UCLA

PURPOSE: Many interventions have been designed to promote psychological adjustment during and following cancer diagnosis and treatment; however, notably few studies have specified the mediating processes through which these interventions work. The primary aim of this research is to examine theoretically and empirically grounded mediators of a web-based psychosocial intervention for women with breast cancer.

METHODS: Women (N = 88) diagnosed with breast cancer (any stage, any time since diagnosis) were randomly assigned to participate in a three-hour workshop for hands-on creation of personal websites. Mediating variables were assessed at baseline, one month and six months following randomization, and dependent variables were assessed at baseline and six months following randomization. Indirect effects were tested using single and multiple mediator models.

RESULTS: Relative to control participants, women randomized to Project Connect Online (PCO) evidenced significant benefit six months later on depressive symptoms, positive mood, and life appreciation, but not negative mood, perceived strengthened relationships, or intrusive thoughts. Change in coping self-confidence, loneliness, and social support from friends mediated the relationship between the intervention and improvement in depressive symptoms. Coping self-confidence mediated the relationship between the intervention and enhanced positive mood, and social support from friends mediated the relationship between the intervention and increased life appreciation. The intervention did not produce a significant change in the hypothesized mediator of self-reported emotional processing/expression.

CONCLUSIONS: Findings indicate how PCO promoted adaptive change and highlight modifiable factors, including coping self-confidence, loneliness, and social support from friends, which contributed to positive adjustment to breast cancer. Examination of why emotional processing/expression was not associated with change in outcome variables suggests possible additional mediators of the treatment effect and ways in which the intervention can be enhanced.