The Relationship between Cognitive Fusion, Sense of Coherence, Rumination, and Psychological distress in Cancer patients: The Mediating role of Emotional Dysregulation

Author
Abstract
This study examined the associations among the cognitive fusion, sense of coherence, rumination, and psychological distress, in cancer patients, as well as the mediating role of emotional dysregulation, in the relationship between this variables in cancer patients. Participants included 200 cancer patients who completed the DASS-21, Cognitive fusion questionnaire, sense of coherence scale, Rumination scale and the DERS-16. Structural equation modeling revealed was a direct associated between rumination with emotion dysregulation and emotion dysregulation with psychological distress. Also, the results indicated that no significant relationship between cognitive fusion and sense of coherence with psychological distress. Interaction-mediation analysis demonstrated that emotion dysregulation in the relationship between cognitive fusion and sense of coherence with psychological distress plays a full mediating role and in the relationship between rumination and psychological distress has minor mediating role. Therefore, considering the relationships between the studied variables and identifying the role of emotional dysregulation as a mediating variable in this regard, paying attention to the findings can be the first step in identifying the variables involved in psychological distress in cancer patients. This is followed by the design and application of evidence-based training and rehabilitation programs to reduce psychological pain and suffering in cancer patients, which can be considered by the mental health team of these patients.
Keywords

Aldao, A., Gee, D. G., De Los Reyes, A., & Seager, I. (2016). Emotion regulation as a transdiagnostic factor in the development of internalizing and externalizing psychopathology: Current and future directions. Dev Psychopathol, 28(4pt1), 927-946. doi:10.1017/s0954579416000638
Ando, M., & Kawano, M. (2018). Relationships among moral distress, sense of coherence, and job satisfaction. Nursing ethics, 25(5), 571-579.
Antoni, M. H., & Dhabhar, F. S. (2019). The impact of psychosocial stress and stress management on immune responses in patients with cancer. Cancer, 125(9), 1417-1431. doi:10.1002/cncr.31943
Asplund, D., Bisgaard, T., Bock, D., Burcharth, J., González, E., Haglind, E., & Smedh, K. (2018). Correction to: Pretreatment quality of life in patients with rectal cancer is associated with intrusive thoughts and sense of coherence. International journal of colorectal disease, 33(3), 355-357.
Bach, P., Hayes, S. C., & Gallop, R. (2012). Long-term effects of brief acceptance and commitment therapy for psychosis. Behavior Modification, 36(2), 165-181.
Bellahcene, A., Bellier, J., Peulen, O., Rademaker, G., Charloteaux, B., Van Laere, S., & Nokin, M. J. (2018). PO-226 Dicarbonyl stress induces ECM remodelling and MAPK signalling activation in metastatic breast cancer cells.
Bjureberg, J., Ljótsson, B., Tull, M. T., Hedman, E., Sahlin, H., Lundh, L. G., Gratz, K. L. (2016). Development and Validation of a Brief Version of the Difficulties in Emotion Regulation Scale: The DERS-16. J Psychopathol Behav Assess, 38(2), 284-296. doi:10.1007/s10862-015-9514-x
Bradt, J., Dileo, C., Magill, L., & Teague, A. (2016). Music interventions for improving psychological and physical outcomes in cancer patients. Cochrane Database of Systematic Reviews, (8).
Brown, L. C., Murphy, A. R., Lalonde, C. S., Subhedar, P. D., Miller, A. H., & Stevens, J. S. (2020). Posttraumatic stress disorder and breast cancer: Risk factors and the role of inflammation and endocrine function. Cancer, 126(14), 3181-3191. doi:10.1002/cncr.32934
Christner, C. H., & Strömsten, T. (2015). Scientists, venture capitalists and the stock exchange: The mediating role of accounting in product innovation. Management Accounting Research, 28, 50-67.
Cohn, E., Lurie, I., Yang, Y. X., Bilker, W. B., Haynes, K., Mamtani, R., . . . Boursi, B. (2018). Posttraumatic Stress Disorder and Cancer Risk: A Nested Case-Control Study. J Trauma Stress, 31(6), 919-926. doi:10.1002/jts.22345
Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behav Res Ther, 38(4), 319-345. doi:10.1016/s0005-7967(99)00123-0
Ehring, T., & Ehlers, A. (2014). Does rumination mediate the relationship between emotion regulation ability and posttraumatic stress disorder? Eur J Psychotraumatol, 5. doi:10.3402/ejpt.v5.23547
Fan, S. J., Kroeger, B., McCormick, K., Mason, J., Sheldon, H., Wainwright, M., & Goberdhan, D. C. (2018). A novel conserved exosome biogenesis pathway mediates adaptive response to microenvironmental stress in cancer cells. Journal of Extracellular Vesicles, 7, 92-92.
Gillanders, D. T., Bolderston, H., Bond, F. W., Dempster, M., Flaxman, P. E., Campbell, L., Remington, B. (2014). The development and initial validation of the cognitive fusion questionnaire. Behav Ther, 45(1), 83-101. doi:10.1016/j.beth.2013.09.001
González-Fernández, S., Fernández-Rodríguez, C., Paz-Caballero, M. D., & Pérez-Álvarez, M. (2018). Treating anxiety and depression of cancer survivors: Behavioral activation versus acceptance and commitment therapy. Psicothema, 30(1), 14-20.
Grezellschak, S., Lincoln, T. M., & Westermann, S. (2015). Cognitive emotion regulation in patients with schizophrenia: Evidence for effective reappraisal and distraction. Psychiatry Research, 229(1–2), 434-439.
Guimond, A.-J., Ivers, H., & Savard, J. (2019). Is emotion regulation associated with cancer-related psychological symptoms? Psychology & Health, 34(1), 44-63. doi:10.1080/08870446.2018.1514462
Hair, J. J. F., Hult, G. T. M., Ringle, C. M., & Sarstedt, M. (2013). A primer on partial least squares structural equation modeling (PLS-SEM). Sage publication.
Hair, J. J. F., Sarstedt, M., Ringle, C. M., & Gudergan, S. P. (2017). Advanced issues in partial least squares structural equation modeling: Sage publications.
Hansen, Å. M., Grynderup, M. B., Rugulies, R., Conway, P. M., Garde, A. H., Török, E., ... & Hogh, A. (2018). A cohort study on self-reported role stressors at work and poor sleep: does sense of coherence moderate or mediate the associations? International archives of occupational and environmental health, 91(4), 445-456.
Hayes, S. C., Barnes-Holmes, D., & Biglan, A. (2016). The Wiley handbook of contextual behavioral science. John Wiley & Sons.
Henry, J. D., & Crawford, J. R. (2005). The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol, 44(Pt 2), 227-239. doi:10.1348/014466505x29657
Hulbert‐Williams, N. J., Storey, L., & Wilson, K. G. (2015). Psychological interventions for patients with cancer: psychological flexibility and the potential utility of Acceptance and Commitment Therapy. European journal of cancer care, 24(1), 15-27.
Jane, O. (2012). Health Psychology: A textbook, 5th edition: Open University Press.
Kline, R.B. (2011). Principles and practice of structural equation modeling, 3nd Ed. New York: Guilford.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. Sydney: Psychology Foundation.
Mahammadzadeh A, Poursharifi H, Alipour A. (2010). Validation of Sense of Coherence (SOC) 13-item scale in Iranian sample. Procedia-Social and Behavioral Sciences, 5, 1451-1455.
Markovitz, S. E., Schrooten, W., Arntz, A., & Peters, M. L. (2015). Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients. Psycho‐Oncology, 24(12), 1639-1645.
Michael, T., Halligan, S. L., Clark, D. M., & Ehlers, A. (2007). Rumination in posttraumatic stress disorder. Depress Anxiety, 24(5), 307-317. doi:10.1002/da.20228
Mills, P., Newman, E. F., Cossar, J., & Murray, G. (2015). Emotional maltreatment and disordered eating in adolescents: Testing the mediating role of emotion regulation. Child Abuse & Neglect, 39, 156-166.
Muzzatti, B., Bomben, F., Flaiban, C., Piccinin, M., & Annunziata, M. A. (2020). Quality of life and psychological distress during cancer: a prospective observational study involving young breast cancer female patients. BMC Cancer, 20(1), 758. doi:10.1186/s12885-020-07272-8
Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61, 115-121
Nuccitelli, C., Valentini, A., Caletti, M. T., Caselli, C., Mazzella, N., Forlani, G., & Marchesini, G. (2018). Sense of coherence, self-esteem, and health locus of control in subjects with type 1 diabetes mellitus with/without satisfactory metabolic control. Journal of endocrinological investigation, 41(3), 307-314.
Ogińska-Bulik, N., & Michalska, P. (2020). The Relationship between Emotional Processing Deficits and Posttraumatic Stress Disorder Symptoms Among Breast Cancer Patients: The Mediating Role of Rumination. Journal of Clinical Psychology in Medical Settings, 27(1), 11-21. doi:10.1007/s10880-019-09606-6
Patron, E., Messerotti Benvenuti, S., Favretto, G., Gasparotto, R., & Palomba, D. (2014). Depression and reduced heart rate variability after cardiac surgery: The mediating role of emotion regulation. Autonomic Neuroscience, 180, 53-58
Pressman, A., Hernandez, A., & Sikka, S. C. (2018). Lifestyle stress and its impact on male reproductive health. In Bioenvironmental Issues Affecting Men's Reproductive and Sexual Health (pp. 73-83). Academic Press.
Priede, A., Hoyuela, F., Umaran-Alfageme, O., & González-Blanch, C. (2019). Cognitive factors related to distress in patients recently diagnosed with cancer. Psycho-Oncology, 28(10), 1987-1994. doi:https://doi.org/10.1002/pon.5178
Razik, S., Ehring, T., & Emmelkamp, P. M. (2013). Psychological consequences of terrorist attacks: prevalence and predictors of mental health problems in Pakistani emergency responders. Psychiatry Res, 207(1-2), 80-85. doi:10.1016/j.psychres.2012.09.031
Shahabi, M., Hasani, J., & Bjureberg, J. (2018). Psychometric Properties of the Brief Persian Version of the Difficulties in Emotion Regulation Scale (The DERS-16). Assessment for Effective Intervention, 45(2), 135-143. doi:10.1177/1534508418800210
Sharpe, L., Curran, L., Butow, P., & Thewes, B. (2018). Fear of cancer recurrence and death anxiety. Psychooncology, 27(11), 2559-2565. doi:10.1002/pon.4783
Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clin Psychol Rev, 57, 141-163. doi:10.1016/j.cpr.2017.09.002
Taghizadeh, A., Pourali, L., Vaziri, Z., Saedi, H. R., Behdani, F., & Amel, R. (2018). Psychological Distress in Cancer Patients. Middle East Journal of Cancer, 9(2), 143-149. doi:10.30476/mejc.2018.42116
Tauber, N. M., O'Toole, M. S., Dinkel, A., Galica, J., Humphris, G., Lebel, S., . . . Zachariae, R. (2019). Effect of Psychological Intervention on Fear of Cancer Recurrence: A Systematic Review and Meta-Analysis. J Clin Oncol, 37(31), 2899-2915. doi:10.1200/jco.19.00572
Taube-Schiff, M., Van Exan, J., Tanaka, R., Wnuk, S., Hawa, R., & Sockalingam, S. (2015). Attachment style and emotional eating in bariatric surgery candidates: The mediating role of difficulties in emotion regulation. Eating Behaviors, 18, 36-40.
Vazquez, D., Rosenberg, S., Gelber, S., Ruddy, K. J., Morgan, E., Recklitis, C., . . . Partridge, A. H. (2020). Posttraumatic stress in breast cancer survivors diagnosed at a young age. Psycho-Oncology, 29(8), 1312-1320. doi:https://doi.org/10.1002/pon.5438