A Structural Model of Posttraumatic Growth Based on Cognitive Appraisal with the Mediating Role of Intrusive and Deliberate Rumination in Cancer Patients

Background: Cancer is a potentially traumatic experience that can challenge patients’ core beliefs about life, health, and the future. Although cancer is often associated with psychological distress, some patients report positive psychological changes known as posttraumatic growth. Cognitive appraisal and post-event rumination may play important roles in explaining why some patients experience growth after cancer.

Methods: This applied descriptive-correlational study was conducted using structural equation modeling. The sample consisted of 202 cancer patients who referred to hospitals in Arak, Iran, in 2025 and were selected through convenience sampling. Data were collected using the Posttraumatic Growth Inventory, the Cognitive Appraisal Scale, and the Event-Related Rumination Inventory. Data were analyzed using descriptive statistics, Pearson correlation coefficients, and structural equation modeling in R software.

Results: The proposed structural model showed acceptable fit to the data, χ²/df = 1.257, RMSEA = .036, CFI = .984, NFI = .930, TLI = .978, IFI = .985, GFI = .943, and AGFI = .902. Threat appraisal had a negative direct effect on posttraumatic growth, β = -.22, p = .01, whereas challenge appraisal, β = .12, p = .03, and resource appraisal, β = .18, p = .01, had positive direct effects. Intrusive and deliberate rumination significantly mediated the relationship between cognitive appraisal and posttraumatic growth.

Conclusion: Cognitive appraisal significantly predicted posttraumatic growth in cancer patients both directly and indirectly through intrusive and deliberate rumination. Reducing threat appraisal and facilitating challenge/resource appraisals and deliberate rumination may help promote posttraumatic growth in cancer patients.