Ambivalence over emotional expression, intrusive thoughts, and posttraumatic stress symptoms among Chinese American breast cancer survivors.

Abstract

Posttraumatic stress symptoms (PTSS) are common among breast cancer survivors. However, the association and the underlying mediating mechanism between psychosocial factors and PTSS were rarely investigated among breast cancer survivors. Previous studies have suggested the importance of emotional expression in cancer survivors' PTSS. This study examined the association between ambivalence over emotional expression (AEE; defined as the conflict between the desire to express feelings and the fear of its consequences) and PTSS, and proposed intrusive thoughts as the mediators in such an association. We tested this proposed mediation model among Chinese breast cancer survivors whose culture discourages emotional expression. Participants were 118 Chinese-speaking breast cancer survivors in the USA, who were diagnosed with breast cancer of stages 0-III within the past 5years. They completed questionnaires measuring their levels of AEE, PTSS, and intrusive thoughts. AEE was positively associated with intrusive thoughts (r=0.43, p<01), which were positively associated with the arousal and avoidance subscales of PTSS (r=0.68 and r=0.62, respectively, p<.01). Path analysis supported a partial mediation model with an indirect effect from AEE to the latent variable of PTSS (with both arousal and avoidance as indicators) via intrusive thoughts (β=0.29; 95% CI= 0.18, 0.42) and the direct effect from AEE to the latent variable of PTSS (β=0.21, 95% CI = 0.07, 0.35), all p<.001. Those who are highly ambivalent about emotion expression tend to have higher PTSS, and this may be partially due to the lack of opportunities to discuss emotional events, thereby increasing the repetitive cancer-related negative thoughts. Intervention for PTSS should consider helping cancer patients to develop adaptive emotional regulation strategies to reduce the detrimental effects of cancer-related intrusive thoughts.