رابطه بین سبک های دلبستگی و پریشانی روانشناختی با نقش میانجی خودکارآمدی و تاب آوری در زنان مبتلا به سرطان پستان

Aim of this study was to investigate the relationship between attachment styles with psychological distress women with breast cancer with the mediating role of self-efficacy and resilience. The current research was descriptive-correlational. The statistical population was all women suffering from breast cancer with an active case in the oncology department of Imam Khomeini (RA) and Imam Hossein (AS) Hospitals in Tehran in 2023. The sample size was selected based on Klein's model (2023) and 250 people were selected by available sampling method. Research data collection tools include depression anxiety stress scale (DASS), revised version adult attachment scale (RAAS), Connor-Davidson resilience Ssale (CD-RISC) and general of self-efficacy scale (GSES). Data were analyzed using Pearson correlation and structural equations modeling with using SPSS and AMOS software version 28. The results showed that attachment styles (secure and ambivalent) have a significant direct effect on psychological distress. The self-efficacy has a significant direct effect on psychological distress and was able significant mediating role in the relationship between attachment styles (secure and ambivalent) and psychological distress. Also, resilience has a significant direct effect on psychological distress and was able significant mediating role in the relationship between attachment styles (secure and ambivalent) and psychological distress. It can be concluded that according to the significant mediating role of resilience and self-efficacy, it is possible to reduce the occurrence of psychological distress in women with breast cancer by using effective interventions such as attachment-oriented interventions such as emotion focused therapy.

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Psychological Distress, Resilience, Self-Efficacy, Attachment Sstyles, Breast Cancer

Introduction

Breast cancer is one of the most common and deadly cancers among women (Kina and et al, 2024) worldwide (De Boniface and et al, 2024) that affects millions of people (Hoque and et al, 2024). After diagnosis, women with breast cancer suffer psychological problems from psychological distress, which manifests itself in the form of anxiety, depression, and stress (Ikhile and et al, 2024; Jayarajah and et al, 2024); Research has shown that depression, stress and anxiety (as symptoms of psychological distress) are common diseases associated with cancer (Blevins and et al, 2024). Having psychological distress in women with breast cancer can cause them to experience less well-being (Yang and et al, 2024). Based on the background of research, one of the predictors of psychological distress is attachment styles (Mazza and et al, 2021; Ciocca and et al, 2024).

What is clear is that attachment styles are related to psychological distress (Mazza and et al, 2021; Ciocca and et al, 2024; Kaswang & Halim, 2024; Karveli and et al, 2024), but what is important is to examine the role of mediating variables in the relationship between styles. attachment is with psychological distress, which in this research, self-efficacy and resilience have been investigated as two possible mediating variables, because self-efficacy (Alyana & Saeed, 2023) and resilience (Muyang and et al, 2022) of Attachment styles are influenced as predictors of this research, and self-efficacy (Pomey and et al, 2023) and resilience affect the results of this research, namely psychological distress (Tao and et al, 2023; Tamannaeifar & Soleimanian, 2024). Therefore, the present research was conducted with the aim of investigate the relationship between attachment styles with psychological distress women with breast cancer with the mediating role of self-efficacy and resilience.

Methodology

The current research was descriptive-correlational. The statistical population was all women suffering from breast cancer with an active case in the oncology department of Imam Khomeini (RA) and Imam Hossein (AS) Hospitals in Tehran in 2023. The sample size was selected based on Klein's model (2023) and 250 people were selected by available sampling method. Research data collection tools include depression anxiety stress scale (DASS) Lovibond and Lovibond (1996), revised version adult attachment scale (RAAS) of Collins (1996), Connor-Davidson resilience Ssale (CD-RISC) Connor-Davidson (2003) and general of self-efficacy scale (GSES) of Sherer and (1982). The criteria for inclusion the research were: diagnosis of breast cancer, being in the treatment stage of radiotherapy, having minimal literacy, full consent to participate in the research and the right to withdraw from the continuation of the research and having enough time to answer the questionnaires and not having Obvious physical and psychological disorders hindered the ability to answer the questionnaires, and the criteria for exclusion the present study were not completing the questions of the research questionnaires and unwillingness to participate in the research, as well as recovery from cancer. All ethical considerations, including the condition of trust and honesty, were observed. In order to collect data, first the samples were selected and if they met the research criteria, the questionnaires were provided to the patients. Data were analyzed using Pearson correlation and structural equations modeling with using SPSS and AMOS software version 28.

Findings

In this research, 206 people (82.4 percent) were married and 44 people (17.6 percent) were single. 61 people (24.4 percent) primary school, 53 people (21.2 percent) high school, 77 people (30.8 percent) diploma, 4 people (1.6 percent), postgraduate, 40 people (16 percent), bachelor 12 people (4.8 percent) were masters and 3 people (1.2 percent) were doctorates. 197 people (78.8 percent) were housewives and 53 people (21.2 percent) were employees. The average of the participants was 49.45 and the standard deviation of age was 11.291. The results showed that attachment styles (secure and ambivalent) have a significant direct effect on psychological distress. The self-efficacy has a significant direct effect on psychological distress and was able significant mediating role in the relationship between attachment styles (secure and ambivalent) and psychological distress. Also, resilience has a significant direct effect on psychological distress and was able significant mediating role in the relationship between attachment styles (secure and ambivalent) and psychological distress. The structural and modified research model showed that the explained variance for psychological distress based on attachment styles with the mediating role of resilience and self-efficacy is equal to 0.46, which indicates that attachment styles with the mediation of self-efficacy and resilience in They explain a total of 46% of the variance of psychological distress.

Conclusion

Terefore, the present research was conducted with the aim of investigate the relationship between attachment styles with psychological distress women with breast cancer with the mediating role of self-efficacy and resilience. This research, like other researches that are conducted in the field of behavioral sciences and psychology, has faced limitations. Among the limitations of the present study were the selection of participants from a geographical area and the use of available sampling. Therefore, it is difficult to generalize the results of this study and in the future, it is necessary to conduct another study targeting different regions. It is suggested that this study be conducted on women with breast cancer in other cities. Because the psychological distress caused by breast cancer as a psychological problem regardless of cultural issues and ethnic and racial differences can have a different nature in all cultures and it is important to identify the factors affecting it in the form of modeling research. It is suggested to pay attention to the role of attachment styles, resilience and self-efficacy in order to improve the psychological distress of women with breast cancer. Because these attachment styles can be changed with interventions such as emotion oriented therapy and attachment oriented interventions. Based on this, psychologists who work in the field of psychological distress of women with breast cancer in counseling centers consider therapeutic workshops such as attachment-oriented interventions and emotion-oriented therapy, resilience training and self-efficacy training for women who have more psychological distress. Help them to reduce these symptoms and strengthen the foundation of family and personal and marital life.

References

Ahangarzadeh Rezaei, S. & Rasouli, M. (2015). Examining the psychometric properties of the Farsi version of the Connor Davidson Resilience Scale in teenagers with cancer. Nursing and Midwifery Journal, 13(9), 739-747. (In Persian)

Alacacioglu, A., Ulger, E., Varol, U., Yildiz, I., Salman, T., Bayoglu, V., ... & Tarhan, M. O. (2015). Depression, anxiety and sexual satisfaction in breast cancer patients and their partners-izmir oncology group study. Asian Pacific Journal of Cancer Prevention, 15(24), 10631-10636.

Alyana, S. I. & Saeed, R. (2023). Self-efficacy as mediator between attachment styles and life satisfaction in adolescents. Pakistan Languages and Humanities Review, 7(3), 104-115.

Bandura, A. (2006). Guide for constructing self-efficacy scales. Self-Efficacy Beliefs of Adolescents, 5(1), 307-337.

Beck, A. T., Steer, R. A. & Brown, G. K. (1996). Manual for Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.

Berg, D. A., Skaalvik, E. M., Asil, M., Hill, M. F., Uthus, M., Tangen, T. N., & Smith, J. K. (2023). Teacher self-efficacy and reasons for choosing initial teacher education programmes in Norway and New Zealand. Teaching and Teacher Education, 125(1), 1-15.

Blevins, T. R., Lo, S. B., Coker, C. A., Arrato, N. A., Reisinger, S. A., Shields, P. G., & Andersen, B. L. (2024). COVID-19 or cancer stress? Anxiety and depressive symptoms in patients with advanced lung cancer. International Journal of Behavioral Medicine, 31(2), 325-330.

Bong, M. & Skaalvik, E. M. (2003). Academic self-concept and self-efficacy: How different are they really? Educational Psychology Review, 15(1), 1–40.

Bostock, J. & Breese, R. (2023). Theorising organisational resilience for sport management research and practice. Managing Sport and Leisure, 28(4), 455-471.

Bowen, D. J., Fernandez Poole, S., White, M., Lyn, R., Flores, D. A., Haile, H. G., & Williams, D. R. (2021). The role of stress in breast cancer incidence: Risk factors, interventions, and directions for the future. International Journal of Environmental Research and Public Health, 18(04), 1871-1888.

Bryan, C., O'Shea, D. & MacIntyre, T. (2019). Stressing the relevance of resilience: A systematic review of resilience across the domains of sport and work. International Review of Sport and Exercise Psychology, 12(1), 70–111.

Buote, V. M., Wood, E. & Pratt, M. (2009). Exploring similarities and differences between online and offline friendships: The role of attachment style. Computers in human Behavior, 25(2), 560-567.

Burguin, A., Diorio, C., & Durocher, F. (2021). Breast cancer treatments: updates and new challenges. Journal of Personalized Medicine, 11(8), 808-820.

Chen, Y., Markowitz, J. C., Blanco, C., Hershman, D. L., Zhang, J. T. & Hellerstein, D. J. (2024). Geographical distance predicts psychiatric treatment retention for Hispanic women with comorbid major depression and breast cancer. Breast Cancer Research and Treatment, 1(2), 1-8.

Cheng, H. L., Leung, D. Y. P., Ko, P. S., Lam, W. M., Lam, P. T., Luk, A. L., ... & Lam, S. C. (2023). Mediating role of self‐efficacy between unmet needs and quality of life in palliative cancer caregivers. Psycho‐Oncology, 32(3), 457-464.

Ciocca, G., Rossi, R., Collazzoni, A., Gorea, F., Vallaj, B., Stratta, P., ... & Di Lorenzo, G. (2020). The impact of attachment styles and defense mechanisms on psychological distress in a non-clinical young adult sample: A path analysis. Journal of Affective Disorders, 273(1), 384-390.

Clark, D. A. & Beck, A. T. (2010). Cognitive theory and therapy of anxiety and depression: Convergence with neurobiological findings. Trends in Cognitive Sciences, 14(9), 418-424.

Collins, N. L. (1996). Working models of attachment: Implications for explanation, emotion, and behavior. Journal of Personality and Social Psychology, 71(4), 810–832. 

Collins, N. R. & Read, S. J. (1990). Adult attachment, working models, and relationship quality in dating couples. Journal of Personality and Social Psychology, 58(1), 644–663.

Conner, K. M. & Davidson, J, R. (2003). Development of a new resilience scale. Depression and Anxiety, 18(1), 76-82.

De Boniface, J., Filtenborg Tvedskov, T., Rydén, L., Szulkin, R., Reimer, T., Kühn, T., ... & Christiansen, P. (2024). Omitting axillary dissection in breast cancer with sentinel-node metastases. New England Journal of Medicine, 390(13), 1163-1175.

Deniz, M. E. & Yıldırım Kurtuluş, H. (2023). Self-efficacy, self-love, and fear of compassion mediate the effect of attachment styles on life satisfaction: A serial mediation analysis. Psychological Reports, 1(2), 1-10.

Fernández, M. S., Rueda, C. Z., Patrignani, G. G., Rivero, J. C. C., & Padilla, J. H. (2023). Adaptation to the disease, resilience and optimism in woman with breast cancer. Revista Colombiana de psiquiatria (English ed.). https://doi.org/10.1016/j.rcpeng.2021.06.016

Galli, N., & Gonzalez, S. P. (2015). Psychological resilience in sport: A review of the literature and implications for research and practice. International Journal of Sport and Exercise Psychology, 13(3), 243–257.

Ghamari Givi, H., Azimi, D. & Mastanabadi, S. (2021). Comparison of communication patterns, self-efficacy and assertiveness at teenage girls with self-mutilation and normal group. Women's Studies Sociological and Psychological, 19(3), 185-212. (In Persian)

Gibby, J. G. & Whiting, J. B. (2022). Insecurity, control, and abuse: What Attachment Theory can teach us about treating intimate partner violence. Contemporary Family Therapy, 1(2), 1-13.

Gillath, O., Hart, J., Noftle, E. E. & Stockdale, G. D. (2009). Development and validation of a state adult attachment measure (SAAM). Journal of Research in Personality, 43(3), 362-373.

Hazen, C. & Shaver, P. (1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511-524.

Hill, Y., Den Hartigh, R. J. R., Meijer, R. R., De Jonge, P. & Van Yperen, N. W. (2018). Resilience in sports from a dynamical perspective. Sport, Exercise, and Performance Psychology, 7(4), 333–341. 

Holt, R., Kornhaber, R., Kwiet, J., Rogers, V., Shaw, J., Law, J. & Cleary, M. (2019). Insecure adult attachment style is associated with elevated psychological symptoms in early adjustment to severe burn: A cross-sectional study. Burns, 45(6), 1359-1366.

Hoque, R., Das, S., Hoque, M. & Haque, E. (2024). Breast cancer classification using XGBoost. World Journal of Advanced Research and Reviews, 21(2), 1985-1994.

Ikhile, D., Ford, E., Glass, D., Gremesty, G. & van Marwijk, H. (2024). A systematic review of risk factors associated with depression and anxiety in cancer patients. Plos One, 19(3), 1-10.

Jayarajah, U., Mithushan, J., Priyan, W. P. H., Peiris, K., Wijayalathge, H., Wijeratne, T., ... & Seneviratne, S. (2024). Prevalence of depression, anxiety and stress and its associated factors among women with breast cancer in Sri Lanka. European Journal of Cancer, 200(1), 1-10.

Karveli, S., Galanis, P., Mitropoulou, E. M., Karademas, E. & Markopoulos, C. (2023). The role of attachment styles on quality of life and distress among early-stage female breast cancer patients: A systematic review. Journal of Clinical Psychology in Medical Settings, 30(4), 724-739.

Kaswang, F. & Halim, M. S. (2024). The roles of personality dimensions and attachment styles on working mothers’ psychological distress during the COVID-19 pandemic. ANIMA Indonesian Psychological Journal, 39(1), 1-11.

Kina, E., Laverdure, J. P., Durette, C., Lanoix, J., Courcelles, M., Zhao, Q., ... & Perreault, C. (2024). Breast cancer immunopeptidomes contain numerous shared tumor antigens. The Journal of Clinical Investigation, 134(1), 1-10.

Kline, R. B. (2023). Principles and Pactice of Structural Equation Modeling. Fourth Edition, Guilford publications.

Kolah kaj, B., Khalaatbari, J., Salahian, A. & Nasrollahi, B. (2023). Prediction of nomophobia based on attachment styles with the mediating role of loneliness in adolescents. Journal of Applied Family Therapy, 4(3), 125-144. (In Persian)

Kuan, C. C., Kuo, W. H., Chang, S. H. & Sun, H. F. (2023). A longitudinal study on the changes in the self‐efficacy of breast cancer patients during adjuvant chemotherapy. Nursing Open, 10(5), 2912-2919.

Lavin, R., Bucci, S., Varese, F. & Berry, K. (2020). The relationship between insecure attachment and paranoia in psychosis: A systematic literature review. British Journal of Clinical Psychology, 59(1), 39-65.

Lewis, K., La Selva, R., Maldonado, E., Annis, M. G., Najyb, O., Cañedo, E. C., ... & Ursini-Siegel, J. (2024). p66ShcA promotes malignant breast cancer phenotypes by alleviating energetic and oxidative stress. Redox Biology, 70(1), 1-10.

Lim, B. H., Hodges, M. A. & Lilly, M. M. (2020). The differential effects of insecure attachment on post-traumatic stress: A systematic review of extant findings and explanatory mechanisms. Trauma, Violence, & Abuse, 21(5), 1044-1060.

Lovibond, S. H. & Lovibond, P. F. (1996). Manual for the Depression Anxiety Stress Scales. Psychology Foundation of Australia.

Manikis, G., Simos, N. J., Kourou, K., Kondylakis, H., Poikonen-Saksela, P., Mazzocco, K., ... & Fotiadis, D. (2023). Personalized risk analysis to improve the psychological resilience of women undergoing treatment for breast cancer: Development of a machine learning–driven clinical decision support tool. Journal of Medical Internet Research, 25(1), 1-10.

Marino, A., Pavone, G., Martorana, F., Fisicaro, V., Motta, L., Spampinato, S., ... & Nunnari, G. (2024). Navigating the nexus: HIV and breast cancer—A critical review. International Journal of Molecular Sciences, 25(6), 1-10.

Martinez-Calderon, J., García-Muñoz, C., Heredia-Rizo, A. M. & Cano-García, F. J. (2024). The prevalence of anxiety and depression in cancer around the world: An overview of systematic reviews evaluating 128 meta-analyses. Journal of Affective Disorders, 1(1), 1-10.

Mazza, C., Colasanti, M., Ricci, E., Di Giandomenico, S., Marchetti, D., Fontanesi, L., ... & Roma, P. (2021). The COVID-19 outbreak and psychological distress in healthcare workers: The role of personality traits, attachment styles, and sociodemographic factors. Sustainability, 13(9), 1-10.

McGahuey, C. A., Gelenberg, A. J., Laukes, C. A., Moreno, F. A., Delgado, P. L., McKnight, K. M. & Manber, R. (2000). The Arizona sexual experience scale (ASEX): Reliability and validity. Journal of Sex and Marital Therapy, 26(1), 25-40.

Midorikawa, H., Tachikawa, H., Kushibiki, N., Wataya, K., Takahashi, S., Shiratori, Y., ... & Yamagata, K. (2023). Association of fear of COVID-19 and resilience with psychological distress among health care workers in hospitals responding to COVID-19: analysis of a cross-sectional study. Frontiers in Psychiatry, 14(1), 1-10.

Mikulincer, M. & Shaver, P. R. (2019). Attachment orientations and emotion regulation. Current Opinion in Psychology, 25(1), 6-10.

Muyang, R. E., Jamil, A. M. & Chan, S. L. (2023). Relationship between attachment styles and personal resilience among malaysian young adults. International Journal of Academic Research in Business and Social Sciences, 13(5), 2773-2790.

Pietrzak, M. & Cieciuch, J. (2024). Discovering the hierarchical structure of variables describing adult attachment: insight from a joint analysis of seven questionnaires. Current Psychology, 43(1). 22938-22948.

Pomey, M. P., Nelea, M. I., Normandin, L., Vialaron, C., Bouchard, K., Côté, M. A., ... & de Guise, M. (2023). An exploratory cross-sectional study of the effects of ongoing relationships with accompanying patients on cancer care experience, self-efficacy, and psychological distress. BMC cancer, 23(1), 369-389.

Rezaei Rad, M., Zarofian, F., Majani, N. & Rezaei Rad, M. (2023). The relationship of self-efficacy with self-regulated learning in the virtual education of students during the Covid-19 epidemic. Journal of Nursing Education 12(2), 15-24. (In Persian)

Rosenberg, M. (1989). Society and the Adolescent Self-Image. Revised Edition. Middletown, CT: Wesleyan University Press.

Saaidian Asl, M., Khanzadeh, M., Hasani, J. & Edrisi, F. (2012). Factor structure and psychometric properties of the Persian version of state adult attachment scale. Journal of Research in Psychological Health, 6(1), 66-78. (In Persian)

Sahebi, A., Asghari, M. & Salari, R. (2005). Validation of depression, anxiety and stress scale for Iranian population. Developmental Psychology: Iranian Psychologists, 1(4), 36-54. (In Persian)

Schermelleh-Engel, K., Moosbrugger, H. & Müller, H. (2003). Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods of Psychological Research Online, 8(2), 23-74.

Sherer, M., Maddux, J. E., Mercandante, B., Prentice-Dunn, S., Jacobs, B. & Rogers, R. W. (1982). The self-efficacy scale: Construction and validation. Psychological Reports, 51(2), 663-671.

Siegel, R. L., Miller, K. D., Fuchs, H. E. & Jemal, A. (2022). Cancer statistics, 2022. CA: a Cancer Journal for Clinicians, 72(1), 1-10.

Sun, J. & Miller, C. H. (2023). Insecure attachment styles and phubbing: The mediating role of problematic smartphone use. Human Behavior and Emerging Technologies, 1(1), 1-11.

Suri, S., Garg, S. & Tholia, G. (2019). Attachment style, perceived social support and loneliness among college students. International Journal of Innovative Studies in Sociology and Humanities, 4(5), 135-143.

Tamannaeifar, M. R. & Suleimanian, Z. (2024). The mediating role of resilience and self-efficacy in relationship between cognitive emotion regulation strategies and psychological distress in women with breast cancer. Journal of Psychological Studies, 20(1), 55-70. (In Persian)

Tamannaeifar, M., & Soleimanian, Z. (2024). The mediating role of resilience and self-efficacy in the relationship between perceived social support and psychological distress in breast cancer patients. Feyz Medical Sciences Journal, 28(1), 76-85. (In Persian)

Tao, L., Xiang, Y., Zeng, X., Fu, L., Li, J. & Chen, H. (2024). Incidence and risk factors for psychological distress in adult female patients with breast cancer: A systematic review and meta-analysis. Frontiers in Psychiatry, 15(1), 1-10.

Tolmacz, R., Bachner-Melman, R., Lev-Ari, L. & Almagor, K. (2022). Interparental conflict and relational attitudes within romantic relationships: The mediating role of attachment orientations. Journal of Social and Personal Relationships, 39(6), 1648-1668.

Trayes, K. P. & Cokenakes, S. E. (2021). Breast cancer treatment. American Family Pphysician, 104(2), 171-178.

Veisi, S., Kashefi, F. & Imani, S. (2024). Fittness the causal-structural relationships of successful intelligence with wisdom with the mediation of musical intelligence in piano players. Social Psychology Research, 14(54), 1-14. (In Persian)

Yang, K., Ren, Y., Peng, W., Wang, X., Du, X., Wang, J. & Jiang, J. (2024). Subjective well-being among Chinese breast cancer patients: The unique contributions of death anxiety, self-esteem, and social support. Journal of Health Psychology, 29(3), 213-224.

Zimmerman, B. J. & Cleary, T. J. (2006). Adolescents’ development of personal agency: The role of self-efficacy beliefs and self-regulatory skill. Self-Efficacy Beliefs of Adolescents, 5(1), 45-69.