The Relationship Between Sense of Coherence and Post-Traumatic Growth in Breast Cancer Survivors: The Mediating Roles of Stress-Related Benefit Finding and Positive Changes in Attitudes Toward Life

Ghazal Taghavirad; Mina Sheykh; Mahsa Talebi Eshkalak; Nazanin Fahimi; Kamran  Pourmohammad Ghouchani

Authors

Ghazal Taghavirad Department of health psychology, Ra.C., Islamic Azad University, Rasht, Iran. Corresponding Author https://orcid.org/0009-0007-1475-7919
Mina Sheykh M.A. in General Psychology, Takestan Higher Education Institute, Qazvin, Iran. Author https://orcid.org/0009-0001-2687-3294
Mahsa Talebi Eshkalak Department of health psychology, To.C., Islamic Azad university,Tonekabon,Iran Author https://orcid.org/0009-0007-5033-2467
Nazanin Fahimi Assistant Professor, Department of Psychology, Faculty of Humanities, Shafagh Institute of Higher Education, Tonekabon, Iran Author https://orcid.org/0009-0005-4614-5699
Kamran Pourmohammad Ghouchani Department of Clinical psychology, Ki.C., Islamic Azad University, Kish, Iran Author https://orcid.org/0000-0003-4590-0224

Keywords:

Sense of Coherence, Post-Traumatic Growth, Benefit Finding, Attitude Toward Life, Breast Cancer Survivors

Abstract

Objective: This study aimed to investigate the relationship between sense of coherence and post-traumatic growth in breast cancer survivors, with stress-related benefit finding and positive changes in attitudes toward life as mediating variables.

Methods and Materials: This descriptive-correlational study employed structural equation modeling. The statistical population consisted of breast cancer survivors in Mashhad, Iran, from whom 400 participants were selected using convenience sampling. Data were collected using Antonovsky’s 29-item Sense of Coherence Questionnaire (1987), Tedeschi and Calhoun’s 21-item Post-Traumatic Growth Inventory (1996), Park’s 17-item Stress-Related Benefit-Finding Questionnaire (1998), and Wallace and Wright’s 24-item Attitude Toward Life Questionnaire (2005). Data were analyzed using SPSS for preliminary statistical analyses and AMOS version 24 for testing the measurement and structural models. Direct and indirect relationships among the study variables were examined, and bootstrap analysis was used to assess the significance of the mediating effects.

Findings: Structural equation modeling indicated that sense of coherence had a positive and statistically significant direct relationship with post-traumatic growth. Stress-related benefit finding significantly mediated the relationship between sense of coherence and post-traumatic growth. Positive changes in attitudes toward life also demonstrated a statistically significant independent mediating effect in this relationship. Furthermore, bootstrap analysis confirmed that the simultaneous indirect effect of stress-related benefit finding and positive changes in attitudes toward life on the association between sense of coherence and post-traumatic growth was statistically significant. The final structural model also demonstrated an acceptable overall fit, supporting the hypothesized relationships among the study variables.

Conclusion: Sense of coherence appears to facilitate post-traumatic growth among breast cancer survivors both directly and through adaptive psychological processes involving benefit finding and positive reconstruction of attitudes toward life.

Downloads

Download data is not yet available.

References

Bakhsh Alizadeh Irani, S., Shahidi, S., & Hazini, M. (2021). Attitude towards Death and Meaning of Life in Terminally Ill Cancer Patients: A Phenomenological Study. Health Psychology, 10(37), 65-82.

Ghorbani, H., Asadi, S., Ghorbani, S., Ghorbani, P., Stepanyan, H., Khlghatyan, N., Aghabalyan, D., Bahrami, S., & Rituraj, R. (2023). Investigating the Predictive Contribution of Attitude Towards Life and Belief System on Self-Resilience and Psychological Toughness of Cancer Patients About the Mediating Role of Emotion Regulation. https://doi.org/10.1109/sami58000.2023.10044491

Hinz, A., Schulte, T., Ernst, J., Mehnert-Theuerkauf, A., Finck, C., Wondie, Y., & Ernst, M. (2023). Sense of coherence, resilience, and habitual optimism in cancer patients. International Journal of Clinical and Health Psychology, 23(2), 100358. https://doi.org/10.1016/j.ijchp.2022.100358

Lee, J. A., Park, H. S., & Kim, W. Y. (2023). The role of self-efficacy and sense of coherence in reducing death anxiety in cancer patients. Psychosocial Oncology Journal, 36(6), 590-601.

Moon, J. H., & Seo, E. (2024). Sense of coherence promotion and occupational and family stress mitigation may improve heart health behaviors in middle-aged working women: a structural equation modelling approach. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1333867

Ruiz-Romeo, M., Ciria‐Suarez, L., Arizu-Onassis, A., Medina, J. C., Serra-Blasco, M., Souto-Sampera, A., Flix-Valle, A., Lucía del Carmen González, A., Villanueva‐Bueno, C., Escudero-Vilaplana, V., Linares, E. J., & Ochoa, C. (2026). Integrating Online Peer Support Into Psychosocial Care for Breast Cancer Survivorship: Effects on Anxiety and Post-Traumatic Growth. https://doi.org/10.21203/rs.3.rs-9616428/v1

Safari, S., Hazrati, S., & Asadbeigi, A. (2025). Diagnostic Role of Sense of Coherence, Distress Tolerance, and Marital Intimacy in Distinguishing Couples with High versus Low Attitudes toward Extramarital Relationships. Ardabil.

Shabani, F., Ghanbari Hashemabadi, B. A., & Karami, A. (2025). Comparison of Family Emotional Climate, Ambivalence over Emotional Expression, Sense of Psychological Coherence, and Self-Criticism in Patients with Psychosomatic Disorders and Cancer with Healthy Individuals [Master's thesis in Family Counseling, Hekmat Razavi Institute of Higher Education].

Su, Y., Zhang, S., Duan, L., & Hu, X. (2026). The Effectiveness of Telemedicine‐Based Psychosocial Intervention for Fear of Cancer Recurrence, Mindfulness, and Posttraumatic Growth in Cancer Survivors: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials. Psycho-Oncology, 35(1). https://doi.org/10.1002/pon.70377

Talebi, G., Rezayi Jamaloui, H., Bagherian Sararodi, R., Oreyzi, H., & Bagherian-Sararoudi, P. (2024). Effectiveness of Meaning-Centered Group Therapy on Death Attitude and Distress Tolerance in Women with Breast Cancer with Death Anxiety. Health Psychology, 13(51), 83-98. https://doi.org/10.30473/hpj.2024.68761.5874

Tock, W. L., Maheu, C., Blondin, S., Lee, V., Neuman, S., & Meterissian, S. (2025). The Effect of Life Coaching on Post‐Traumatic Growth and Well‐Being in Breast Cancer Survivors: A Randomized Controlled Trial. Psycho-Oncology, 34(10). https://doi.org/10.1002/pon.70295

Ullah, Z., Khan, M. N., Din, Z. U., & Afaq, S. (2021). Breast Cancer Awareness and Associated Factors Amongst Women in Peshawar, Pakistan: A Cross-Sectional Study. Breast Cancer: Basic and Clinical Research, 15, 11782234211025346. https://doi.org/10.1177/11782234211025346

Wang, F., Nie, A., Liao, S., Zhang, Z., & Su, X. (2024). Therapy-related symptoms and sense of coherence: the mediating role of social support and hope in lung cancer patients undergoing chemotherapy. Patient Preference and Adherence, 2559-2568. https://doi.org/10.2147/PPA.S480306

Wenji, X. U., Sun, J., Y, L., Chen, Y. C., 智晓旭, Zhang, L., & Du, S. (2026). Posttraumatic Growth Among Cancer Patients: A Conceptual Analysis. Nursing and Health Sciences, 28(2). https://doi.org/10.1111/nhs.70371