Abstract

Living with metastatic breast cancer (MBC) represents a chronic stressor characterized by high mortality threat, uncontrollability, and other unique adaptive challenges. To date, the experience of advanced malignant disease has been relatively neglected in psychosocial research, and clarifying the factors that can facilitate or impede adjustment in this context are important priorities for clinical science. The goal of the current longitudinal study was to examine the role of emotional approach coping processes and personal resources in predicting adjustment to MBC. At two timepoints separated by three months, 90 women diagnosed with Stage IV breast cancer completed self-report measures of cancer-specific emotional expression and processing, social support, coping self-efficacy, hope, and both general and cancer-specific positive and negative adjustment. In addition, women provided saliva samples to assess diurnal cortisol rhythm, a measure of neuroendocrine regulation linked to prognosis in the context of MBC. In hierarchical multiple regressions, emotional processing at study entry was significantly associated with increases in depressive symptoms and cancer-specific intrusive and avoidant thoughts, particularly for women with low levels of emotional support or low self-efficacy to manage their cancer-related emotions. Emotional expression moderated the impact of cancer-specific intrusive thoughts on depressive symptoms at follow-up and appeared to protect women low in social support or emotional self-efficacy from increases in distress. Emotional processing and emotional expression also interacted to predict neuroendocrine regulation at follow-up, such that the use of these emotional approach processes in tandem predicted steeper, more salutary diurnal cortisol slopes than the use of either strategy alone. This study represents the first longitudinal investigation of emotional approach coping in the context of MBC and suggests that the adaptive significance of these coping strategies depends on the interpersonal and intrapersonal context in which they occur. Results have implications for clinical interventions, indicating that emotional processing in the absence of emotional expression or among women with limited social support or low levels of coping self-efficacy may contribute to increased distress and impaired neuroendocrine regulation. In contrast, emotional expression may attenuate the association between cancer-specific intrusive thoughts and subsequent depressive symptoms.