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The needs of families who care for patients with cancer at home: Are we meeting them Journal of Advanced Nursing, 10, 575 581 Holland, J C (1982) Psychological aspects of cancer In J F Holland & E Frei III (Eds), Cancer medicine (pp 1175 1203) New York: Oxford University Press Holland, J C (1990) Historical overview In J C Holland & J H Rowland (Eds), Handbook of psychooncology (pp 3 12) New York, Oxford University Press Hosaka, T (1996) A pilot study of a structured psychiatric intervention for Japanese women with breast cancer Psycho-Oncology, 5, 59 65 Houts, P S, Nezu, A M, Nezu, C M, & Bucher, J A (1996) A problem-solving model of family caregiving for cancer patients Patient Education and Counseling, 27, 63 73 Houts, P S, Nezu, A M, Nezu, C M, Bucher, J A.

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, & Lipton, A (Eds) (1994) Homecare guide for cancer Philadelphia: American College of Physicians Houts, P S, Yasko, J, Kahn, S B, Schelzel, G, & Marconi, K (1986) Unmet psychological, social and economic needs of persons with cancer in Pennsylvania Cancer, 58, 2355 2361..

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research is needed to examine dose-response issues Longitudinal experimental research with humans is also needed to examine effects of exercise on cognitive functioning and molecular, biochemical, morphological, and physiological changes underlying these effects EXERCISE AND REDUCTIONS IN ANXIETY AND DEPRESSION AND INCREASES IN POSITIVE MOOD The constructs of anxiety and depression are linked in that they are concepts typically included under the more general rubric of affect or mood (specifically, negative mood) Mood, according to Lazarus (1991), represents a transient state, whereas af fect represents something more enduring However, given that affect and mood are often used interchangeably, and to remain consistent with the current exercise literature, depression, anxiety, and positive and negative mood are all included under the rubric of mood in this chapter.

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Gauvin and Brawley (1993) argue that this approach may be better suited to understanding the relationship of affect and exercise because the models derived from it are intended to be broad and encompassing conceptualizations of affective experience In established market economies, such as the United States, mental disorders are second only to heart disease in disability-adjusted life years, a measure of years of life lost to premature death and years lived with a disability of specified severity and duration (Murray & Lopez, 1997) This represents 22% of the total burden of disease, with anxiety, depression, and substance use disorders accounting for three-quarters of all mental disorders Among American adults, anxiety and depression affect approximately 19 million and 188 million people, respectively (Narrow, Rae, & Regier, 1998; Robins & Regier, 1990).

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Nearly half of these cases occur before 14 years of age, and often those who are anxious as children end up being depressed as adults (Gorman, 2002) It is estimated that only half of all mental disorders can be averted with existing treatment methods (eg, psychological and pharmacological) and that either more effective treatment methods need to be developed or better preventive interventions need to be employed (Andrews & Wilkinson, 2002) Exercise is considered by many to be a very promising preventative and a less costly intervention than psychotherapy or drug treatments Anxiety is an unpleasant emotional state associated with a negative form of cognitive appraisal typified by worry, self-doubt, and apprehension and psychophysiologi-.

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Thus, there appears to be a slight advantage to the stress management training. What is it about RAP that predisposes a child to develop IBS as an adult Some possible explanations include: (a) hypersensitivity to abdominal pain as a child continues into generalized GI tract sensitivity as an adult; (b) an anxious child grows up to be an anxious adult who is more likely to develop IBS; or (c) early learning about GI symptoms, the sick role and health care seeking predisposes him or her to be sensitive to GI symptoms and seek health care as an adult. General Comments We have addressed RAP as a possible developmental precursor to IBS, which has been understudied. Research in this area has begun to address questions similar to that in the IBS literature, including the role of stressful events and psychological distress in the onset and maintenance of symptoms. Treatment of RAP has been limited to a few behavioral interventions, but seems to show much promise. It is possible, that as we develop a more complete understanding of the psychosocial factors in uencing the experience of RAP, we will be able to offer more speci c interventions. Next, we look at psychological interventions as they apply to IBS.

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