Adaptation to colorectal cancer and ostomy: Psychological flexibility mitigates loneliness associated with social withdrawal.

Purpose: Colorectal cancer (CRC) survivors with permanent stomas may commonly suffer from social withdrawal and subsequently experience loneliness. However, the relationship between social withdrawal and loneliness may vary depending on the individual's psychological flexibility based on Acceptance and Commitment Therapy (ACT) theory. The present study thus examined the association between social withdrawal and loneliness by focusing on the potential moderating roles of psychological flexibility among CRC survivors with permanent stomas.

Methods: A cross-sectional sample of 289 CRC survivors with permanent stomas completed the social withdrawal subscales, the stoma acceptance and valuable actions scale, and the 6-item revised UCLA Loneliness scale. Moderation analysis using the PROCESS macro in SPSS was conducted to examine the moderating effects of psychological flexibility and its two components, stoma acceptance and valuable actions.

Results: The results indicated that social withdrawal was positively associated with loneliness (r = 0.423, P < 0.001). The moderating analyses showed that psychological flexibility significantly moderated the association of social withdrawal with loneliness (interaction term = - 0.017, P = 0.006). Further exploratory analyses found that the moderating effect of valuable actions was significant (interaction term = - 0.028, P = 0.005), while the stoma acceptance was not.

Conclusion: Psychological flexibility, as well as valuable actions, may serve as a protective factor in the potential effects of social withdrawal on loneliness among CRC survivors with permanent stomas.