title: Emotional approach coping and the effects of online peer-led support group participation among patients with breast cancer: a longitudinal study.
abstract: BACKGROUND
  Previous research on the effects of online peer support on psychological well-being of patients with cancer showed mixed findings. There is a need for longitudinal studies explaining if and when online peer-led support groups are beneficial. How patients cope with emotions that come along with the cancer diagnosis might influence effectiveness of online participation. Emotional approach coping is a construct encompassing the intentional use of emotional processing and emotional expression in efforts to manage adverse circumstances.
  
  
  OBJECTIVE
  In this longitudinal study, we hypothesize that mixed findings in previous research are partly caused by individual differences in coping with emotions, which may moderate the effects of online support group participation on patients' well-being.
  
  
  METHODS
  A total of 133 Dutch patients with breast cancer filled out a baseline (T0) and a follow-up (T1, 6 months later) questionnaire assessing intensity of online participation within the online support community, emotional approach coping (ie, actively processing and expressing emotions), and psychological well-being (depression, emotional well-being, and breast cancer-related concerns). There were 109 patients who visited an online support community at both points in time. Repeated measures ANOVAs assessed change in well-being over time.
  
  
  RESULTS
  Results showed 3-way interactions of time, online intensity of participation, and emotional approach coping on emotional well-being (F1,89=4.232, P=.04, η(2) ρ=.045) and depression (F1,88=8.167, P=.005, η(2) ρ=.085). Online support group participation increased emotional well-being over time for patients who scored low on emotional approach coping at T0, provided that they were highly active online. Patients who were highly active online with a high score on emotional approach coping reported no change in sense of well-being, but showed the highest score on well-being overall. Participating less frequently online was only beneficial for patients who scored high on emotional approach coping, showing an increase in well-being over time. Patients participating less frequently and with a low score on emotional approach coping reported no significant change in well-being over time.
  
  
  CONCLUSIONS
  This study extends previous findings on the effects of online peer support in two ways: by testing changes in well-being as a function of intensity of online support group participation and by examining the role of individual differences in emotional coping styles. Findings showed no negative effects of intense support group participation. Participating frequently online was especially helpful for patients who approach their emotions less actively; their emotional well-being increased over time. In contrast, frequent online users who actively approach their emotions experienced no change in well-being, reporting highest levels of well-being overall. For patients who participate less intensively within the support community, coping style seems to outweigh effects of online participation; over time, patients who actively approached emotions experienced an increase in psychological well-being, whereas patients with a low score on emotional approach coping reported no change in depression and emotional well-being.
authors.affiliation: VU University Amsterdam, Department of Communication Science, Amsterdam, Netherlands. a.e.batenburg@vu.nl.
authors.forename: Anika
authors.identifier: http://orcid.org/0000-0001-5197-6423
authors.initials: A
authors.lastname: Batenburg
authors.forename: Enny
authors.identifier: http://orcid.org/0000-0002-0367-6757
authors.initials: E
authors.lastname: Das
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology*; D003863:Depression / Q000209:etiology / Q000628:therapy; D004644:Emotions; D005260:Female; D006801:Humans; D020407:Internet; D008137:Longitudinal Studies; D008875:Middle Aged; D010379:Peer Group; D012657:Self-Help Groups; D011795:Surveys and Questionnaires
keywords: Internet; breast neoplasms; emotions; online systems; self-help groups; social support