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Implicit loneliness, emotion regulation, and depressive symptoms in breast cancer survivors

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Abstract

Among individuals coping with cancer, emotional approach coping—expressing and processing emotions following negative events—has been identified as a potentially adaptive form of emotion regulation. However, its mental health benefits may depend on social-cognitive factors and on how it is implemented. This study examined loneliness as a determinant of emotion regulation associations with depressive symptoms in women with breast cancer. Loneliness was examined as an implicit social-cognitive phenomenon (i.e., automatic views of oneself as lonely), and emotional expression and processing were examined as both explicit and implicit processes. Approximately 11 months after diagnosis, 390 women completed explicit measures of coping through cancer-related emotional expression and processing; an implicit measure of expression and processing (an essay-writing task submitted to linguistic analysis); and an implicit association test measuring loneliness. Depressive symptoms were assessed 3 months later. Regardless of implicit loneliness, self-reported emotional expression (but not emotional processing) predicted fewer depressive symptoms, whereas implicit expression of negative emotion during essay-writing predicted more symptoms. Only among women high in implicit loneliness, less positive emotional expression and more causal processing during the writing task predicted more depressive symptoms. Results suggest that explicit and implicit breast cancer-related emotion regulation have distinct relations with depressive symptoms, and implicit loneliness moderates effects of implicit emotional approach. Findings support implicit processes as influential mechanisms of emotion regulation and suggest targets for intervention among breast cancer survivors.

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Notes

  1. For the present purposes, we use the term “cancer survivor” as defined by both the American Cancer Society and the National Cancer Institute, which includes anyone diagnosed with cancer through the end of life, regardless of treatment or remission.

  2. Dropout was significantly more frequent at UCLA (62 women; 21 %) than at the University of Arizona (8 women; 5 %); the 9-month sample thus included proportionally more women at the University of Arizona (40 %) versus UCLA (60 %) compared to study entry (Arizona 35 %, UCLA 65 %), χ2(1) = 20.80, p < .001. Dropouts were significantly younger, M = 52.5 years, SD = 13.9, than women retained at 9 months (see Table 1), t(450) = −2.75, p = .006, d = −0.36. Cancer stage among dropouts was (stages 1, 2, 3, and 4 respectively) 29 (42 %), 23 (33 %), 8 (12 %), and 9 (13 %), and differed significantly from retained participants, χ2(3) = 9.34, p = .025, with proportionally fewer stage 2 and 4 participants in the 9-month sample. Dropout and retained participants did not differ significantly in ethnicity, χ2(7) = 5.84, p = .56, relationship status, χ2(5) = 6.24, p = .28, education, χ2(5) = 3.69, p = .60, income, χ2(3) = 3.90, p = .27, or depressive symptoms at study entry, t(451) = 1.85, p = .07.

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Acknowledgments

This research was supported by 1R01 CA133081 (Stanton and Weihs, co-PIs) and NCI P30CA023074—University of Arizona Cancer Center Support Grant. Brett Marroquín was supported by NIMH Grant 5 T32 MH 015750 in Biobehavioral Issues in Physical and Mental Health (Christine Dunkel Schetter, PI). Johanna Czamanski-Cohen was supported by NCI R25T Cancer Prevention and Control Fellowship R25 CA078447-14 (David Alberts, PI). The authors are grateful to Martha Barrón and Alexandra Jorge for study coordination, and to Joshua Wiley for guidance regarding data analyses.

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  1. Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095, USA

    Brett Marroquín

  2. Department of Psychiatry and University of Arizona Comprehensive Cancer Center, University of Arizona, Tucson, AZ, USA

    Johanna Czamanski-Cohen & Karen L. Weihs

  3. Department of Psychology, Department of Psychiatry and Biobehavioral Sciences, and Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA

    Annette L. Stanton

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Brett Marroquín, Johanna Czamanski-Cohen, Karen L. Weihs, Annette L. Stanton declare that they do not have any conflict of interest.

Human and animal rights and Informed consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.

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Marroquín, B., Czamanski-Cohen, J., Weihs, K.L. et al. Implicit loneliness, emotion regulation, and depressive symptoms in breast cancer survivors. J Behav Med 39, 832–844 (2016). https://doi.org/10.1007/s10865-016-9751-9

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