The role of cognitive bias in psychological distress variability among Chinese cancer survivors

Abstract

This thesis addresses three primary objectives: (1) to examine the role of attentional bias and interpretative bias in differentiating Chinese breast cancer (BC) survivors reporting persistent high distress from those reporting low-stable distress; (2) using longitudinal data to map distinct trajectories of Fear of cancer recurrence (FCR) over 12 months among Chinese patients with BC or colorectal cancer (CRC); (3) and to examine if metacognition, indirectly via attentional bias, intrusive thoughts and avoidance (hallmarks of cognitive attentional syndrome) predicted FCR trajectory membership.

Two independent studies were conducted among Chinese cancer survivors. Study I cross-sectionally assessed 140 BC survivors identified in an ongoing longitudinal study of distress trajectories as featuring low-stable (n= 73) or persistent high (n= 67) distress. A group of healthy controls (n= 150) was additionally included as a reference group. Participants completed the Hospital Anxiety and Depression Scale (HADS) evaluating psychological distress, two modified dot-probe tasks assessing attentional bias and an ambiguous cues task assessing interpretative bias for threat-related vs neutral information. Four-way repeated measure of analyses of variance and one-way analyses of variance were used to compare attentional bias and interpretative bias scores between groups respectively (Objective 1). Study II, a longitudinal study, assessed 270 BC (n=163) or CRC (n=107) patients at 8-weeks, 3-months, 6-months, and 12-months post-surgery on a measure of FCR (FCRI-SF). Metacognition (MCQ-30), intrusive and avoidant thoughts (CIES-R) and attentional bias (dot-probe tasks) were assessed at baseline. Latent growth mixture modelling identified FCR trajectories (Objective 2). Fully-adjusted Multinomial Logistic Regression identified whether direct and indirect effects of metacognition through CAS determined FCR trajectory membership (Objective 3).

In Study I, there was no significant difference in scores of attentional bias and interpretative bias for negatively-valenced or cancer-related information in distress status in the BC sample. A weak, but significant time-course effect in attention bias for negatively-valenced or cancer-related information was observed. Survivors with persistent distress exhibited an attentional allocation away from the stimulus under supraliminal conditions. Survivors with persistent distress and healthy controls with high distress did not differ in scores of attentional bias and interpretative bias for threat-related stimuli. In Study II, three distinct FCR trajectories were identified, namely, Low-stable (62.4%), High-stable (29.2%) and Recovery (8.3%). Compared with Low-stable group, Recovery FCR patients held greater Negative beliefs about worry and High-stable FCR patients reported poorer Cognitive confidence. The effect of Negative beliefs about worry was partially mediated by avoidance and fully mediated by intrusive thoughts. Attentional bias did not predict FCR trajectories.

BC survivors with persistent distress may use avoidant coping style to cope with cancer diagnosis, as reflected in controlled attentional bias for threat-related information. However, the role of such attentional bias in the individual variation in FCR became less important, when intrusive and avoidant thoughts, and a higher-level factor metacognition were taken into account. Modifying metacognitive knowledge to interrupt maladaptive cognitive processing including intrusion and avoidance may be an effective therapeutic intervention for patients at risk of persistent FCR/distress.