Optimistic: Building Subjective Well-being and Post Traumatic

Growth on Post-mastectomy Women

Nurul Hartini, Vania Ardelia, Valina Khiarin Nisa

Clinical Psychology and Mental Health, Universitas Airlangga

Keywords: Optimism, Post-Traumatic Growth, Subjective Well-Being, Mastectomy.

Abstract: Losing the anatomy of the body will bring psychological pressure. For women, losing parts of the body that

have symbolic benefits such as breast will lead them to extreme emotional response. Mastectomy is one of

breast cancer treatment that makes a woman lose one or all of her breasts. This study was conducted to

examine the role of optimism in post-traumatic development in post-mastectomy women with subjective

well-being as a variable mediator. Instruments used in this study were post-traumatic growth questionnaires,

subjective well-being questionnaires, and optimistic questionnaires. Data were collected from 78 post-

mastectomy patients and chemotherapy or radiation therapy treatments. Regression Hayes Process statistical

techniques used to analyse data. Results showed that optimism provides subjective prediction and positive

relation direction with subjective well-being. Therefore, an increase of optimism will affect subjective well-

being to increase as well. Optimism also found to be significant in predicting post-traumatic growth.

However, subjective well-being may not necessarily directly increase post-traumatic growth of post-

mastectomy breast cancer patients.

1 INTRODUCTION

World Health Organization (WHO) noted that

cancer as one of leading cause of death worldwide,

especially to underprivileged and developing

countries. Data and Information Center Ministry of

Health Republic of Indonesia (2015) reported that

prevalence of cancer patients on all ages population

in Indonesia has reached 1,4% from approximately

254,9 million citizens as equal to 356,860 people.

Therefore, Minister of Health Republic of Indonesia

declared a Cancer Elimination Commitment in

Indonesia as coincided with World Cancer Day on

February 4th, 2015. The most common type in

Indonesian women is breast cancer and cervical

cancer. Jawa Pos (2017) found that on 2012-2015,

breast cancer patient in Public Local Hospital dr.

Soetomo Surabaya attained to 7,743 patients.

Managements on cancer patients consisted of

surgery, chemotherapy, radiation therapy, hormone

therapy, and immunology therapy (Cancer Council

Australia, 2016). There is various type of surgeries

on cancer, including mastectomy, which referred to

surgery on breast cancer patients to remove the

entire breast. Furthermore, Lismidiati, Setyowati,

and Afiyanti (2011) stated that the loss of specific

anatomy of body parts which has symbolic meaning

on women (e.g. breasts) would cause extreme

emotional response. This statement indeed supported

as post-surgery experience specifically to losing

certain body anatomy such as breasts on mastectomy

surgery on women could cause psychological

distress symptoms (e.g. anxiety, angry, confused,

depression) (Mirowsky and Ross, 2002; Lepperta,

Legrob and Kjerulff, 2007; Drapeau, Marchand and

Beaulieu-Prévost, 2012).

Post-mastectomy women would experience

uncomfortable feelings, stress, even trauma. Trauma

itself could be defined as post-traumatic stress

disorders (PTSD), which described as utmost

response towards heavy stressor, increased anxiety,

avoiding stimulus that associated to certain trauma,

dullness on emotional response, and symptoms

occurred for more than a month (Kring, Johnson,

Davison and Neale, 2012). On the other hand, there

were also women who managed to continue their life

and developed themselves in positive dispositions

after mastectomy and getting through medication.

Taylor (1998) and Wortan (2009) emphasized that

stressful event in life could brought changes to

positive experience as a result of struggle with

traumatic event. Moreover, Seligman and

162

Hartini, N., Ardelia, V. and Nisa, V.

Optimistic: Building Subjective Well-being and Post Traumatic Growth on Post-mastectomy Women.

DOI: 10.5220/0008586701620167

In Proceedings of the 3rd Inter national Conference on Psychology in Health, Educational, Social, and Organizational Settings (ICP-HESOS 2018) - Improving Mental Health and Harmony in

Global Community, pages 162-167

ISBN: 978-989-758-435-0

Csikszmihalyi (2000) along with Tedeschi and

Calhoun (2004) explained that implementation of

individual resiliency concepts who experienced

trauma were known as post-traumatic growth.

Post-traumatic growth defined as positive

psychological changes which indicated by

relationship to others, new possibilities, personal

strength, spiritual change, and appreciation to life

(Tedeschi and Calhoun, 1996). These indicators

were most likely to occurred among post-

mastectomy women (Mahleda and Hartini, 2008;

Rahmah and Widuri, 2011; Rachmawati and

Halimah, 2015).

Furthermore, internal processes became the main

determinant to influenced and controlled process of

acquiring psychologically well-being (Compton,

2005; Snyder and Lopez, 2007). Studies on positive

mental health and positive psychology believe that

human has positive basic potential to guide them

reached balance in their life. In addition, this human

potential will help human survive in their life. To

conclude, current research aimed to explore internal

processes specifically optimism role towards post-

traumatic growth through subjective well-being as

mediator on post-mastectomy breast cancer patient.

2 METHODS

This current research was a survey study that used

questionnaire to collect data. Three instruments were

used in this study, namely post-traumatic growth

questionnaire, subjective well-being questionnaire,

and optimism questionnaire. Data were collected

from 78 post-mastectomy breast cancer patients and

went through chemotherapy medication (i.e.

radiation therapy).

Post-traumatic growth instrument used in current

research was adapted from Post-Traumatic Growth

Inventory (PTGI) by Tedeschi and Calhoun (1996).

PTGI consisted of five dimensions comprised of

relationship to others, new possibilities, personal

strength, spiritual change, and appreciation to life.

This instrument consisted of 21 items (⍺ = 0,73).

Subjective well-being scale was composed by

researcher based on concept of subjective well-being

by Diener (1984). According to Diener (1984),

subjective well-being emphasized happiness on

cognitive and affection aspects. Well-being referred

to individual evaluation on their life, including

cognitive appraisal towards their life satisfaction and

affection appraisal to their mood and emotions.

Well-being itself could be seen from two dimensions

namely life satisfaction and occurrence of positive or

negative affect. This scale consisted of 10 items (⍺ =

0,78).

Furthermore, optimism scale was adapted from

Life Orientation Test Revised Optimism Scale

(Scheider, et. al., 1994; Peterson, 2000). Optimism

described as individual response who has

expectations in the future. Optimistic person will

include efforts to overcome difficulties, attempted to

reach goals, and evaluated their expectation of

success. They also expect good things will happen in

the future. This scale consisted of 10 items (⍺ =

0,83).\

Data were analyzed using Regression Process

Hayes statistical techniques with SPSS 2.0 Program

for Macintosh. Analysis was done using subjective

well-being variable as mediator in order to

illustrated participants’ post-traumatic growth on

every aspect of PTG itself. In conclusion, present

research hypothesized that optimism significantly

influenced post-traumatic growth among post-

mastectomy breast cancer patients that went through

chemotherapy medication or radiation therapy with

subjective well-being as mediator variable.

3 RESULTS

The result of regression analysis to predict

subjective well-being from optimism is shown in

Table 1.

Table 1: Regression Analysis to Predict Subjective Well-Being from Optimism

Outcome: SWB

Model Summar

R R

MSE F df1 df2 P

0,151 0,227 3,920 1,768 1.000 76.000 0,188

Model

Coeff Se T P LLCI ULCI

constan

35,833 1,207 29,676 0,000 33,428 38,237

OPT 0,037 0,281 1,323 0,187 -0,019 0,093

Optimistic: Building Subjective Well-being and Post Traumatic Growth on Post-mastectomy Women

163

Optimism found to be significant in predicting

subjective well-being (b = 0,04; t = 1,32; p = 0,19;

R2 = 0,227) which accounted for 2% of the variation

in predicting subjective well-being. Moreover,

positive correlation also found between optimism

and subjective well-being which shown by b positive

value. Based on this correlation, the increase of

value optimism will be followed by the increase of

subjective well-being (Field, 2013).

Result of correlation between post-traumatic

growth to other variables (i.e. subjective well-being

and optimism) can be seen in Table 2. Based on the

results, optimism shown to be significantly

influenced to post-traumatic growth (p = 0,000; ⍺ <

0,05), which indicated that optimism were able to

predict post-traumatic growth significantly while

including subjective well-being in analysis model. In

contrast, post-traumatic growth found to be

irrelevant in predicting subjective well-being (p =

0,837).

Table 3 provided total effect model on optimism

and post-traumatic growth mediation model.

According to Field (2013), total effect model

referred to predictor effect towards analysis results

by excluding mediator variable from the model (i.e.

correlation between optimism and post-traumatic

growth). Based on Table 3, it could be seen that

optimism was able to predict post-traumatic growth

notably (p = 0,000) by excluding subjective well-

being from the model. Moreover, this model

accounted for 88,3% to explained post-traumatic

growth. In addition, if subjective well-being

included to model, positive correlation was found

between optimism and post-traumatic growth (b =

2,284).

In addition to total effect model, indirect effects

also obtained from mediation results which

explained optimism variable and post-traumatic

growth (Table 4). Based on Table 4, indirect effects

of optimism to post-traumatic growth estimated in

0,003. Moreover, an accurate estimate of indirect

effects can be seen from b value (i.e. BootLLCI and

BootULCI values).

Table 4. Indirect Effects from Mediation Model

Indirect effect of X on Y

Effect

Boot

BootLLCI BootULCI

SWB 0,003 0,017 -0,027 0,045

As stated by Field (2013), if b value on indirect

effects did not showed zero results then it could

indicate an occurrence of indirect correlation

between independent variable and dependent

variable. In other words, mediator variable could

mediate between these variables. As shown in Table

4, BootLLCI value and BootULCI value appeared at

-0,027 and 0,045 respectively, which means that

estimated value of indirect effect in this model lied

between -0,027 to 0,045. Since zero results appeared

within those range, it can be said that influenced of

Table 2: Correlation Between Post-Traumatic Growth to Subjective Well-Being and Optimism

Outcome: PTG

Model Summar

R R

MSE F df1 df2 P

0,939 0,884 45,507 284,381 2.000 75.000 0,000

Model

coeff se T P LLCI ULCI

constan

-9,208 14,596 -0,631 0,530 -38,285 19,868

SWB 0,081 0,391 0,206 0,837 -0,698 0,859

OPT 2,281 0,969 23,544 0,000 2,088 2,474

Table 3: Total Effect Model of Optimism and Post-Traumatic Growth Mediation

Outcome: PTG

Model Summar

R R

MSE F df1 df2 P

0,939 0,883 44,933 575,976 1,000 76.000 0,000

Model

coeff se T P LLCI ULCI

constan

-6,324 4,088 -1,547 0,126 -24,466 1,818

OPT 2,284 0,095 23,999 0,000 2,095 2,474

ICP-HESOS 2018 - International Conference on Psychology in Health, Educational, Social, and Organizational Settings

164

optimism towards post-traumatic growth and

mediated by subjective well-being has unremarkable

figures.

In conclusion, current study showed that

subjective well-being insignificantly mediated

directly towards post-traumatic growth. Therefore,

subjective well-being was not necessarily increased

post-traumatic growth directly among breast cancer

post-mastectomy patients.

4 DISCUSSIONS

Person who diagnosed with cancer and required to

went through various therapy would experience

stressful period which could affect their

psychological aspects and social skills (Ho,

Rajandram, Chan, Samman, McGrath and Zwahlen,

2011). Furthermore, post-mastectomy patients and

were undergoing on medication (e.g. chemotherapy

or radiation therapy) tend to showed fluctuate

emotional changes. These progression of emotional

states could be referenced to concepts by Kubler

Ross (Santrock, 2015) which explained five stages

of grief to denial, anger, bargaining, depression, and

acceptance. Therefore, most of post-mastectomy and

undergoing medication patients would still be in first

several phase (i.e. denial, anger, and depression

phase) due to their experienced of sickness and

illness on pain they felt as consequence of

chemotherapy and radiation therapy. Moreover,

these sickness, illness, and pain would cause

anxiety, hopelessness, and insomnia (Hartini, 2004).

Eventually, post-mastectomy patients would

gradually enter bargaining and acceptance phase,

even it would take some time differently for each

patients. Once they reached to acceptance, patients

would be able to envisioned their future, decreased

their anxiety, hopelessness, and insomnia. These

phase could affect the ability to formed optimism

among patients to lived life after suffered such

illness. According to Ho, et. al. (2011), positive

coping strategy (e.g. hope and optimism) were

assumed to be significantly influenced individual

post-traumatic growth.

Self-acceptance and optimism among post-

mastectomy patients would induced positive

feelings, satisfaction against life experiences which

they have been through, along with increased in

positive affect while lowered in negative affect.

These psychological state reflected patients

subjective well-being. Moreover, it has been known

optimism that accompanied by social support would

take part as protective factors in preventing stress to

post-mastectomy patients (Applebaum, Stein, Lord-

Bessen and Pessin, 2014). Therefore, a high level of

optimism could reduce anxiety and depressive

symptoms. Other than that, optimism was known to

be able to improved better quality of life among

patients.

Study by Scheier and Carver (1985; 1992);

Scheier, et. al. (1999); and Schneider (2001) found

that optimism could resulted in both psychological

and physical healthiness. Optimistic person would

adopt healthy behavior to their life as an effort to

maintain their health state. While Kivimaki, et. al.

(2005) also stated that pessimistic and hopeless

individual would invested less effort to adopted

healthy lifestyle which resulted in rather negative

psychological and physical healthiness than positive.

Based on previous discussion above showed that

breast cancer patients could achieve post-traumatic

growth. As Wortman (2009) and Mahelda and

Hartini (2011) also supported those statement

describing two factors that were able to developed

post-traumatic growth namely cognitive processing

and disclosure. Furthermore, Rahmah and Widuri

(2011) stated that post-traumatic growth affected by

external and internal factors. External factors

referred to family support (e.g. husband, children,

grandchild, parents, and siblings) while internal

factors covered spirituality factors and reframing.

Optimism significantly impacted on subjective

well-being amongst post-mastectomy patients, as it

brought out positive response and expectations to

future. Optimistic patients would constantly put

effort to coped with difficulties and achieved

recovery. Moreover, internal process also known as

main determinant to affect and controlled the

process in acquiring subjective well-being.

Meanwhile, subjective well-being itself was

indirectly influenced post-traumatic growth.

Indicators of post-mastectomy patients who

managed to achieve post-traumatic growth were

individual that able to maintained harmonious

relationship to others, determined new possibilities,

acquiring personal strength, had a spiritual change

by devoting themselves to God, and capable to

appreciate their life.

There is however limitation to this research

regarding participants and control variable.

Insufficient number of participants in current

research has caused inability to generalized results in

this study. Additionally, researcher did not control

participants background criteria such as education

background and socioeconomic status.

Optimistic: Building Subjective Well-being and Post Traumatic Growth on Post-mastectomy Women

165

5 CONCLUSIONS

Post-mastectomy women on undergoing medication

need optimism to recovered themselves. Optimism

were notably significant in predicting subjective

well-being, whereas increased optimism would be

followed by increased subjective well-being as well.

Likewise, optimism also significantly affected post-

traumatic growth, in which high level of optimism

could strengthened post-traumatic growth. In

conclusion, internal motivation to recovery and

social support would help patients through their

medication thoroughly.

REFERENCES

Applebaum, A.J., Stein, E.M., Lord-Bessen, J., Pessin, H.,

Rosenfeld, B. and Breitbart, W., 2014. Optimism,

Social Support, and Mental Health Outcomes in

Patients with Advanced Cancer. Psychooncology,

23(3), pp. 299-306.

Cancer Council Australia, 2016. Chemotherapy. [on-line]

Available at: <

http://www.cancer.org.au/about-cancer/treatment/che

motherapy.html> [Accessed 14 June 2016].

Cancer Council Australia, 2016. Radiotherapy. [on-line]

<Available at

http://www.cancer.org.au/about-cancer/treatment/radio

therapy.html> [Accessed 14 June 2016].

Davidson, G.C., Neale, J.M. and Kring, A.M., 2004.

Psikologi Abnormal. 9th ed. Jakarta: Raja Grafindo

Persada.

Field, A., 2013. Discovering Statistics Using IBM SPSS

Statistics. 4th ed. London: Sage.

Oers, Van., 2013. Anxiety and the Patient with Breast

Cancer: A Review of Current Research and Practice.

Review Article, 55(6), pp. 525-529

Rachmawati, N. and Halimah, L., 2015. Studi Deskriptif

Mengenai Gambaran Posttraumatic Growth (PTG)

pada Wanita Penderita Kanker Payudara Pasca

Masektomi di Bandung Cancer Society (BCS)

(Descriptive Study of Post-traumatic Growth on Post-

Mastectomy Women in Bandung Cancer Society).

Psikologi Prosiding Psikologi UNISBA, pp. 2460-

6448.

Ho, S., Rajandram, R.K., Chan, N., Samman, N.,

McGrath, C. and Zwahlen, R.A., 2011. The roles of

hope and optimism on post-traumatic growth in oral

cavity cancer patients. Oral Oncology, 47, pp. 121-

124.

Kivimaki M., Vahtera, J., Elovainio, M., Helenius, H.,

Singh-Manoux, A. and Pentti, J., 2005. Optimism and

Pessimism as Predictors of Change in Health After

Death or Onset of Severe Illness in Family. Health

Psychology, 24(4), pp. 413-421.

Liputan 6, 2013. Penyakit Berbahaya yang Paling Sering

Diderita Kaum Wanita. [on-line]. Available at: <

http://health.liputan6.com/read/566916/penyakit-

berbahaya-yang-paling-sering-diderita-kaum-wanita>

[Accessed 16 June 2016].

Mahleda I.P.M. and Hartini, N., 2008. Post-Traumatic

Growth Pada Pasien Kanker Payudara Pasca

Mastektomi Usia Dewasa Madya (Post-traumatic

Growth on Post-Mastectomy Breast Cancer Patients in

Middle Adulthood). Jurnal UNAIR, [e-journal].

Available through: Jurnal Universitas Airlangga

<http://journal.unair.ac.id/filerPDF/110810226_3v.pdf

> [Accessed 02 October 2015].

Neuman, W.L., 2006. Social Research Methods:

Qualitative and Quantitative Approaches. 4th ed.

USA: Pearson Education Limited.

Neuman, W.L., 2013. Metode Penelitian Sosial

Pendekatan Kualitatif dan Kuantitatif. 7th ed. Jakarta:

Indeks.

Peterson C., 2000. The future of optimism. American

Psychologist, 55(1), pp. 44-56.

Peterson, C., Park, N., Pole, N., D’Andrea, W. and

Seligman, M.E.P., 2008. Strengths of Character and

Posttraumatic Growth. Journal of Traumatic Stress,

21(2), pp. 214–217.

PTGI, 2012. What is PTG?. [on-line]. Available at: <

https://ptgi.uncc.edu/what-is-ptg/> [Accessed 02

January 2016].

Data and Information Center Ministry of Health Republic

of Indonesia., 2015. Health Data and Information

Report of Cancer. Jakarta: Ministry of Health

Republic of Indonesia.

Rahmah, A.F. and Widuri, E.L., 2011. Post Traumatic

Growth Pada Penderita Kanker Payudara (Post-

Traumatic Growth on Breast Cancer Patients).

Humanitas, 8(2).

Santrock, J.W., 2011. Perkembangan Masa Hidup (Life-

Span Development). 13th ed. Jakarta: Gelora Aksara

Pratama.

Santrock, J., 2015. A Topical Approach to Life Span

Development. 8th ed. USA: McGraw-Hill Inc.

Scheier, M.F. and Carver, C.S., 1985. Optimism, coping,

and health: Assessment and implication of generalized

outcome expectancies. Health Psychology, 4(3), pp.

219-247.

Scheier, M.F. and Carver, C.S., 1992. Effects of optimism

on psychological and physical well-being: The

influence of generalized outcome expectancies. Health

Psychology, 16(2), pp. 201-228.

Scheier, M.F., Matthews, K.A., Owens, J.F., Schulz, R.,

Bridges, M.W., Magovern, G.J. and Carver, C.S.,

1999. Optimism and rehospitalization after coronary

artery bypass graft surgery. Archives of Internal

Medicine, 159, pp. 829-835.

Schneider, S.L., 2001. Insearch of realistic optimism:

meaning, knowledge and warm fuzziness. American

Psychologist, 56(3), pp. 250-263.

ICP-HESOS 2018 - International Conference on Psychology in Health, Educational, Social, and Organizational Settings

166

Tedeschi, R.G. and Calhoun, L.G., 1996. The Post-

traumatic Growth Inventory: Measuring the Positive

Legacy of Trauma. Journal of Traumatic Stress, 9(3).

Tedeschi, R.G. and Calhoun, L.G., 2004. Post-traumatic

Growth: Conceptual Foundations and Empirical

Evidence. Psychological Inquiry, 15(1), 1-18.

Tedeschi, R.G. and Calhoun, L.G., 2004. The Foundations

of Post-traumatic Growth: New Considerations.

Psychological Inquiry, 15(1), 93-102.

Weiss, T., (2002). Post-traumatic growth in women with

breast cancer and their husbands: An inter-subjective

validation study. Journal Psychosocial Oncology, 20,

65-80.

Wortman, C.B., 2009. Post-traumatic Growth: Progress

and Problems. [pdf] Available at: <

http://www.psychology.sunysb.edu/cwortman-

/papers/Posttraumatic_Growth.pdf> [Accessed 02

October 2015].

Optimistic: Building Subjective Well-being and Post Traumatic Growth on Post-mastectomy Women

167