The mediating effect of emotion regulation on the relationship between childhood trauma and physical and cognitive symptoms in cancer patients and survivors.

BACKGROUND

In addition to psychological wellbeing, adverse childhood experiences (ACEs) can pose a significant threat to physical health as individuals age. These risks may be particularly burdensome for cancer survivors.

AIMS: This study assessed relationships between ACEs and physical symptoms associated with cancer survivorship in a mixed cancer sample. We used multiple mediation to test if different emotion regulation mediated the relationship between ACEs and physical health. Moderated mediation tested whether these mediation effects differed between those who were currently undergoing or had finished cancer treatment.

METHODS

Cancer patients and survivors (N = 244) completed the Adverse Childhood Experiences Scale (ACES) to assess histories of traumatic experiences before age 18. Patients and survivors also completed the Short Form-36 to measure their self-reported health, physical functioning, pain, and fatigue and the PROMIS Applied Cognition subscale to assess self-reported cognitive difficulties. To index emotion regulation, they completed the Difficulties with Emotion Regulation Scale, Penn State Worry Questionnaire, Rumination-Reflection Questionnaire, and the Mindful Attention and Awareness Scale.

RESULTS

Worry, rumination, mindfulness, and difficulties with emotion regulation mediated the association between ACEs and pain, fatigue, self-rated health, physical functioning, and cognitive problems. Moderated mediation models revealed that with difficulties with emotion regulation as the mediating variable, models were significant only for participants who were currently undergoing cancer treatment.

CONCLUSIONS

Maladaptive and adaptive emotion regulation strategies provide a pathway through which ACEs can alter physical health during cancer treatment and survivorship. These findings emphasize the need for emotion regulation skills training to ameliorate the physical impact of ACEs as individuals navigate cancer.