Skip to main content

Advertisement

SpringerLink
Log in

The effect of disgust-related side-effects on symptoms of depression and anxiety in people treated for cancer: a moderated mediation model

  • Published:
Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

As maladaptive disgust responses are linked to mental health problems, and cancer patients may experience heightened disgust as a result of treatments they receive, we explored the associations between disgust-related side-effects and symptoms of depression and anxiety in people treated for cancer. One hundred and thirty two (83 women, M age = 57.48 years) participants answered questions about their treatments, side-effects, disgust responding, and mental health. Experiencing bowel and/or bladder problems, sickness and/or nausea (referred to here as “core” disgust-related side-effects) was significantly related to greater symptoms of depression and borderline increased anxiety. Further, these links were explained by a moderated mediation model, whereby the effects of core disgust side-effects on depression and anxiety were mediated by (physical and behavioural) self-directed disgust, and disgust propensity moderated the effect of core disgust side-effects on self-disgust. These findings stress the importance of emotional responses, like disgust, in psychological adaptation to the side-effects of cancer treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  • Abdul-Hamid, S., Denman, C., & Dudas, R. B. (2014). Self-relevant disgust and self-harm urges in patients with borderline personality disorder and depression: A pilot study with a newly designed psychological challenge. PLoS ONE, 9, e99696. doi:10.1371/journal.pone.0099696

    Article  PubMed  PubMed Central  Google Scholar 

  • Alanazi, F. S. M., Powell, P. A., & Power, M. (2015). Depression as a disorder of disgust. In P. A. Powell, P. G. Overton, & J. Simpson (Eds.), The revolting self: Perspectives on the psychological, social, and clinical implications of self-directed disgust (pp. 151–165). London: Karnac.

    Google Scholar 

  • Arrieta, O., Angulo, L. P., Núñez-valencia, C., Dorantes-gallareta, Y., Macedo, E. O., Martínez-López, D., et al. (2013). Association of depression and anxiety on quality of life, treatment adherence, and prognosis in patients with advanced non-small cell lung cancer. Annals of Surgical Oncology, 20, 1941–1948. doi:10.1245/s10434-012-2793-5

    Article  PubMed  Google Scholar 

  • Bauer, R. M., Bastian, P. J., Gozzi, C., & Stief, C. G. (2009). Postprostatectomy incontinence: All about diagnosis and management. European Urology, 55, 322–333. doi:10.1016/j.eururo.2008.10.029

    Article  PubMed  Google Scholar 

  • Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. New York, NY: Harper Row.

    Google Scholar 

  • Bollen, K. A., & Stine, R. A. (1992). Bootstrapping goodness-of-fit measures in structural equation models. Sociological Methods and Research, 21, 205–229. doi:10.1177/0049124192021002004

    Article  Google Scholar 

  • Bredin, M. (1999). Mastectomy, body image and therapeutic massage: A qualitative study of women’s experience. Journal of Advanced Nursing, 29, 1113–1120. doi:10.1046/j.1365-2648.1999.00989.x

    Article  CAS  PubMed  Google Scholar 

  • Carey, M. P., & Burish, T. G. (1988). Eitology and treatment of the psychological side effects associated with cancer chemotherapy: A critical review and discussion. Psychological Bulletin, 104, 307–325. doi:10.1037/0033-2909.104.3.307

    Article  CAS  PubMed  Google Scholar 

  • Chapman, H. A., & Anderson, A. K. (2012). Understanding disgust. Annals of the New York Academy of Sciences, 1251, 62–76. doi:10.1111/j.1749-6632.2011.06369.x

    Article  PubMed  Google Scholar 

  • Cisler, J. M., Olatunji, B. O., & Lohr, J. M. (2009). Disgust, fear, and the anxiety disorders: A critical review. Clinical Psychology Review, 29, 34–46. doi:10.1016/j.cpr.2008.09.007

    Article  PubMed  Google Scholar 

  • Curtis, V., Aunger, R., & Rabie, T. (2004). Evidence that disgust evolved to protect from risk of disease. Proceedings of the Royal Society B: Biological Sciences, 271, S131–S133. doi:10.1098/rsbl.2003.0144

    Article  PubMed  PubMed Central  Google Scholar 

  • Davey, G. C. L. (2011). Disgust: The disease-avoidant emotion and its dysfunctions. Philosophical Transactions of the Royal Society of London. Series B, Biological sciences, 366, 3453–3465. doi:10.1098/rstb.2011.0039

    Article  PubMed  PubMed Central  Google Scholar 

  • Davey, G. C. L., Bickerstaffe, S., & MacDonald, B. A. (2006). Experienced disgust causes a negative interpretation bias: A causal role for disgust in anxious psychopathology. Behaviour Research and Therapy, 44, 1375–1384. doi:10.1016/j.brat.2005.10.006

    Article  PubMed  Google Scholar 

  • DiMatteo, M. R., Lepper, H. S., & Croghan, T. W. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160, 2101–2107. doi:10.1001/archinte.160.14.2101

    Article  CAS  PubMed  Google Scholar 

  • Ekman, P. (1999). Basic emotions. In T. Dalgleish & M. J. Power (Eds.), Handbook of cognition and emotion (pp. 45–60). New York, NY: Wiley.

    Google Scholar 

  • Else-Quest, N. M., LoConte, N. K., Schiller, J. H., & Hyde, J. S. (2009). Perceived stigma, self-blame, and adjustment among lung, breast and prostate cancer patients. Psychology & Health, 24, 949–964. doi:10.1080/08870440802074664

    Article  Google Scholar 

  • Falagas, M. E., Zarkadoulia, E. A., Ioannidou, E. N., Peppas, G., Christodoulou, C., & Rafailidis, P. I. (2007). The effect of psychosocial factors on breast cancer outcome: A systematic review. Breast Cancer Research, 9, 1–23. doi:10.1186/bcr1744

    Article  Google Scholar 

  • Fox, J. (2008). Applied regression analysis and generalized linear models (2nd ed.). London: Sage.

    Google Scholar 

  • Gilbert, P. (2000). The relationship of shame, social anxiety and depression: The role of the evaluation of social rank. Clinical Psychology and Psychotherapy, 7, 174–189. doi:10.1002/1099-0879(200007)7:3<174::aid-cpp236>3.0.co;2-u

    Article  Google Scholar 

  • Gilbert, P. (2015). Self-disgust, self-hatred, and compassion-focused therapy. In P. A. Powell, P. G. Overton, & J. Simpson (Eds.), The revolting self: Perspectives on the psychological, social, and clinical implications of self-directed disgust (pp. 223–242). London: Karnac.

    Google Scholar 

  • Goetz, A. R., Cougle, J. R., & Lee, H.-J. (2013). Revisiting the factor structure of the 12-item Disgust Propensity and Sensitivity Scale—Revised: Evidence for a third component. Personality and Individual Differences, 55, 579–584. doi:10.1016/j.paid.2013.04.029

    Article  Google Scholar 

  • Goldenberg, J. L., Arndt, J., Hart, J., & Routledge, C. (2008). Uncovering an existential barrier to breast self-exam behavior. Journal of Experimental Social Psychology, 44, 260–274. doi:10.1016/j.jesp.2007.05.002

    Article  PubMed  PubMed Central  Google Scholar 

  • Goldin, P. R., McRae, K., Ramel, W., & Gross, J. J. (2008). The neural bases of emotion regulation: Reappraisal and suppression of negative emotion. Biological Psychiatry, 63, 577–586. doi:10.1016/j.biopsych.2007.05.031

    Article  PubMed  Google Scholar 

  • Gordon, R. A. (2010). Regression analysis for the social sciences. New York, NY: Routledge.

    Google Scholar 

  • Greenberg, L. (2008). Emotion and cognition in psychotherapy: The transforming power of affect. Canadian Psychology, 49, 49–59. doi:10.1037/0708-5591.49.1.49

    Article  Google Scholar 

  • Gross, J. J. (1998). Antecedent- and response-focused emotion regulation: Divergent consequences for experience, expression, and physiology. Journal of Personality and Social Psychology, 74, 224–237. doi:10.1037/0022-3514.74.1.224

    Article  CAS  PubMed  Google Scholar 

  • Haidt, J. (2015). Means for the DS-R. Unpublished aggregated data. Retrieved from http://people.stern.nyu.edu/jhaidt/DSR-means.docx

  • Hallgren, K. A. (2012). Computing inter-rater reliability for observational data: An overview and tutorial. Tutorials in Quantitative Methods for Psychology, 8, 23–24.

    PubMed  PubMed Central  Google Scholar 

  • Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76, 408–420. doi:10.1080/03637750903310360

    Article  Google Scholar 

  • Hayes, A. F., & Scharkow, M. (2013). The relative trustworthiness of inferential tests of the indirect effect in statistical mediation analysis: Does method really matter? Psychological Science, 24, 1918–1927. doi:10.1177/0956797613480187

    Article  PubMed  Google Scholar 

  • Hinz, A., Krauss, O., Hauss, J. P., Höckel, M., Kortmann, R. D., Stolzenburg, J. U., & Schwarz, R. (2010). Anxiety and depression in cancer patients compared with the general population. European Journal of Cancer Care, 19, 522–529. doi:10.1111/j.1365-2354.2009.01088.x

    Article  CAS  PubMed  Google Scholar 

  • Hosaka, T., Aoki, T., Watanabe, T., Okuyama, T., & Kurosawa, H. (1999). Comorbidity of depression among physically ill patients and its effect on the length of hospital stay. Psychiatry and Clinical Neurosciences, 53, 491–495. doi:10.1046/j.1440-1819.1999.00580.x

    Article  CAS  PubMed  Google Scholar 

  • Kennifer, S. L., Alexander, S. C., Pollak, K. I., Jeffreys, A. S., Olsen, M. K., Rodriguez, K. L., et al. (2009). Negative emotions in cancer care: Do oncologists’ responses depend on severity and type of emotion? Patient Education and Counseling, 76, 51–56. doi:10.1016/j.pec.2008.10.003

    Article  PubMed  Google Scholar 

  • Llorente, M. D., Burke, M., Gregory, G. R., Bosworth, H. B., Grambow, S. C., Horner, R. D., et al. (2005). Prostate cancer: A significant risk factor for late-life suicide. The American Journal of Geriatric Psychiatry, 13, 195–201. doi:10.1097/00019442-200503000-00004

    Article  PubMed  Google Scholar 

  • Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression, anxiety and stress scales (2nd ed.). Sydney: Psychology Foundation.

    Google Scholar 

  • Luckett, T., Butow, P. N., King, M. T., Oguchi, M., Heading, G., Hackl, N. A., et al. (2010). A review and recommendations for optimal outcome measures of anxiety, depression and general distress in studies evaluating psychosocial interventions for English-speaking adults with heterogeneous cancer diagnoses. Supportive Care in Cancer, 18, 1241–1262. doi:10.1007/s00520-010-0932-8

    Article  PubMed  Google Scholar 

  • MacKinnon, D. P. (2008). Introduction to statistical mediation analysis. New York, NY: Lawrence Erlbaum.

    Google Scholar 

  • Mallinckrodt, B., Abraham, W. T., Wei, M., & Russell, D. W. (2006). Advances in testing the statistical significance of mediation effects. Journal of Counseling Psychology, 53, 372–378. doi:10.1037/0022-0167.53.3.372

    Article  Google Scholar 

  • Moncrieff-Boyd, J., Allen, K., Byrne, S., & Nunn, K. (2014). The Self-Disgust Scale revised version: Validation and relationships with eating disorder symptomatology. Journal of Eating Disorders, 2, O48. doi:10.1186/2050-2974-2-S1-O48

    Article  PubMed Central  Google Scholar 

  • Neal, C., Beckjord, E. B., Rechis, R., Schaeffer, J., Berno, D., & Duchover, Y. (2007). Cancer stigma and silence around the world. Austin, TX: LIVESTRONG Foundation.

    Google Scholar 

  • Office for National Statistics. (2015). Mortality statistics: Deaths registered in England and Wales, 2014. Swansea: Office for National Statistics.

    Google Scholar 

  • Olatunji, B. O., Cisler, J. M., Deacon, B. J., Connolly, K., & Lohr, J. M. (2007a). The Disgust Propensity and Sensitivity Scale-Revised: Psychometric properties and specificity in relation to anxiety disorder symptoms. Journal of Anxiety Disorders, 21, 918–930. doi:10.1016/j.anxdis.2006.12.005

    Article  PubMed  Google Scholar 

  • Olatunji, B. O., Cox, R., & Kim, E. H. (2015). Self-disgust mediates the associations between shame and symptoms of bulimia and obsessive-compulsive disorder. Journal of Social and Clinical Psychology, 34, 239–258. doi:10.1521/jscp.2015.34.3.239

    Article  Google Scholar 

  • Olatunji, B. O., Forsyth, J. P., & Cherian, A. (2007b). Evaluative differential conditioning of disgust: A sticky form of relational learning that is resistant to extinction. Journal of Anxiety Disorders, 21, 820–834. doi:10.1016/j.anxdis.2006.11.004

    Article  PubMed  Google Scholar 

  • Olatunji, B. O., Williams, N. L., Lohr, J. M., & Sawchuk, C. N. (2005). The structure of disgust: Domain specificity in relation to contamination ideation and excessive washing. Behaviour Research and Therapy, 43, 1069–1086. doi:10.1016/j.brat.2004.08.002

    Article  PubMed  Google Scholar 

  • Olatunji, B. O., Williams, N. L., Tolin, D. F., Abramowitz, J. S., Sawchuk, C. N., Lohr, J. M., & Elwood, L. S. (2007c). The Disgust Scale: Item analysis, factor structure, and suggestions for refinement. Psychological Assessment, 19, 281–297. doi:10.1037/1040-3590.19.3.281

    Article  PubMed  Google Scholar 

  • Overton, P. G., Markland, F. E., Taggart, H. S., Bagshaw, G. L., & Simpson, J. (2008). Self-disgust mediates the relationship between dysfunctional cognitions and depressive symptomatology. Emotion, 8, 379–385. doi:10.1037/1528-3542.8.3.379

    Article  CAS  PubMed  Google Scholar 

  • Park, J. H., Schaller, M., & Crandall, C. S. (2007). Pathogen-avoidance mechanisms and the stigmatization of obese people. Evolution and Human Behavior, 28, 410–414. doi:10.1016/j.evolhumbehav.2007.05.008

    Article  Google Scholar 

  • Powell, P. A., Overton, P. G., & Simpson, J. (2014). The revolting self: An interpretative phenomenological analysis of the experience of self-disgust in females with depressive symptoms. Journal of Clinical Psychology, 70, 562–578. doi:10.1002/jclp.22049

    Article  PubMed  Google Scholar 

  • Powell, P. A., Simpson, J., & Overton, P. G. (2013). When disgust leads to dysphoria: A three-wave longitudinal study assessing the temporal relationship between self-disgust and depressive symptoms. Cognition and Emotion, 27, 900–913. doi:10.1080/02699931.2013.767223

    Article  PubMed  Google Scholar 

  • Powell, P. A., Simpson, J., & Overton, P. G. (2015a). An introduction to the revolting self: Self-disgust as an emotion schema. In P. A. Powell, P. G. Overton, & J. Simpson (Eds.), The revolting self: Perspectives on the psychological, social, and clinical implications of self-directed disgust (pp. 1–24). London: Karnac.

    Google Scholar 

  • Powell, P. A., Simpson, J., & Overton, P. G. (2015b). Self-affirming trait kindness regulates disgust toward one’s physical appearance. Body Image, 12, 98–107. doi:10.1016/j.bodyim.2014.10.006

    Article  PubMed  Google Scholar 

  • Power, M. J., & Dalgleish, T. (2008). Cognition and emotion: From order to disorder (2nd ed.). Hove: Psychology Press.

    Google Scholar 

  • Reeve, D. (2015). Disgust and self-disgust: A disability studies perspective. In P. A. Powell, P. G. Overton, & J. Simpson (Eds.), The revolting self: Perspectives on the psychological, social, and clinical implications of self-directed disgust (pp. 53–74). London: Karnac.

    Google Scholar 

  • Reynolds, L. M., Bissett, I. P., & Consedine, N. S. (2015a). Predicting the patients who will struggle with anal incontinence: Sensitivity to disgust matters. Colorectal Disease, 17, 73–80. doi:10.1111/codi.12781

    Article  CAS  PubMed  Google Scholar 

  • Reynolds, L. M., Consedine, N. S., Pizarro, D. A., & Bissett, I. P. (2013). Disgust and behavioral avoidance in colorectal cancer screening and treatment: A systematic review and research agenda. Cancer Nursing, 36, 122–130. doi:10.1097/NCC.0b013e31826a4b1b

    Article  PubMed  Google Scholar 

  • Reynolds, L. M., McCambridge, S. A., Bissett, I. P., & Consedine, N. S. (2014). Trait and state disgust: An experimental investigation of disgust and avoidance in colorectal cancer decision scenarios. Health Psychology, 33, 1495–1506. doi:10.1037/hea0000023

    Article  PubMed  Google Scholar 

  • Reynolds, L. M., McCambridge, S. A., & Consedine, N. S. (2015b). Self-disgust and adaptation to chronic physical health conditions: Implications for avoidance and withdrawal. In P. A. Powell, P. G. Overton, & J. Simpson (Eds.), The revolting self: Perspectives on the psychological, social, and clinical implications of self-directed disgust (pp. 75–88). London: Karnac.

    Google Scholar 

  • Rozin, P., & Fallon, A. E. (1987). A perspective on disgust. Psychological Review, 94, 23–41. doi:10.1037/0033-295X.94.1.23

    Article  CAS  PubMed  Google Scholar 

  • Rozin, P., Haidt, J., & McCauley, C. R. (2008). Disgust. In M. Lewis, J. M. Haviland-Jones, & L. F. Barrett (Eds.), Handbook of emotions (3rd ed., pp. 757–776). New York, NY: Guilford Press.

    Google Scholar 

  • Schaller, M., & Park, J. H. (2011). The behavioral immune system (and why it matters). Current Directions in Psychological Science, 20, 99–103. doi:10.1177/0963721411402596

    Article  Google Scholar 

  • Siegel, S., & Castellan, N. J. (1988). Nonparametric statistics for the behavioral sciences 2. New York: McGraw-Hill.

    Google Scholar 

  • Simpson, J., Carter, S., Anthony, S. H., & Overton, P. G. (2006). Is disgust a homogeneous emotion? Motivation and Emotion, 30, 31–41. doi:10.1007/s11031006-9005-1

    Article  Google Scholar 

  • Skarstein, J., Aass, N., Fosså, S. D., Skovlund, E., & Dahl, A. A. (2000). Anxiety and depression in cancer patients: Relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. Journal of Psychosomatic Research, 49, 27–34. doi:10.1016/S0022-3999(00)00080-5

    Article  CAS  PubMed  Google Scholar 

  • Smith, D. M., Loewenstein, G., Rozin, P., Sherriff, R. L., & Ubel, P. A. (2007). Sensitivity to disgust, stigma, and adjustment to life with a colostomy. Journal of Research in Personality, 41, 787–803. doi:10.1016/j.jrp.2006.09.006

    Article  PubMed  PubMed Central  Google Scholar 

  • Smith, A. B., Selby, P. J., Velikova, G., Stark, D., Wright, E. P., Gould, A., & Cull, A. (2002). Factor analysis of the Hospital Anxiety and Depression Scale from a large cancer population. Psychology and Psychotherapy: Theory, Research and Practice, 75, 165–176. doi:10.1348/147608302169625

    Article  Google Scholar 

  • Spiegel, D. (1997). Psychosocial aspects of breast cancer treatment. Seminars in Oncology, 24, S36–S47.

    Google Scholar 

  • Van Overveld, M., de Jong, P. J., Peters, M. L., Cavanagh, K., & Davey, G. C. L. (2006). Disgust propensity and disgust sensitivity: Separate constructs that are differentially related to specific fears. Personality and Individual Differences, 41, 1241–1252. doi:10.1016/j.paid.2006.04.021

    Article  Google Scholar 

  • Vartanian, L. R. (2010). Disgust and perceived control in attitudes toward obese people. International Journal of Obesity, 34, 1302–1307. doi:10.1038/ijo.2010.45

    Article  CAS  PubMed  Google Scholar 

  • Walker, J., Hansen, C. H., Martin, P., Symeonides, S., Ramessur, R., Murray, G., & Sharpe, M. (2014). Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: A cross-sectional analysis of routinely collected clinical data. The Lancet Psychiatry, 1, 343–350. doi:10.1016/S2215-0366(14)70313-X

    Article  PubMed  Google Scholar 

  • Whelton, W. J., & Greenberg, L. S. (2005). Emotion in self-criticism. Personality and Individual Differences, 38, 1583–1595. doi:10.1016/j.paid.2004.09.024

    Article  Google Scholar 

  • Wolf, E. J., Harrington, K. M., Clark, S. L., & Miller, M. W. (2013). Sample size requirements for structural equation models: An evaluation of power, bias, and solution propriety. Educational and Psychological Measurement, 76, 913–934. doi:10.1177/0013164413495237

    Article  PubMed  PubMed Central  Google Scholar 

  • Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370. doi:10.1111/j.1600-0447.1983.tb09716.x

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by a postgraduate studentship grant to Haffiezhah Azlan from MARA Education Sponsorship Division, Malay for Indigenous People’s Trust Council (MARA), MARA Head Office 21, Jalan Raja Laut 50609 Kuala Lumpur: 330408224812. We thank Kate Adkins for her help with coding the data for this study.

Author information

Authors and Affiliations

  1. Department of Economics, InstEAD, University of Sheffield, 9 Mappin Street, Sheffield, S1 4DT, UK

    Philip A. Powell

  2. Department of Psychology, University of Sheffield, Sheffield, UK

    Haffiezhah A. Azlan & Paul G. Overton

  3. Division of Health Research, Lancaster University, Lancaster, UK

    Jane Simpson

Authors
  1. Philip A. Powell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Haffiezhah A. Azlan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jane Simpson
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul G. Overton
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philip A. Powell.

Ethics declarations

Conflict of interest

Philip A. Powell, Haffiezhah A. Azlan, Jane Simpson and Paul G. Overton declare that they have no 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. Provided Funding information has to be tagged.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Powell, P.A., Azlan, H.A., Simpson, J. et al. The effect of disgust-related side-effects on symptoms of depression and anxiety in people treated for cancer: a moderated mediation model. J Behav Med 39, 560–573 (2016). https://doi.org/10.1007/s10865-016-9731-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10865-016-9731-0

Keywords

Search

Navigation