Negative automatic thoughts mediate the effects of emotion regulation on distress in women with breast and gynecological cancer

Cancer's emotionally taxing nature offers a compelling real-world model for examining psychological distress. Despite its relevance, empirical research remains limited on the cognitive mechanisms, particularly self-referent negative automatic thoughts (NATs) and emotion regulation (ER), sustaining distress in chronic illness. In this cross-sectional study women (N = 230) diagnosed with breast or gynecological cancer completed self-report measures of distress, depressive and anxiety symptoms, cognitive emotion regulation and negative automatic thoughts, along with sociodemographic and clinical data. Structural equation modeling was used for analysis. Mediation analyses revealed that maladaptive emotion regulation was positively associated with psychological distress (β = 0.405), depression (β = 0.631), and anxiety (β = 0.660), with NATs partially mediating these effects. Adaptive ER showed weaker total effects, but significant indirect effects via reduced NATs. A latent distress or general psychological distress (PD) model demonstrated excellent fit and confirmed partial mediation. NATs uniquely predicted depressive symptoms beyond general distress, underscoring their central role. The findings highlight the central role of maladaptive ER and NATs in psychological distress among cancer patients. The results support cognitive models suggesting that targeting maladaptive cognitive patterns may yield improvements in emotional well-being. The PD model offers a parsimonious, transdiagnostic framework for conceptualizing shared vulnerability across symptom domains.