Title : Experiencing future-self disengagement in patients with gastrointestinal cancers: The role of intolerance of uncertainty, obsessive symptom monitoring, and perception of effort
Abstract:
Background and Objective: Gastrointestinal cancers present patients with high levels of uncertainty about physical symptoms, response to treatment, and the future of the disease. However, intolerance of uncertainty alone may not be sufficient to explain impaired future-imagining, and cognitive-physical processes may mediate this relationship. The present study tested a process model in which intolerance of uncertainty was associated with increased symptom hypermonitoring, and symptom hypermonitoring was associated with greater future-self disengagement, both directly and through increased perception of effort in daily activities.
Method: In this multicenter cross-sectional study, 346 adult patients with gastrointestinal cancers in hospitals in Tehran participated. Intolerance of uncertainty, symptom overmonitoring, perceived effort, and future self-disconnection were measured with standardized instruments or validated adapted versions. The proposed model was examined by structural equation modeling and indirect effects estimation. Age, sex, cancer stage, active treatment status, and total physical symptom burden were entered as control variables.
Findings: The structural model showed a good fit to the data (CFI = .958, TLI = .951, RMSEA = .045, 90% CI [.038, .052], SRMR = .041). Greater intolerance of uncertainty was significantly associated with greater symptom overmonitoring (β = .48, p < .001). Symptom hypermonitoring also predicted higher effort perceptions (β = .31, p < .001) and was directly related to greater future self-disengagement (β = .24, p < .001). Higher perceived effort was also associated with greater future self-disengagement (β = .27, p < .001). In contrast, the direct path from intolerance of uncertainty to effort perceptions was not significant after symptom hypermonitoring (β = .07, p = .18), and the direct effect of intolerance of uncertainty on future self-disengagement did not reach significance after controlling for mediators (β = .08, p = .14). The indirect chain effect of intolerance of uncertainty on future self-disconnection through symptom overmonitoring and perceived effort was significant (β = .04, 95% bootstrap CI [.02, .07]). In addition, the shorter indirect path from intolerance of uncertainty to future self-disconnection through symptom overmonitoring alone was also significant (β = .12, 95% CI [.07, .17]). Overall, the model explained approximately 31% of the variance in future self-disconnection.
Conclusion: The findings support a model in which the psychological impact of illness uncertainty is shaped not primarily by a direct path but rather by the patient's body-mind. Patients with lower tolerance for uncertainty may monitor their physical symptoms more; This hypermonitoring, even after controlling for actual symptom burden, is associated with greater experience of effort in daily activities and with difficulty imagining the future as an extension of the current self. The inconsistency in the direct paths from intolerance of uncertainty to perceived effort and future self-disconnection suggests that “inability to accept uncertainty” alone is probably insufficient to produce these outcomes, and that hypermonitoring of symptoms could be a key cognitive-physical link in the model. The persistence of a direct association between hypermonitoring of symptoms and future self-disconnection suggests that not all of the effect of this variable is explained by perceived effort and that other processes, such as threatening interpretation of symptoms, reduced sense of control, or altered body and future perceptions, are likely to play a role. This model could provide a basis for longitudinal research and interventions that target tolerance of uncertainty, regulation of attention to symptoms, and perceived cost of daily activities rather than focusing solely on anxiety and depression.
Keywords: Gastrointestinal cancer; Intolerance of uncertainty; Hypermonitoring of symptoms; Perception of effort; Dissociation from future self; Psycho-oncology
