Stuck in the spin cycle: Avoidance and intrusions following breast cancer diagnosis

Abstract

These findings provide empirical support for the theoretical contention that avoidance and intrusive thoughts and emotions reciprocally influence one another following stressful events. Additionally, in the months shortly after breast cancer diagnosis, intrusions and avoidance are positively related. However, the relationships attenuate over time, which could indicate resolved cognitive and emotional processing of the cancer experience. Statement of contribution What is already known on this subject? Following stressful life events, individuals often experience intrusive thoughts and feelings related to the event and they report avoidance of such reminders. Many studies demonstrate that greater intrusions predict more subsequent use of avoidance coping, and other studies show that greater use of avoidance predicts more intrusions. Their reciprocal relation has not been examined, however. What does this study add? This is the first examination of the concurrent, reciprocal influence of intrusions and avoidance. Findings suggest that accounting for the bidirectional influence of avoidance and intrusions best estimates hypothesized models. Higher intrusions and avoidance predicted each other for the first 3 months after study entry, but the relationship diminished 6 months after study entry, perhaps due to productive mental processing of the stress of breast cancer diagnosis and treatment.

Within-person changes in cancer-related distress predict breast cancer survivors’ inflammation across treatment

“…Previous findings highlighted intrusive thoughts as central drivers of cancer-related distress among survivors (Epping-Jordan et al, 1999). However, avoidance and intrusive thoughts both occur commonly among survivors (Bauer et al, 2017;Mehrabi, Hajian, Simbar, Hoshyari, & Zayeri, 2015). This study extends previous findings by highlighting both intrusive thoughts and avoidance as influencers of inflammation.…”

“…Zero-order correlations among study variables at Visit 1 are presented in Table 3. Overall, levels of cancer-related distress in this study resembled previous research, with it being highest at Visit 1 (post diagnosis, pretreatment), and lower following treatment (Bauer, Wiley, Weihs, & Stanton, 2017;Cordova et al, 1995). Women's mean CESD score at Visit 1 was 16.57.…”

The Affect Regulation in Cancer framework: Understanding affective responding across the cancer trajectory

“…To that end, individuals may use several attentional deployment strategies, during each phase of the cancer trajectory, for example, by focusing on work and/or hobbies to avoid having to talk or reflect on one's cancer experience. Moreover, in a recent study, Bauer et al (2017) found a reciprocal relationship between intrusions and avoidance symptoms in a large sample of breast cancer patients between 2 and 5 months post-diagnosis. However, by 8 months post-diagnosis, this reciprocal association had declined which the authors attributed to the likelihood of patients having adapted following the initial acute distress period of being diagnosed with cancer; hence, they proposed that patients were more likely to use more adaptive emotional processing by 8 months post-diagnosis.…”

“…In fact, oscillating between focusing on one’s cancer-related thoughts (i.e. intrusions) and avoiding focusing on cancer has been documented to occur within the initial diagnostic and treatment phases as patients adapt to their circumstances, although the reciprocity between cancer-related intrusions and avoidance diminishes over time (Bauer et al, 2017). Hence, the rigid, chronic use of a particular strategy (or restricted set of strategies) is pivotal in determining whether an affect regulation strategy has a maladaptive effect.…”

A preventive intervention to modify depression risk targets after breast cancer diagnosis: Design and single‐arm pilot study

“…Stage 0 of the NIH Model involves basic science and research to identify mutable targets for intervention. Accordingly, the MYA project developed and tested a biopsychosocial model of risk and protective factors and processes for depression as they unfold during the year after breast cancer diagnosis and used these data to create a brief depression risk screener …”