Psychological distress, attachment insecurity and spiritual well-being in cancer patients

Psychological distress in cancer patients is adequately documented in research (Mehnert et al. 2014). It includes emotional, cognitive, social and functional problems, potentially leading to feelings of dependency and helplessness. Also existential distress and the search for meaning are recognized to be an important issue for patients (Vehling et al., 2017). Although spiritual well-being and meaning in life is known to reduce psychological distress in cancer patients, specific sources of meaning have been little explored. Also, knowledge of other specific intraindividual factors leading to high psychological distress in this clientele is scarce. Social relatedness and patients´ feeling of security, as well as trust in health care providers are known to reduce distress in cancer patients. Patient attachment styles affect the perception of social support and influence their reactions to feelings of dependency and the loss of control. The present thesis first of all aimed to identify specific factors influencing cancer patients’ psychological distress, such as specific sources of meaning, attachment insecurity and spiritual well-being. Through that further knowledge about how to develop individually tailored cancer care programs and psychotherapeutic interventions can be gained. Specific sources of meaning, as well as attachment insecurity influence psychological distress in cancer patients. The association of attachment insecurity and psychological distress is further mediated by spiritual well-being. Psychooncological interventions helping patients to deal with their distress have been developed and evaluated in the last two decades (Faller, 2013). Especially for female patients suffering from breast cancer the range of therapeutic options is wide. Interventions for advanced cancer patients containing special elements concerning their shortened life expectancy and special challenges in their social roles and relationships are in the process of development and evaluation (Lo et al., 2016; Scheffold et al., 2017; Schulz-Kindermann & Vehling, 2017). The meaning-based, short-term intervention CALM (Managing Cancer and Living Meaningfully) (Hales et al., 2010) includes attachment and spirituality as two important elements for the therapy. As a second aim of this thesis, CALM has been tested in a Pilot Study to evaluate the feasibility of the following RCT.:1. Introduction 3 1.1. Psychological distress in cancer patients 3 1.2. Sources of Meaning and Spiritual well-being in cancer patients 4 1.3. Attachment in cancer patients 6 1.4. Association of attachment and spiritual well-being 7 1.5. Psychooncological Interventions 8 2. Research objectives 11 3. Methods 12 3.1. Study design & Samples 12 3.2. Measures 13 4. Outline of publications 17 4.1. Sources of meaning in cancer patients - influences on global meaning, anxiety and depression in a longitudinal study. 18 4.2. Insecure attachment predicts depression and death anxiety in advanced cancer patients. 21 4.3. Spiritual well-being mediates the association between attachment insecurity and psychological distress in advanced cancer patients. 23 4.4. „Managing Cancer and Living Meaningfully“ Qualitative Pilotergebnisse einer sinnbasierten Kurzzeittherapie für fortgeschritten erkrankte Krebspatienten (CALM). 25 5. Summary/Zusammenfassung 27 6. References 31 7. Appendix 39 7.1. Erklärung über die eigenständige Abfassung der Arbeit 39 7.3. Curriculum Vitae 41 7.4. Publikationsverzeichnis 42 7.5. Danksagung 4