The impact of early maladaptive schemas on anxiety and depression among early-stage breast cancer patients: direct and mediated pathways through illness representations.

Abstract

Background: Illness representations and Early Maladaptive Schemas (EMSs) play a significant role in shaping emotional self-regulation processes. EMSs are trait-like structures that constitute vulnerability factors associated with psychopathology in adulthood. Adverse life events, such as a breast cancer (BC) diagnosis, are assumed to trigger these EMSs. The present study examined, in a sample of BC patients, whether EMSs are related to anxiety/depression, directly as well as indirectly, through illness representations.

Methods: The study employed a prospective design, and newly diagnosed BC patients (N = 95; mean age = 50.4) completed self-report questionnaires within 4 wk (T0), 4 months (T1), and 12 months (T2) after surgery. The Young Schema Questionnaire-Short Form (YSQ-S3), the Brief Illness Perception Questionnaire (Brief IPQ), and the Hospital Anxiety and Depression Scale (HADS) were used.

Results: Path analysis revealed a statistically significant direct effect of T0 Vulnerability to Harm on T2 anxiety (β = 0.23, p = 0.014). Vulnerability to Harm also predicted anxiety and depression through emotional representations (β = 0.16 and 0.13, respectively, p < 0.01). A direct effect of the Enmeshment EMS was also observed on anxiety (β = 0.21 p = 0.010).

Conclusion: Vulnerability to Harm and Enmeshment EMSs both fall under the "impaired autonomy/performance" domain, reflecting lower self-esteem, diminished ability to function independently, and heightened fear. Recognizing these dispositional factors early is crucial for preventing long-term distress. The finding that illness representations mediated the relationship only for the Vulnerability to Harm EMS suggests a unique relationship between this schema and how individuals perceive their illness, likely due to its relevance to the illness experience.