Predicting negative mood state and personal growth in African American and White long-term breast cancer survivors

Duke University Medical Center, Durham, NC 27708, USA.
Annals of Behavioral Medicine (Impact Factor: 4.2). 07/2006; 31(3):195-204. DOI: 10.1207/s15324796abm3103_1
Source: PubMed


Relatively little research has examined cognitive processes that may impact psychological adaptation in older long-term breast cancer survivors (BCS).
This study investigated the strength of a conceptual model based on the literature and Uncertainty in Illness Theories which proposes that negative mood state and personal growth in older long-term White and African American BCS would be predicted by the combined influences of demographic and disease variables, social support, religious participation, and cognitive processes (uncertainty, catastrophizing, troublesome thoughts, and cognitive reframing).
Baseline data were gathered from 524 BCS (369 Whites and 155 African Americans, 5-9 years postdiagnosis) prior to their participating in an uncertainty management intervention program. The conceptual model was tested using structural equation modeling.
The multigroup model showed good fit to the data and explained substantial variance in negative mood state and personal growth. Cognitive processes showed both direct and indirect effects on outcomes in the expected directions. Several ethnic differences were found: African Americans were more negatively affected by comorbidities and Whites by symptom distress, whereas cognitive reframing was a stronger predictor of personal growth for African Americans than Whites.
This is one of the first studies to explore predictors of both negative mood and personal growth in a multiethnic sample of BCS. These findings suggest that cognitive processes play an important role in psychological adaptation to breast cancer survivorship. These processes are amenable to change, suggesting a logical target for intervention with this population.

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    • "Concerning catastrophizing, we found a small negative effect on personal growth. This finding fits well with research examining catastrophizing in the context of chronic pain and illness, showing that this strategy leads to higher levels of negative mood and reduced personal growth (Porter et al. 2006; Sturgeon and Zautra 2013). One unexpected finding concerned the few significant effects on wellbeing of positive refocusing, putting into perspective and acceptance—which are theoretically considered as adaptive forms of emotion regulation (e.g., Carver et al. 1989; Garnefski et al. 2001). "
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    • "We thought that Bruchon-Schweitzer's (2002, p. 92) integrative model stemming from the Lazarus and Folkman's (1984) transactional model of stress could be heuristic to that purpose. Indeed, (1) this model has proven its validity in many health-related issues (e.g., Echteld, van Elderen, & van der Kamp, 2003; Epping-Jordan et al., 1999; Luszczynska, Mohamed, & Schwarzer, 2005; Porter et al., 2006); (2) it takes into account different types of variables such as medical and social, personality variables, and variables of how people perceive and react to a stressful event, called transactional variables; and (3) this model tests direct and indirect effects because it specifies that transactional variables mediate the effect of antecedent ones (i.e., medical, social, and personality variables) on quality of life. Among the antecedents, two variables emerge as being of particular interest with regard to mental health after cancer: age as a protective factor (Bloom, Peterson, & Kang, 2007; Tomich & Helgeson, 2002) and chemotherapy as a risk factor (Casso, Buist, & Taplin, 2004; Le Corroller-Soriano, Bouhinik, Auquier, & Moatti, 2008b; Paskett et al., 2008). "
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    • "Regarding psychological predictors, consistent with our hypothesis, dispositional positive affectivity and adaptative coping (active, positive, relational, religious and denial coping) were positively associated with posttraumatic growth. These findings are consistent with literature pointing out the beneficial effect on growth of positive, active and religious coping (Lechner et al., 2006; Park et al., 1996; Porter et al., 2006; Urcuyo et al., 2005), as well as relational coping (Armeli, Gunthert, & Cohen, 2001) or denial coping (Helgeson et al., 2006; Park & Fenster, 2004). But there are two important conclusions to be drawn here: first the very long term persistent effect of coping on perceived positive changes due to cancer experience, and second the additional 25.1% of explained variance by coping strategies controlling for personality, thus demonstrating that posttraumatic growth is not only dependent on positive personality, but also on what happened during disease and treatment. "
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