to decreases in reported emotional support and increases in depressive symptoms over the study period. Further, decreases in emotional support mediated the effect of swearing on disease-severity adjusted changes in depressive symptoms..These exploratory results are consistent with the notion that swearing can sometimes repel emotional support at the expense of psychological adjustment. This is one of the first studies to examine the role of swearing, a ubiquitous but understudied psychological phenomenon, in a medical context.
• Wert, J. M., & Weihs, K. L. (2011). A primary care focus on the treatment of patients with major depressive disorder.. The American journal of the medical sciences, 342(4), 324-30. doi:10.1097/maj.0b013e318210ff56
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  Major depressive disorder (MDD) is a common psychiatric illness affecting nearly 20% of adults in the United States at least once during their lifetime. MDD is frequently diagnosed and treated in the primary care setting. Management of the disease may be complicated by patients and family members feeling stigmatized by the diagnosis and not understanding that depression is a treatable medical illness, which, in turn, fosters low rates of adherence to treatment recommendations. Incomplete or delayed response to treatment, adverse events associated with antidepressants and medical or psychiatric comorbidities also interfere with optimal depression management. This article presents an overview of diagnostic and treatment guidelines for MDD and focuses on challenges encountered by primary care physicians. The role of antidepressant medications, psychotherapy and nonpharmacologic interventions for the treatment of patients with MDD is described, and factors influencing treatment selection, such as adverse event profiles and patient characteristics, are examined.
• Lane, R. D., & Weihs, K. L. (2010). Freud's antiquities. Psychodynamic Practice, 16(1), 77-78. doi:10.1080/14753630903457988
• Weihs, K. L., Weihs, K. L., Skrepnek, G. H., Reed, P. G., Malone, D. C., & Hess, L. M. (2010). Preferences of patients and oncologists for advanced ovarian cancer treatment-related health States. Health Outcomes Research in Medicine, 1(1), e51-e59. doi:10.1016/j.ehrm.2010.02.001
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  Abstract Purpose The purpose of this study was to compare expected utility preferences of various health outcomes of chemotherapy treatment among ovarian-cancer patients receiving chemotherapy, ovarian cancer patients who were post-treatment (eg, under surveillance), and oncologists who treat this disease. Methods Participants were asked to score 6 hypothetical ovarian cancer treatment-related health states using both a rating scale and the standard gamble. Scores were obtained in the range of 0.0 (death) to 1.0 (perfect health) for each hypothetical health state, with a difference of 0.10 being practically meaningful, and were analyzed by analysis of variance. Results Seventy-five eligible participants were included in this study (41 ovarian-cancer patients and 34 oncologists). Patients and physicians reported similar responses in the rating scale exercise (F = 0.854, P = .43). However, when the health states were presented with an element of uncertainty via the standard gamble exercise, patients who were under surveillance reported significantly different expected utilities of the health states from physicians and from patients who were receiving treatment, demonstrating greater risk aversion than the other groups (F = 4.270, P = .018). Conclusions This study suggests that there are significant differences in expected utility preferences among patients who are under surveillance as opposed to oncologists or patients receiving treatment, despite similarities in rating scale values. These findings suggest a need to further evaluate these differences in expected utility preferences in the context of decision in the setting of recurrent disease, where a patient under surveillance must make decisions related to re-initiation of therapy at a time when her preferences are likely to significantly differ from those of oncologists.
• Michael, Y. L., Carlson, N. E., Chlebowski, R. T., Aickin, M., Weihs, K. L., Ockene, J. K., Bowen, D. J., & Ritenbaugh, C. (2009). Influence of stressors on breast cancer incidence in the Women's Health Initiative.. Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 28(2), 137-46. doi:10.1037/a0012982
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  To examine associations among life events stress, social support, and breast cancer incidence in a cohort of postmenopausal women. DESIGN AND MAIN OUTCOME MEASURE: Women's Health Initiative observational study participants, breast cancer free at entry, who provided assessment of stressful life events, social support, and breast cancer risk factors, were prospectively followed for breast cancer incidence (n = 84,334)..During an average of 7.6 years of follow-up, 2,481 invasive breast cancers were diagnosed. In age-adjusted proportional hazards models, 1 stressful life event was associated with increased risk, but risk decreased with each additional stressful life event. After adjustment for confounders the decreasing risk was not significant. Stressful life events and social support appeared to interact in relation to breast cancer risk such that women who had greater number of stressful life events and low social support had a decreased risk of breast cancer..This study found no independent association between stressful life events and breast cancer risk. The results are compatible with a more complex model of psychosocial factors interacting in relation to breast cancer risk.
• Weihs, K. L., Weihs, K. L., Roe, D. J., Pournajafi-nazarloo, H., Frank, D., & Carter, C. (2009). Oxytocin administration, but not social housing condition, reduces growth rate of human breast cancer xenografts (MCF7) in SCID mice.. Cancer Research, 69(2), 331s. doi:10.1158/0008-5472.sabcs-5076
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  CTRC-AACR San Antonio Breast Cancer Symposium: 2008 Abstracts Abstract #5076 Background: Oxytocin decreases human breast cancer cell proliferation in vitro and oxytocin receptors are reported to be present on at least 80% of human breast tumors. Animal studies show increased oxytocin levels in association with pair bonding, maternal care giving and mating behavior. Our experiment tested two hypotheses: 1) exogenous administration of oxytocin(OT) and 2) sibling-group housing, compared to individual housing, will reduce the growth in human breast cancer cell -MCF7-xenografts in SCID mice. We also hypothesized this effect would be mediated by differences in circulating OT. Materials and Methods: A 2 X 2 design was used to study 48 animals. Half of the animals lived in group(GRP) housing, the others were housed singly(SGL). Half of the animals in each housing group received OT (10-9 M) administered by a continuous release pellet(Innovative Research of America) and the others received a placebo(PBO) pellet. At weaning(4 wks), SCID mice were randomized to individual cages vs. groups of 4 mice per cage. At maturation (vaginal cornification-8 wks), continuous release estrogen pellets were implanted and two days later MCF7 cells(0.1ml/10X106)were implanted in the mammary fat pad. Pellets containing OT or PBO were implanted, subcutaneously, 2 days after the MCF7 cells. Plasma was collected 2 days prior to and 2 days following pellet & cell implantation, 14 days later and at sacrifice (41 – 60 d) for analysis of OT concentration using enzyme immunoassay (Assay Designs, Inc). Tumor volumes were measured every three days. Statistical Analyses: A natural log transformation of the plasma OT levels was used to reduce skewness in the observed values. Tumor volumes were converted to cubed root to linearize and a regression line was fit to generate tumor growth rate(slope). Differences in tumor growth rate by housing condition (GRP/SGL), oxy Rx(Y/N) and OT plasma levels were tested by mixed effects ANOVA. Results: OT plasma levels in animals with OT pellets, as compared to PBO, were significantly different at 2 & 14 days after pellet implantation(p=0.001), but not at baseline or at sacrifice. OT plasma levels were higher in group vs single housing (p=.023). Due to the lack of difference in plasma OT at the time of sacrifice, we limited prediction of tumor growth rate to the first 29 days when OT pellets were secreting OT (extrapolation from levels at 2 & 14 days). Slower tumor growth rate occurred with OT treatment compared to PBO(p=0.031), and with higher OT plasma levels(p=0.032) but not with group vs. single housing. Discussion: Continuous oxytocin administration over 29 days produced increased oxytocin plasma levels and both were associated with reduced MCF7 xenograft growth rate in SCID mice. Our next step will be to test whether breast tumor oxytocin receptor density moderates the association between plasma oxytocin and tumor growth rate. Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5076.
• Weihs, K. L., Enright, T. M., & Simmens, S. J. (2008). Close relationships and emotional processing predict decreased mortality in women with breast cancer: preliminary evidence.. Psychosomatic medicine, 70(1), 117-24. doi:10.1097/psy.0b013e31815c25cf
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  To examine close relationships and emotional processing as predictors of breast cancer mortality..Ninety women were enrolled at 14 +/- 5 months after diagnosis of Stage II/III breast cancer. The Nottingham Prognostic Index (NPI) quantified disease severity. Cox proportional hazards analyses were used to predict mortality using standardized variables..Twenty-one subjects developed recurrent disease and 16 died during an 8-year follow-up. NPI predicted increased mortality: risk ratio (RR) = 1.60 (CI = 1.05-2.41). Decreased mortality was predicted by confiding marriage (CONF): RR = 0.31 (CI = 0.10-0.99), and number of dependable, nonhousehold supports (SUPP): RR = 0.41 (CI = 0.21-0.80). A composite measure of close relationships (standardized CONF + SUPP = SUPPCONF) had a strong protective effect: RR = 0.30 (CI = 0.13-0.69). Two emotion processing variables, acceptance of emotion and emotional distress (POMS-TOT) were found to be negatively correlated (r = -.49). Acceptance of emotion predicted decreased mortality (RR = 0.46 (CI = 0.24-0.86)) when analyzed together with emotional distress, but not separately. There was a trend for a protective effect of emotional distress: RR = 0.37 (CI = 0.12-1.09) in the same analysis. RRs for mortality in a multivariable analysis were: SUPPCONF: RR = 0.55 (CI = 0.30-1.00); acceptance of emotion: RR = 0.48 (CI = 0.25-0.91); and emotional distress: RR = 0.40 (CI = 0.14-1.19)..Two aspects of close relationships--marital confiding and dependable, nonhousehold supports--were protective against breast cancer progression. Acceptance of emotion, after controlling for emotional distress, also predicted decreased mortality. Analysis of close relationships together with emotion processing variables suggested unique protective effects against mortality, but a larger study is necessary to determine whether this is the case.
• Weihs, K. L., Enright, T. M., & Simmens, S. J. (2008). Response. Psychosomatic Medicine, 70(Issue 6). doi:10.1097/psy.0b013e318180f27f
• Politi, M. C., Enright, T. M., & Weihs, K. L. (2007). The effects of age and emotional acceptance on distress among breast cancer patients.. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 15(1), 73-9. doi:10.1007/s00520-006-0098-6
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  This study examined whether emotional acceptance moderates the relationship between age and distress among breast cancer patients near the end of the first year after diagnosis..The Emotional acceptance scale and the Profile of Mood States scale were completed by 79 women with Stage II or III breast cancer..Results showed that younger women reported greater distress than older women. Those who were less accepting of their emotions also reported greater distress than those who were more accepting, regardless of age..These results suggest that emotional acceptance may be beneficial for both younger and older women facing breast cancer. Additional implications of these findings are discussed.
• Weihs, K. L. (2007). Review of Individuals, families and the new era of genetics: A biopsychosocial perspective.. Families, Systems, & Health, 25(2), 223-226. doi:10.1037/1091-7527.25.2.223
• Weihs, K. L., Enright, T. M., Weihs, K. L., Krouse, R., Enright, T. M., & Badger, T. A. (2006). Interpersonal relationship quality in people with cancer. Psycho-oncology, 15(1), S3.
• Weihs, K. L., Simmens, S. J., Mizrahi, J., Enright, T. M., Hunt, M. E., & Siegel, R. S. (2005). Dependable social relationships predict overall survival in Stages II and III breast carcinoma patients.. Journal of psychosomatic research, 59(5), 299-306. doi:10.1016/j.jpsychores.2004.12.002
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  The effect of support, from dependable non-household relationships, on breast cancer progression was studied using a prospective, longitudinal design..Dependable social support was assessed in women with invasive breast carcinoma Stages II and III within 18 months after diagnosis. Disease outcome was monitored for 8 to 9 years. Cox regression analyses, including the Nottingham Prognostic Index (NPI) score of disease severity, tested the association between the number of dependable support persons and time to death..Ninety participants listed between 1 and 16 dependable nonhousehold support persons (mean = 6, S.D. = 4). There were 21 recurrences and 16 deaths from breast cancer at the end of the study. The number of dependable supports predicted decreased mortality [RR = 0.41 (0.21-0.80), P = .01] after controlling for NPI. NPI predicted increased mortality [RR = 1.6 (1.0, 2.4), P = .05]..For patients with Stages II and III breast cancer, the number of dependable, nonhousehold relationships predicts decreased mortality, after accounting for disease severity.
• Carroll, B. J., Schneider, L. S., Clary, C. M., Newhouse, P. A., Shiovitz, T., Weihs, K. L., Nelson, J. C., & Krishnan, K. R. (2004). Sertraline and the Cheshire Cat in Geriatric Depression [6] (multiple letters). American Journal of Psychiatry, 161(4), 759-761.
• Schneider, L. S., Nelson, J. C., Clary, C. M., Krishnan, K. R., Shiovitz, T., Weihs, K. L., & Newhouse, P. A. (2004). Dr. Schneider and Colleagues Reply. American Journal of Psychiatry, 161(4), 759-a-761. doi:10.1176/appi.ajp.161.4.759-a
• Kimmel, P. L., Chawla, L. S., Amarasinghe, A., Peterson, R. A., Weihs, K. L., Simmens, S. J., Alleyne, S., Burke, H. B., Cruz, I., & Veis, J. H. (2003). Anthropometric measures, cytokines and survival in haemodialysis patients.. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 18(2), 326-32. doi:10.1093/ndt/18.2.326
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  Lower serum albumin concentration (sAlb) and higher levels of pro-inflammatory cytokines have been reported to predict death in patients treated with haemodialysis (HD). SAlb, along with anthropometric measures, has been used as a surrogate marker for nutritional status in patients with chronic disease. Though adequate nutrition has been considered an important factor for patients treated with HD, it has not been established if any nutritional markers other than lower serum albumin and lower body mass index (BMI) predict death. Furthermore, it has not been shown whether anthropometric measures other than BMI are associated with predictors of mortality..At the outset of the study, patients were assessed using demographic and anthropometric indices including arm fat area (AFA), arm muscle area (AMA), BMI, per cent ideal weight (PIW), pre-dialysis sAlb, and circulating levels of tumour necrosis factor-alpha (TNF-alpha), IL-1 and IL-6. A severity index, previously demonstrated to be a mortality marker, was used to grade medical co-morbidity..Two-hundred and forty patients entered the study. The mean age was 55.1+/-14.3 years, mean sAlb 3.76+/-0.60 mg/dl, mean AFA 1742+/-1225 mm(2), mean AMA 5464+/-1817 mm(2), mean PIW 101.0+/-21.3% and mean BMI 24.9+/-5.6 kg/m(2). PIW, BMI, AFA and AMA were, as expected, all highly correlated with one another. SAlb correlated with serum transferrin; however, neither sAlb nor serum transferrin concentration correlated with circulating cytokine levels. Circulating cytokines and sAlb did not correlate with PIW, BMI, AFA or AMA. In Cox regression analyses using multiple control variables, IL-6 predicted survival, while the anthropometric measures did not..Pro-inflammatory cytokines and sAlb are robust predictors of death in patients treated with HD. PIW and BMI correlate well with other anthropometric measures in patients treated with HD, but these measures do not correlate with markers of inflammation. Anthropometric measures are poor predictors of survival compared with measures linked to the acute-phase response.
• Liebowitz, M. R., Demartinis, N. A., Londborg, P. D., Smith, W. T., Chung, H., Fayyad, R., Clary, C. M., & Weihs, K. L. (2003). Efficacy of sertraline in severe generalized social anxiety disorder: results of a double-blind, placebo-controlled study.. The Journal of clinical psychiatry, 64(7), 785-92. doi:10.4088/jcp.v64n0708
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  Generalized social anxiety disorder is an early onset, highly chronic, frequently disabling disorder with a lifetime prevalence of approximately 13%. The goal of the current study was to evaluate the efficacy and tolerability of sertraline for the treatment of severe generalized social anxiety disorder in adults..After a 1-week single-blind placebo lead-in period, patients with DSM-IV generalized social phobia were randomly assigned to 12 weeks of double-blind treatment with flexible doses of sertraline (50-200 mg/day) or placebo. Primary efficacy outcomes were the mean change in the Liebowitz Social Anxiety Scale (LSAS) total score and the responder rate for the Clinical Global Impressions-Improvement scale (CGI-I), defined as a CGI-I score
• Schneider, L. S., Nelson, J. C., Clary, C. M., Krishnan, K. R., Shiovitz, T., Weihs, K. L., & Newhouse, P. A. (2003). An 8-week multicenter, parallel-group, double-blind, placebo-controlled study of sertraline in elderly outpatients with major depression.. The American journal of psychiatry, 160(7), 1277-85. doi:10.1176/appi.ajp.160.7.1277
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  There have been few placebo-controlled trials of selective serotonin reuptake inhibitors for depressed elderly patients. This placebo-controlled study of sertraline was designed to confirm the results of non-placebo-controlled trials..The subjects were outpatients age 60 years or older who had a DSM-IV diagnosis of major depressive disorder and a total score on the 17-item Hamilton Depression Rating Scale of 18 or higher. The patients were randomly assigned to 8 weeks of double-blind treatment with placebo or a flexible daily dose of 50 or 100 mg of sertraline. The primary outcome variables were the Hamilton scale and Clinical Global Impression (CGI) scales for severity and improvement..A total of 371 patients assigned to sertraline and 376 assigned to placebo took at least one dose. At endpoint, the patients receiving sertraline evidenced significantly greater improvements than those receiving placebo on the Hamilton depression scale and CGI severity and improvement scales. The mean changes from baseline to endpoint in Hamilton score were -7.4 points (SD=6.3) for sertraline and -6.6 points (SD=6.4) for placebo. The rate of CGI-defined response at endpoint was significantly higher for sertraline (45%) than for placebo (35%), and the time to sustained response was significantly shorter for sertraline (median, 57 versus 61 days). There were few discontinuations due to treatment-related adverse events, 8% for sertraline and 2% for placebo..Sertraline was effective and well tolerated by older adults with major depression, although the drug-placebo difference was not large in this 8-week trial.
• Demartinis, N., Chung, H., Weihs, K. L., Liebowitz, M. R., & Clary, C. M. (2002). Results from a randomized, double-blind, multicenter trial of sertaline in the treatment of moderate-to-severe social phobia (social anxiety disorder). European Neuropsychopharmacology, 12(12), 352. doi:10.1016/s0924-977x(02)80559-4
• Fisher, L., Weihs, K. L., & Baird, M. A. (2002). Families, health, and behavior - A section of the Commissioned Report by the Committee on Health and Behavior: Research, Practice, and Policy Division of Neuroscience and Behavioral Health and Division of Health Promotion and Disease Prevention Institute of Medicine, National Academy of Sciences. Families, Systems, & Health, 20(1), 7-46. doi:10.1037/h0089481
• Weihs, K. L., Fisher, L., & Baird, M. A. (2002). Families and the management of chronic disease, report for the Committee on Health and Behavior: research practice and policy; Institute of Medicine, National Academy of Sciences. Families, Systems, & Health, 20(1), 7-46. doi:https://doi.org/10.1037/h0089481
• Weihs, K. L., Houser, T. L., Batey, S. R., Ascher, J. A., Bolden-watson, C., Donahue, R. M., & Metz, A. (2002). Continuation phase treatment with bupropion SR effectively decreases the risk for relapse of depression.. Biological psychiatry, 51(9), 753-61. doi:10.1016/s0006-3223(01)01317-8
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  This was the first controlled continuation phase study (up to 1-year total treatment) to evaluate the safety and efficacy of bupropion SR for decreasing the risk for relapse of depression in patients who responded to bupropion SR..Patients with recurrent major depression were treated with bupropion SR 300 mg/day during an 8-week open-label phase. Responders (based on Clinical Global Impressions Scale for Improvement of Illness scores) entered a randomized, double-blind phase where they received bupropion SR 300 mg/day or placebo for up to 44 weeks. After randomization, relapse was defined as the point at which the investigator intervened by withdrawing the patient from the study to treat depression..Four hundred twenty-three patients were randomized. A statistically significant difference in favor of bupropion SR over placebo was seen in the time to treatment intervention for depression when survival curves were compared (log-rank test, p =.003). Statistically significant separation between bupropion SR and placebo began at double-blind week 12 (p
• Bolden-watson, C., Houser, T. L., Batey, S. R., Ascher, J. A., Richard, N. E., Evoniuk, G., Metz, A., Weihs, K. L., & Goodale, E. (2001). Long-term treatment with bupropion SR effectively prevents the relapse and recurrence of depression. European Neuropsychopharmacology, 13, S207. doi:10.1016/s0924-977x(01)80180-2
• Weihs, K. L. (2001). Social support network size predicts breast cancer recurrence and mortality, after control for disease severity. Psychosomatic Medicine, 63(1).
• Weihs, K. L., Batey, S. R., Houser, T. L., Donahue, R. M., & Ascher, J. A. (2001). Dr. Weihs and colleagues reply [3]. The Journal of Clinical Psychiatry, 62(5), 374-375.
• Weihs, K. L., Batey, S. R., Houser, T. L., Donahue, R. M., & Ascher, J. A. (2001). Reply to Letter to the Editor “Type II Error and Antidepressants”. The Journal of Clinical Psychiatry, 62(5), 374-375. doi:10.4088/jcp.v62n0512c
• Fisher, L., & Weihs, K. L. (2000). Can addressing family relationships improve outcomes in chronic disease? Report of the National Working Group on Family-Based Interventions in Chronic Disease.. The Journal of family practice, 49(6), 561-6.
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  The management of patients with chronic disease constitutes the largest single cost to the health care system in the United States. New approaches and methods are needed to reduce preventable complications and to enhance the health and well-being of patients with chronic disease and their families. Interventions that target the family setting in which disease management takes place have emerged as an alternative to traditional strategies that focus only on the individual patient or that consider the family only as a peripheral source of positive or negative social support. In this approach, the educational, relational, and personal needs of all family members are emphasized. Data reviewed by the National Working Group on Family-Based Interventions in Chronic Disease identified potential mechanisms by which the relational context of the family affects disease management and how characteristics of family relationships serve as risk or protective factors. In this paper we describe the major forms of family-based interventions, review the results of selected clinical trials, and present applications for clinical practice. The data suggest that approaches to the management of chronic disease should be expanded to include the broader relational context in which disease management takes place. Although it adds complexity to clinical intervention, this approach increases clinical flexibility, addresses the important players in disease management, and accounts for a significant number of risk and protective factors that affect outcome.
• Ginexi, E. M., Simmens, S. J., Hoyt, D. R., & Weihs, K. L. (2000). Natural disaster and depression: a prospective investigation of reactions to the 1993 midwest floods.. American journal of community psychology, 28(4), 495-518. doi:10.1023/a:1005188515149
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  A statewide sample of 1735 Iowa residents, approximately half of whom were victims of the 1993 Midwest Floods, participated in interviews 1 year prior to, and 30 to 90 days after, the disaster. Employing a rigorous methodology including both control-group comparisons and predisaster assessments, we performed a systematic evaluation of the disaster's impact. Overall, the disaster led to true but small rises in depressive symptoms and diagnoses 60-90 days postflood. The disaster-psychopathology effect was not moderated by predisaster depressive symptoms or diagnostically defined depression; rather, predisaster symptoms and diagnoses uniquely contributed to increases in postdisaster distress. However, increases in symptoms as a function of flood impact were slightly greater among respondents with the lowest incomes and among residents living in small rural communities, as opposed to on farms or in cities. Implications for individual- and community-level disaster response are discussed.
• Kimmel, P. L., Peterson, R. A., Weihs, K. L., Simmens, S. J., Alleyne, S., Cruz, I., & Veis, J. H. (2000). Multiple measurements of depression predict mortality in a longitudinal study of chronic hemodialysis outpatients.. Kidney international, 57(5), 2093-8. doi:10.1046/j.1523-1755.2000.00059.x
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  The medical risk factors associated with increased mortality in hemodialysis (HD) patients are well known, but the psychosocial factors that may affect outcome have not been clearly defined. One key psychosocial factor, depression, has been considered a predictor of mortality, but previous studies have provided equivocal results regarding the association. We sought to determine whether depressive affect is associated with mortality in a longitudinal study of end-stage renal disease (ESRD) patients treated with HD, using multiple assessments over time..Two hundred ninety-five outpatients with ESRD treated with HD were recruited from three outpatient dialysis units in Washington D.C. to participate in a prospective cohort study with longitudinal follow-up. Patients were assessed every six months for up to two years using the Beck Depression Inventory (BDI), age, serum albumin concentration, Kt/V, and protein catabolic rate (PCR). A severity index, previously demonstrated to be a mortality marker, was used to grade medical comorbidity. The type of dialyzer with which the patient was treated was noted. Patient mortality status was tracked for a minimum of 20 and a maximum of 60 months after the first interview. Cox proportional hazards models, treating depression scores as time-varying covariates in a univariable analysis, and controlling for age, medical comorbidity, albumin concentration, and dialyzer type and site in multivariable models, were used to assess the relative mortality risk..The mean (+/- SD) age of our population at initial interview was 54.6 +/- 14.1 years. The mean PCR was 1.06 +/- 0.27 g/kg/day, and the mean Kt/V was 1.2 +/- 0.4 at baseline, suggesting that the patients were well nourished and dialyzed comparably to contemporary U.S. patients. The patients' mean BDI at enrollment was 11.4 +/- 8.1, in the range of mild depression. Patients' baseline level of depression was not a significant predictor of mortality at 38.6 months of follow-up. In contrast, when depression was treated as a time-varying covariate based on periodic follow-up assessments, the level of depressive affect was significantly associated with mortality in both single variable and multivariable analyses..Higher levels of depressive affect in ESRD patients treated with HD are associated with increased mortality. The effects of depression on patient survival are of the same order of magnitude as medical risk factors. Our findings using both controls for factors possibly confounded with depressive affect in patients with ESRD and time-varying covariate analyses may explain the inconsistent results of previous studies of depression and mortality in ESRD patients. Time-varying analyses in longitudinal studies may add power to defining and sensitivity to establishing the association of psychosocial factors and survival in ESRD patients. The mechanism underlying the relationship of depression and survival and the effect of interventions to improve depression in HD outpatients and general medical inpatients should be studied.
• Kimmel, P. L., Peterson, R. A., Weihs, K. L., Simmens, S. J., Alleyne, S., Cruz, I., Yanovski, J. A., Veis, J. H., Phillips, T. M., & Shidler, N. R. (2000). Dyadic relationship conflict, gender, and mortality in urban hemodialysis patients.. Journal of the American Society of Nephrology : JASN, 11(8), 1518-1525. doi:10.1681/asn.v1181518
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  The effects of dyadic satisfaction and conflict have not been well defined in the hemodialysis (HD) population. The aim of this study was to determine whether the perception of decreased dyadic satisfaction was associated with mortality in patients treated with HD, and if so, whether there were different relationships between risk factors, and differential outcomes in men and women. A total of 174 HD patients, primarily African-Americans, involved in dyadic relationships for more than 6 mo had indices of dyadic satisfaction, depression, perception of illness effects, social support, behavioral compliance with the dialysis prescription, and plasma interleukin-1 (IL-1) and beta-endorphin levels measured. Cox proportional hazards models assessed relative mortality risks. Patients' dyadic satisfaction scores correlated with beta-endorphin levels. There was no correlation of IL-1 or beta-endorphin with any psychosocial or behavioral compliance measure in the group as a whole. Correlations between psychosocial, medical, and neuroimmunologic variables were different in men and women. For women, dyadic satisfaction correlated with beta-endorphin levels, depression, and perception of illness. Women with higher dyadic satisfaction and decreased dyadic conflict were at decreased mortality risk, but dyadic adjustment indices were unassociated with differential survival in the larger group of men. Correlations between neuroendocrine and immune markers are different in African-American male and female HD patients. Greater dyadic satisfaction and lower dyadic conflict are independently associated with decreased mortality in female African-American HD patients, of the same order of magnitude as medical risk factors. Such effects may be attributable to a relationship between dyadic satisfaction and conflict and health-related behaviors, or through an effect on neuroendocrine or immunologic status.
• Kimmel, P. L., Varela, M. P., Peterson, R. A., Weihs, K. L., Simmens, S. J., Alleyne, S., Amarashinge, A., Mishkin, G. J., Cruz, I., & Veis, J. H. (2000). Interdialytic weight gain and survival in hemodialysis patients: effects of duration of ESRD and diabetes mellitus.. Kidney international, 57(3), 1141-51. doi:10.1046/j.1523-1755.2000.00941.x
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  Medical mortality determinants in end-stage renal disease (ESRD) patients treated with hemodialysis (HD) are well known. More recently, associations have been established between the dose of dialysis administered and patient survival. We showed in a prospective study that both dialyzer type and patient compliance with the dialysis prescription were independently associated with survival. Although several parameters of dialytic technique and patient compliance are associated with differential survival in patients with ESRD treated with HD, the association of interdialytic weight gain (IWG) with survival is unclear. No study has assessed the relationship between IWG and mortality in HD patients, controlled for multiple medical risk factors. The aim of our study was to determine whether IWG was associated with survival in patients with ESRD treated with HD, controlling for multiple medical and dialytic risk factors..We prospectively conducted an observational, longitudinal, multicenter study of 283 urban HD patients to determine the relationship of IWG with several dialytic parameters and patient survival. Medical risk factors such as demographic indices and comorbid conditions were assessed. We studied Kt/V, the protein catabolic rate (PCR), serum albumin and anthropometric measurements, behavioral compliance indices, dialyzer characteristics, and serum electrolyte concentrations, and correlated these with IWG. In addition, the duration of dialysis was assessed in HD patients with and without diabetes mellitus. Cox proportional hazards models assessed the relative mortality risk of increased IWG, controlling for variations in medical comorbidity and other mortality determinants..The mean (+/- SD) age of our population was 54.6 +/- 14.1 years, and the mean time they were treated with HD was 30.4 +/- 46.9 months. The mean IWG was 1.54 +/- 0.71% dry wt/day. Correlations were found between increased IWG and younger age, and lower midarm circumference, and increased Kt/V, PCR, and serum potassium concentration. The mean follow-up period was 48.9 +/- 10.6 months. An increase in IWG was associated with a significantly increased relative mortality risk in diabetic ESRD patients treated with HD when variations in age, comorbidity, serum albumin concentration, and dialyzer type and site were controlled. There was, however, no association of increased mortality risk with increased IWG in the larger population of patients without diabetes. In further analyses, the increased mortality risk associated with increased IWG was found to be present only in patients with diabetes mellitus who had recently started HD therapy for ESRD..IWG is correlated with several nutritional and dialytic variables and with parameters that predict survival in HD patients. Increased IWG is independently associated with decreased survival of diabetic ESRD patients treated with HD, after adjusting for variation in other medical risk factors. The population of incident diabetic HD patients is particularly susceptible to increased risk associated with increased IWG. The mechanisms underlying these results are obscure, but IWG might be associated with poorer survival in this population if it were linked to worsened hypertension, cardiovascular stress, or poorer glycemic control. Interventions to improve compliance with IWG in incident diabetic HD patients are warranted.
• Weihs, K. L., Enright, T. M., Simmens, S. J., & Reiss, D. (2000). Negative affectivity, restriction of emotions, and site of metastases predict mortality in recurrent breast cancer.. Journal of psychosomatic research, 49(1), 59-68. doi:10.1016/s0022-3999(00)00143-4
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  To assess whether negative affectivity and restriction of emotions predict survival time with recurrent breast cancer..Thirty-two patients with recurrent breast cancer, diagnosed 6-19 months earlier and stabilized using surgical, medical and/or radiation therapies, were enrolled. Cox regression survival analyses, including initial severity of metastases (RR=4.3 [1.3-14.3]; p=0.02), were used to explore the association of psychological variables with survival..Low chronic anxiety in the context of low emotional constraint predicted low mortality (RR 0.07 [0.01-0.52]; p=0.007). However, patients with low chronic anxiety scores but with high constraint had higher mortality (RR=3.7 [1.2-11.5; p=0.02). High chronic anxiety, with or without high constraint, also predicted earlier death, as did high control of feelings..An integrated model of negative affectivity in the context of restriction of emotions appears to strengthen the prediction of survival based on severity of breast cancer metastases.
• Weihs, K. L., Settle, E. C., Batey, S. R., Houser, T. L., Donahue, R. M., & Ascher, J. A. (2000). Bupropion sustained release versus paroxetine for the treatment of depression in the elderly.. The Journal of clinical psychiatry, 61(3), 196-202. doi:10.4088/jcp.v61n0309
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  Depression is a serious and widespread emotional disorder among the elderly. This study compared the efficacy and safety of bupropion sustained release (SR) with the selective serotonin reuptake inhibitor paroxetine in the treatment of major depression in elderly outpatients..Elderly (> or = 60 years) outpatients with major depressive disorder (DSM-IV criteria) were evaluated in this 6-week multicenter, randomized, double-blind study comparing bupropion SR, 100-300 mg/day, and paroxetine, 10-40 mg/day. Efficacy was assessed by changes in scores on the Hamilton Rating Scales for Depression (HAM-D) and Anxiety (HAM-A) and the Clinical Global Impressions-Severity of Illness and -Improvement scales. Safety was assessed by monitoring adverse events, vital signs, and body weight..A total of 100 patients ranging in age from 60 to 88 years were randomly assigned to treatment with bupropion SR (N = 48) or paroxetine (N = 52). Measurements of efficacy were similar between the 2 treatment groups, with both groups showing improved scores on all depression rating scales. Headache, insomnia, dry mouth, agitation, dizziness, and nausea occurred in > 10% of patients in both groups; somnolence, diarrhea, constipation, and anorexia occurred in > 10% of patients in the paroxetine group. No statistically significant differences between groups in vital signs or weight were found..Both bupropion SR and paroxetine were safe and effective for the treatment of depression in the elderly. Because of its favorable side effect profile, bupropion SR may provide a safe and effective nonserotonergic treatment alternative that is well suited as an antidepressant for the elderly.
• Clayton, A., Clavet, G., McGarvey, E., Warnock, J., & Weiss, K. (1999). Assessment of sexual functioning during the menstrual cycle. Journal of Sex and Marital Therapy, 25(4). doi:10.1080/00926239908404005
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  In a study of 115 women who presented with complaints of premenstrual symptoms, we investigated the relationship between the menstrual cycle and different aspects of sexual functioning, using the Changes in Sexual Functioning Questionnaire. Women who were assessed at the screening visit during the late luteal phase of their menstrual cycle reported less desire to engage in sexual activity and less frequent sexual activity than women who were assessed during other phases of the menstrual cycle. The 24 women who returned for the second and third visits reported less frequent orgasms and less satisfaction from their orgasms premenstrually than during midcycle. © 1999 Taylor & Francis Group, LLC.
• Simmens, S. J., Weihs, K. L., Howe, G. W., & Enright, T. M. (1999). Marital Satisfaction and Emotional Adjustment After Breast Cancer. Journal of Psychosocial Oncology, 17(1), 33-49. doi:10.1300/j077v17n01_03
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  Abstract The Profile of Mood States was used to measure distress in 44 patients with breast cancer at 15 and 34 months after the diagnosis. Marital satisfaction, measured by the Dyadic Adjustment Scale, was found to predict change in patients' distress over time. Patients who reported that their marriage was unsatisfactory, regardless of their report of distress 15 months after the diagnosis, were at greater risk for elevated distress in the future than were those who were satisfied with their marriage. The findings suggest that marital satisfaction could be used as an indicator of a patient's trajectory of distress over time.
• Frank, J. B., Minerva, E., Lieberman, D. Z., & Weihs, K. L. (1998). Women's mental health in primary care. Depression, anxiety, somatization, eating disorders, and substance abuse.. The Medical clinics of North America, 82(2), 359-89. doi:10.1016/s0025-7125(05)70611-8
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  Primary care physicians can improve the care of women patients by applying new concepts of women's physiology and psychosocial development. New developmental models that emphasize the importance of relationships in women's self-concept and well-being have led to effective psychotherapies for depression, eating disorders, anxiety and substance abuse. Many of these therapies can be offered in brief formats suitable to primary care settings. New biological treatments including the use of estrogen, thyroid hormone and bright light for depression and refeeding to increase metabolic rate in eating disorders also promise to expand the range of mental health problems that generalist physicians can treat successfully.
• Kimmel, P. L., Peterson, R. A., Weihs, K. L., Simmens, S. J., Alleyne, S., Cruz, I., & Veis, J. H. (1998). Psychosocial factors, behavioral compliance and survival in urban hemodialysis patients.. Kidney international, 54(1), 245-54. doi:10.1046/j.1523-1755.1998.00989.x
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  The medical risk factors associated with increased mortality in hemodialysis (HD) patients are well known, but the psychosocial factors that may affect outcome have not been clearly defined. Psychosocial factors could affect mortality through interaction with parents' nutrition or their compliance with the dialysis prescription. We conducted a prospective, longitudinal, multicenter study of urban HD patients to determine the contribution of compliance and psychosocial factors to patient survival..Patients were assessed using indices of social support, patient's assessments of their well-being, including illness effects (IEQ), and satisfaction with life (SWLS), the Beck Depression Inventory (BDI), serum albumin concentration, Kt/V and protein catabolic rate (PCR). Behavioral compliance was measured three ways: percent time actually dialyzed per treatment compared to prescribed time (shortening behavior); percent sessions attended (skipping behavior) and total integrated time compliance (% TCOMP). A severity index, previously demonstrated to be a mortality marker, was used to grade medical comorbidity. The typed of dialyzer the patient was treated with was noted. A Cox proportional hazards model, controlling for age, medical comorbidity, albumin concentration and dialyzer type was used to assess relative mortality risk of variations in psychosocial factors and behavioral compliance..A total of 295 patients (60.8% of those eligible) agreed to participate. The mean ( +/- SD) age of our population was 54.6 +/- 14.1 year, mean PCR was 1.06 +/- 0.27 g/kg/day, and mean Kt/V 1.2 +/- 0.4, suggesting the patients were well nourished and adequately dialyzed. The patients' mean BDI was 11.4 +/- 8.1 (in the range of mild depression). Patients' SWLS was similar to that of a group of patients without chronic illness. After a 26 month mean follow-up period, higher levels of perceived social support, improved perception of the effects of illness and increased behavioral compliance were significantly associated with decreased relative mortality risk (0.8, 0.77, and 0.79, respectively), controlled for variations in patients' age, severity of illness, serum albumin concentration and dialyzer type. Variations in depression and Kt/V were not predictors of mortality during the observation period..Lower levels of social support, decreased behavioral compliance with the dialysis prescription, and increased negative perception of the effects of illness are independently associated with increased mortality in ESRD patients treated with HD. The effects are of the same order of magnitude as medical risk factors. Such effects may be attributable to a relationship between a patients' perception of social support and effects of illness and behavior, with other factors such as the provision of better medical care in patients with larger social networks. The mechanism underlying the relationship of psychosocial factors and compliance and survival, and the effect of interventions to improve perception of illness, and increase social support and compliance with the dialysis prescription in HD patients should be studied.
• Kimmel, P. L., Phillips, T. M., Simmens, S. J., Peterson, R. A., Weihs, K. L., Alleyne, S., Cruz, I., Yanovski, J. A., & Veis, J. H. (1998). Immunologic function and survival in hemodialysis patients.. Kidney international, 54(1), 236-44. doi:10.1046/j.1523-1755.1998.00981.x
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  Although the medical determinants of mortality in patients with end-stage renal disease (ESRD) treated with hemodialysis (HD) are well appreciated, the contribution of immunologic parameters to survival in such patients is unclear, especially when variations in age, medical comorbidity and nutrition are controlled. In addition, although dysregulation of cytokine metabolism has been appreciated in patients with ESRD, the association of these parameters with outcomes has not been established. Recently, the type of dialyzer used in patients' treatment has been associated with survival, but the mechanisms underlying these findings, including their immune effects, have not been established. We conducted a prospective, cross-sectional, observational multicenter study of urban HD patients to determine the contribution of immunological factors to patient survival. We hypothesized increased proinflammatory cytokines would be associated with increased mortality, and that improved immune function would be associated with survival..Patients were assessed using demographic and anthropometric indices, Kt/V, protein catabolic rate (PCR) and immunologic variables including circulating cytokine [interleukin (IL)-1, IL-2, IL-4, IL-5, IL-6, IL-12, IL-13 and tumor necrosis factor (TNF)-alpha] levels, total hemolytic complement activity (CH50), and T cell number and function. A severity index, previously demonstrated to be a mortality marker, was used to grade medical comorbidity. A Cox proportional hazards model, controlling for patients' age, severity index, level of serum albumin concentration, dialyzer type and dialysis site was used to asses relative survival risk..Two hundred and thirty patients entered the study. The mean (+/- SD) age of the population was 54.4 +/- 14.2 years, mean serum albumin concentration was 3.86 +/- 0.47 g/dl, mean PCR was 1.1 +/- 0.28 g/kg/day, and mean Kt/V 1.2 +/- 0.3. Patients' serum albumin concentration was correlated with levels of Kt/V and PCR, and their circulating IL-13 and TNF-alpha levels, but negatively with their circulating IL-2 levels, T-cell number and T-cell antigen recall function. T-cell antigen recall function correlated negatively with PCR, but not Kt/V. There was no correlation of any other immune parameter and medical or demographic factor. Immune parameters, were all highly intercorrelated. Mean level of circulating cytokines in HD patients were in all cases greater than those of a normal control group. There were few differences in medical risk factors or immune parameters between patients treated with different types of dialyzers. After an almost three-year mean follow-up period, increased IL-1, TNF-alpha, IL-6, and IL-13 levels were significantly associated with increased relative mortality risk, while higher levels of IL-2, IL-4, IL-5, IL-12, T-cell number and function, and CH50 were associated with improved survival. The difference in survival between patients treated with unmodified cellulose dialyzers and modified or synthetic dialyzers approached the level of statistical significance, but there were no differences in levels of circulating cytokines between these two groups..Higher levels of circulating proinflammatory cytokines are associated with mortality, while immune parameters reflecting improved T-cell function are associated with survival in ESRD patients treated with HD, independent of other medical risk factors. These factors may serve as markers for outcome. The mechanism underlying the relationship of immune function and survival, and the effect of interventions to normalize immune function in HD patients should be studied.
• Weihs, K. L. (1998). Review of Family caregiving in mental illness.. Families, Systems, & Health, 16(4), 455-457. doi:10.1037/h0089948
• Hoyt, D. R., Conger, R. D., Valde, J. G., & Weihs, K. L. (1997). Psychological distress and help seeking in rural America.. American journal of community psychology, 25(4), 449-70. doi:10.1023/a:1024655521619
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  The implications of exposure to acute and chronic stressors, and seeking mental health care, for increased psychological distress are examined. Research on economic stress, psychological distress, and rural agrarian values each point to increasing variability within rural areas. Using data from a panel study of 1,487 adults, a model predicting changes in depressive symptoms was specified and tested. Results show effects by size of place for men but not for women. Men living in rural villages of under 2,500 or in small towns of 2,500 to 9,999 people had significantly greater increases in depressive symptoms than men living in the country or in larger towns or cities. Size of place was also related to level of stigma toward mental health care. Persons living in the most rural environments were more likely to hold stigmatized attitudes toward mental health care and these views were strongly predictive of willingness to seek care. The combination of increased risk and less willingness to seek assistance places men living in small towns and villages in particular jeopardy for continuing problems involving depressed mood.
• Weihs, K. L. (1997). "Mental healthcare in the primary care setting:" Comment.. Families, Systems, & Health, 15(1), 37-39. doi:10.1037/h0089804
• Kimmel, P. L., Peterson, R. A., Weihs, K. L., Simmens, S. J., Boyle, D. H., Umana, W. O., Kovac, J. A., Alleyne, S., Cruz, I., & Veis, J. H. (1996). Psychologic functioning, quality of life, and behavioral compliance in patients beginning hemodialysis.. Journal of the American Society of Nephrology : JASN, 7(10), 2152-9. doi:10.1681/asn.v7102152
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  Psychologic and demographic characteristics have been shown to correlate with behavioral compliance in studies of prevalent hemodialysis (HD) patients. Few data, however, exist on the psychologic characteristics or their relationship to compliance in patients initiating HD treatment, or incident patients. Our previous work with prevalent HD patients showed an interrelationship among social support, perception of the effects of illness, and depression measured by a standardized depression index and a cognitive depression index deleting somatic symptoms. To compare psychosocial and behavioral compliance parameters in incident and prevalent patients, 99 incident HD patients undergoing dialysis for less than 6 months were assessed by using a variety of questionnaires. The patients' mean standardized depression index score was in the range of mild depression. There was no difference in mean age, Karnofsky functional status, perception of effects of illness or standardized or cognitive depression scores between incident patients and 149 prevalent patients treated with HD for 6 to 246 months. Satisfaction with life scores and perception of sexual adjustment were better, but Kt/V (quantitative measure of the amount of dialysis provided) and protein catabolic rate were lower in incident than in prevalent patients. Social support and perception of illness scores correlated with depression measures in incident patients, findings that were similar to prevalent patients. Incident (as did prevalent) patients showed striking bivariate correlations between the psychosocial and depression variables, but fewer correlations between psychologic and compliance measures. Both standard compliance parameters, such as mean predialysis serum phosphorus and potassium concentration, and behavioral compliance were better in incident than in prevalent patients. Worsened sexual adjustment, functional status, and increased severity of illness were correlated with improved behavioral compliance in incident patients. Behavioral compliance styles correlated with different social support and severity of medical illness variables in incident and prevalent patients, when assessed by multiple linear regression analysis. These different patterns suggest the existence of different mechanisms of adaptation in the groups. Measures focused on increasing delivery of dialysis and enhancing social support in urban African-American patients starting HD therapy may be useful in improving compliance with the dialysis prescription, and indirectly improving survival.
• Weihs, K. L. (1996). Commentary: Dilemmas in coping with breast cancer.. Families, Systems, & Health, 14(1), 89-93. doi:10.1037/h0089825
• Kimmel, P. L., Peterson, R. A., Weihs, K. L., Simmens, S. J., Boyle, D. H., Cruz, I., Umana, W. O., Alleyne, S., & Veis, J. H. (1995). Aspects of quality of life in hemodialysis patients.. Journal of the American Society of Nephrology : JASN, 6(5), 1418-26. doi:10.1681/asn.v651418
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  The proper means of measuring quality of life in chronically ill patients is unclear. Because different measures may assess varied aspects of patients' experience and because they may be interrelated in different ways, the relationship between several of these quality-of-life measures, including indices of psychological well-being, social support, and severity of illness in ESRD patients treated with hemodialysis (HD), was prospectively assessed. In addition, it was determined whether patients' assessment of quality of life, along any dimension, was related to patient compliance in three urban HD units, in a population largely composed of African-American patients. Severity of illness scores correlated with both attendance and compliance with the dialysis prescription. Karnofsky scores correlated inversely with age, depression, social environment, and level of severity of illness, as expected, but not with behavioral compliance measures. Social support scores correlated with perception of illness, depression, satisfaction with life, and adjustment to illness scores, but not with behavioral or standard compliance measures. Perception of illness scores correlated with depression, social support, adjustment to illness, and satisfaction with life scores, but not with Karnofsky ratings, severity scores, or standard and/or behavioral compliance measures. Social environment scores correlated with almost all assessed variables, with the exception of anthropometric measurements, predialysis phosphorus levels, and behavioral compliance measures. Satisfaction with life scores (a global, subjective measure of quality of life) correlated with advancing age, level of social support, severity of illness, and the presence of a relationship, but were not correlated with Karnofsky scores. These data suggest that quality of life in patients treated with HD must be measured in several ways. The Psychological Adjustment to Illness Scale Social Environment score may be a useful, generalizable adjunct measure of quality of life in HD patients, in addition to the Satisfaction With Life Scale. Quality of life and perception of the effects of illness are not necessarily associated with functional ability in HD patients. These findings must be considered where making decisions about the discontinuation of HD treatment.
• Kimmel, P. L., Peterson, R. A., Weihs, K. L., Simmens, S. J., Boyle, D. H., Verme, D., Umana, W. O., Veis, J. H., Alleyne, S., & Cruz, I. (1995). Behavioral compliance with dialysis prescription in hemodialysis patients.. Journal of the American Society of Nephrology : JASN, 5(10), 1826-34. doi:10.1681/asn.v5101826
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  The relationship between compliance and outcome is poorly understood, partially because there has been no gold standard for measuring compliance in hemodialysis patients. To investigate interrelationships between psychological, medical, and compliance factors, hemodialysis (HD) patients were studied with the Beck Depression Inventory, and a subset, the Cognitive Depression Index, the Perception of Illness Effects scale, and the Multidimensional Scale of Perceived Social Support. Behavioral compliance was measured in three ways: (1) percent time compliance (signifying "shortening behavior"); (2) percent attendance (signifying "skipping behavior) (3) percent total time compliance, assessing patients' time on dialysis normalized for prescribed time, including all shortenings and absences. Standard compliance indicators (predialysis serum potassium and phosphorus concentrations and interdialytic weight gain) were also analyzed. The patients' mean Beck Depression Inventory was in the range of mild depression. The prevalence of depression was 25.5%. Both depression indices correlated with Perception of Illness Effects scale scores. In general, social support was related to both measures of depression and perception of illness effects. Total time compliance was 95.8 +/- 5.0%. Younger patients were more likely to skip treatments compared with older patients. Time compliance comprised a wide spectrum, with most patients relatively compliant, whereas a small proportion received far less than their prescribed dialysis. Skipping and shortening behaviors did not correlate, suggesting that these constitute two separate types of noncompliant behaviors. Time compliance parameters did not correlate with potassium levels or interdialytic weight gain, but did correlate with phosphorus levels. Interrelationships between behavioral compliance measures and other parameters varied between units and patients of different gender. Finally, behavioral compliance patterns were stable over months in patients.(ABSTRACT TRUNCATED AT 250 WORDS)
• Kimmel, P. L., Peterson, R. A., & Weihs, K. L. (1993). Survival in hemodialysis patients: the role of depression.. Journal of the American Society of Nephrology : JASN, 4(1), 12-27. doi:10.1681/asn.v4112
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  Depression has been identified at the most prevalent psychologic problem in patients with ESRD treated with hemodialysis (HD). Depression has been associated with mortality in HD patients; however, the similarity of the symptoms of depressive disorders to those of uremia and the difficulties in measuring depression and dissociating psychologic from physical aspects of depression in such patients render these studies difficult to evaluate. Conflicting data regarding the effects of depression on survival in HD patients may be the result of using somatic symptoms in quantifying the extent of depression. In this review, studies regarding the diagnosis of depression in HD patients, the association of depression and survival in HD patients in light of recent work on factors related to the morbidity and mortality in the ESRD population, and aspects of therapy for depression in HD patients are considered. Specifically, depression may affect immunologic function, nutrition, and compliance factors that may affect the prescription and delivery of dialysis, which may, in turn, influence outcome. Alternatively, depression may be an independent factor in influencing survival. Cognitive depression measures may be more useful in predicting outcome in HD patients than standard measures used in nonmedically ill populations. Although there are few studies of the effect of treatment of depression on outcome in HD patients, it is reasonable to hypothesize that treatment of depressive disorders in HD patients might effect outcome. Further studies on the association of depression and its treatment and mortality in ESRD patients are warranted.
• Chapados, J. T., & Weihs, K. L. (1986). Interviewing skills training--a study.. Social science & medicine (1982), 23(1), 31-4. doi:10.1016/0277-9536(86)90321-7
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  A randomized investigation was conducted to study the effect of a structural 10-week course on the development of interviewing skills of first year medical students. The experimental group (16 students) received interviewing skills training based on the Developmental Helping Model as described by Carkhuff in 1982. The comparison group (16 students) received traditionally focused training with emphasis on gathering information about the patient's presenting problem through the use of open-ended questions. The dependent measure was interviewing skills level. Each student was videotaped with a simulated patient during the initial (pre-test) and final (post-test) sessions of the course. Tapes were rated by blinded reviewers according to Carkhuff's five point scale of Developmental Helping. No pre-test differences were found between groups. At post-test, the experimental group showed significantly higher ratings. This data suggests that teaching specific interviewing skills is more effective than non-skill oriented training for development of medical students' ability to interview patients.
• Weihs, K. L. (1984). Bluefish and scombroid poisoning.. The Journal of family practice, 18(6), 834.
• Weihs, K. L., & Loxterkamp, D. (1978). Involved students preparing to serve.. Commitment, 3(3), 20-21.

Proceedings Publications

• Weihs, K. L., Price, S. N., Weihs, K. L., Verlaque, R., Trejo, J. I., Price, S. N., Liu, Y., Hamann, H. A., Halaby, L. M., & Guzman, D. (2020). Subjective Sleep Quality and Sleep Recommendations Received by Patients with Cancer and Depression. In Sleep, 43, A387-A387.
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  AbstractIntroductionDiagnoses of cancer and depression are independent predictors of poor sleep, but less is known about subjective sleep quality among patients with both of these potential risk factors or about recommendations made by physicians for improving sleep among this population. This study examines correlates of poor subjective sleep quality and sleep recommendations received by patients with cancer enrolled in the Collaborative Oncology Project to Enhance Depression Care (COPE-D), a collaborative care intervention to treat depression among patients with cancer. MethodsParticipants were 74 adult cancer survivors. Demographic and clinical characteristics, subjective sleep quality, and provider sleep recommendations were obtained by patient self-report prior to intervention. Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), general health status was measured using the PROMIS Global-10, and depressive symptoms were measured using the PHQ-9. Results81% of patients reported significantly poor sleep quality (PSQI global scores >8) and 75.3% reported poor sleep efficiency (
• Fisher, L., Hessler, D., Polonsky, W., Masharani, U., Guzman, S., Bowyer, V., Strycker, L., Ahmann, A., Basina, M., Blumer, I., Chloe, C., Kim, S., Peters, A., Shumway, M., Weihs, K., & Wu, P. (2018, Spring). T1-REDEEM: A randomized controlled trial to reduce diabetes distress among adults with type 1 diabetes. In n/a, 41, 1862-1869.
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  OBJECTIVE: To compare the effectiveness of two interventions to reduce diabetes distress (DD) and improve glycemic control among adults with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS: Individuals with T1D (n = 301) with elevated DD and HbA1c were recruited from multiple settings and randomly assigned to OnTrack, an emotion-focused intervention, or to KnowIt, an educational/behavioral intervention. Each group attended a full-day workshop plus four online meetings over 3 months. Assessments occurred at baseline and 3 and 9 months. Primary and secondary outcomes were change in DD and change in HbA1c, respectively. RESULTS: With 12% attrition, both groups demonstrated dramatic reductions in DD (effect sized = 1.06; 78.4% demonstrated a reduction of at least one minimal clinically important difference). There were, however, no significant differences in DD reduction between OnTrack and KnowIt. Moderator analyses indicated that OnTrack provided greater DD reduction to those with initially poorer cognitive or emotion regulation skills, higher baseline DD, or greater initial diabetes knowledge than those in KnowIt. Significant but modest reductions in HbA1c occurred with no between-group differences. Change in DD was modestly associated with change in HbA1c (r = 0.14, P = 0.01), with no significant between-group differences. CONCLUSIONS: D Dcanbesuccess fully reducedamong distressed in dividuals with T1D withe levated HbA1c using both education/behavioral and emotion-focused approaches. Reductions in DD are only modestly associated with reductions in HbA1c. These findings point to the importance of tailoring interventions to address affective, knowledge, and cognitive skills when intervening to reduce DD and improve glycemic control.
• Kogan, A. V., Kogan, A. V., Allen, J. J., Allen, J. J., Weihs, K. L., & Weihs, K. L. (2013). Cardiac vagal control, social functioning, and emotional adjustment in breast cancer. In Psychosomatic Medicine, 77, A85.

Presentations

• Marshall, C. A., Weihs, K. L., Hamann, H., Armin, J. S., Trejo, J., & Redondo, F. (2018, November). Partnering with a statewide professional organization of community health workers (CHWs) to support families managing cancer. American Public Health Association annual conference.
• Weihs, K. L. (2017, June/Summer). Preventive Intervention to Reduce Depression in the Year After Breast Cancer Diagnosis: A precision/Experimental Medicine Approach. Annual meeting of the Academy of Behavioral Medicine Research. Santa Fe, NM: Academy for Behavioral Medicine Research.
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  eihs, KL (2017, June 23) Preventive Intervention to Reduce Depression in the Year After Breast Cancer Diagnosis: A Precision/ Experimental Medicine Approach. 2017 Academy of Behavioral Medicine Research Annual Meeting, Santa Fe, New Mexico.
• Weihs, K. L., Kogan, A., Stanton, A. L., Wiley, J., & Allen, J. (2015, March). Cardiac Vagal Control and Coping Strategies as Predictors of Depression in Breast Cancer. American Psychosomatic Society 73rd Annual Scientific Meeting. Savannah, GA.
• Weihs, K. L., Lane, R. D., Landa, A., & Gundel, H. (2015, January). Symptom Formation and mechanisms of Change in Somatoform Disorders: Research findings and implications for treatment. Psychodynamic Psychoanalytic Research Society, 5th Annual Meeting. New York, NY.
• Weihs, K. L., Weihs, K. L., Raison, C. L., Raison, C. L., Pace, T. W., Pace, T. W., Dodds, S., Dodds, S., Bell, M., Bell, M., Eparvier, L., Eparvier, L., Fiero, M., & Fiero, M. (2015, July). Feasibility and Effects of Cognitively-Based Compassion Training (CBCT) on Psychological Well-Being in Breast Cancer Survivors: A Randomized, Wait List Controlled Pilot Study. 2015 World Congress of Psycho-Oncology. Washington, D.C.: American PsychoOncology Society.
• Weihs, K. L., Wiley, J. F., Crespi, C. M., Krull, J. L., Allen, J. J., & Stanton, A. L. (2015, January). Intraindividual Variability in Cancer-Related Avoidance Coping predicts Depressive Symptoms. Annual meeting of the American Psychosomatic Society.

Poster Presentations

• Weihs, K. L. (2020, December/Fall). Chronic interpersonal stress predicts depressive outcomes in the first year of invasive breast cancer: Moderation by the serotonin-transporter polymorphism. San Antonio Breast Cancer Conference. Virtual - due to COVID: Society for Surgical Oncology.
• Weihs, K. L., Czamanski, J., Hebi, M., & Lane, R. D. (2020, March/Spring). Validation of the Levels of The Emotional Awareness Scale in Arabic (LEAS-Ar). American Psychosomatic Society, Annual MeetingAmerican Psychosomatic Society.
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  Poster presenting methods used for translation of LEAS scale and glossary into Arabic
• Weihs, K. L., Reed, R. G., Butler, E. A., Sbarra, D. A., Breen, E. C., & Irwin, M. R. (2015, March). Associations between pro-inflammatory cytokines and physical symptoms are moderated by emotional acceptance in women with breast cancer.. American Psychosomatic Society 73rd Annual Scientific Meeting. Savannah, GA.