Intrusion, avoidance, and psychological distress among individuals with cancer

Objective: The goal of the study was to examine the utility of Creamer's co gnitive processing theory of trauma in a sample of individuals undergoing t reatment for cancer. This theory proposes that avoidance is a maladaptive s trategy of dealing with intrusive thoughts about a traumatic experience and suggests that avoidance mediates the relation between intrusive thoughts a nd later psychological distress. The role of disease-related factors, speci fically changes in physical impairment and disease stage, was also examined . Methods: Patients (N = 189) undergoing treatment for cancer completed que stionnaires at three time points, spaced 3 months apart. Intrusive thoughts , functional impairment, and psychological distress were assessed at Time 1 , avoidance and functional impairment at Time 2, and psychological distress was assessed again at Time 3. The fit of the model was tested separately f or patients with early-stage (stages 1 and 2) and late-stage (stages 3 and 4) disease. Results: The mediational role for avoidance was supported among patients with advanced stages of cancer but not for patients with early-st age disease. Results were inconsistent with predictions about the role of p hysical impairment. Among individuals with late-stage cancer, changes in fu nctional impairment were not predictive of greater avoidance, and impairmen t had a significant but weak effect on the change in distress. Among patien ts with early-stage cancer, a deterioration in physical impairment was asso ciated with increases in avoidance, and deterioration in physical impairmen t increased distress. Conclusions: The results of this study were partially consistent with Creamer's cognitive processing theory. A moderating effect was found for disease stage on associations between intrusions, avoidance, physical impairment, and distress.