Mediators of an Internet-based psychosocial intervention for women with breast cancer.

OBJECTIVE: Many interventions have been designed to promote psychological adjustment in cancer survivors; however, notably few studies have specified the mediating processes through which these interventions work. The primary aim of this research is to examine theoretically and empirically grounded mediators of an Internet-based psychosocial intervention for women with breast cancer. METHOD: Women (N = 88) diagnosed with breast cancer were randomly assigned to participate in a 3-hr workshop for creation of personal websites or a waitlist control. Mediating variables and dependent variables were assessed at baseline, 1 month, and 6 months following workshop participation. Indirect effects were tested using single and multiple mediator models. RESULTS: Relative to control participants, women randomized to Project Connect Online (PCO) evidenced statistically significant benefit 6 months after the workshop on depressive symptoms, positive mood, and life appreciation, as well as on hypothesized mediators (i.e., coping self-confidence, loneliness, social support from friends, but not emotional processing and expression). Change over 6 months in coping self-confidence, loneliness, and social support from friends mediated the relationship between the intervention and improvement in depressive symptoms. Coping self-confidence mediated the relationship between PCO and enhanced positive mood, and social support from friends mediated the relationship between PCO and increased life appreciation. CONCLUSIONS: Findings indicate how PCO promoted adaptive change and highlighted modifiable factors, including coping self-confidence, loneliness, and social support from friends, which contributed to positive adjustment to breast cancer. Additional potential mediators and ways in which the intervention can be enhanced are addressed.