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Hide and “sick”: Self-concealment, shame and distress in the setting of psycho-oncology

Published online by Cambridge University Press:  21 June 2017

Reut Wertheim ,
Ilanit Hasson-Ohayon ,
Michal Mashiach-Eizenberg ,
Noam Pizem ,
Einat Shacham-Shmueli  and
Gil Goldzweig
Reut Wertheim*
Affiliation:
Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
Ilanit Hasson-Ohayon
Affiliation:
Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
Michal Mashiach-Eizenberg
Affiliation:
Department of Health Systems Management, Max Stern Academic College of Emek Yezreel, Emek Yezreel, Israel
Noam Pizem
Affiliation:
Chaim Sheba Medical Center at Tel Hashomer, Ramat-Gan, Israel
Einat Shacham-Shmueli
Affiliation:
Chaim Sheba Medical Center at Tel Hashomer, Ramat-Gan, Israel
Gil Goldzweig
Affiliation:
The School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Israel
*
Address correspondence and reprint requests to Reut Wertheim, Department of Psychology, Bar Ilan University, Ramat-Gan, 52900, Israel. E-mail: [email protected].
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Abstract

Objective:

Both trait and contextual self-concealment, as well as shame- and guilt-proneness, have previously been found to be associated with psychological distress. However, findings regarding the associations between these variables among patients with cancer and among the spouses of patients with cancer are limited. The aim of the current study was therefore to investigate the relationship between shame-proneness and psychological distress (anxiety and depression) by examining the mediating role of both trait and contextual self-concealment among patients with cancer and among the spouses of patients with cancer.

Method:

The current study was part of a large-scale cross-sectional study on self-concealment among patients with cancer and spouses of patients with cancer. It was based on two independent subsamples: patients with cancer and spouses of patients with cancer, who were not dyads. A total of 80 patients with cancer and 80 spouses of (other) patients with cancer completed questionnaires assessing shame- and guilt-proneness, trait and contextual self-concealment, anxiety, and depression.

Results:

Results indicate that spouses reported both greater shame-proneness and anxiety than did patients (main effect of role). Female participants reported greater shame-proneness, higher levels of contextual self-concealment, and greater depression and anxiety than did male participants (main effect of gender). No group differences (role/gender) were found for guilt-proneness and trait self-concealment. Trait and contextual self-concealment partially mediated the relationship between shame-proneness and distress, pointing out the need to further examine additional mediators.

Significance of results:

Findings suggest that contextual self-concealment and shame-proneness are important variables to consider when assessing distress in the setting of psycho-oncology. Study results may have significant clinical implications regarding the need to identify patients and spouses who are more prone to shame and self-concealment behavior in order to better tailor interventions for them.

Keywords

Self-concealmentShame-pronenessGuilt-pronenessDistressCancer
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Special Issue 4: Topics in Bereavement , August 2018 , pp. 461 - 469
Copyright
Copyright © Cambridge University Press 2017 

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References

REFERENCES

Barr, P. (2012). A dyadic analysis of negative emotion personality predisposition effects with psychological distress in neonatal intensive care unit parents. Psychological Trauma: Theory, Research, Practice, and Policy, 4(4), 347–355.Google Scholar
Beesley, V.L., Smithers, B.M., Khosrotehrani, K., et al. (2015). Supportive care needs, anxiety, depression and quality of life amongst newly diagnosed patients with localised invasive cutaneous melanoma in Queensland, Australia. Psycho-Oncology, 24(7), 763–770.Google Scholar
Behrendt, H. & Ben-Ari, R. (2012). The positive side of negative emotion: The role of guilt and shame in coping with interpersonal conflict. The Journal of Conflict Resolution, 56(6), 1116–1138.Google Scholar
Benetti-McQuoid, J. & Bursik, K. (2005). Individual differences in experiences of and responses to guilt and shame: Examining the lenses of gender and gender role. Sex Roles, 53(1), 133–142.Google Scholar
Bjelland, I., Dahl, A.A., Haug, T.T., et al. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. Journal of Psychosomatic Research, 52(2), 69–77.Google Scholar
Bruno, S., Lutwak, N. & Agin, M.A. (2009). Conceptualizations of guilt and the corresponding relationships to emotional ambivalence, self-disclosure, loneliness and alienation. Personality and Individual Differences, 47(5), 487–491.Google Scholar
Cramer, K.M. & Barry, J.E. (1999). Psychometric properties and confirmatory factor analysis of the Self-Concealment Scale. Personality and Individual Differences, 27(4), 629–637.Google Scholar
Dirkse, D., Lamont, L., Li, Y., et al. (2014). Shame, guilt, and communication in lung cancer patients and their partners. Current Oncology, 21(5), e718–e722.Google Scholar
Fergus, T.A., Valentiner, D.P., McGrath, P.B., et al. (2010). Shame- and guilt-proneness: Relationships with anxiety disorder symptoms in a clinical sample. Journal of Anxiety Disorders, 24(8), 811–815.Google Scholar
Forssén, A.S., Carlstedt, G. & Mörtberg, C.M. (2005). Compulsive sensitivity—A consequence of caring. A qualitative investigation into women carer's difficulties in limiting their labours. Health Care for Women International, 26(8), 652–671.Google Scholar
Giner-Sorolla, R., Piazza, J. & Espinosa, P. (2011). What do the TOSCA guilt and shame scales really measure: Affect or action? Personality and Individual Differences, 51(4), 445–450.Google Scholar
Gross, C.A. & Hansen, N.E. (2000). Clarifying the experience of shame: The role of attachment style, gender, and investment in relatedness. Personality and Individual Differences, 28(5), 897–907.Google Scholar
Hagedoorn, M., Sanderman, R., Bolks, H.N., et al. (2008). Distress in couples coping with cancer: A meta-analysis and critical review of role and gender effects. Psychological Bulletin, 134(1), 1–30.Google Scholar
Hajdarevic, S., Rasmussen, B.H. & Hörnsten, Å. (2014). You never know when your last day will come and your trip will be over—Existential expressions from a melanoma diagnosis. European Journal of Oncology Nursing, 18(4), 355–361.Google Scholar
Hasson-Ohayon, I., Ehrlich-Ben Or, S., Vahab, K., et al. (2012). Insight into mental illness and self-stigma: The mediating role of shame proneness. Psychiatry Research, 200(2), 802–806.Google Scholar
Hasson-Ohayon, I., Goldzweig, G., Braun, M. & Galinsky, D. (2010). Women with advanced breast cancer and their spouses: Diversity of support and psychological distress. Psycho-Oncology, 19(11), 1195–1204.Google Scholar
Hayes, A.F. (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. New York: Guilford Press.Google Scholar
Hill, J., Holcombe, C., Clark, L., et al. (2011). Predictors of onset of depression and anxiety in the year after diagnosis of breast cancer. Psychological Medicine, 41(7), 1429–1436.Google Scholar
IBM Corporation (2011). IBM SPSS Statistics for Windows, Version 20.0. Armonk, NY: IBM Corporation.Google Scholar
Kelly, A.E. & Yip, J.J. (2006). Is keeping a secret or being a secretive person linked to psychological symptoms? Journal of Personality, 74(5), 1349–1369.Google Scholar
Lambert, S., Pallant, J.F. & Girgis, A. (2011). Rasch analysis of the Hospital Anxiety and Depression Scale among caregivers of cancer survivors: Implications for its use in psycho-oncology. Psycho-Oncology, 20(9), 919–925.Google Scholar
Larson, D.G. & Chastain, R.L. (1990). Self-concealment: Conceptualization, measurement, and health implications. Journal of Social & Clinical Psychology, 9(4), 439–455.Google Scholar
Larson, D.G., Chastain, R.L., Hoyt, W.T., et al. (2015). Self-concealment: Integrative review and working model. Journal of Social & Clinical Psychology, 34(8), 705–729.Google Scholar
LoConte, N.K., Else-Quest, N.M., Eickhoff, J., et al. (2008). Assessment of guilt and shame in patients with non-small-cell lung cancer compared with patients with breast and prostate cancer. Clinical Lung Cancer, 9(3), 171–178.Google Scholar
Lynch, J.S., Hill, E.D., Nagoshi, J.L., et al. (2012). Mediators of the shame–guilt–psychological adjustment relationship. Scandinavian Journal of Psychology, 53(5), 437–443.Google Scholar
Manne, S., Badr, H. & Kashy, D.A. (2012). A longitudinal analysis of intimacy processes and psychological distress among couples coping with head and neck or lung cancers. Journal of Behavioral Medicine, 35(3), 334–346.Google Scholar
Morrison, A.P. (1983). Shame, the ideal self, and narcissism. Contemporary Psychoanalysis, 19, 295–318.Google Scholar
Moser, M.T., Künzler, A., Nussbeck, F., et al. (2013). Higher emotional distress in female partners of cancer patients: prevalence and patient–partner interdependencies in a 3-year cohort. Psycho-Oncology, 22(12), 2693–2701.Google Scholar
Pineles, S.L., Street, A.E. & Koenen, K.C. (2006). The differential relationships of shame-proneness and guilt-proneness to psychological and somatization symptoms. Journal of Social & Clinical Psychology, 25(6), 688–704.Google Scholar
Qualtrics Research Suite (2005). Qualtrics. Provo, UT. Available from http://www.qualtrics.com.Google Scholar
Shin, D.W., Park, J.H., Kim, S.Y., et al. (2014). Guilt, censure, and concealment of active smoking status among cancer patients and family members after diagnosis: A nationwide study. Psycho-Oncology, 23(5), 585–591.Google Scholar
Stuewig, J. & McCloskey, L.A. (2005). The relation of child maltreatment to shame and guilt among adolescents: Psychological routes to depression and delinquency. Child Maltreatment, 10(4), 324–336.Google Scholar
Tangney, J.P. (1990). Assessing individual differences in proneness to shame and guilt: Development of the Self-Conscious Affect and Attribution Inventory. Journal of Personality and Social Psychology, 59(1), 102–111.Google Scholar
Tangney, J.P. (1996). Conceptual and methodological issues in the assessment of shame and guilt. Behaviour Research and Therapy, 34(9), 741–754.Google Scholar
Tangney, J.P. & Dearing, R.L. (2002). Shame and Guilt. New York: Guilford Press.Google Scholar
Tangney, J.P., Wagner, P., Fletcher, C., et al. (1992). Shamed into anger? The relation of shame and guilt to anger and self-reported aggression. Journal of Personality and Social Psychology, 62(4), 669–675.Google Scholar
Uji, M., Kitamura, T. & Nagata, T. (2011). Self-conscious affects: Their adaptive functions and relationship to depressive mood. American Journal of Psychotherapy, 65(1), 27–46.Google Scholar
Ussher, J.M. & Perz, J. (2010). Gender differences in self-silencing and psychological distress in informal cancer carers. Psychology of Women Quarterly, 34(2), 228–242.Google Scholar
Uysal, A. & Lu, Q. (2011). Is self-concealment associated with acute and chronic pain? Health Psychology, 30(5), 606–614.Google Scholar
Vodermaier, A. & Millman, R.D. (2011). Accuracy of the Hospital Anxiety and Depression Scale as a screening tool in cancer patients: A systematic review and meta-analysis. Supportive Care in Cancer, 19(12), 1899–1908.Google Scholar
Wei, M., Shaffer, P.A., Young, S.K., et al. (2005). Adult attachment, shame, depression, and loneliness: The mediation role of basic psychological needs satisfaction. Journal of Counseling Psychology, 52(4), 591–601.Google Scholar
Wertheim, R., Hasson-Ohayon, I., Mashiach-Eizenberg, M., et al. (2016). Self-concealment among couples who cope with chronic illness: Development and preliminary validation of the Couples Illness Self-Concealment (CISC) questionnaire. Supportive Care in Cancer, 24(12), 4951–4959.Google Scholar
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.Google Scholar