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Experiences of the war metaphor as a method of emotion regulation in women with metastatic breast cancer

Hulse, Sarah Belle (2023) Experiences of the war metaphor as a method of emotion regulation in women with metastatic breast cancer. Undergraduate Thesis, University of Pittsburgh. (Unpublished)

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Background: In the study of cancer care, emotional distress has been referred to as the “sixth vital sign” (Bultz & Carlson, 2005) with a variety of emotion regulation strategies employed to assist patients in navigating their illness experience. The war metaphor is one strategy used frequently in breast cancer to inspire individuals in a “fight” against cancer. Despite prominent use, the impact of this language for emotion regulation has not been examined in an academic setting nor with consideration toward patients with metastatic breast cancer (MBC) and requires further study.
Methods: This study involved a semi-structured interview considering the war metaphor’s impact on women’s illness experience with MBC. Participants had been diagnosed with MBC for at least 6 months or following 1 disease progression and were undergoing treatment at an NCI designated cancer center in Western Pennsylvania at the time of interview. Each participant underwent an individual interview exploring the war metaphor’s impact on illness experience. Qualitative thematic analysis was performed to assess emotional response to the lived experience of cancer, emotion regulation strategies indicated, and feelings about the war metaphor.
Results: Five themes were identified in participants’ (n=22) interviews. First, women with MBC perceive the diagnosis as an “unfair fight” due to its incurable nature. Second, the “fighting spirit” established by the war metaphor encourages emotional suppression and is a barrier to acceptance of metastatic disease. Third, many women use negative reappraisals to cope with the lived experience of MBC. Fourth, women with MBC express a perceived need to “be strong” in the face of their disease, encouraging emotional suppression. Fifth, patients describe themselves as “living life” and are resistant to being defined by their cancer diagnosis.
Conclusions: Faced with the chronic implications of MBC, use of the war metaphor in this patient population may promote negative emotional experiences. For some, the war metaphor applies pressure to prioritize positivity in the face of diagnosis and treatment, in a unique clinical context where this may not be adaptive. These findings affirm a need to consider patients’ language preferences to best facilitate coping and psychological adjustment to illness.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Hulse, Sarah Bellesah219@pitt.edusah219
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorMarsland, Annamarsland@pitt.edumarsland
Committee MemberRosenzweig, Margaretmros@pitt.edumros
Committee MemberForest, Amandaforest@pitt.eduforest
Committee MemberLeBlanc,
Date: 24 April 2023
Date Type: Publication
Defense Date: 27 March 2023
Approval Date: 24 April 2023
Submission Date: 18 April 2023
Access Restriction: 2 year -- Restrict access to University of Pittsburgh for a period of 2 years.
Number of Pages: 56
Institution: University of Pittsburgh
Schools and Programs: David C. Frederick Honors College
Dietrich School of Arts and Sciences > Psychology
Degree: BPhil - Bachelor of Philosophy
Thesis Type: Undergraduate Thesis
Refereed: Yes
Uncontrolled Keywords: Metastatic breast cancer, war metaphor, emotion regulation, meaning making, narrative medicine
Date Deposited: 24 Apr 2023 17:27
Last Modified: 24 Apr 2023 17:27


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