The effects of spirituality on anxiety and depression among breast cancer patients: the moderating effects of alexithymia and mindfulness

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Amy Tais Banner (Creator)
The University of North Carolina at Greensboro (UNCG )
Web Site:
Craig Cashwell

Abstract: Breast cancer is one of the most prevalent forms of cancer among women in the United States. In fact, the American Cancer Society estimated that over 180,000 new breast cancer cases would be diagnosed in 2008 (American Cancer Society, 2007). The diagnosis and treatment of breast cancer are associated with physical pain, unpleasant side effects, distressing changes in physical appearance and functioning, anxiety, depression, and existential concerns (Keitel & Kopala, 2000). Further, researchers have indicated that anxiety and depression exacerbate the burden of breast cancer (Badger, Braden, Mishel, & Longman, 2004; Bender, Ergyn, Rosenzweig, Cohen, & Sereika, 2005). In addition, research results have suggested that spirituality buffers the anxiety and depression often associated with negative life events (Young, Cashwell, & Scherbakova, 2000). More specifically, spirituality has been associated with overall and emotional well-being among breast cancer patients (Romero et al., 2006). Researchers suggest, however, that in order to obtain a more robust picture of spirituality, the construct must be assessed within a broader context of well-being (Cashwell, Glosoff, & Hammond, in press; Cotton, Levine, Fitzpatrick, Dold, & Targ, 1999). Alexithymia (restriction of emotions) and mindfulness are two constructs that contribute to the broader context of breast cancer patient well-being. Alexithymia has been associated with higher levels of depression among breast cancer patients (Cordova, Cunningham, Carlson, & Andrykowski, 2001) whereas the practice of mindfulness has been associated with improved quality of life among breast cancer patients (Witek-Janusek, Albuquerque, Rambo Chroniak, Chroniak, Durazo-Arvizu, & Mathews, 2008). The purpose of this study, then, was to examine spirituality among breast cancer patients within a broader context of well-being by investigating the relationship between spirituality and both anxiety and depression as moderated by alexithymia and mindfulness among non-metastatic breast cancer patients. Also, because demographic factors may influence anxiety and depression among breast cancer patients, relationship status and stage of breast cancer were included in the research questions and analyses. A sample of 69 women in treatment for non-metastatic breast cancer completed a mailed survey. These women had received surgical treatment within the past year or were currently receiving radiation, chemotherapy, hormone therapy, or biological therapy. Instrumentation included the Spirituality Assessment Scale (Howden, 1992); the Toronto Alexithymia Scale – 20 (Bagby, Parker, & Taylor, 1994a; Bagby, Parker, & Taylor, 1994b); the Five Facet Mindfulness Questionnaire (Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006); the Trimodal Anxiety Questionnaire (Lehrer & Woolfolk, 1982); the Center for Epidemiologic Studies Short Depression Scale (Andresen, Malmgren, Carter, & Patrick, 1994); and a brief demographic questionnaire. As expected, spirituality was negatively correlated with both anxiety and depression whereas alexithymia was positively associated with anxiety and depression. Unexpectedly, alexithymia was positively correlated with mindfulness, mindfulness was positively correlated with anxiety and depression, and spirituality was not significantly correlated with either alexithymia or mindfulness. Also, spirituality, alexithymia, and mindfulness each were predictive of both anxiety and depression and accounted for 39% of the variance in anxiety and 43% of the variance in depression. Neither alexithymia nor mindfulness, however, operated as moderators of the relationship between spirituality and both anxiety and depression. Interestingly, in the prediction of anxiety, both alexithymia and mindfulness were stronger predictors than was spirituality. Regarding depression, however, spirituality was a stronger predictor than either alexithymia or mindfulness, accounting for 25% of the variance in depression by itself. Demographic factors played only a small role in the analyses. Stage of breast cancer accounted for a small amount of the variance in anxiety beyond what was accounted for by spirituality, alexithymia, and mindfulness. This study highlighted the importance of examining spirituality in a broader context of well-being. The findings provide direction for future research and useful implications for counselors working with breast cancer patients.

Additional Information

Language: English
Date: 2009
Alexithymia, Anxiety, Breast cancer, Depression, Mindfulness, Spirituality
Breast $x Cancer $x Psychological aspects.
Spirituality $x Health aspects.
Breast $x Cancer $x Religious aspects.
Health $x Religious aspects.
Depression in women.
Anxiety in women.
Alexithymia $x Women.
Mental healing.

Email this document to