The relationships among hope, optimism, attentional bias, cancer-related rumination and psychological distress in cancer patients

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The experience of cancer challenges the body and the mind. A solid body of evidence has amassed on what help breast cancer patients cope with adversities. In the field of positive psychology, the concepts of hope and optimism further our understanding of the role future expectancies play in goal-directed pursuits and in psychological adjustment to adverse events. Snyder’s theory of hope (2002) conceptualizes that goal directed behaviours have two components -- pathways and agency thinking. Pathways thinking is associated with finding the routes to achieve a desired goal. Agency thinking provides the mental energy to initiate and persist in pursuing goals. Hope is consistently linked with better outcomes in academics, athletic, health care and community settings (Snyder et al., 2005). The literature on optimism (Scheier & Carver, 1985) describes the characteristics of optimists and pessimists. Optimists hold positive future expectancies with positive emotions keeping individuals actively engaged in their goals despite frustrations. Pessimists are more inclined to use avoidant coping in response to the negative emotions engendered in their negative expectancies. In the present project, hope and optimism are investigated in a group of breast cancer patients who are recently diagnosed with recurrent, advanced or metastatic disease in Hong Kong. To the best of the author’s knowledge, no other studies have investigated future expectancies in advanced breast cancer patients in a longitudinal design. Findings suggested that agency hope and optimism together account for 27 - 29% of the variation in concurrent distress; and 52 - 54% of the distress three months later. Optimism was an independent predictor of concurrent and three-month psychological distress. However agency hope was not an independent predictor. The results of the present study are compared with a published study (Ho, et al., 2011) of hope and optimism in a group of oral cavity cancer survivors, who did not have an active disease. In both the advanced breast and oral cavity cancer patient groups, hope and optimism together predicted distress. But optimism was a stronger predictor relative to agency hope in the advanced breast cancer patients whose disease outcome was less certain. The present study also attempts to decipher the cognitive processes postulated to be mediators in the relationship between future expectancies and psychological adjustment. In the advanced breast cancer group, attention to negative information mediated the relationship between optimism and concurrent anxiety and depression. In the oral cavity cancer survivors, negative cancer-related rumination mediated in the relationship between agency hope and depression, and in the relationship between optimism and anxiety and depression. The implications of the findings are discussed in light of the possible different cognitive processes of patients who are faced with two different disease conditions.