Cancer, Attachment, and Resilience

Cancer diagnosis, treatment and subsequent changes in life are well known to
cause emotional distress in people. Although most individuals with cancer are
able to adapt to the changes and losses imposed by the illness, others (25-30
%) develop clinically significant problems (e.g., mood and anxiety
disorders)(Carlson & Bultz, 2004). One of the key goals in psychosocial
oncology is to determine why some people are able to adapt to cancer while
others continue to suffer. Insight in the determinants of these individual
differences is necessary to design optimal interventions. One of the most
widely accepted theories in psychosocial oncology is the stress-coping theory.
This theory is limited, however, by inconsistencies, in the ability to explain
individual differences and in bridging the gap between theory and praxis
(Brennan, 2001; Somerfield & McCrae, 2000).

The purpose of the proposed study is twofold. First, to test a process model of
adaptation that distinguishes between the changes in life imposed by the
illness (i.e., subjective cancer experience), the immediate (emotional,
cognitive, and behvaioral) responses to these changes, and the psychosocial
problems that may develop when the immediate responses persist beyond their
adaptive benefit. Second, to investigate individual differences in the
adaptation process by including intra- and interpersonal factors that may put
people at risk for maladjustment. When risk factors can be identified it may be
possible to prevent psychological problems and it may provide clues for how to
treat psychological problems in oncology.

In this 4-year prospective study we will follow newely diagnosed cancer
patients for 12 months. To be able to assess when and how stressors evolve into
psychological problems, assessment will be done every three months, with a
total of five assessment points.

Both self-report measures and structured (clinical) interviews will be used in
order to gain fuller insight in the adaptation processes. A structured
interview will take place at T1 (within three months after diagnosis) and T5
(12 months after T1) and will be conducted by trained psychologist. Self-report
measures will be completed by participants at all assessment point (T1-T5). The
assessment at T1 and T5 will take approximately 60 to 90 minutes and the
intermediate assessments will take approximately 30 to 45 minutes. Total
assessment time over a one year period will be maximal 5 / 6 hours .