The Mediating Role of Early Maladaptive Schemas in the Relationship Between Attachment Styles and Adjustment to Early-Stage Breast Cancer.

Background: Individual differences play an important role in adjustment to breast cancer. This longitudinal study explored the potential mediating role of Early Maladaptive Schemas (EMSs) in the relationship between attachment styles and psychological adjustment.

Methods: Ninety-five early-stage female breast cancer patients participated in this longitudinal study and completed validated self-report questionnaires within 4 weeks and 12 months post-surgery measuring attachment styles (ECR-R), EMSs (YSQ-S3), anxiety (HADS-A), depression (HADS-D), and quality of life (EORTC-QLQ C30). Structural equation modeling was utilized to test direct and indirect effects.

Results: Vulnerability to harm/illness schema had a direct effect on all outcomes, while the enmeshment EMS had a direct effect on anxiety only. Moreover, vulnerability to harm/illness schema fully mediated the relationship between attachment anxiety and psychological outcomes. No significant direct or indirect effects were observed for attachment avoidance.

Conclusion: The findings underscore the role of the illness-specific EMS -vulnerability to harm/illness-in psychological distress pathways among breast cancer patients. In non-clinical samples, cancer-related demands and stressors likely amplify the activation of only those schemas closely tied to the psychological challenges of living with cancer, while other EMSs may hold little relevance. Interventions targeting illness-specific EMSs may enhance coping and emotional well-being in this population.