Illness cognitions, cognitive fusion, avoidance and self-compassion as predictors of distress and quality of life in a heterogenous sample of adults, after cancer


David T. Gillanders, Ashleigh K. Sinclair, Margaret MacLean & Kirsten Jardine


This study explored the predictive power of illness cognitions, cognitive fusion, avoidance and self-compassion in influencing distress and quality of life in people who have experienced cancer.

A quantitative cross-sectional design was used. 105 adults with various cancer diagnoses completed measures of cancer related thoughts, coping styles, self-compassion, cognitive fusion, distress and quality of life. Correlation, linear regression and conditional process analysis was used to explore relationships between predictor variables, distress and quality of life.

Although predictors were individually related to distress and quality of life in theoretically consistent ways, regression analysis showed that cognitive fusion was the strongest predictor of anxiety symptoms, whilst cancer related cognitions and avoidant coping were the strongest predictors of depressive symptoms and quality of life. Threatening illness appraisals did not directly predict anxiety, rather cognitive fusion mediated this relationship. This path was also moderated by self-compassion, such that for those higher in self-compassion, the impact of threatening illness appraisals and fusion on anxiety was attenuated. Illness appraisals did not directly predict depressive symptoms, but their influence on depression was mediated by avoidant coping. For quality of life, both direct and indirect effects were observed. Illness cognitions, avoidance and fusion all directly influenced quality of life and this was not moderated by self-compassion.

Threatening appraisals of cancer, cognitive fusion and avoidant coping were found to be the strongest predictors of distress and lowered quality of life after cancer. Interventions focused on reducing cognitive fusion and emotional avoidance, such as Acceptance and Commitment Therapy should be further explored in this population. Threatening illness cognitions directly influence both anxiety and quality of life. Conceptualisations of cognitive modification strategies from within contextual behavioural science could be useful in exploiting this potential treatment target, whilst staying theoretically consistent.

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