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Fox Chase Cancer Center (S.M.), Philadelphia, Pennsylvania; Research Analysis and Consultation, (M.G.), and Mt. Sinai School of Medicine (K.D.H.), New York, New York.
Address reprint requests to: Sharon L. Manne, PhD, Fox Chase Cancer Center, 510 Township Line Road, Philadelphia, PA 19012. Email: sl_manne{at}fccc.edu
OBJECTIVE: The goal of the study was to examine the utility of Creamer’s cognitive processing theory of trauma in a sample of individuals undergoing treatment for cancer. This theory proposes that avoidance is a maladaptive strategy of dealing with intrusive thoughts about a traumatic experience and suggests that avoidance mediates the relation between intrusive thoughts and later psychological distress. The role of disease-related factors, specifically changes in physical impairment and disease stage, was also examined.
METHODS: Patients (N = 189) undergoing treatment for cancer completed questionnaires at three time points, spaced 3 months apart. Intrusive thoughts, functional impairment, and psychological distress were assessed at Time 1, avoidance and functional impairment at Time 2, and psychological distress was assessed again at Time 3. The fit of the model was tested separately for patients with early-stage (stages 1 and 2) and late-stage (stages 3 and 4) disease.
RESULTS: The mediational role for avoidance was supported among patients with advanced stages of cancer but not for patients with early-stage disease. Results were inconsistent with predictions about the role of physical impairment. Among individuals with late-stage cancer, changes in functional impairment were not predictive of greater avoidance, and impairment had a significant but weak effect on the change in distress. Among patients with early-stage cancer, a deterioration in physical impairment was associated with increases in avoidance, and deterioration in physical impairment increased distress.
CONCLUSIONS: The results of this study were partially consistent with Creamer’s cognitive processing theory. A moderating effect was found for disease stage on associations between intrusions, avoidance, physical impairment, and distress.
Key Words: cognitive processing • cancer • avoidance • intrusive thoughts
Abbreviations: CARES = Cancer Rehabilitation and Evaluation System; OR = odds ratio; CI = confidence interval; SEM = structural equation modeling; CFI= Comparative Fit Index; GFI = Goodness of Fit Index; AGFI = Adjusted Goodness of Fit Index; NNFI = Nonnormed Fit Index; RMSEA = root mean square error of approximation.
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