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Psychooncology. 2018 Mar;27(3):983-989. doi: 10.1002/pon.4620. Epub 2018 Jan 15.

The role of cognitive bias in relation to persistent distress among women diagnosed with breast cancer.

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Centre for Psycho-Oncology Research and Training, School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong.
Laboratory of Neuropsychology, The University of Hong Kong, Pokfulam, Hong Kong.
Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong.



To examine if bias in attention to and interpretation of cancer-related stimuli differentiates women with persistent psychological distress from those with low/transient distress following breast cancer.


One-hundred forty women classified in a prior longitudinal study as having low (n = 73) or persistent high (n = 67) distress completed 2 modified dot-probe tasks assessing attention bias and an ambiguous cues task assessing interpretation bias toward cancer-related vs neutral information. Psychological distress was assessed using the Hospital Anxiety Depression Scale. Four-way repeated analysis of variance was adopted.


Participants with persistent high distress from the original study who continued to report high Hospital Anxiety Depression Scale scores (≥8) on recruitment into the present study comprised the persistent distress group (ie, 31 reporting high anxiety and 30 reporting high depression scores). Persistent distress and low distress groups did not differ in attentional bias toward negative-stimuli or cancer-related information, but a significant time-course effect in attentional bias toward negative-stimuli or cancer-related information was observed, with women in the persistent distress group showing a significant bias away from negative-stimuli or cancer-related information under supraliminal conditions. There was a borderline difference in interpretation bias scores between low anxiety and chronic anxiety groups (P = .065), with correlation suggesting a significant positive association (r = 0.20, P = .019).


Women with persistent distress may adopt avoidance strategies to cope with breast cancer. Moreover, women reporting persistent anxiety may have a tendency to negatively interpret ambiguous information, leading to illness preoccupation. These findings offer critical insight for clinicians to develop tailored interventions to help women with persistent psychological distress.


attention bias; breast cancer; chronic distress; cogntivie bias; interpretation bias

[Indexed for MEDLINE]

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