Mediating Effects of Forgiveness on Marital Intimacy and Mental Health of Breast Cancer Women with Attachment Injury
Abstract
The purpose of this study was to investigate the effects of attachment injury on marital intimacy and mental health and to test the mediating effects of forgiveness in breast cancer women. Total 216 women with breast cancer who had experience of attachment injury participated in this study. Data was collected at two clinics of breast cancer in general hospital in Seoul and Kyounggi province. Hypothetical model was consisted of variables with attachment injury, marital intimacy, mental health, and forgiveness. Amos 18.0 was used to identify fitness and analyze the paths of the model. The results were as follows. First, fitness indices of hypothetical model indicated that the data did not fit well and it needed to be modified. After modification model fit showed good with χ2=29.0, Normed χ2= 1.61(CMIN/DF), GFI=.97, AGFI=.93, NFI=.90, SRMR=.06, TLI=.91, RMSEA=.05. Second, four paths from attachment injury to marital intimacy, mental health, and forgiveness and from forgiveness to marital intimacy were significant. But path from forgiveness to mental health was not significant. Third, forgiveness was not a significant mediating variable between attachment injury and mental health but a significant mediating variable between attachment injury and marital intimacy. Forgiveness was the strongest influencing factor to marital intimacy in the model. Attachment injury and forgiveness explained 63% of marital intimacy and 8% of mental health. It is suggested to include forgiveness in development of education and marital therapy for breast cancer women with attachment injury.
- keywords
- Breast cancer, Attachment injury, Forgiveness, Marital intimacy, Mental health, 유방암, 애착손상, 용서, 부부친밀감, 정신건강
Reference
강희선, 염수영, 전은영 (2013). 유방암 생존자 부부를 위한 중재 연구 문한고찰. 여성건강간호학회지, 19(3), 153-165.
김광일, 원호택, 이정호, 김광윤 (1978). 간이정신진단검사의 한국판 표준화 연구: 정상인의 반응특성. 신경정신의학, 17, 449-458.
김동배, 안인경 (2004). 한국인의 정신건강 개념에 관한 연구. 한국사회복지학, 56(1), 203-233.
김수진, 도현심 (2001). 부-모간 양육행동의 관련변인: 부부관계의 질, 어머니의 인성 특성 및 기질. 한국가정관리학회지, 19(5), 101-114.
김정은, 박경민, 고효정 (2003). 유방절제술 받은 여성과 배우자에 대한 지지교육이 삶의 질에 미치는 효과. 한국모자보건학회지, 7(2), 233-242.
김현주, 안현의 (2011). 공감능력과 결혼만족도의 관계에서 용서의 매개효과. 한국심리학회지: 상담 및 심리치료. 23(1), 157-174.
김정화 (2013). 애착손상을 경험한 부부를 대상으로 한 애착손상 해결모델의 적용: 용서과정과 관계회복을 중심으로. 단국대학교 석사학위논문.
민성길, 박청산, 한정옥 (1993). 홧병에 있어서의 방어기제와 대응전략. 신경정신의학, 32(4), 506-515.
박종효 (2003). 용서와 건강의 관련성 탐색. 한국심리학회지: 건강, 8(2), 301- 321.
배병렬 (2013). Amos 19 구조방정식 모델링-원리와 실제. 청람.
손병호, 안세현 (2006). 한국인 유방암 환자들의 생존율 분석. 유방암학회지, 9(3), 1-16.
양영숙, 김봉환 (2009). 부부갈등과 심리적 부적응과의 관계에서 공감과 용서의 매개효과. 상담학연구, 10(2), 683-699.
오영희 (2004). 대학생의 부모-자녀 갈등경험, 용서, 정신건강의 관계. 교육심리연구, 18(3), 59-77.
오영희 (2011). 한국인 용서척도 단축형의 개발과 타당화. 한국심리학회지: 건강, 16(4), 799-813.
윤수정 (2004). 용서간호 중재 프로그램이 진행성 여성암 환자의 용서와 정신건강에 미치는 효과. 고신대학교 박사학위 논문.
임인숙 (2006). 유방암, 손상된 몸과 여성성의 위기감. 한국여성학, 22(4), 5-46.
임화순 (2007). 유방암 환자에게 적용한 간호중재 효과에 대한 메타분석. 고려대학교 대학원 석사학위논문.
중앙암등록본부 (2014). 2011년 국가 암 등록 통계. http://ncc.re.kr/manage/manage
하늘, 배성만, 현명호 (2011). 성 피해자의 수치심과 우울의 관계에서 용서의 매개효과. 한국심리학회지: 건강. 16(4), 725-737.
하은혜, 이선희, 유은승, 김종흔, 강한성, 노정실, 이근석 (2011). 유방암 환자의 화병과 우울증상과의 관계. 한국심리학회지: 여성, 16(1), 115-133.
Al-Mabuk, R., Enright, R. D., & Cardis, P. (1995). Forgiveness education with parentally love-deprived college students. Journal of Moral Education, 24, 427-444.
Atkinson, L. (1997). Attachment and psychopathology: From laboratory to clinic. In L. Atkinson & K. J. Zucker (Eds.), Attachment and psychopathology (pp. 3-16). New York: Guilford.
Battle, C. C., Imber, S. D., Hoehn-Saric, R., Stone, A. R., Nash, E. R., & Frank, J. D. (1966). Target complaints as criteria of improvement. American Journal of Psychotherapy, 20, 184-192.
Barber L., Maltby, J., & Macaskill, A. (2005). Angry memories and thoughts of revenge: The relationship between forgiveness and anger rumination. Personality and Individual Differences, 39, 253-262.
Baumeister, R. F., Exline, J. J., & Sommer, K. L. (1998). The victim role, grudge theory, and two dimensions of forgiveness. In E. L. Worthington, Jr. (Ed.), Dimensions of forgiveness: Psychological research and theological perspectives (pp. 79-106). Philadelphia: Templeton Foundation Press.
Begovic-Juhant, A., Chmielewski, A., Iwuagwu, S., & Chapman, L. A. (2012). Impact of body image on depression and quality of life among women with breast cancer. Journal of Psychosocial Oncology, 30(4), 446-460.
Brooks, C. W. (2007). Forgiveness and empathy in victims of sexual aggression and their relationship with mental and physical health. Idaho State University, Unpublished doctoral dissertation.
Burgess, C., Cornelius, V., Love, S. Graham, J., Richards, M., Ramirez, A. (2005). Depression and anxiety in women with early breast cancer: five year observational cohort study. British Medical Journal, 330, 702-705.
Cano, A. & O'Leary, K. D. (2000). Infidelity and separations precipitate major depressive episodes and symptoms of nonspecific depression and anxiety. Journal of Consulting and Clinical Psychology, 68(5), 774- 781.
Chapman D. M., & Caldwell, B. E. (2012). Attachment injury resolution in couples when one partner is trans-identified. Journal of Systemic Therapies, 31(2), 36-53.
Cosgrove, L., & Konstam, V. (2008). Forgiveness and forgetting: Clinical implications for mental health counselors. Journal of Mental Health Counseling, 30(1), 1-13.
Derogatis, L. R. (1973). The SCL-90: An outpatient psychiatric rating scale-Preliminary report. Psychopharmacology Bulletin, 9, 13-27.
Diener, E. Lucsa, R. E., & Oishi, S. (2005). Subjective well-being. The science of happiness and life satisfaction. In C. R. Snyder(Eds.). Handbook of positive psychology(2nd ed.), (pp. 63-73). New York: Oxford University Press.
Edwards, J. K. (2007). Relationship satisfaction: The role of attachment, conflict, empathy, and forgiveness. Unpublished doctoral dissertation, Purdue University
Fincham, F. D. (2000). The kiss of porcupines: From attributing responsibility to forgiving. Personal Relationships, 7, 1-23.
Fonagy, P. (2001). Attachment theory and psychoanalysis. Other Press: New York.
Freedman, S., Enright, R. D., & Knutson, J. (2005). A progress report on the process model of forgiveness. In E. L. Worthington, Jr. (Ed.), Handbook of forgiveness (pp. 393-106). New York: Routledge.
Gordon, K., Baucom, D. H., & Snyder, D. K. (2000). The use of forgiveness in marital therapy. In M. McCullough, K., Pargament, & C. Thoresen (Eds.), Forgiveness: theory, research, and practice (pp. 203-227). New York: Guilford Press.
Greenberg, L., Warwar, S., & Malcolm, W. (2010). Emotion-focused couples therapy and the facilitatin of forgiveness. Journal of marital and Family Therapy, 36(1), 28-42.
Greene, S. M.. & Griffin, W. A. (1998). Symptom study in context: Effects of marital quality on signs of Parkinson's disease during patient- spouse interaction. Psychiatry, 61, 35-45.
Hagedoorn M, Sanderman R, Coyne J, & Bolks H, Tuinstra J. (2008). Distress in couples coping with cancer: A meta-analysis and critical review of role and gender effects. Psychological Bulletin, 134(1), 1-30.
Hall A, A'Hern R, Fallowfield L. (1999). Are we using appropriate self-report questionnaires for detecting anxiety and depression in women with early breast cancer? European Journal of Cancer, 35, 79-85.
Hansen, M. J. (2002). Forgiveness as an educational intervention goal for persons at the end of life. Unpublished doctoral dissertation, University of Wisconsin, Madison.
Hazan, C., & Zeifman, D. (1999). Pair bonds as attachments: Evaluating the evidence. In J. cassidy & P. R. Shaver (eds.). Handbook of Attachment Theory and Research..
Hemstrom, O. (1996). Is marriage dissolution linked to differences in mortality risks for men and women? Journal of Marriage and the Family, 58(2), 366-378.
Herman, J. L. (1992). Trauma and recovery. New York: Basic Books.
Herring, M., & Kaslow, N. J. (2002). Depression and attachment in families: a child-focused perspective. Family Process, 41(3), 494-518.
Iqbal, A., Qureshi, A., & Siddiqui, K. S. (2001). The incidence of anxiety among spouses of breast cancer patients. International Journal of Psychosocial Rehabilitation, 6, 13-20.
Johnson, S. M. (1996). The practice of emotionally focused marital therapy: Creating connection. New York: Brunner-Mazel.
Johnson, S. M. (2004).. Attachment theory: a guide for healing couple relationships. In J. Simpson & S. Rholes (Eds.), Adult attachment: new directions and emerging issues. New york: Guilford press.
Johnson, S, M., & Lebow, J. (2000). The coming of age of couples therapy: A decade review. Jornal of Marital and Family therapy, 26, 23-38.
Johnson, S, M., Makinen, J. A., & Millikin, J. W. (2001). Attachment injuries in couple relationships: A new perspective on impasses in couples therapy. Journal of Marital and Family Therapy, 27(2), 145-155.
Kachadourian, L. K., Fincham, F., & Davila, J. (2004). The tendency to forgive in dating and married couples: The role of attachment and relationship satisfaction. Personal Relationships, 11, 373-393.
Lutjen, L. J., Silton N. R., & Flannelly, K. J. (2012). Religion, Forgiveness, Hostility and Health: A Structural Equation Analysis. Journal of Religion and Health, 51, 468-478.
Macaskill, A. (2012). Differentiating Dispositional Self-Forgiveness from other-forgiveness: Associations with mental health and life satisfaction. Journal of Social and Clinical Psychology, 31(1), 28-50.
Makinen, J. A. & Johnson, S. M. (2006). Resolving attachment injuries in couples using emotionally focused therapy: steps toward forgiveness and reconciliation. Journal of Counseling and Clinical Psychology, 74(6), 1055-1064.
Malcolm, W. M., Warwar, S., & Greenberg, L. (2005). Facilitating forgiveness in individual therapy as an approach to resolving interpersonal injuries. In E. L. Worthington, Jr. (Ed.), Handbook of forgiveness (pp.379-392). New york: Brunner-Routledge.
Manne S, & Badr H. (2008). Intimacy and relationship processes in couples’ psychosocial adaptation to cancer. Cancer, 112, 2541-2555.
Meneses, C. W. & Greenberg, L. S. (2011). The construction of a model of the process of couples' forgiveness in emotion-focused therapy for couples. Journal of Marital and Family therapy, 37(4), 491-502.
Meneses, C. W., & Greenberg, L. (2014). Interpersonal forgiveness in Emotion focused couples' therapy: relating process to outcome. Journal of Marital and Family Therapy, 40(1), 49-67.
Millikin, J. A. (2000). Resolving attachment injuries in couples using emotionally focused therapy: A process study. Unbublished doctoral dissertation. Virginia Polytechnique Institute and State University, Virginia.
Naaman, S., Pappas, J. D., Makinen, J., Zuccarini, D., & Johnson-Douglas, S. (2005). Treating attachment injured couples with emotionally focused therapy: A case study approach. Psychiatry, 68(1), 55-77.
Orcutt, H. K., Pickett, S. M., & Pope, E. B. (2005). Experiential avoidance and forgiveness as mediators in the relation between traumatic interpersonal events and posttraumatic stress disorder symptoms. Journal of Social and Clinical Psychology, 24(7), 1003-1029.
Reed, G. L., & Enright, R. D. (2006). The effects of forgiveness therapy on depression, anxiety, and posttraumatic stress for women after spousal emotional abuse. Journal of Consulting and Clinical Psychology, 74(5), 920-920.
Rodrigue, J. R., & Hoffman, R.. G, (1994). Caregivers of adults with cancer: Multidimensional correlates of psychological distress. Journal of Clinical Psychology in Medical Settings, 1, 231-244.
Sandra, N. Pappas, J. D., Judy, M., Dino, Z. & Johnson, S. (2005). Treating attachment injured couples with emotionally focused therapy: A case study approach. Psychiatry, 68(1), 55-77.
Schore, A. (1994). Affect regulation and the organization of self. Hillside, NJ: Erlbaum.
Sheri, P. (2002). Breaking the cycle: A clinical example of disrupting an insecure attachment system. Journal of Mental Health Counseling, 24(4), 358-366.
Shields, C. G., & Rousseau, S. J. (2004). A pilot study of an intervention for breast cancer survivors and their spouses. Family Process, 43, 95-107.
Solomon, Z., Dekel, R., & Zerach, G. (2008). The relationships between posttraumatic stress symptom clusters and marital intimacy among war veterans. Journal of Family Psychology, 22(5), 659-666.
Solomon, Z., Dekel, R., & Zerach, G. (2009). Posttraumatic stress disorder and marital adjustment: the mediating role of forgiveness. Family Process, 48(4), 546-558.
Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38(1), 15-38.
Tsang, J., Mccullough, M. E., & Fincham, F. D. (2006). The longitudinal association between forgiveness and relationship closeness and commitment. Journal of social and Clinical Psychology, 25(4), 448-472.
van der Kolk, B. A., & McFarlane, A. C. (1996). The black hole of trauma. In B. A. van der Kolk, A. C. McFarlane, & L. Weisaeth (Eds.), Traumatic stress: The effects of overwhelming experience on mind, body, and society (pp. 3-23). New York: Guilford.
Weihls K., Enright T., Howe G., Simmens, S. J. (1999). Marital satisfaction and emotional adjustment after breast cancer. Journal of Psychosocial Oncology, 17, 33-49.
Whisman, M. A. & Wagers, T. P. (2005). Assessing relationship betrayals. Journal of Clinical Psychology: In Session, 61, 1383-1391.
Witvliet, C. V. O., Phipps, K. A., Feldman, M. E., & Beckham, J. C. (2004). Posttraumatic mental and physical health correlates of forgiveness and religious coping in military veterans. Journal of Traumatic Stress, 17, 269-273.
Worthington, E. L. Jr., Witvliet, C. V. O., Pietrini, P., & Miller, A. J. (2007). Forgiveness and health. Journal of Behavioral Medicine, 30, 291-300.
Zimmermann, T., Scott, J., & Heinrichs, N. (2010). Individual and dyadic predictors of body Image in women with breast cancer. Psychological Oncology, 19(10), 1061-1068.
- Downloaded
- Viewed
- 0KCI Citations
- 0WOS Citations