Degree of self-certainty is related to the association between cognitive flexibility and anxiety following breast cancer treatments.

OBJECTIVE

Executive functioning difficulties-notably cognitive flexibility-are frequent following breast cancer (BC) treatment. Conflicting findings suggest that factors beyond anticancer treatments contribute to these changes. Anxiety and self-representation modifications are potential contributors. We explored the relationships among self-representations, anxiety, and cognitive flexibility in women with nonmetastatic BC compared with healthy controls (HCs).

METHOD: We compared 54 BC patients to 47 HCs. We collected questionnaire data on self-representations (Questionnaire of Self-Representation: certainty and valence), state-trait anxiety (State-Trait Anxiety Inventory), and cognitive flexibility (Trail Making Test). Group comparisons were made using t tests or Wilcoxon tests, as appropriate. Spearman's correlations were calculated within each group. Linear regression was used to evaluate how self-representations were associated with the anxiety-cognitive flexibility relationship.

RESULTS

BC patients had higher self-certainty and Trail Making Test scores, indicating slightly reduced cognitive flexibility compared with HCs. In both groups, lower Questionnaire of Self-Representation scores (i.e., less certainty and positivity about oneself) correlated with higher anxiety. In HCs, higher Trail Making Test scores-thus lower cognitive flexibility-correlated with lower Questionnaire of Self-Representation scores and higher anxiety. In BC patients, higher levels of self-certainty were associated with a statistically positive anxiety-cognitive flexibility relationship (i.e., higher anxiety linked to poorer cognitive flexibility), while lower levels of self-certainty were associated with a statistically negative anxiety-cognitive flexibility relationship (lower anxiety linked to better cognitive flexibility).

CONCLUSIONS

These findings suggest that, in BC patients, self-certainty moderates the relationship between anxiety and cognitive flexibility in BC patients. The results highlight the relevance of self-representation in the neuropsychological evaluation of BC patients. (PsycInfo Database Record (c) 2026 APA, all rights reserved).