"Why me?" - women's use of spiritual causal attributions in making sense of breast cancer

Objective: This study addressed the role of positive (event is due to God's Love or to God's Will) and negative (event is due to God's Anger) spiritual causal attributions in women's adjustment to breast cancer.Design: Ninety-three women diagnosed with breast cancer were assessed at six times from pre-diagnosis through twoyears post-surgery.Main outcome measures: Women completed positive and negative measures of spiritual causal attributions (e.g. God's Love), cognitive appraisals (e.g. threat), coping behaviour (e.g. avoidance) and well-being (e.g. distress).Results: Positive spiritual attributions were consistently related to positive aspects of adjustment (e.g. positive appraisal, acceptance coping, and/or emotional well-being) while negative spiritual attribution was related to negative factors (e.g. appraisals of loss and uncontrollability, avoidance coping, and/or emotional distress). Path analyses revealed that the effects of positive and negative spiritual attributions on well-being were mediated by general cognitive appraisal and coping behaviour. Cross-lagged correlational analysis revealed a downward spiral' effect wherein the negative attribution of God's Anger at pre-diagnosis predicted greater distress at 1week pre-surgery which in turn predicted an increase in the negative attribution and so on across time.Conclusion: Although positive spiritual attributions may help women maintain an attitude of hope and acceptance in the face of cancer, results indicate that the effects of negative spiritual attribution can play a significant role in undermining their well-being.