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Cited by 41Cancer survivorship and careMindfulness and Compassion InterventionsWomen's cancer prevention and management

Chronic illness-related cognitive fusion explains the impact of body dissatisfaction and shame on depression symptoms in breast cancer patients

Open access
Trindade, Inês A., Marta‐Simões, Joana, Ferreira, Cláudia, Pinto‐Gouveia, José·2018·Clinical Psychology & Psychotherapy
DOI 10.1002/cpp.2323
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Abstract

Breast cancer is linked to psychological distress and mood disorders that are in turn associated with higher psychological dysfunction and decreased breast cancer survival. It is considered that psychological health in breast cancer is considerably affected by body image impairment, which in turn seems to be highly associated with shame. However, the impact of these variables on mental health may not be direct. The current study aimed to explore a comprehensive model regarding the role of chronic illness‐related cognitive fusion in the relationship of body image dissatisfaction and chronic illness‐related shame with depression symptoms. The sample was composed of 75 women with nonmetastatic breast cancer, recruited in a Radiotherapy Service in central Portugal. The conducted path model presented an excellent fit and accounted for 59% of the variance of depressive symptomatology. Further, it demonstrated that body image dissatisfaction's impact on depressed mood is significantly explained by the mechanisms of chronic illness‐related shame and chronic illness‐related cognitive fusion. It was also revealed that chronic illness‐related cognitive fusion additionally mediated the impact of chronic illness‐related shame on depression. These findings are suggestive of the importance of body image and chronic illness shame in the determination of breast cancer patients' depression symptoms and also the central role of chronic illness‐related cognitive fusion in these relationships. Therefore, the implementation of acceptance and defusion‐based psychotherapeutic interventions to improve mental health in cancer patients seems to be of great importance.

Verified 2026-10-09 · 1 reference not checked yet

AI snapshot

Written from the paper’s full text.

TL;DR

In 75 women with nonmetastatic breast cancer, chronic illness-related cognitive fusion mediated the relationships of body image dissatisfaction and chronic illness-related shame with depression symptoms. The final path model explained 59% of the variance in depressive symptomatology.

Key findings

  • The final path model had excellent fit: χ²(3)=0.97, p=0.808; CFI=1.00, TLI=1.00, GFI=1.00, RMSEA=0.00. It accounted for 33% of the variance in chronic illness-related shame, 41% in chronic illness-related cognitive fusion, and 59% in depression symptoms.
  • Body image dissatisfaction directly predicted chronic illness-related shame (β=0.53); shame directly predicted cognitive fusion (β=0.64) and depression (β=0.37); cognitive fusion directly predicted depression (β=0.43).
  • Body image dissatisfaction’s effect on depression was fully mediated by shame and cognitive fusion (indirect effect=0.34, 95% CI [0.21, 0.47], p<0.001; total effect=0.49). Shame’s effect on depression was partially mediated by cognitive fusion (indirect effect=0.27, 95% CI [0.10, 0.44], p<0.01; total effect=0.79).
  • Body image dissatisfaction also had an indirect effect on cognitive fusion via shame (0.34, 95% CI [0.22, 0.46], p<0.001; total effect=0.48).

Methods

  • Cross-sectional study of 75 women with nonmetastatic breast cancer, ages 36–85 years (M=57.60, SD=10.18), recruited from the Radiotherapy Service of Coimbra University Hospital, Portugal, over 10 months. Eligibility excluded psychotic or manic symptoms, suicide risk, communication or cognitive problems, and formal psychological therapy.
  • Measures included the Cognitive Fusion Questionnaire–Chronic Illness (CFQ-CI), Body Image Scale (BIS), Chronic Illness-related Shame Scale (CISS), and the depression subscale of the Depression Anxiety Stress Scales (DASS-21).
  • Analyses used Pearson correlations in SPSS v22 and path analysis in Amos with maximum likelihood estimation, controlling for age, with bootstrap procedures (5,000 samples) for 95% bias-corrected confidence intervals; non-significant paths were progressively removed.

Limitations

  • The paper states that the cross-sectional design precludes causation, the small sample size may limit generalization, and the tested model may be circular because body image difficulties can be influenced by depression symptoms and shame/cognitive fusion can also affect body image dissatisfaction.
  • The paper also states that other emotion regulation processes (e.g., experiential avoidance, uncommitted action) were not explored, and depression was assessed by self-report rather than clinical interview.
  • Evident from the text: the sample came from a single radiotherapy service and had a specific treatment profile (majority stage IA or IIA; 4% had undergone mastectomy; 64% had finished radiotherapy and were on hormonal therapy), which may further limit generalizability.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1002/cpp.2323

Cites

53 of 54 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

0 of 37 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Chronic illness-related shame was correlated with chronic illness-related cognitive fusion (r = -0.64).

    “Chronic illness-related shame was also positively and strongly correlated with chronic illness-related cognitive fusion (r = -0.64;p < 0.001)”
    Quote in the paperSubstantial claim
  • Findingown data

    The final path model accounted for 41% of the variance of chronic illness-related cognitive fusion.

    “The model accounted for 33% of the variance of chronic illness-related shame, 41% of the variance of chronic illness-related cognitive fusion, and 59% of the variance of depression symptoms.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The final path model accounted for 33% of the variance of chronic illness-related shame.

    “The model accounted for 33% of the variance of chronic illness-related shame, 41% of the variance of chronic illness-related cognitive fusion, and 59% of the variance of depression symptoms.”
    Quote in the paperNot a substantial claim
  • Findingown data

    The final path model accounted for 59% of the variance of depression symptoms.

    “The model accounted for 33% of the variance of chronic illness-related shame, 41% of the variance of chronic illness-related cognitive fusion, and 59% of the variance of depression symptoms.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Body image dissatisfaction was significantly linked with chronic illness-related cognitive fusion (r = 0.32).

    “chronic illness-related cognitive fusion (CFQ-CI; r = 0.32; p < 0.001)”
    Quote in the paperSubstantial claim
  • May combine two claims. 12
  • Classified as probably not a substantial claim. 30
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    The final path model had an excellent fit to the empirical data, with a non-significant chi-square and CFI, TLI, GFI, and RMSEA values indicating good fit.

    “The final model (Figure 1) presented an excellent adjustment to the empirical data, with a non-significant chi-square of χ2(3) = 0.97, p = 0.808, the following goodness-of-fit indices: CFI = 1.00;TLI = 1.00;GFI = 1.00;RMSEA = 0.00 (95% CI [0.00, 0.12]; p = 0.847).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Age had a significant positive correlation with depressive symptomatology (r = 0.32).

    “Results from the conducted correlation analyses (Table 2) revealed that age was not associated with body image dissatisfaction (BIS), presenting only a significant and positive correlation with depressive symptomatology (DASS-21; r = 0.32; p < 0.010).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Age was not associated with body image dissatisfaction.

    “Results from the conducted correlation analyses (Table 2) revealed that age was not associated with body image dissatisfaction (BIS), presenting only a significant and positive correlation with depressive symptomatology (DASS-21; r = 0.32; p < 0.010).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Chronic illness-related cognitive fusion influences depression symptoms and partially mediates the effects of body dissatisfaction and chronic illness-related shame on depression symptoms in breast cancer patients.

    “Chronic illness-related cognitive fusion seemed to influence depression symptoms and partially mediated the effects of body dissatisfaction and chronic illnessrelated shame on this outcome.”
    • Also stated in: § Discussion · plain
      “Findings highlight the influence of body image dissatisfaction and chronic illness-related shame in breast cancer patients' depression symptoms and the central role of chronic illness-related cognitive fusion in these relationships.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingown data

    The effect of body image dissatisfaction on depression symptoms was fully mediated by chronic illness shame and cognitive fusion.

    “the finding that the effect of body image dissatisfaction on depression symptoms was totally mediated by chronic illness shame and cognitive fusion”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Body image dissatisfaction has no direct effect on chronic illness-related cognitive fusion; its effect is indirect and fully mediated by chronic illness-related shame.

    “Body image dissatisfaction did not present a direct effect on chronic illness-related cognitive fusion but rather an indirect effect totally mediated by chronic illness-related shame.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Chronic illness-related cognitive fusion is a mediator of the impact of both body image dissatisfaction and chronic illness-related shame on depression symptoms.

    “These results thus show that chronic illness-related cognitive fusion seems to be a mediator of the impact of both body image dissatisfaction and chronic illness-related shame on depression symptoms.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The relationships among body image dissatisfaction, chronic illness-related shame, chronic illness-related cognitive fusion, and depression symptoms are directional/causal as specified in the path model.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The path model controlled for the effect of age.

    “A path analysis tested a theoretical model that examined whether chronic illness-related cognitive fusion (endogenous variable) would mediate the impact of body image dissatisfaction (independent, exogenous variable) and chronic illness-related shame on depressive symptomatology (endogenous variables), while controlling for the effect of age”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The assumption of normality was confirmed through visual inspection of the distributions.

    “The assumption of normality was confirmed through the visual inspection of the distributions (Kline, 2005).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Kline, 2005

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    Psychological health in breast cancer is considerably affected by body image difficulties, which are exacerbated after diagnosis and further treatments.

    “It is considered that psychological health in breast cancer is considerably affected by body image difficulties, which are exacerbated after diagnosis and further treatments (Chua, DeSantis, Teo, & Fingeret, 2015).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Chua, DeSantis, Teo, & Fingeret, 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Shame specifically associated with chronic illness was found to be linked to depression symptoms in inflammatory bowel disease patients.

    “This specific dimension of shame was found to be linked to depression symptoms in inflammatory bowel disease patients (Trindade, Ferreira, & Pinto-Gouveia, 2017b).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Trindade, Ferreira, & Pinto-Gouveia, 2017b

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Chronic illness-related shame has been suggested as a predictor of psychosocial functioning in a mixed sample of chronic patients and in a sample of inflammatory bowel disease patients.

    “This construct has also been suggested as a predictor of psychosocial functioning in a mixed sample of chronic patients (Trindade, Duarte, Ferreira, Coutinho, & Pinto-Gouveia, 2018) and in a sample of inflammatory bowel disease patients (Trindade, Ferreira, & Pinto-Gouveia, 2017c).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Trindade, Duarte, Ferreira, Coutinho, & Pinto-Gouveia, 2018

      Not checked in the free run.

    • cites Trindade, Ferreira, & Pinto-Gouveia, 2017c

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a prospective study with breast cancer patients, body image dissatisfaction predicted lower levels of psychosocial adjustment (quality of life and emotional distress).

    “In a prospective study with breast cancer patients (Moreira & Canavarro, 2010), body image dissatisfaction predicted lower levels of psychosocial adjustment (quality of life and emotional distress).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moreira & Canavarro, 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Literature has widely covered the link between shame and body image difficulties in both community and clinical samples.

    “Literature has in fact widely covered the link between this painful emotion and body image difficulties in both community and clinical samples (e.g., Ferreira, Pinto-Gouveia, & Duarte, 2013;Gee & Troop, 2003).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Ferreira, Pinto-Gouveia, & Duarte, 2013

      Not checked in the free run.

    • cites Gee & Troop, 2003

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Within an evolutionary perspective, shame is considered a response that, by signalling the possibility of a loss of attractiveness and social rejection, enables the recognition and adjustment of personal aspects or attitudes.

    “Within an evolutionary perspective, shame is considered a response that, by signalling the possibility of a loss of attractiveness and social rejection, enables the recognition and adjustment of personal aspects or attitudes (Gilbert & Procter, 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gilbert & Procter, 2006

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Physical appearance may be a source of shame because it may lead to the perception that one is failing to reach desirable sociocultural standards.

    “Given that it may lead to the perception that one is failing to reach desirable sociocultural standards, physical appearance may thus be a source of shame (Duarte, Pinto-Gouveia, Ferreira, & Batista, 2015;Fingeret, 2010).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Duarte, Pinto-Gouveia, Ferreira, & Batista, 2015

      Not checked in the free run.

    • cites Fingeret, 2010

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The experience of shame is frequently associated with nonadaptive defensive responses that increase vulnerability to several mental health problems.

    “This experience is frequently associated with nonadaptive defensive responses (such as avoidance, isolation, and submission) which increase the vulnerability to several mental health problems (e.g., Gilbert & Procter, 2006).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gilbert & Procter, 2006

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Cognitive fusion seems to be a strong predictor of decreased quality of life in cancer patients.

    “Further, cognitive fusion seems to be a strong predictor of decreased quality of life in cancer patients (Gillanders, Sinclair, MacLean, & Jardine, 2015).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gillanders, Sinclair, MacLean, & Jardine, 2015

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Prospective studies with inflammatory bowel disease samples have revealed the impact of cognitive fusion on depression symptoms and on the evolution of reported psychological and physical health over 18 months.

    “Prospective studies with inflammatory bowel disease samples have revealed the impact of cognitive fusion on depression symptoms (Trindade, Ferreira, & Pinto-Gouveia, 2017a) and on the evolution of reported psychological and physical health over a course of 18 months (Trindade, Ferreira, & Pinto-Gouveia, 2018b).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Trindade, Ferreira, & Pinto-Gouveia, 2017a

      Not checked in the free run.

    • cites Trindade, Ferreira, & Pinto-Gouveia, 2018b

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Premisecitation

    A recent study showed that the effect of chronic illness-related shame on psychological health seems to be partially mediated by chronic illness-related cognitive fusion.

    “A recent study showed that the effect of this dimension of shame on psychological health seems to be partially mediated by the mechanisms of chronic illnessrelated cognitive fusion (Trindade, Ferreira, & Pinto-Gouveia, 2018a).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Trindade, Ferreira, & Pinto-Gouveia, 2018a

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Increased rumination and avoidance behaviours may subsequently lead to isolation, decreased quality of interpersonal relationships, reduced investment in pleasurable activities, decreased self-care, and higher levels of depression symptomatology.

    “which may subsequently lead to isolation, decreased quality of interpersonal relationships, reduced investment in pleasurable activities, decreased self-care, and thus, higher levels of depression symptomatology.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    This is the first study to examine the relationship between chronic illness-related cognitive fusion and body image.

    “This is the first study to examine the relationship between chronic illness-related cognitive fusion and body image.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

    Premisereasoning

    When one is fused, behaviour becomes overly regulated by cognitions, leading to an increasingly narrower range of action.

    “When one is fused, behaviour becomes overly regulated by cognitions, leading to an increasingly narrower range of action.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The cross-sectional nature of the study means the conducted analyses do not imply causation.

    “The cross-sectional nature of the study may be the main limitation of the studythe conducted analyses do not imply causation”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    Cognitive fusion, when over-extended, leads to the establishment of a relationship with one's perceptions and thoughts as if they were literally true rather than seeing them as subjective interpretations of reality.

    “Cognitive fusion, when over-extended, leads to the establishment of a relationship with one's perceptions and thoughts as they were literally true rather than seeing them as subjective interpretations of reality (Luoma & Hayes, 2003).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Luoma & Hayes, 2003

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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A study in a mixed sample of cancer patients found a link between cognitive fusion and decreased quality of life, although the measure of cognitive fusion regarded general cognitions.

    “A study by Gillanders et al. (2015) in a mixed sample of cancer patients also presented a link between cognitive fusion and decreased quality of life, although the measure of cognitive fusion regarded general cognitions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Gillanders et al. (2015)

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The self-report nature of the measure used to assess depression symptoms did not allow the evaluation of clinical depression per se.

    “the self-report nature of the measure used to assess depression symptoms did not allow the evaluation of clinical depression per se”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The tested model may be circular.

    “It should also be acknowledged that the tested model may be circular.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study's small sample size may not allow generalization of the results.

    “Because this study's small sample size may not allow the generalization of results”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Depression Anxiety Stress Scales-21 has presented good internal consistencies for the depression subscale in the original (alpha = 0.88) and Portuguese (alpha = 0.85) validation studies.

    “The DASS-21 has presented good internal consistencies for the depression subscale in the original (αDEP = 0.88) and Portuguese (αDEP = 0.85) validation studies.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Lovibond & Lovibond, 1995

      Not checked in the free run.

    • cites Pais-Ribeiro, Honrado, & Leal, 2004

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Chronic Illness-related Shame Scale has revealed very good psychometric properties, with Cronbach's alphas between 0.91 and 0.93, in its original Portuguese study.

    “The CISS has revealed very good psychometric properties (with Cronbach's αs between 0.91 and 0.93) in its original Portuguese study.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Trindade et al., 2017b

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Body Image Scale is a 10-item self-report instrument that has been widely validated and used in cancer patients to measure affective, behavioural and cognitive dimensions of body image.

    “The BIS is a 10-item self-report instrument that has been widely validated and used in cancer patients to measure three dimensions of body image: the affective (e.g., feeling self-conscious of the body), behavioural (e.g., difficulty at looking at the naked body), and cognitive (e.g., dissatisfaction with appearance) dimensions.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hopwood, Fletcher, Lee, & Al Ghazal, 2001

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The Cognitive Fusion Questionnaire-Chronic Illness presented excellent psychometric properties in its original Portuguese study, with Cronbach's alphas between 0.95 (breast cancer sample) and 0.97 (healthy sample).

    “In its original, Portuguese study, this scale presented excellent psychometric properties with Cronbach's αs between 0.95 (breast cancer sample) and 0.97 (healthy sample).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Trindade, Duarte, et al., 2018

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All procedures performed in this study were in accordance with the 1964 Helsinki declaration and its later amendments, and the Ethics Committees of the involved institutions approved the study.

    “All procedures performed in this study were in accordance with the 1964 Helsinki declaration and its later amendments.The Ethics Committees of the involved institutions approved the study (CHUC [CES/152] and FPCE-UC [CEDI 3/11/2016]).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Body Image Scale presented good psychometric properties in its original (alpha = 0.93) and Portuguese (alpha = 0.93) versions.

    “The scale presented good psychometric properties in its original (α = 0.93) and Portuguese versions (α = 0.93).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Hopwood, Fletcher, Lee, & Al Ghazal, 2001

      Not checked in the free run.

    • cites Moreira, Silva, Marques, & Canavarro, 2010

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    General cognitive fusion impacts psychopathology across different populations.

    “Several studies on general cognitive fusion's impact on psychopathology, in different populations, are also corroborated (e.g., Bardeen & Fergus, 2016;Dinis et al., 2015;Gillanders et al., 2014;Trindade et al., 2017a;Trindade, Ferreira, & Pinto-Gouveia, 2018b).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Bardeen & Fergus, 2016

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    • cites Dinis et al., 2015

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    • cites Gillanders et al., 2014

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36 of 36

  • The paper relies on this without support.

    There is no existing data on the relationship between shame specifically related to chronic illness and mental health in breast cancer patients.

    “Nevertheless, there is no existing data on the relationship between shame specifically related to chronic illness and mental health in breast cancer patients.”

  • The paper relies on this without support.

    The relationships among body image dissatisfaction, chronic illness-related shame, chronic illness-related cognitive fusion, and depression symptoms are directional/causal as specified in the path model.

    “A path analysis tested a theoretical model that examined whether chronic illness-related cognitive fusion (endogenous variable) would mediate the impact of body image dissatisfaction (independent, exogenous variable) and chronic illness-related shame on depressive symptomatology (endogenous variables), while controlling for the effect of age”
2 of 2

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In other medical populations, cognitive fusion (and not illness-related symptoms) was related to levels of depression.

    “In other medical populations, cognitive fusion (and not illness-related symptoms) was related to levels of depression (Carvalho et al., 2019; Trindade et al., 2018).”

    From Acceptance and commitment therapy for individuals with depressive and anxiety symptoms following acquired brain injury: A non-concurrent multiple baseline design across four cases. (2023) · cites this paper as Trindade et al., 2018

    In the results section on depressed mood (page unavailable), chronic illness-related cognitive fusion directly predicted depression symptoms in breast cancer patients. The paper does not establish the contrasting claim that illness-related symptoms were not related to depression; its model examined body dissatisfaction and illness-related shame rather than comparing fusion with physical illness symptoms. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Determinants related to depression include low self-esteem and shame.

    “Determinants related to this condition include low self-esteem and shame, among other factors [269,270,275,278].”

    From Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature (2021) · cites this paper as [270]

  • A wide range of factors have been linked to depression, such as (low) optimism levels, maladaptive coping (such as avoidance), body image issues, and maladaptive perfectionism.

    “A wide range of factors have been linked to depression, such as the aforementioned determinants, but also: (low) optimism levels, maladaptive coping (such as avoidance), body image issues, and maladaptive perfectionism, among others [269,270,272,273,275,276,279,285,286].”

    From Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature (2021) · cites this paper as [270]

Statistics recomputed

Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.

  • Consistentχ²(3) = 0.97reported p = .808 · recomputed p = .809

    “χ2(3) = 0.97, p = .808”

1 of 1

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

  • Total effect of shame on depression does not equal its reported effects

    Major

    The reported direct effect is 0.37 and the indirect effect is 0.27, giving a total of 0.64 rather than 0.79.

    Reported 0.79 · recomputed 0.64

1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. Arbuckle J. L., 2013, Amos 22.0 User's Guide
  2. IBM Corp, 2013, IBM SPSS Statistics for Windows, Version 22.0.
  3. Kline R. B., 2005, Principle and practice of structural equation modeling
  4. Luoma J. B., 2003, Empirically supported techniques of cognitive behavioral therapy: A step‐by‐step guide for clinicians, 71
  5. Pais‐Ribeiro J. L., 2004, Contribuição Para O Estudo Da Adaptação Portuguesa Das Escalas De Ansiedade, Depressão E Stress (EADS) De 21 Itens De Lovibond E Lovibond [Contribution for the study of the Portuguese adaptation of Lovibond and Lovibond's Depression Anxiety Stress Scales (DASS)], Psicologia, Saúde & Doenças, 5, 229
  6. 10.1037/0278-6133.22.6.632 · DOI
  7. Stewart B. W., 2014, World cancer report 2014, World Health Organization, 1

Cited by

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Related

Authors
Trindade, I. A., Marta‐Simões, J., Ferreira, C., & Pinto‐Gouveia, J.
Affiliations
University of Coimbra (PT)
Corresponding author
Trindade, Inês A.
ORCID
Venue
Clinical Psychology & Psychotherapy
Publisher
Wiley
Published
2018-09-12
Volume
25
Issue
6
Pages
886-893
ISSN
  • 1063-3995 (ISSN-L)
  • 1099-0879
DOI
10.1002/cpp.2323
OpenAlex
W2889637815
Semantic Scholar
62edd9d92a8a129f16c46a56fb102620e74bcb2e
Cited by
41
References
54
Citations by year
2026: 7 · 2025: 5 · 2024: 4 · 2023: 6 · 2022: 9 · 2021: 2 · 2020: 5 · 2019: 3
FWCI
0.94
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Psychology & Psychotherapy (publishedVersion)
  • PubMed (publishedVersion)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
  • Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion)
Funders
Fundação para a Ciência e a Tecnologia (SFRH/BD/101906/2014)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Keywords
breast cancer, body dissatisfaction, depressive symptoms, acceptance and commitment therapy, defusion, psychological distress in cancer patients, mediation model
MeSH terms
Adult, Aged, Aged, 80 and over, Body Image, Breast Neoplasms, Chronic Disease, Cognition, Depressive Disorder, Female, Humans, Middle Aged, Personal Satisfaction, Shame

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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