A Structural Model of Posttraumatic Growth Based on Cognitive Appraisal with the Mediating Role of Intrusive and Deliberate Rumination in Cancer Patients
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Objective: This study aimed to develop a structural model of posttraumatic growth based on cognitive appraisal, with intrusive and deliberate rumination as mediating variables among cancer patients.
Methods and Materials: This descriptive-correlational study was conducted using structural equation modeling. The sample consisted of 202 cancer patients referred to hospitals in Arak, Iran, in 2025, who were selected through convenience sampling. Data were collected using the Posttraumatic Growth Inventory, Cognitive Appraisal Scale, and Event-Related Rumination Inventory. Data were analyzed using descriptive statistics, Pearson correlation coefficients, and structural equation modeling in R software. Model fit was evaluated using standard fit indices.
Findings: The proposed structural model demonstrated acceptable fit: χ²/df = 1.257, RMSEA = .036, CFI = .984, NFI = .930, TLI = .978, IFI = .985, GFI = .943, and AGFI = .902. Threat appraisal negatively predicted posttraumatic growth (β = −.22, p = .01), whereas challenge appraisal (β = .12, p = .03) and resource appraisal (β = .18, p = .01) positively predicted posttraumatic growth. Intrusive and deliberate rumination significantly mediated the relationships between cognitive appraisal components and posttraumatic growth. Threat appraisal showed negative indirect effects through intrusive rumination (β = −.11, p = .01) and deliberate rumination (β = −.04, p = .04), while challenge and resource appraisals showed positive indirect effects through both rumination pathways.
Conclusion: Cognitive appraisal contributes to posttraumatic growth in cancer patients both directly and indirectly through rumination processes. Interventions targeting maladaptive threat appraisal and promoting adaptive meaning-making may facilitate psychological growth.
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