Journal of Behavioral Medicine

, Volume 37, Issue 1, pp 22–36 | Cite as

Which symptoms matter? Self-report and observer discrepancies in repressors and high-anxious women with metastatic breast cancer

  • Janine Giese-DavisEmail author
  • Rie Tamagawa
  • Maya Yutsis
  • Suzanne Twirbutt
  • Karen Piemme
  • Eric Neri
  • C. Barr Taylor
  • David Spiegel


Clinicians working with cancer patients listen to them, observe their behavior, and monitor their physiology. How do we proceed when these indicators do not align? Under self-relevant stress, non-cancer repressors respond with high arousal but report low anxiety; the high-anxious report high anxiety but often have lower arousal. This study extends discrepancy research on repressors and the high-anxious to a metastatic breast cancer sample and examines physician rating of coping. Before and during a Trier Social Stress Test (TSST), we assessed affect, autonomic reactivity, and observers coded emotional expression from TSST videotapes. We compared non-extreme (N = 40), low-anxious (N = 16), high-anxious (N = 19), and repressors (N = 19). Despite reported low anxiety, repressors expressed significantly greater Tension or anxiety cues. Despite reported high anxiety, the high-anxious expressed significantly greater Hostile Affect rather than Tension. Physicians rated both groups as coping significantly better than others. Future research might productively study physician-patient interaction in these groups.


Repression Anxiety Breast cancer Emotional expression Hostility Tension Physician-patient interaction 



We presented portions of this study at the annual meetings of the International Psycho-Oncology Society Conference, Quebec City, May 25–29, 2010, American Psychosomatic Society, San Antonio, March 9–12, 2011, and The Canadian Association of Psycho-oncology, Toronto, May 4–6, 2011. This study was funded by NIA/NCI Program Project AG18784. It was also supported in part by grant 5 M01 RR000070 from the National Center for Research Resources, National Institutes of Health. Alberta Cancer Research Institute grants 24551 and 24397 for salary support to Janine Giese-Davis. In addition, we would like to thank project director Bita Nouriani, M.S., research assistants Manijeh Parineh, Ansgar Conrad, Nausheen Ali, Allyson DeLorenzo, Julie Hall, panel members for the TSST, Emotion coders (particularly Lara Rangel, Elisa Hernandez, Kristina Roos, and Priscilla Gonzalez), Kate Collie, Ph.D. for editing assistance, and the women who participated.


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Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Janine Giese-Davis
    • 1
    • 2
    • 3
    Email author
  • Rie Tamagawa
    • 2
    • 3
  • Maya Yutsis
    • 4
  • Suzanne Twirbutt
    • 1
  • Karen Piemme
    • 1
  • Eric Neri
    • 1
  • C. Barr Taylor
    • 1
  • David Spiegel
    • 1
  1. 1.Department of Psychiatry and Behavioral SciencesStanford University School of MedicineStanfordUSA
  2. 2.Department of Oncology, Division of Psychosocial OncologyUniversity of CalgaryCalgaryCanada
  3. 3.Department of Psychosocial ResourcesTom Baker Cancer Centre, Alberta Health Services, Holy Cross SiteCalgaryCanada
  4. 4.Department of PsychologyPalo Alto VA Health Care SystemPalo AltoUSA

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