Journal of Behavioral Medicine

, Volume 32, Issue 2, pp 174–186 | Cite as

A longitudinal study on the role of spirituality in response to the diagnosis and treatment of breast cancer

  • Terry Lynn Gall
  • Elizabeth Kristjansson
  • Claire Charbonneau
  • Peggy Florack
Original Paper


This longitudinal study addressed the role of spirituality in women’s response to breast cancer. Ninety-three women diagnosed with breast cancer were assessed on various measures of image of God, positive attitude, social well-being and emotional distress at pre-diagnosis, 6 months post-surgery and 1 year post-surgery. As compared to women who dropped out of the study, this sample reported religion to be less important in their daily lives. Path analyses showed evidence of direct and indirect effects of positive and negative images of God on emotional distress in cross-sectional but not longitudinal data. A positive image of God was related to greater concurrent distress while a negative image of God was indirectly related to greater distress through the pathways of social well-being and positive attitude. In the longitudinal path model, a pre-diagnosis measure of religious salience was the only aspect of spirituality that predicted an increase in distress at 1 year post-surgery. The cross-sectional analyses provided limited support for the “religious/spiritual mobilization” hypothesis as put forth by Pargament (The psychology of religion and coping. New York: Guilford Press, 1997). There was also limited support for the mediator variables of positive attitude and social well-being as mechanisms through which spirituality influences adjustment. Finally, there was no support that spirituality acted in a protective manner rather the negative elements of spirituality were more prominent in relation to various aspects of women’s adjustment to breast cancer. Such results suggest that women who were less spiritually/religiously involved prior to the onset of breast cancer and who attempt to mobilize these resources under the stress of diagnosis may experience a negative process of spiritual struggle and doubt that, in turn, has implications for their long-term adjustment.


Breast cancer Spirituality Religion Coping 


  1. Acklin, M. W., Brown, E. C., & Mauger, P. A. (1983). The role of religious values in coping with cancer. Journal of Religion and Health, 22(4), 322–333. doi:10.1007/BF02279928.CrossRefGoogle Scholar
  2. Ai, A. L., Dunkle, R. E., Peterson, C., & Bolling, S. F. (1998). The role of private prayer in psychological recovery among midlife and aged patients following cardiac surgery. The Gerontologist, 38(5), 591–601.PubMedGoogle Scholar
  3. Ai, A. L., Tice, T. N., Peterson, C., & Huang, B. (2005). Prayers, spiritual support, and positive attitudes in coping with the September 11 National crisis. Journal of Personality, 73(3), 763–791. doi:10.1111/j.1467-6494.2005.00328.x.PubMedCrossRefGoogle Scholar
  4. Alferi, S., Culver, J., Carver, C. S., Arena, P., & Antoni, M. H. (1999). Religiosity, religious coping, and distress: A prospective study of Catholic and evangelical Hispanic women in treatment for early stage breast cancer. Journal of Health Psychology, 4, 343–356.Google Scholar
  5. Arbuckle, J. L., (Copyright, 1983–2006) AMOS 7. Bethlehem, PA: AMOS Development Corporation.Google Scholar
  6. Brady, M. J., Cella, D. F., Mo, F., Bonomi, A. E., Tulsky, D. S., Lloyd, S. R., et al. (1997). Reliability and validity of the functional assessment of cancer therapy—Breast quality of life instrument. Journal of Clinical Oncology, 15(3), 974–986.PubMedGoogle Scholar
  7. Bush, E. G., Rye, M. S., Brant, C. R., Emery, E., Pargament, K. I., & Riessinger, C. A. (1999). Religious coping with chronic pain. Applied Psychophysiology and Biofeedback, 24(4), 249–260. doi:10.1023/A:1022234913899.PubMedCrossRefGoogle Scholar
  8. Carver, C. S., Pozo, C., Harris, S. D., Noriega, V., Scheier, M. F., Robinson, D. S., et al. (1993). How coping mediates the effect of optimism on distress: A study of women with early stage breast cancer. Journal of Personality and Social Psychology, 65(2), 375–390. doi:10.1037/0022-3514.65.2.375.PubMedCrossRefGoogle Scholar
  9. Cotton, S. P., Levine, E. G., Fitzpatrick, C. M., Dold, K. H., & Targ, E. (1999). Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer. Psycho-Oncology, 8, 429–438. doi :10.1002/(SICI)1099-1611(199909/10)8:5<429::AID-PON420>3.0.CO;2-P.PubMedCrossRefGoogle Scholar
  10. Culver, J. L., Arena, P. L., Wimberly, S. R., Antoni, M. H., & Carver, C. S. (2004). Coping among African-American, Hispanic and Non-hispanic white women recently treated for early stage breast cancer. Psychology & Health, 19(2), 157–166. doi:10.1080/08870440310001652669.CrossRefGoogle Scholar
  11. Daaleman, T. P., Cobb, A. K., & Frey, B. B. (2001). Spirituality and well-being: An exploratory study of the patient perspective. Social Science and Medicine, 53, 1503–1511. doi:10.1016/S0277-9536(00)00439-1.PubMedCrossRefGoogle Scholar
  12. Dull, V. T., & Skokan, L. A. (1995). A cognitive model of religion’s influence on health. The Journal of Social Issues, 51(2), 49–64.CrossRefGoogle Scholar
  13. Ellison, C. G., & Levin, J. S. (1998). The religion-health connection: Evidence, theory, and future directions. Health Education & Behavior, 25(6), 700–720. doi:10.1177/109019819802500603.CrossRefGoogle Scholar
  14. Exline, J. J., Yali, A. M., & Lobel, M. (1999). When God disappoints: Difficulty forgiving God and its role in negative emotion. Journal of Health Psychology, 4(3), 365–379.CrossRefGoogle Scholar
  15. Feher, S., & Maly, R. C. (1999). Coping with breast cancer in later life: The role of religious faith. Psycho-Oncology, 8, 408–416. doi :10.1002/(SICI)1099-1611(199909/10)8:5<408::AID-PON409>3.0.CO;2-5.PubMedCrossRefGoogle Scholar
  16. Fehring, R. J., Miller, J. F., & Shaw, C. (1997). Spiritual well-being, religiosity, hope, depression, and other mood states in elderly people coping with cancer. Oncology Nursing Forum, 24(4), 663–671.PubMedGoogle Scholar
  17. Fitchett, G., Rybarczyk, B. D., DeMarco, G. A., & Nicholas, J. J. (1999). The role of religion in medical rehabilitation outcomes: A longitudinal study. Rehabilitation Psychology, 44(4), 333–353. doi:10.1037/0090-5550.44.4.333.CrossRefGoogle Scholar
  18. Gall, T. L. (2004). Relationship with God and the quality of life of prostate cancer survivors. Quality of Life Research, 13, 1357–1368. doi:10.1023/B:QURE.0000040789.49691.59.PubMedCrossRefGoogle Scholar
  19. Gall, T. L., Basque, V., Damasceno-Scott, M., & Vardy, G. (2007). Spirituality and the current adjustment of adult survivors of childhood sexual abuse. Journal for the Scientific Study of Religion, 46(1), 101–117. doi:10.1111/j.1468-5906.2007.00343.x.CrossRefGoogle Scholar
  20. Gall, T. L., & Cornblat, M. W. (2002). Breast cancer survivors give voice: A qualitative analysis of spiritual factors in long-term adjustment. Psycho-Oncology, 11, 524–535. doi:10.1002/pon.613.PubMedCrossRefGoogle Scholar
  21. Gall, T. L., & Grant, K. (2005). Spiritual disposition and understanding illness. Pastoral Psychology, 53(6), 515–533. doi:10.1007/s11089-005-4818-y.CrossRefGoogle Scholar
  22. Gall, T. L., Míguez de Renart, R. M., & Boonstra, B. (2000). Religious resources in long-term adjustment to breast cancer. Journal of Psychosocial Oncology, 18(2), 21–38. doi:10.1300/J077v18n02_02.CrossRefGoogle Scholar
  23. Gorsuch, R. L. (1968). The conceptualization of God as seen in adjective ratings. Journal for the Scientific Study of Religion, 7, 56–64. doi:10.2307/1385110.CrossRefGoogle Scholar
  24. Granqvist, P. (1998). Religiousness and childhood attachment patterns: On the question of compensation or correspondence. Journal for the Scientific Study of Religion, 37, 350–367. doi:10.2307/1387533.CrossRefGoogle Scholar
  25. Harris, R. C., Dew, M. A., Lee, A., Amaya, M., Buches, L., Reetz, D., et al. (1995). The role of religion in heart-transplant recipients’ long-term health and well-being. Journal of Religion and Health, 34(1), 17–32. doi:10.1007/BF02248635.CrossRefGoogle Scholar
  26. Hill, M. A. (1997). SPSS Missing Value Analysis™ 7.5. Chicago, Ill: SPSS.Google Scholar
  27. Hill, P. C., & Butter, E. M. (1995). The role of religion in promoting physical health. Journal of Psychology and Christianity, 14(2), 141–155.Google Scholar
  28. Hu, L., & Bentler, P. M. (1999). Cut-off criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRefGoogle Scholar
  29. Irving, L. M., Snyder, C. R., & Crowson, J. J., Jr. (1998). Hope and coping with cancer by college women. Journal of Personality, 66, 195–214. doi:10.1111/1467-6494.00009.PubMedCrossRefGoogle Scholar
  30. Jenkins, R. A., & Pargament, K. I. (1995). Religion and spirituality as resources for coping with cancer. Journal of Psychosocial Oncology, 13(1/2), 51–74. doi:10.1300/J077V13N01_04.CrossRefGoogle Scholar
  31. Keefe, F. J., Affleck, G., Lefebvre, J., Underwood, L., Caldwell, D. S., Drew, J., et al. (2001). Living with rheumatoid arthritis: The role of daily spirituality and daily religious and spiritual coping. Journal of Pain, 2(2), 101–110. doi:10.1054/jpai.2001.19296.PubMedCrossRefGoogle Scholar
  32. King, M., Speck, P., & Thomas, A. (1994). Spiritual and religious beliefs in acute illness—Is this a feasible area for study? Social Science and Medicine, 38(4), 631–636. doi:10.1016/0277-9536(94)90260-7.PubMedCrossRefGoogle Scholar
  33. Kirkpatrick, L. (2005). Attachment, evolution and the psychology of religion. New York: Guilford Press.Google Scholar
  34. Kline, R. B. (2005). Principles and practice of structural equation modeling (2nd ed.). New York, NY: Guilford Press.Google Scholar
  35. Koenig, H. G., Hays, J. C., George, L. K., Blazer, D. G., Larson, D. B., & Landerman, L. R. (1997a). Modeling the cross-sectional relationships between religion, physical health, social support and depressive symptoms. The American Journal of Geriatric Psychiatry, 5(2), 131–144.PubMedGoogle Scholar
  36. Koenig, H. G., McCullough, M. E., & Larson, D. B. (2001). Handbook of religion and health. Oxford: Oxford University Press.Google Scholar
  37. Koenig, H. G., Weiner, D. K., Peterson, B. L., Meador, K. G., & Keefe, F. J. (1997b). Religious coping in the nursing home: A biopsychosocial model. International Journal of Psychiatry in Medicine, 27(4), 365–376.PubMedGoogle Scholar
  38. Lawrence, R. (1997). Measuring the image of God: The God image inventory and the God image scales. Journal of Psychology and Theology, 25(2), 214–226.Google Scholar
  39. Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer.Google Scholar
  40. Levin, J. (2001). God, faith, and health: Exploring the spirituality-healing connection. Toronto: Wiley.Google Scholar
  41. Maton, K. I. (1989). The stress-buffering role of spiritual support: Cross-sectional and prospective investigations. Journal for the Scientific Study of Religion, 28(3), 310–323. doi:10.2307/1386742.CrossRefGoogle Scholar
  42. McIntosh, D. N., Silver, R. C., & Wortman, C. B. (1993). Religion’s role in adjustment to a negative life event: Coping with the loss of a child. Journal of Personality and Social Psychology, 65(4), 812–821. doi:10.1037/0022-3514.65.4.812.PubMedCrossRefGoogle Scholar
  43. McNair, D. M., Lorr, M., & Droppleman, L. F. (1992). POMS manual: Profile of mood states. San Diego: Edits/Educational and Industrial Testing Service.Google Scholar
  44. Mickley, J., Soeken, K., & Belcher, A. (1992). Spiritual well-being, religiousness and hope among women with breast cancer. Image—The Journal of Nursing Scholarship, 24(4), 267–272. doi:10.1111/j.1547-5069.1992.tb00732.x.PubMedCrossRefGoogle Scholar
  45. Nairn, R. C., & Merluzzi, T. V. (2003). The role of religious coping in adjustment to cancer. Psycho-Oncology, 12, 428–441. doi:10.1002/pon.654.PubMedCrossRefGoogle Scholar
  46. O’Brien, M. E. (1982). Religious faith and adjustment to long-term hemodialysis. Journal of Religion and Health, 21, 68–80. doi:10.1007/BF02273896.CrossRefGoogle Scholar
  47. Oman, D., & Thoresen, C. E. (2005). Do religion and spirituality influence health? In R. F. Paloutizian & C. L. Park (Eds.), Handbook of the psychology of religion and spirituality (pp. 435–459). New York: The Guilford Press.Google Scholar
  48. Pargament, K. I. (1997). The psychology of religion and coping. New York: Guilford Press.Google Scholar
  49. Pargament, K. I., Ano, G. G., & Wachholtz, A. B. (2005). The religious dimension of coping: Advances in theory, research, and practice. In R. F. Paloutizian & C. L. Park (Eds.), Handbook of the psychology of religion and spirituality (pp. 479–495). New York: The Guilford Press.Google Scholar
  50. Pargament, K. I., Koenig, H. G., & Perez, L. (2000). The many methods of religious coping: Development and initial validation of the RCOPE. Journal of Clinical Psychology, 56(4), 519–543. doi :10.1002/(SICI)1097-4679(200004)56:4<519::AID-JCLP6>3.0.CO;2-1.PubMedCrossRefGoogle Scholar
  51. Pargament, K. I., Tarakeshwar, N., Ellision, C., & Wulff, K. M. (2001). Religious coping among the religious: The relationships between religious coping and well-being in a national sample of Presbyterian clergy, elders, and members. Journal for the Scientific Study of Religion, 40(3), 497–513. doi:10.1111/0021-8294.00073.CrossRefGoogle Scholar
  52. Park, C. L. (2005). Religion and meaning. In R. F. Paloutizian & C. L. Park (Eds.), Handbook of the psychology of religion and spirituality (pp. 295–314). New York: The Guilford Press.Google Scholar
  53. Park, C. L., & Cohen, L. (1993). Religious and non-religious coping with the death of a friend. Cognitive Therapy and Research, 17(6), 561–577. doi:10.1007/BF01176079.CrossRefGoogle Scholar
  54. Rabins, P. V., Fitting, M. D., Eastham, J., & Zabora, J. (1990). Emotional adaptation over time in care-givers for chronically ill elderly people. Age and Ageing, 19, 185–190. doi:10.1093/ageing/19.3.185.PubMedCrossRefGoogle Scholar
  55. Schaefer, C. A., & Gorsuch, R. L. (1991). Psychological adjustment and religiousness: The multivariate belief-motivation theory of religiousness. Journal for the Scientific Study of Religion, 30, 448–461. doi:10.2307/1387279.CrossRefGoogle Scholar
  56. Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A re-evaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063–1078. doi:10.1037/0022-3514.67.6.1063.PubMedCrossRefGoogle Scholar
  57. Schou, I., Ekeberg, Ǿ., & Ruland, C. M. (2005). The mediating role of appraisal and coping in the relationship between optimism–pessimism and quality of life. Psycho-Oncology, 14, 718–727. doi:10.1002/pon.896.PubMedCrossRefGoogle Scholar
  58. Sherman, A. C., & Simonton, S. (2001). Religious involvement among cancer patients: Associations with adjustment and quality of life. In T. G. Plante & A. C. Sherman (Eds.), Faith and health: Psychological perspectives (pp. 167–194). New York: The Guilford Press.Google Scholar
  59. Snyder, C. R., Harris, C., Anderson, J. R., Holleran, S. A., Irving, L. M., Sigmon, S. T., et al. (1991). The will and the ways: Development and validation of an individual-differences measure of hope. Journal of Personality and Social Psychology, 60(4), 570–585. doi:10.1037/0022-3514.60.4.570.PubMedCrossRefGoogle Scholar
  60. Stanton, A. L., Danoff-Burg, S., & Huggins, M. E. (2002). The first year after breast cancer diagnosis: Hope and coping strategies as predictors of adjustment. Psycho-Oncology, 11, 93–102. doi:10.1002/pon.574.PubMedCrossRefGoogle Scholar
  61. Strawbridge, W. J., Shema, S. J., Cohen, R. D., & Kaplan, G. A. (2001). Religious attendance increases survival by improving and maintaining good health behaviors, mental health, and social relationships. Annals of Behavioral Medicine, 23(1), 68–74. doi:10.1207/S15324796ABM2301_10.PubMedCrossRefGoogle Scholar
  62. Taylor, E. J., Outlaw, F. H., Bernardo, T. R., & Roy, A. (1999). Spiritual conflicts associated with praying about cancer. Psycho-Oncology, 8, 386–394. doi :10.1002/(SICI)1099-1611(199909/10)8:5<386::AID-PON407>3.0.CO;2-C.PubMedCrossRefGoogle Scholar
  63. Tix, A. P., & Frazier, P. A. (1998). The use of religious coping during stressful life events: Main effects, moderation, and mediation. Journal of Consulting and Clinical Psychology, 66(2), 411–422. doi:10.1037/0022-006X.66.2.411.PubMedCrossRefGoogle Scholar
  64. Wink, P., & Dillon, M. (2001). Religious involvement and health outcomes in late adulthood: Findings from a longitudinal study of women and men. In T. G. Plante & A. C. Sherman (Eds.), Faith and health: Psychological perspectives (pp. 75–106). New York: The Guilford Press.Google Scholar
  65. Zuckerman, D. M., Kasl, S. V., & Ostfeld, A. M. (1984). Psychosocial predictors of mortality among the elderly poor. American Journal of Epidemiology, 119, 410–423.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Terry Lynn Gall
    • 1
  • Elizabeth Kristjansson
    • 2
  • Claire Charbonneau
    • 1
  • Peggy Florack
    • 3
  1. 1.Saint Paul UniversityOttawaCanada
  2. 2.University of OttawaOttawaCanada
  3. 3.Women’s Breast Health CentreOttawa HospitalOttawaCanada

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