In collaboration with Payame Noor University and Iranian Health Psychology

Document Type : research

Authors

1 PhD Candidate.Department of Psychology, Central Tehran Branch, Islamic . Azad University, Tehran. Iran

2 Assistant Professor in Psychology, Department of Psychology, Central Tehran Branch, Islamic . Azad University, Tehran. Iran

3 Department of Psychology, Payame Noor University, Tehran, Iran

4 Assistant Professor, Department of Psychology, Faculty of Psychology and Educational Science, Central Tehran Branch, Islamic Azad University, Tehran, Iran

Abstract

Objective: The role of cognitive, metacognitive, and meta-emotional factors in psychological distress has been clearly confirmed. The current research aims to examine a psychological distress model based on intolerance of uncertainty and emotional schemas of cancer patients with the mediating role of metacognitive beliefs and cognitive avoidance.
Method: Regarding the methodology, the present study was correlational based on structural equation modeling. The study sample included 300 cancer patients who visited various hospitals in Tehran and completed the questionnaires of uncertainty intolerance, stress, depression, anxiety, emotional schemas, metacognitive beliefs, and cognitive avoidance.
Results: Findings demonstrated that the proposed model has appropriate fitness among cancer patients. Also, the relationship between mediating variables and endogenous and exogenous variables is significant. The variables under investigation explained 46 percent of psychological distress variance in the patients.
Conclusion: Psychological distress in cancer patients is affected by the interaction of excessive emotional states, intolerance of uncertainty, such as metacognitive beliefs, and emotional schemas.

Keywords

Article Title [Persian]

پریشانی روانشناختی بر اساس مولفه‌های شناختی، فراشناختی و فراهیجانی در بیماران مبتلا به سرطان

Authors [Persian]

  • سمیه هاشمی زاده 1
  • مهدیه صالحی 2
  • امین رفیعی پور 3
  • افسانه قنبری پناه 4

Abstract [Persian]

مقدمه: نقش مولفه‌های شناختی، فراشناختی و فراهیجانی در پریشانی ‌روان‌شناختی مورد تائید قرارگرفته است. هدف پژوهش حاضر بررسی مدل پریشانی روانشناختی بر اساس عدم تحمل ابهام و طرحواره‌های هیجانی افراد مبتلا به سرطان: نقش میانجی باورهای فراشناختی و اجتناب شناختی  بود. روش: پژوهش حاضر به روش همبستگی و با استفاده از مدل‌سازی معادلات ساختاری انجام شد. نمونه شامل 300 نفر از بیماران مبتلا به سرطان مراجعه‌کننده به بیمارستان‌های شهر تهران بودند که پرسش‌نامه‌های عدم تحمل ابهام، استرس، افسردگی و اضطراب، طرحواره‌های هیجانی، باورهای فراشناختی و اجتناب شناختی را تکمیل کردند. یافته‌ها: نتایج نشان داد این مدل در بیماران مبتلا به سرطان برازش مناسبی دارد و روابط بین متغیرهای میانجی با متغیرهای درون‌زا و برون‌زا معنادار بود. متغیرهای مورد بررسی مدل، 46 درصد از وایانس پریشانی روانشناختی را در این بیماران تبیین کردند. نتیجه‌گیری: پریشانی روانشناختی بیماران مبتلا به سرطان تحت تاثیر تعامل حالت‌های هیجانی شدید، عدم تحمل ابهام، مانند باورهای فراشناختی، طرحواره‌های هیجانی قرار دارد.

Keywords [Persian]

  • سرطان
  • پریشانی روانشناختی
  • طرحواره‌های هیجانی
  • روانشناسی سلامت
  • ابعاد شناختی
Abdolpoor, Q., Hashemi, T., Shaeeri, M., & Alizadeh, F. (2018). The relationship of the Intolerance of uncertainty and worry and metacognitive beliefs in people with depressive symptoms. Journal of Psychology and Psychiatry, 5(2), 15-26.
Ahadianfard, P., Asgharnejad Farid, A., Fathali Lavasani, F., & Ashoori, A. (2017). Role of cognitive, metacognitive, and meta-emotional components in prediction of emotional distress in students. IJPCP, 23(2), 178-191.
Alschuler, K. N., & Beier, M. L. (2015). Intolerance of uncertainty: Shaping an agenda for research on coping with multiple sclerosis. International journal of MS care, 17(4), 153-158.
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychological assessment, 10(2), 176.
Asnaashari, S., mohammadkhani, S., & Hassanabadi, H. (2017). Cognitive model of anxiety in cancer patients: The role of cognitive and metacognitive components. Health Psychology, 6(21), 66-85.
Atai, S., Fati, L., & Ahmadi Abhari, S. A. (2013). Rumination and cognitive behavioral avoidance in depressive and social anxiety disorders: Comparison between dimensional and categorical approaches. IJPCP, 19(4), 283-295.
Bartone, P. T., & Homish, G. G. (2020). Influence of hardiness, avoidance coping, and combat exposure on depression in returning war veterans: A moderated-mediation study. Journal of affective disorders, 265, 511-518.
Basaknejad, S., Moeini, N., & Mehrabizadeh Honarmand, M. (2011). The relationship between post event processing and cognitive avoidance with social anxiety among students. Journal Behavioral Sciences, 4(4), 335-340.
Boakye, E. A., Osazuwa-Peters, N., Mohammed, K. A., Challapalli, S., Buchanan, P., Burroughs, T. E., & Varvares, M. A. (2020). Prevalence and factors associated with diagnosed depression among hospitalized cancer patients with metastatic disease. Social Psychiatry and Psychiatric Epidemiology, 55(1), 15-23.
Bokuniewicz, S. (2020). Tolerance of uncertainty and ambiguity of the situation and anxiety as a state and as a feature. The Journal of Education, Culture, and Society, 11(2), 224-236.
Bovbjerg, D. H., Keefe, F. J., Soo, M. S., Manculich, J., Van Denburg, A., Zuley, M. L., ... & Shelby, R. A. (2019). Persistent breast pain in post-surgery breast cancer survivors and women with no history of breast surgery or cancer: Associations with pain catastrophizing, perceived breast cancer risk, breast cancer worry, and emotional distress. Acta Oncologica, 58(5), 763-768.
Brown, T. A., Chorpita, B. F., Korotitsch, W. and Barlowv, D. (1997). Psychometric properties of the depression anxiety stress scales(DASS) in clinical samples. Behav Res Ther, 35,79-89.
Buhr, K., & Dugas, M. J. (2002). The intolerance of uncertainty scale: Psychometric properties of the england version. Behavior Research and Therapy, 40, 931-945.
Capobianco, L., Faija, C., Husain, Z., & Wells, A. (2020). Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: A systematic review. PloS one, 15(9), e0238457.
Carleton, R. N., Mulvogue, M. K., Thibodeau, M. A., McCabe, R. E., Antony, M. M., & Asmundson, G. J. (2012). Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. Journal of Anxiety Disorders, 26(3), 468-479.
Chen, J., Long, D. R., Guo, X. J., Liu, Y., & You, H. X. (2021). Anxiety and depression symptoms among ovarian cancer patients in China: A cross-sectional study. Frontiers of Nursing, 7(4), 321-327.
Chen, S., Yao, N., & Qian, M. (2018). The influence of uncertainty and intolerance of uncertainty on anxiety. Journal of behavior therapy and experimental psychiatry, 61, 60-65.
Cook, S. A., Salmon, P., Dunn, G., Holcombe, C., Cornford, P., & Fisher, P. (2015). The association of metacognitive beliefs with emotional distress after diagnosis of cancer. Health Psychology, 34(3), 207.
Curran, L., Sharpe, L., & Butow, P. (2017). Anxiety in the context of cancer: A systematic review and development of an integrated model. Clinical psychology review, 56, 40-54.
Dashtban Jami, S., Bayazi, M., Zaeemi, H., & Hojat, K. (2014). Assessment of relation between emotional schemas and meta cognitive beliefs and depression. JNKUMS, 6(2), 297-305.
Davey, G. C., & Wells, A. (2006). Worry and it᾿s psychological disorders, theory, assessment and treatment. Jouhn Wiley& sons.
Eisenberg, S. A., Kurita, K., Taylor‐Ford, M., Agus, D. B., Gross, M. E., & Meyerowitz, B. E. (2015). Intolerance of uncertainty, cognitive complaints, and cancer‐related distress in prostate cancer survivors. Psycho‐Oncology, 24(2), 228-235.
Fisher, P. L., McNicol, K., Cherry, M. G., Young, B., Smith, E., Abbey, G., & Salmon, P. (2018). The association of metacognitive beliefs with emotional distress and trauma symptoms in adolescent and young adult survivors of cancer. Journal of psychosocial oncology, 36(5), 545-556.
Freeston, M. H., Rhéaume, J., Letarte, H., Dugas, M. J., & Ladouceur, R. (1994). Why do people worry? Personality and individual differences, 17(6), 791-802.
Gravetter, F., & Wallnau, L. (2014). Essentials of statistics for the behavioral sciences (8th ed.). Wadsworth.
Hamer, M., Chida, Y., & Molloy, G. J. (2009). Psychological distress and cancer mortality. Journal of psychosomatic research, 66(3), 255-258.
Hammermüller, C., Hinz, A., Dietz, A., Wichmann, G., Pirlich, M., Berger, T., ... & Zebralla, V. (2021). Depression, anxiety, fatigue, and quality of life in a large sample of patients suffering from head and neck cancer in comparison with the general population. BMC Cancer, 21(1), 1-11.
Hill, E. M., & Hamm, A. (2019). Intolerance of uncertainty, social support, and loneliness in relation to anxiety and depressive symptoms among women diagnosed with ovarian cancer. Psycho‐oncology, 28(3), 553-560.
Karami, S., Banijamali, S., Khosravi, Z., & Parhoon, H. (2017). Role of emotional schemas in predicting anxiety and depression of cancer patients. Journal of Research in Behavioral Sciences, 3, 291-298.
Kargar, A, Basaknejad, S., Hamid, N., & Razmjoo, S. (2019). Examining metacognitive beliefs, positive states of mind and encounter based on emotional coping as predictors of cancer patients’ following of treatment . Unpublished master thesis in psychology, Shahid Chamran University, Ahvaz, Iran.
Karimi Moghaddam, M., Sadeghi firoozabadi, V., Imani, S., & Zakeri, M. (2020). The Effectiveness of Mindfulness-Based Group Therapy on Improving Metacognitive Beliefs in Preventing Relapse of Women Consuming Stimulants. Iranian Journal of Health Psychology, 2(2), 127-135.
Langford, D. J., Morgan, S., Cooper, B., Paul, S., Kober, K., Wright, F., ... & Dunn, L. B. (2020). Association of personality profiles with coping and adjustment to cancer among patients undergoing chemotherapy. Psycho‐oncology, 29(6), 1060-1067.
Lauriola, M., Tomai, M., Palma, R., La Spina, G., Foglia, A., Panetta, C., ... & Pontone, S. (2019). Intolerance of uncertainty and anxiety-related dispositions predict pain during upper endoscopy. Frontiers in psychology, 10, 1112.
Leahy, R. L. (2002). A model of emotional schemas. Cognitive and behavioral practice, 9(3), 177-190.
Leahy, R. L. (2007). Emotional schemas and resistance to change in anxiety disorders. Cognitive and Behavioral Practice, 14(1), 36-45.
Leahy, R. L. (2007). Emotional schemas and self-help: Homework compliance and obsessive-compulsive disorder. Cognitive and Behavioral Practice, 14(3), 297-302.
Leahy, R. L. (2011). Emotional schema therapy: A bridge over troubled waters. In J. D Herbert, & E. M. Forman (Eds.), Acceptance and mindfulness in cognitive behavior therapy (pp.109-131). New Jersey: Wiley.
Leahy, R. L., Wupperman, P., Edwards, E., Shivaji, S., & Molina, N. (2019). Metacognition and emotional schemas: Effects on depression and anxiety. International Journal of Cognitive Therapy, 12(1), 25-37.
Lenzo, V., Sardella, A., Martino, G., & Quattropani, M. C. (2020). A systematic review of metacognitive beliefs in chronic medical conditions. Frontiers in Psychology, 10, 2875.
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy, 33(3), 335-343.
Mahmoodaliloo, M., Shahjuee, T., & hashemi, Z. (2011). Comparison of intolerance of uncertainty, negative problem orientation, cognitive avoidance, positive beliefs about worries in patient whit generalized anxiety disorder and control group. Journal of Modern psychological Researches, 5(20), 169-187.
Manafi, S. F., & Dehshiri, G. (2017). Fear of disease progression in patients with cancer and multiple sclerosis and its relation to emotional problems. Health Psychology, 6(22), 115-130.
Mazloom, M., Yaghubi, H., & Mohammadkhani, S. (2016). Post-traumatic stress symptom, metacognition, emotional schema and emotion regulation: A structural equation model. Personality and Individual Differences, 88, 94-98.
Meyers, L. S, Gamest. G., & Goarin, A. J. (2006). Applied multivariate research, design and interpretation. Sage publication.
Mihailova, S., & Jobson, L. (2020). The impact of depression and culture on responses to intrusive autobiographical memories: Cognitive appraisals, cognitive avoidance, and brooding rumination. British Journal of Clinical Psychology, 59(1), 66-79.
Nolen-Hoeksema, S., Wisco, B. E., Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400-424.
Papageorgiou, C., & Wells, A. (2001). Metacognitive beliefs about rumination in recurrent major depression. Cognitive and Behavioral Practice, 8(2), 160-164.
Pournamdarian, S., Birashk, B., & Asgharnejad Farid, A. (2012). The clarification of contribution of meta-cognitive beliefs in explaining the symptoms of depression, anxiety and stress in nurses. Knowledge & Research in Applied Psychology, 13(3), 86-94.
Quattropani, M. C., Lenzo, V., Mucciardi, M., & Toffle, M. E. (2016). Metacognition as predictor of emotional distress in cancer patients.
Rabieenejad, R., Zargar, Y., Davoudi, I., & Mobini, S. (2016). Effectiveness of computerized cognitive bias moderation program on cognitive extortions, cognitive avoidance and social anxiety syptoms of students at Shahid Chamran University of Ahvaz. Unpublished master thesis in clinical psychology, Shahid Chamran University, Ahvaz, Iran.
Rahimian Boogar, E., Kian Ersi, F., & Tarbaran, F. (2013). Investigating the relationships of emotional schema, cognitive-behavioral avoidance and cognitive-affective system with generalized anxiety disorder and obsessive-compulsive disorder. Pajoohande, 18(5), 267-276.
Rettie, H., & Daniels, J. (2020). Coping and tolerance of uncertainty: Predictors and mediators of mental health during the COVID-19 pandemic. American Psychologist.
Rezaei, M., Ghazanfari, F. & Rezaei, F., (2016). The role of childhood trauma, early maladaptive schemas, emotional schemas and experimental avoidance on depression: A structural equation modeling. Psychiatry research, 246, 407-414.
Salarifar, M., & Pooretemad, H. (2011). The relationship between metacognitive beliefs and anxiety and depression disorder . Yafte, 13(4), 29-38.
Samani, S., & Jokar, B. (2007). Investigating the reliability and validity of the short form of depression, anxiety and psychological pressure. Social Sciences and Humanities of Shiraz University, 26(3), 65-76.
Sanderson, C. A. (2012). Health psychology (2nd ed.). Wiley Global Education.
Sexton, K. A., & Dugas, M. J. (2008). The cognitive avoidance questionnaire: validation of the English translation. Journal of Anxiety Disorders, 22(3), 355-370.
Shirinzadeh Dastgiri, S., Goudarzi, M., Rahimi, C., & Kaziri, Q. (2008). Examining factor structure, validity, and reliability of metacognitive questionnaire. Journal of Psychology, 12(4), 445-461.
Tan, H. J., Marks, L. S., Hoyt, M. A., Kwan, L., Filson, C. P., Macairan, M., ... & Stanton, A. L. (2016). The relationship between intolerance of uncertainty and anxiety in men on active surveillance for prostate cancer. The Journal of urology, 195(6), 1724-1730.
Weiner, A. B., Carton, S. J. (2012). Avoidant coping: a mediator of maladaptive perfectionism and test anxiety. Personality and Individual Difference, 52, 632–636.
Wells, A. (1999). A metacognitive model and therapy for generalized anxiety disorder. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 6(2), 86-95.
Wells, A. (2011). Metacognitive therapy for anxiety and depression. Guilford Press.
Wells, A., Cartwright- Hatton, S. (2004). A short form of metacognitions questionnaire: Properties of the MCQ 30. Behavior Research and Therapy, 42, 385-396.
Yang, X., Wu, X., Gao, M., Wang, W., Quan, L., & Zhou, X. (2020). Heterogeneous Patterns of Posttraumatic Stress Symptoms and Depression in Cancer Patients. Journal of Affective Disorders.
Yao, N., Qian, M., Jiang, Y., & Elhai, J. D. (2020). The Influence of intolerance of uncertainty on anxiety and depression symptoms in Chinese-speaking samples: Structure and validity of the Chinese translation of the intolerance of uncertainty scale. Journal of Personality Assessment, 1-10.
Yavuz, K. F., Turkcapar, M. H., Demirel, B., & Karadere, E. (2011). Adaptation, validity and reliability of the Leahy emotional schema scale Turkish version based on Turkish university students and workers. J Psychiatry Neurological Sci, 24(4), 273-82.
Zakeri, M.Hassani, J., & Esmaeeli, N. (2017). Effectiveness of processing emotion regulation strategies training (PERST) in psychological distress (PD) of patient with vitiligo. Health psychology, 6(23), 39-56.
Zheng, X., Tao, G., Huang, P., He, F., Shao, X., Xu, Y., ... & Yang, G. (2020). Self-reported depression of cancer patients under 2019 novel coronavirus pandemic. Available at SSRN 3555252.