Prediction of Psychological Helplessness and Fault Tolerance Based on Emotional Alexithymia in Women with Breast Cancer

Cancer is a chronic disease that has been increasingly considered by researchers, and breast cancer is one of the most common cancer types in the world, accounting for 50% of deaths. In Iran, breast cancer (22 per 100,000) is the most common cancer among women. In addition, breast cancer affects Iranian women about a decade earlier than in western countries. Cancer-related crisis causes imbalance and disharmony in the thoughts, body, and soul, but the most common condition for the patient is alexithymia during this period. Emotions are a set of schemas based on information processing and include symbolic and non-symbolic processes and visualizations. One of the most important factors to consider in patients with breast cancer is psychological helplessness. Various studies show that people with specific diseases have lower mental health. Many of them suffer from anxiety, anger, sadness, social isolation, and depression, which together cause the person to become psychologically helpless. Another psychological variable that is associated with or can affect cancer is fault tolerance. Failure occurs when a person fails to achieve the desired goal. Failure is generally understood as a state of inhibition in satisfying the motive or interference in goal response or in the mediating action that leads to that goal. Fault tolerance refers to a person's ability to show resilience in the face of repeated failure and a hostile environment. Failure to find local and foreign researches on women with breast cancer makes it necessary to research in this area and determine whether psychological helplessness and fault tolerance can be predicted based on alexithymia in women with breast cancer.

This cross-sectional predictive correlational study was performed on 230 women with breast cancer who were referred to the specialized surgery and cancer clinic of Dr. Mousavi Hospital in Gorgan and the comprehensive cancer center of Imam Khomeini Hospital in Sari in 2018. The instruments used to collect data included the demographic questionnaire, the Toronto Emotional Dysfunction Questionnaire, the Psychological Helplessness Questionnaire, and the Fault Tolerance Questionnaire. The data were then analyzed using Pearson correlation coefficient and stepwise regression in SPSS version 16. The confidence level was considered at P<0.01.

Regarding the alexithymia variable, 3.25% of the patients had difficulty identifying emotions and regarding the psychological helplessness variable, 7.78% of the patients had symptoms of high anxiety, and regarding fault intolerance variable, 6.17% of the patients had symptoms of intolerance of injustice. There was a direct relationship between the variables of alexithymia and the subscales of depression (P<0.003), anxiety (P<0.002), stress (P<0.001), and psychological helplessness (P<0.000). It can also be said that there was a direct relationship between alexithymia and subscales of intolerance of emotional failure (P<0.001), sadness intolerance (P<0.001), intolerance of failure (P<0.005), and intolerance of injustice (P<0.002). Alexithymia was also able to predict psychological helplessness (P<0.000), and fault tolerance (P<0.001).

The overall result of the study showed a significant direct correlation between alexithymia, psychological helplessness, and fault intolerance, in a way that an increase in alexithymia score increased depression, anxiety, and stress of women with breast cancer, and alexithymia was directly correlated with fault intolerance, meaning that with increasing alexithymia score in women with breast cancer, the ability to tolerate discomfort, injustice, and lack of progress decreased in these women. According to these results, it is necessary to teach emotion regulation strategies along with using other treatment methods to reduce stress, depression, and anxiety and increase resilience and fault tolerance of women with breast cancer.