title: Emotional distress impacts fear of the future among breast cancer survivors not the reverse.
abstract: BACKGROUND
  Fear of the future is one of the most stressful aspects of having cancer. Research to date has conceptualized fear of the future as a precursor of distress or stress-response symptoms. Yet it is equally plausible that distress would predict increased fear of the future or that they would have a reciprocal influence on each other. The purpose of the present study was to examine the bidirectional relations between fear of the future and distress as well as intrusion and avoidance among breast cancer survivors at 3, 7, 11, and 15 months after diagnosis.
  
  
  METHODS
  We used a bivariate latent difference score model for dynamic change to examine these bidirectional relationships among 146 early-stage breast cancer survivors. Using Lisrel version 8.80, we examined four models testing different hypothesized relationships between fear of the future and distress and intrusion and avoidance.
  
  
  RESULTS
  Based on model fit evaluation, our data shows that decreases in distress over time lead to a reduction of fear of the future but that changes in fear do not lead to changes in distress. On the other hand, there is no relationship between changes in fear of the future and intrusion and avoidance over time.
  
  
  CONCLUSIONS
  Ongoing fear of the future does not appear to be a necessary condition for the development of stress-response symptoms.
  
  
  CONCLUSIONS
  Future studies need to explore the role of distressing emotions in the development and exacerbation of fear of the future among cancer survivors.
authors.affiliation: School of Psychology, University of Ottawa, 11 Marie Curie, Ottawa, ON, Canada. Sophie.Lebel@uottawa.ca
authors.forename: Sophie
authors.initials: S
authors.lastname: Lebel
authors.forename: Zeev
authors.initials: Z
authors.lastname: Rosberger
authors.forename: Linda
authors.initials: L
authors.lastname: Edgar
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Devins