Abstract
The aim of this study was to investigate the moderating and mediating role of global meaning and emotional expressivity in the relationship between intrusive thoughts and psychological adjustment (as indicated by mental health status) in a sample of breast cancer patients (N = 153). Coping with cancer was also included as an intervening variable to be tested. Moderating effects were explored using a series of hierarchical regression analysis, while multiple mediated effects were tested through bootstrapping procedures. Results showed that global personal meaning had both direct and indirect (mediating) effects on psychological adjustment. Emotional expressivity had neither moderating nor mediating effects on psychological adjustment. These results indicated that a strong sense of personal meaning and purpose in life, and an integrated understanding of self and life may lessen the impact of intrusive thoughts on breast cancer patients’ psychological adjustment and mental health status. Implications of the findings for clinical practice and recommendations for future research are discussed.
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Anagnostopoulos, F., Kolokotroni, Ph., Spanea, E., & Chryssochoou, M. (2006). The mini-mental adjustment to cancer (Mini-MAC) scale: Construct validation with a Greek sample of breast cancer patients. Psycho-Oncology, 15, 79–89.
Anagnostopoulos, F., Niakas, D., & Pappa, E. (2005). Construct validation of the Greek SF-36 Health Survey. Quality of Life Research, 14, 1959–1965.
Anagnostopoulos, F., Niakas, D., & Tountas, Y. (2009). Comparison between exploratory factor-analytic and SEM-based approaches to constructing SF-36 summary scores. Quality of Life Research, 18, 53–63.
Andrykowski, M. A., Cordova, M. J., McGrath, P. C., Sloan, D. A., & Kenady, D. E. (2000). Stability and change in posttraumatic stress disorder symptoms following breast cancer treatment: A 1-year follow-up. Psycho-Oncology, 9, 69–78.
Andrykowski, M. A., Cordova, M. J., Studts, J. L., & Miller, T. W. (1998). Posttraumatic stress disorder after treatment for breast cancer: Prevalence of diagnosis and use of the PTSD Checklist-Civilian Version (PCL-C) as a screening instrument. Journal of Consulting and Clinical Psychology, 66, 586–590.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.
Bauer-Wu, S., & Farran, C. J. (2005). Meaning in life and psycho-spiritual functioning. Journal of Holistic Nursing, 23, 172–190.
Breitbart, W., Rosenfeld, B., Gibson, C., Pessin, H., Poppito, S., Nelson, C., et al. (2010). Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psycho-Oncology, 19, 21–28.
Brewin, C. R., Watson, M., McCarthy, S., Hyman, P., & Dayson, D. (1998a). Memory processes and the course of anxiety and depression in cancer patients. Psychological Medicine, 28, 219–224.
Brewin, C. R., Watson, M., McCarthy, S., Hyman, P., & Dayson, D. (1998b). Intrusive memories and depression in cancer patients. Behaviour Research and Therapy, 36, 1131–1142.
Cordova, M. J., Andrykowski, M. A., Kenady, D. E., McGrath, P. C., Sloan, D. A., & Redd, W. H. (1995). Frequency and correlates of posttraumatic-stress-disorder-like symptoms after treatment for breast cancer. Journal of Consulting and Clinical Psychology, 63, 981–986.
Davis, C. G., Nolen-Hoeksema, S., & Larson, J. (1998). Making sense of loss and benefiting from the experience: Two construals of meaning. Journal of Personality and Social Psychology, 75, 561–574.
Glinder, J. G., Beckjord, E., Kaiser, C. R., & Compas, B. E. (2007). Psychological adjustment to breast cancer: Automatic and controlled responses to stress. Psychology and Health, 22, 337–359.
Greenstein, M., & Breitbart, W. (2000). Cancer and the experience of meaning: A group psychotherapy program for people with cancer. American Journal of Psychotherapy, 54, 486–500.
Hanson-Frost, M., Suman, V. J., Rummans, T. A., Dose, A. M., Taylor, M., Notovny, P., et al. (2000). Physical, psychological, and social well-being of women with breast cancer: The influence of disease phase. Psycho-Oncology, 9, 221–231.
Hirai, K., Suzuki, Y., Tsuneto, S., Ikenaga, M., Hosaka, T., & Kashiwagi, T. (2002). A structural model of the relationships among self-efficacy, psychological adjustment, and physical condition in Japanese advanced cancer patients. Psycho-Oncology, 11, 221–229.
Hoeymans, N., Garssen, A. A., Westert, G. P., & Verhaak, P. F. M. (2004). Measuring mental health of the Dutch population: A comparison of the GHQ-12 and the MHI-5. Health and Quality of Life Outcomes, 2, 23.
Holmbeck, G. N. (1997). Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: Examples from the child-clinical and pediatric psychology literatures. Journal of Consulting and Clinical Psychology, 65, 599–610.
Horowitz, M. J. (1986). Stress response syndromes (2nd ed.). Northvale, NJ: Jason Aronson.
Horowitz, M. J., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209–218.
Janoff-Bulman, R. (1989). Assumptive worlds and the stress of traumatic events: Applications of the schema construct. Social Cognition, 7, 113–136.
Janoff-Bulman, R. (1992). Shattered assumptions: Toward a new psychology of trauma. New York: Free Press.
Janoff-Bulman, R. (2004). Posttraumatic growth: Three explanatory models. Psychological Inquiry, 15, 30–34.
Joseph, S., & Linley, P. A. (2005). Positive adjustment to threatening events: An organismic valuing theory of growth through adversity. Review of General Psychology, 9, 262–280.
Kafetsios, K. (2006). Social support and well-being in contemporary Greek society: Examination of multiple indicators at different levels of analysis. Social Indicators Research, 76, 127–145.
Kennedy-Moore, E., & Watson, J. C. (2001). How and when does emotional expression help? Review of General Psychology, 5, 187–212.
Kring, A., Smith, D., & Neal, J. (1994). Individual differences in dispositional expressiveness: Development and validation of the emotional expressivity scale. Journal of Personality and Social Psychology, 66, 934–949.
Lam, W. W. T., & Fielding, R. (2007). Is self-efficacy a predictor of short-term post-surgical adjustment among Chinese women with breast cancer? Psycho-Oncology, 16, 651–659.
Lepore, S. J. (2001). A social-cognitive processing model of emotional adjustment to cancer. In A. Baum & B. L. Andersen (Eds.), Psychosocial interventions for cancer (pp. 99–116). Washington, DC: American Psychological Association.
Lethborg, C., Aranda, S., Cox, S., & Kissane, D. (2007). To what extent does meaning mediate adaptation to cancer? The relationship between physical suffering, meaning in life, and connection to others in adjustment to cancer. Palliative and Supportive Care, 5, 377–388.
Meraviglia, M. (2006). Effects of spirituality in breast cancer survivors. Oncology Nursing Forum, 33, E1–E7.
Mullen, P. M., Smith, R. M., & Hill, E. W. (1993). Sense of coherence as a mediator of stress for cancer patients and spouses. Journal of Psychosocial Oncology, 11, 23–46.
Mystakidou, K., Tsilika, E., Parpa, E., Galanos, A., & Vlahos, L. (2007). Psychometric properties of the Impact of Event Scale in Greek cancer patients. Journal of Pain and Symptom Management, 33, 454–461.
Pappa, E., Kontodimopoulos, N., & Niakas, D. (2005). Validating and norming of the Greek SF-36 Health Survey. Quality of Life Research, 14, 1433–1438.
Park, C. L., & Folkman, S. (1997). Meaning in the context of stress and coping. Review of General Psychology, 1, 115–144.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.
Primo, K., Compas, B. E., Oppedisano, G., Howell, D. C., Epping-Jordan, J. E., & Krag, D. N. (2000). Intrusive thoughts and avoidance in breast cancer: Individual differences and association with psychological distress. Psychology and Health, 15, 1141–1153.
Quartana, P. J., Laubmeier, K. K., & Zakowski, S. G. (2006). Psychological adjustment following diagnosis and treatment of cancer: An examination of the moderating role of positive and negative emotional expressivity. Journal of Behavioral Medicine, 29, 487–498.
Reker, G. T. (1994). Logotheory and logotherapy: Challenges, opportunities, and some empirical findings. International Forum for Logotherapy, 17, 47–55.
Reker, G. T. (1999). Manual of the Life Attitude Profile-Revised (3rd printing). Peterborough: Student Psychologists Press.
Rumpf, H., Meyer, C., Hapke, U., & John, U. (2001). Screening for mental health: Validity of the MHI-5 using DSM-IV axis I psychiatric disorders as gold standard. Psychiatry Research, 105, 243–253.
Schnoll, R. A., Harlow, L. L., Brandt, U., & Stolbach, L. L. (1998). Using two factor structures of the Mental Adjustment to Cancer (MAC) Scale for assessing adaptation to breast cancer. Psycho-Oncology, 7, 424–435.
Schou, I., Ekeberg, O., & Ruland, C. M. (2005). The mediating role of appraisal and coping in the relationship between optimism–pessimism and quality of life. Psycho-Oncology, 14, 718–727.
Schwartz, C. E., Daltroy, L. H., Brandt, U., Friedman, R., & Stolbach, L. (1992). A psychometric analysis of the Mental Adjustment to Cancer Scale. Psychological Medicine, 22, 203–210.
Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7, 422–445.
Smith, M. Y., Redd, W. H., Peyser, C., & Vogl, D. (1999). Post-traumatic stress disorder in cancer: A review. Psycho-Oncology, 8, 521–537.
Stanton, A. L., Danoff-Burg, S., Cameron, C. L., Bishop, M., Collins, C. A., Kirk, S. B., et al. (2000). Emotionally expressive coping predicts psychological and physical adjustment to breast cancer. Journal of Consulting and Clinical Psychology, 68, 875–882.
Taylor, S. E. (1983). Adjustment to threatening events: A theory of cognitive adaptation. American Psychologist, 38, 1161–1173.
Vickberg, S. M. J., Bovbjerg, D. H., DuHamel, K. N., Currie, V., & Redd, W. H. (2000). Intrusive thoughts and psychological distress among breast cancer survivors: Global meaning as a possible protective factor. Behavioral Medicine, 25, 152–160.
Vickberg, S. M., DuHamel, K. N., Smith, M. Y., Manne, S. L., Winkel, G., Papadopoulos, E. B., et al. (2001). Global meaning and psychological adjustment among survivors of bone marrow transplant. Psycho-Oncology, 10, 29–39.
Ware, J. E., Kosinski, M., & Gandek, B. (2003). SF-36 Health Survey: Manual and interpretation guide. Lincoln, RI: Quality-Metric Inc.
Watson, M., Greer, S., Young, J., Inayat, Q., Burgess, C., & Robertson, B. (1988). Development of a questionnaire of adjustment to cancer: The MAC scale. Psychological Medicine, 18, 203–209.
Watson, M., Law, M., dos Santos, M., Greer, S., Baruch, J., & Bliss, J. (1994). The Mini-MAC: Further development of the Mental Adjustment to Cancer Scale. Journal of Psychosocial Oncology, 12, 33–46.
Zakowski, S. G., Valdimarsdottir, H. B., & Bovbjerg, D. H. (2001). Emotional expressivity and intrusive cognitions in women with family histories of breast cancer: Application of a cognitive processing model. British Journal of Health Psychology, 6, 151–165.
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Anagnostopoulos, F., Slater, J. & Fitzsimmons, D. Intrusive Thoughts and Psychological Adjustment to Breast Cancer: Exploring the Moderating and Mediating Role of Global Meaning and Emotional Expressivity. J Clin Psychol Med Settings 17, 137–149 (2010). https://doi.org/10.1007/s10880-010-9191-6
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DOI: https://doi.org/10.1007/s10880-010-9191-6