This meta-analysis examined whether effects of psychosocial interventions on psychological distress in cancer patients are conditional upon pre-intervention distress levels. Published articles and unpublished dissertations between 1980 and 2005 were searched for interventions reporting the Hospital Anxiety and Depression Scale (HADS) or the Spielberger State-Trait Anxiety Inventory (STAI). Multilevel mixed-effects modeling was used to meta-analyze effect-sizes separately for the HADS (27 trials, 2424 patients) and STAI (34 trials, 2029 patients). Pre-intervention distress significantly moderated intervention effects, explaining up to 50% of the between-study effect-size variance: effects on anxiety and depression were generally negligible when pre-intervention distress was low and pronounced when it was high. These results could not be explained by differences in intervention type, setting, dose, and whether intervention was targeted at distressed patients. Psychosocial interventions may be most beneficial for cancer patients with elevated distress. Future research should identify which treatment components are most effective for these patients to facilitate optimal treatment tailoring and cost-effective health care. KeywordsAnxiety; depression; cancer; psychosocial; intervention; meta-analysis A considerable number of trials have tested psychosocial interventions designed to reduce emotional distress and improve the quality of life of adult cancer patients. The overall efficacy of these interventions is vigorously debated (Stefanek et al., 2006). Studies have yielded mixed results, and previous systematic and meta-analytic reviews have drawn disparate conclusions about whether psychosocial treatment is generally beneficial (Meyer and Mark, 1995;Rehse and Pukrop, 2003;Tatrow and Montgomery, 2006) or ineffective Newell et al., 2002) in reducing distress among cancer patients. Thus, it appears crucial to examine potential determinants of differential treatment efficacy, that is, to identify for whom and under what conditions interventions prove successful or not (King et al., 2008).Intervention studies have commonly included cancer patients regardless of their current emotional well-being Sheard and Maguire, 1999). However, there is substantial heterogeneity in the psychological sequelae of cancer diagnosis. While 20-40% of patients show clinically meaningful anxiety and depression, many report only transient emotional disruption and overall adjust quite well to the illness (van't Spijker et al., 1997;Zabora et al., 2001). For that reason, it has been argued that the efficacy of intervention might well increase if it was selectively provided for those who are most in need because they Sheard and Maguire, 1999;Stanton, 2005).In recent years, evidence has emerged suggesting greater benefits of psychosocial interventions among patients who show elevated distress (Andersen et al., 2004;Boesen et al., 2005;Carmack Taylor et al., 2007;Given et al., 2004;Goodwin et al., 2001;Taylor et al., 2003) or lack psychoso...

Data from two studies describe the development of an implicit measure of humility and support the idea that dispositional humility is a positive quality with possible benefits. In Study 1, 135 college students completed Humility and Self-Esteem Implicit Association Tests (IATs) and several self-report measures of personality self-concept. Fifty-four participants also completed the Humility IAT again approximately 2 weeks later and their humility was rated by close acquaintances. The Humility IAT was found to be internally and temporally consistent. Implicit humility correlated with self-reported humility relative to arrogance, implicit self-esteem, and narcissism (inversely). Humility was not associated with self-reported low selfesteem, pessimism, or depression. In fact, self-reported humility relative to arrogance correlated positively with self-reported self-esteem, gratitude, forgiveness, spirituality, and general health. In addition, self-reported humility and acquaintancerated humility correlated positively; however, implicit humility and acquaintance-rated humility were not strongly associated. In Study 2, to examine the idea that humility might be associated with increased academic performance, we examined actual course grades of 55 college students who completed Humility and Self-Esteem IATs. Implicit humility correlated positively with higher actual course grades when narcissism, conscientiousness, and implicit self-esteem were simultaneously controlled. Implications and future research directions are discussed.

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