緒論：乳癌病人的身心調適是臨床照顧中不可忽視的重要議題。過去研究指出乳癌病人容易因疾病帶來的影響 （如：外觀改變、疾病污名化）而經歷羞恥感經驗，然羞恥感之構念受到較少關注。羞恥感為包含認知、情緒、行為等多面向的整體經驗，核心為個體感受到自我是不足的、有缺陷的之負向自我認知，負向認知可能對乳癌病人的疾病調適帶來負向影響 。 本研究欲嘗試推論羞恥感的影響機制，羞恥感可能影響病人因應疾病的癌症自我效能，亦可能影響病人採取的因應行為 ，進而影響因應結果，負向影響其生活品質。故本研究欲透過縱貫追蹤資料，針對乳癌病人探討羞恥感、癌症自我效能、因應與生活品質的關係。
研究方法： 本研究使用台灣北部某醫學中心的大型臨床追蹤研究資料，納入乳癌病人於術後一個月與六個月追蹤評估中所填答之短版癌症行為量表、台灣癌症態度量表、短版因應量表與台灣簡明版世界衛生組織生活品質問卷等資料，以測量乳癌病人的羞恥感、癌症自我效能、因應、與生活品質，羞恥感以兩種方式進行計分，包含兩題與六題版本。以路徑分析檢驗羞恥感、癌症自我效能、因應是否對生活品質具有顯著預測力，以及包含不同時間點變項的兩個模型，探討癌症自我效能與因應是否中介羞恥感與生活品質之間的關係 。 模式一以術後一個月的羞恥感、癌症自我效能、因應與術後六個月的生活品質；模式二以術後一個月的羞恥感與術後六個月的癌症自我效能、因應、生活品質，進行路徑分析。
研究結果 ： 本研究納入之有效資料共 63 筆， 平均年齡為 54.03 歲 （SD＝10.42）。模型二預測力較佳，路徑分析之參數結果顯示(1) 術後一個月的羞恥感可顯著負向直接預測術後六個月的生理生活品質，以及顯著負向間接預測術後六個月的心理、社會、環境生活品質；(2) 術後一個月的羞恥感可顯著負向預測術後六個月的癌症自我效能；(3) 術後六個月的癌症自我效能可顯著向預測術後六個月的各範疇生活品質；(4) 術後六個月的癌症自我效能可顯著向預測術後六個月的個人因應、顯著負向預測術後六個月的逃避因應；(5) 術後六個月的個人因應可顯著向預測術後六個月的心理生活品質， 社會支持因應可顯著向預測術後六個月的社會生活品質，逃避因應可顯著負向預測術後六個月的心理、社會生活品質。模型二的中介模型結果顯示三條顯著預測路徑(1) 術後一個月的羞恥感經由術後六個月的癌症自我效能，預測術後六個月的各範疇生活品質，癌症自我效能具顯著部分中介效果；(2) 術後一個月的羞恥感經由癌症自我效能預測術後六個月的個人因應，進而預測心理生活品質；(3) 術後一個月的羞恥感經由癌症自我效能預測術後六個月的逃避因應，進而預測心理與社會生活品質。
討論：(1) 乳癌病人在疾病初期因罹病產生的羞恥認知，對其長期的疾病調適有顯著影響，羞恥認知包含乳癌病人的身體意象下降、癌症污名化等相關認知構念，然以負向自我認知為核心的羞恥傾向本身即具有顯著影響。(2) 癌症自我效能為羞恥感與生活品質的顯著中介因子，羞恥認知可能透過降低乳癌病人因應疾病的信心進而形成負向影響 ，同時亦表示癌症自我效能為乳癌病人的重要資源，增強癌症自我效能可減緩羞恥感帶來的負向影響。(3) 癌症自我效能可進一預測個人因應與逃避因應，當羞恥認知導致病人癌症自我效能下降，可能進一使病人降低積極因應行為、增加逃避因應的傾向，進而負向影響生活品質。上述結果顯示乳癌病人的羞恥感具有跨時間的持續影響，並初釐清其影響生活品質的機制，為臨床照護中值得持續關注的焦點。

Objective: Psychosocial adjustment among breast cancer patients is a critical focus in clinical care. Previous research has indicated that breast cancer patients are prone to experiencing shame in response to disease-related changes, such as alterations in physical appearance and cancer-related stigmatization, yet the construct of shame has received relatively limited attention. Shame is a multidimensional experience encompassing cognitive, emotional, and behavioral components, with a core characterized by negative self-evaluations in which the individual perceives the self as inadequate or defective. Such negative self-cognition may adversely affect the disease adjustment of breast cancer patients. This study aimed to examine the mechanisms of shame's influence on disease adjustment in breast cancer patients, proposing that shame may undermine patients' cancer self-efficacy and shape their coping behaviors, ultimately affecting coping outcomes and negatively impacting quality of life. Therefore, using longitudinal data, this study investigated the relationships among shame, cancer self-efficacy, coping strategies, and quality of life in breast cancer patients.
Method: Data for this study were drawn from a large-scale longitudinal clinical study conducted at a medical center in northern Taiwan. Breast cancer patients' responses to the Cancer Behavior Inventory-Brief, the Taiwan Attitude toward Cancer Scale, the Brief COPE, and the WHOQOL-BREF Taiwan Version, collected at 1-month(T1) and 6-month(T2) post-surgical follow-up assessments, were included for analysis. These
measures assessed shame, cancer self-efficacy, coping strategies, and quality of life, with shame scored using two versions: a two-item version and a six-item version. Path analysis was conducted to examine whether shame, cancer self-efficacy, and coping strategies significantly predicted quality of life, and to test two models incorporating variables from different time points, investigating whether cancer self-efficacy and coping strategies mediated the relationship between shame and quality of life. Model 1 used shame(T1), cancer self-efficacy(T1), coping strategies(T1) to predict quality of life(T2); Model 2 used shame(T1), cancer self-efficacy(T2), coping strategies(T2) to predict quality of life(T2).
Result：A total of 63 valid cases were included in the analysis, with a mean age of 54.03 years (SD = 10.42). Model 2 demonstrated a better predictive power. Path analysis results indicated that: (1) shame(T1) significantly and directly predicted lower physical quality of life(T2), and significantly and indirectly predicted lower psychological, social, and environmental quality of life(T2); (2) shame(T1) significantly predicted lower cancer self-efficacy(T2); (3) cancer self-efficacy(T2) significantly predicted higher quality of life across all domains(T2); (4) cancer self-efficacy(T2) significantly predicted higher personal coping(T2) and lower avoidant
coping(T2); (5) personal coping(T2) significantly predicted higher psychological quality of life(T2), social support coping(T2) significantly predicted higher social quality of life(T2), and avoidant coping(T2) significantly predicted lower psychological and social quality of life(T2). The mediation results of Model 2 revealed three significant indirect pathways: (1) shame(T1) predicted quality of life across all domains(T2)via cancer self-efficacy (T2), with cancer self-efficacy exhibiting a significant partial mediation effect; (2) shame(T1) predicted psychological quality of
life(T2) via cancer self-efficacy (T2) and personal coping(T2); (3) shame(T1) predicted psychological and social quality of life(T2) via cancer self-efficacy(T2) and avoidant coping(T2).
Discussion：(1) Shame experienced by breast cancer patients in the early stages of the disease had a significant impact on their long-term disease adjustment. Although shame is associated with related constructs such as body image decline and cancer stigmatization, shame-proneness characterized by negative self-cognition demonstrated
significant independent predictive effects. (2) Cancer self-efficacy was a significant mediator between shame and quality of life, suggesting that shame may exert its negative influence by undermining patients' confidence in coping with their disease. This also highlights cancer self-efficacy as an important psychological resource, whereby enhancing cancer self-efficacy may buffer the adverse effects of shame. (3)
Cancer self-efficacy further predicted personal coping and avoidant coping, indicating that when shame leads to reduced cancer self-efficacy, patients may be less likely to engage in active coping behaviors and more inclined toward avoidant coping, thereby negatively affecting quality of life. These findings demonstrate that shame in breast
cancer patients exerts a sustained influence across time, providing preliminary insight into how shame affects quality of life, and highlighting shame as an important focus deserving greater attention in clinical care.

王詠儀（2021）。初探乳癌病人於術後一個月之癌症態度，因應，及生活品質的關係。國立政治大學心理學系學位論文，1-96。
李作英、周桂如、穆佩芬、李惠玲、葉美玲（2012）。初診斷乳癌婦女其壓力感受。腫瘤護理雜誌，12(2)，25-36。
吳文珺（2020）。自我效能對乳癌病人生活品質的影響－術前心理健康衛教團體之追蹤研究。政治大學心理學系學位論文，1-103.
姚開屏（2002）。健康相關生活品質概念與測量原理之簡介。臺灣醫學，6(2)，183-192。
鄭斐文（2023）。做乳房: 醫療論述與乳癌病患的身體經驗。人文及社會科學集刊，35(4)，715-757.
衛生福利部國民健康署（2025）。中華民國107年癌症登記報告。取自https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=5015&pid=19656
Al-Ghazal, S. K., Fallowfield, L., & Blamey, R. W. (2000). Comparison of psychological aspects and patient satisfaction following breast conserving surgery, simple mastectomy and breast reconstruction. European Journal of Cancer, 36(15), 1938-1943.
Alonzo, A. A., & Reynolds, N. R. (1995). Stigma, HIV and AIDS: An exploration and elaboration of a stigma trajectory. Social science & medicine, 41(3), 303-315.
Andrews, B. (1995). Bodily shame as a mediator between abusive experiences and depression. Journal of abnormal psychology, 104(2), 277.
Andrews, B., & Hunter, E. (1997). Shame, early abuse, and course of depression in a clinical sample: A preliminary study. Cognition & Emotion, 11(4), 373-381.
Andrews, B., Brewin, C. R., Rose, S., & Kirk, M. (2000). Predicting PTSD symptoms in victims of violent crime: the role of shame, anger, and childhood abuse. Journal of Abnormal Psychology, 109(1), 69-73.
Baldwin, K. M., Baldwin, J. R., & Ewald, T. (2006). The relationship among shame, guilt, and self-efficacy. American Journal of Psychotherapy, 60(1), 1-21.
Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), 143-164.
Bandura, A., & Walters, R. H. (1977). Social learning theory (Vol. 1). Prentice-hall.
Begovic-Juhant, A., Chmielewski, A., Iwuagwu, S., & Chapman, L. A. (2012). Impact of body image on depression and quality of life among women with breast cancer. Journal of Psychosocial Oncology, 30(4), 446-460.
Brennan, M. E., Bell, K., Hamid, G., Gilchrist, J., & Gillingham, J. (2023). Consumer experiences of shame in clinical encounters for breast cancer treatment.“Who do you think you are–Angelina Jolie?”. The Breast, 72, 103587.
Brockington, I. F., Hall, P., Levings, J., & Murphy, C. (1993). The community's tolerance of the mentally ill. The British Journal of Psychiatry, 162(1), 93-99.
Brunet, J., Price, J., & Harris, C. (2022). Body image in women diagnosed with breast cancer: a grounded theory study. Body image, 41, 417-431.
Bu, X., Li, S., Cheng, A. S., Ng, P. H., Xu, X., Xia, Y., & Liu, X. (2022). Breast cancer stigma scale: a reliable and valid stigma measure for patients with breast cancer. Frontiers in psychology, 13, 841280.
Carver, C. S., Scheier, M. F., & Weintraub, J. K. (1989). Assessing coping strategies: a theoretically based approach. Journal of Personality and Social Psychology, 56(2), 267-283.
Cash, T. F., & Pruzinsky, T. (2002). Body image: A handbook of theory, research, and clinical practice. (No Title).
Cash, T. F. (2004). Body image: Past, present, and future. Body image, 1(1), 1-5.
Cash, T. F., & Smolak, L. (Eds.). (2011). Body image: A handbook of science, practice, and prevention. Guilford press.
Castonguay, A. L. (2017). Body-related shame and guilt predict physical activity in breast cancer survivors over time. Number 4/July 2017, 44(4), 465-475.
Chapple, A., Ziebland, S., & McPherson, A. (2004). Stigma, shame, and blame experienced by patients with lung cancer: qualitative study. BMJ, 328(7454), 1470.
Chesney, M. A., Neilands, T. B., Chambers, D. B., Taylor, J. M., & Folkman, S. (2006). A validity and reliability study of the coping self‐efficacy scale. British journal of health psychology, 11(3), 421-437.
Chirico, A., Lucidi, F., Merluzzi, T., Alivernini, F., De Laurentiis, M., Botti, G., & Giordano, A. (2017). A meta-analytic review of the relationship of cancer coping self-efficacy with distress and quality of life. Oncotarget, 8(22), 36800-36811.
Chu, Q., Wong, C. C., Chen, L., Shin, L. J., Chen, L., & Lu, Q. (2021). Self‐stigma and quality of life among Chinese American breast cancer survivors: A serial multiple mediation model. Psycho‐Oncology, 30(3), 392-399.
Cook, D. R. (1994). Internalized shame scale: Professional manual. Channel Press.
Cook, D. R. (1996). Empirical studies of shame and guilt: The Internalized Shame Scale. In D. L. Nathanson (Ed.), Knowing feeling: Affect, script, and psychotherapy (pp. 132-165). W. W. Norton & Company.
Cooley, C. H. (1902). Human nature and the social order. Scribner.
Corrigan, P. W., & Watson, A. C. (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice, 9(1), 35-53.
Corrigan, P. W., Rafacz, J., & Rüsch, N. (2011). Examining a progressive model of self-stigma and its impact on people with serious mental illness. Psychiatry Research, 189(3), 339-343.
Corrigan, P. W., Watson, A. C., & Barr, L. (2006). The self–stigma of mental illness: Implications for self–esteem and self–efficacy. Journal of Social and Clinical Psychology, 25(8), 875-884.
Cunningham, A. J., Lockwood, G. A., & Cunningham, J. A. (1991). A relationship between perceived self-efficacy and quality of life in cancer patients. Patient education and counseling, 17(1), 71-78.
Danhauer, S. C., Crawford, S. L., Farmer, D. F., & Avis, N. E. (2009). A longitudinal investigation of coping strategies and quality of life among younger women with breast cancer. Journal of Behavioral Medicine, 32(4), 371-379.
Davies, B., & Harré, R. (1990). Positioning: The discursive production of selves. Journal for the theory of social behaviour, 20(1), 43-63.
Dear, M., Taylor, S. M., & Hall, G. B. (1980). External effects of mental health facilities. Annals of the Association of American Geographers, 70(3), 342-352.
Dewan, M. F., Hassouneh, D., Song, M., & Lyons, K. S. (2020). Development of the breast cancer stigma scale for Arab patients. Asia-Pacific Journal of Oncology Nursing, 7(3), 295-300.
Else-Quest, N. M., LoConte, N. K., Schiller, J. H., & Hyde, J. S. (2009). Perceived stigma, self-blame, and adjustment among lung, breast and prostate cancer patients. Psychology and Health, 24(8), 949-964.
Erikson, E. H. (1963). Childhood and society (Vol. 2, p. 1964). New York: Norton.
Falk Dahl, C. A., Reinertsen, K. V., Nesvold, I. L., Fosså, S. D., & Dahl, A. A. (2010). A study of body image in long‐term breast cancer survivors. Cancer, 116(15), 3549-3557.
Fang, S. Y., Balneaves, L. G., & Shu, B. C. (2010). " A struggle between vanity and life": the experience of receiving breast reconstruction in women of Taiwan. Cancer nursing, 33(5), E1-E11.
Fang, S. Y., Chang, H. T., & Shu, B. C. (2015). Objectified body consciousness, body image and quality of life in women with breast cancer. Asian Nursing Research, 9(4), 268-274.
Ferrell, B. R., Grant, M., Funk, B., Otis-Green, S., & Garcia, N. (1997). Quality of life in breast cancer: Part I: Physical and social well-being. Cancer Nursing, 20(6), 398-408.
Fife, B. L., & Wright, E. R. (2000). The dimensionality of stigma: A comparison of its impact on the self of persons with HIV/AIDS and cancer. Journal of Health and Social Behavior, 41(1), 50–67.
Fobair, P., Stewart, S. L., Chang, S., D'Onofrio, C., Banks, P. J., & Bloom, J. R. (2006). Body image and sexual problems in young women with breast cancer. Psycho‐Oncology, 15(7), 579-594.
Gilbert, P. (1997). The evolution of social attractiveness and its role in shame, humiliation, guilt and therapy. British Journal of Medical Psychology, 70(2), 113-147.
Gilbert, P. (2000). The relationship of shame, social anxiety and depression: The role of the evaluation of social rank. Clinical Psychology & Psychotherapy, 7(3), 174-189.
Gilbert, P., & Andrews, B. (Eds.). (1998). Shame: Interpersonal behavior, psychopathology, and culture. Oxford University Press.
Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high shame and self‐criticism: Overview and pilot study of a group therapy approach. Clinical Psychology & Psychotherapy, 13(6), 353-379.
Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Prentice-Hall.
Goffman, E. (2009). Stigma: Notes on the management of spoiled identity. Simon and schuster.
Harbeck, N., Penault-Llorca, F., Cortes, J., Gnant, M., Houssami, N., Poortmans, P., Ruddy, K., Tsang, J., & Cardoso, F. (2019). Breast cancer. Nature Reviews Disease Primers, 5(1), Article 66.
Helms, R. L., O'Hea, E. L., & Corso, M. (2008). Body image issues in women with breast cancer. Psychology, Health and medicine, 13(3), 313-325.
Herek, G. M., & Capitanio, J. P. (1999). AIDS stigma and sexual prejudice. American behavioral scientist, 42(7), 1130-1147.
Hutchinson, P. (2025). Stigma and shame. In Handbook of the philosophy of medicine (pp. 1635-1654). Springer Netherlands.
Hutchinson, P., & Dhairyawan, R. (2017). Shame, stigma, HIV: philosophical reflections. Medical Humanities, 43(4), 225-230.
Jang, M., & Kim, J. (2018). A structural model for stress, coping, and psychosocial adjustment: A multi-group analysis by stages of survivorship in Korean women with breast cancer. European Journal of Oncology Nursing, 33, 41-48.
Jin, R., Xie, T., Zhang, L., Gong, N., & Zhang, J. (2021). Stigma and its influencing factors among breast cancer survivors in China: A cross-sectional study. European Journal of Oncology Nursing, 52, 101972.
Kang, N. E., Kim, H. Y., Kim, J. Y., & Kim, S. R. (2020). Relationship between cancer stigma, social support, coping strategies and psychosocial adjustment among breast cancer survivors. Journal of Clinical Nursing, 29(21-22), 4368-4378.
Khalili, N., Farajzadegan, Z., Mokarian, F., & Bahrami, F. (2013). Coping strategies, quality of life and pain in women with breast cancer. Iranian Journal of Nursing and Midwifery Research, 18(2), 105-111.
Kissane, D. W., Patel, S. G., Baser, R. E., Bell, R., Farberov, M., Ostroff, J. S., ... & Shah, J. P. (2013). Preliminary evaluation of the reliability and validity of the Shame and Stigma Scale in head and neck cancer. Head & Neck, 35(2), 172-183.
Kvillemo, P., & Bränström, R. (2014). Coping with breast cancer: a meta-analysis. PLoS One, 9(11), e112733.
Lazarus, R. S. (1991). The person-environment relationship, motivation and coping. In Emotion and coping (pp. 88-126). Stanford University Press.
Lazarus, R. S., & Folkman, S. (1984). Stress, appraisal, and coping. Springer.
Leeming, D., & Boyle, M. (2004). Shame as a social phenomenon: A critical analysis of the concept of dispositional shame. Psychology and psychotherapy: Theory, research and practice, 77(3), 375-396.
Lewis, H. B. (1971). Shame and guilt in neurosis. Psychoanalytic Review, 58(3), 419-438.
Lewis, H. B. (1987). Shame and the narcissistic personality. In D. L. Nathanson (Ed.), The many faces of shame (pp. 93-132). Guilford Press.
Lewis, H. B. (1988). The role of shame in symptom formation. In Emotions and psychopathology (pp. 95-106). Springer US.
Li, S., Xiang, Y., Li, H., Yang, C., He, W., Wu, J., ... & Ye, Z. (2024). Body image, self-efficacy, and sleep quality among patients with breast cancer: a latent profile and mediation analysis. European Journal of Oncology Nursing, 71, 102652.
LoConte, N. K., Else-Quest, N. M., Eickhoff, J., Hyde, J., & Schiller, J. H. (2008). Assessment of guilt and shame in patients with non–small-cell lung cancer compared with patients with breast and prostate cancer. Clinical Lung Cancer, 9(3), 171-178.
MacKinnon, D. (2012). Introduction to statistical mediation analysis. Routledge.
Mantzoukas, S., Kotrotsiou, S., Mentis, M., Paschou, A., Diamantopoulos, E., Kotrotsiou, E., & Gouva, M. (2021). Exploring the impact of shame on health‐related quality of life in older individuals. Journal of Nursing Scholarship, 53(4), 439-448.
Margolis, G. J., Goodman, R. L., Rubin, A., & Pajac, T. F. (1989). Psychological factors in the choice of treatment for breast cancer. Psychosomatics, 30(2), 192-197.
Mehrabi, E., Hajian, S., Simbar, M., Hoshyari, M., & Zayeri, F. (2015). Coping response following a diagnosis of breast cancer: A systematic review. Electronic physician, 7(8), 1575.
Merluzzi, T. V., & Martinez Sanchez, M. A. (1997). Assessment of self-efficacy and coping with cancer: development and validation of the cancer behavior inventory. Health Psychology, 16(2), 163-170.
Moreira, H., & Canavarro, M. C. (2010). A longitudinal study about the body image and psychosocial adjustment of breast cancer patients during the course of the disease. European journal of oncology nursing, 14(4), 263-270.
Montazeri, A. (2008). Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. Journal of Experimental & Clinical Cancer Research, 27, 32.
Ośmiałowska, E., Misiąg, W., Chabowski, M., & Jankowska-Polańska, B. (2021). Coping strategies, pain, and quality of life in patients with breast cancer. Journal of Clinical Medicine, 10(19), 4469.
Paek, M. S., Ip, E. H., Levine, B., & Avis, N. E. (2016). Longitudinal reciprocal relationships between quality of life and coping strategies among women with breast cancer. Annals of Behavioral Medicine, 50(5), 775-783.
Peng, H. L., Chen, Y. H., Lee, H. Y., Tsai, W. Y., Chang, Y. L., Lai, Y. H., & Chen, S. C. (2024). Factors associated with shame and stigma among head and neck cancer patients: a cross-sectional study. Supportive Care in Cancer, 32(6), 357.
Rosenberg, M. (1965). Rosenberg self-esteem scale (RSE). Acceptance and commitment therapy. Measures package, 61(52), 18.
Rosman, S. (2004). Cancer and stigma: experience of patients with chemotherapy-induced alopecia. Patient Education and Counseling, 52(3), 333-339.
Rottmann, N., Dalton, S. O., Christensen, J., Frederiksen, K., & Johansen, C. (2010). Self-efficacy, adjustment style and well-being in breast cancer patients: a longitudinal study. Quality of Life Research, 19(6), 827-836.
Scheff, T. J. (1988). Shame and conformity: The deference-emotion system. American Sociological Review, 53(3), 395-406.
Shrout, P. E., & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: new procedures and recommendations. Psychological methods, 7(4), 422.
Sontag, S., & Broun, H. H. (1978). Illness as metaphor (Vol. 3). Farrar, Straus and Giroux.
Stanton, A. L., & Snider, P. R. (1993). Coping with a breast cancer diagnosis: a prospective study. Health Psychology, 12(1), 16-23.
Stanton, A. L. (2006). Psychosocial concerns and interventions for cancer survivors. Journal of clinical oncology, 24(32), 5132-5137.
Tang, P. L., Mayer, D. K., Chou, F. H., & Hsiao, K. Y. (2016). The experience of cancer stigma in Taiwan: a qualitative study of female cancer patients. Archives of Psychiatric Nursing, 30(2), 204-209.
Tangney, J. P., Dearing, R. L., Wagner, P. E., & Gramzow, R. (1989). Test of self-conscious affect–3.
Tangney, J. P. (1990). Assessing individual differences in proneness to shame and guilt: development of the Self-Conscious Affect and Attribution Inventory. Journal of personality and social psychology, 59(1), 102.
Tangney, J. P. (1996). Conceptual and methodological issues in the assessment of shame and guilt. Behaviour Research and Therapy, 34(9), 741-754.
Tangney, J. P., & Dearing, R. L. (2003). Shame and guilt. The Guilford Press.
Telch, C. F., & Telch, M. J. (1986). Group coping skills instruction and supportive group therapy for cancer patients: a comparison of strategies. Journal of consulting and clinical psychology, 54(6), 802.
Tomkins, S. (1963). Affect imagery consciousness: Volume II: The negative affects (Vol. 1). Springer publishing company.
Trindade, I. A., Duarte, J., Ferreira, C., Coutinho, M., & Pinto‐Gouveia, J. (2018). The impact of illness‐related shame on psychological health and social relationships: Testing a mediational model in students with chronic illness. Clinical Psychology & Psychotherapy, 25(3), 408-414.
Trindade, I. A., Marta‐Simões, J., Ferreira, C., & Pinto‐Gouveia, J. (2018). Chronic illness‐related cognitive fusion explains the impact of body dissatisfaction and shame on depression symptoms in breast cancer patients. Clinical psychology & psychotherapy, 25(6), 886-893.
Trindade, I. A., Ferreira, C., & Pinto‐Gouveia, J. (2017). Chronic illness‐related shame: Development of a new scale and novel approach for IBD patients' depressive symptomatology. Clinical Psychology & Psychotherapy, 24(1), 255-263.
Wang, A. W. T., Cheng, C. P., Chang, C. S., Chen, D. R., Chen, S. T., Shieh, V., ... & Hsu, W. Y. (2016). Does the factor structure of the brief COPE fit different types of traumatic events? European Journal of Psychological Assessment, 34(3), 162-171.
White, Craig A. “Body Image Dimensions and Cancer: A Heuristic Cognitive Behavioural Model.” Psycho-oncology (Chichester, England) May 2000: 183–192. Web.
Williamson, T. J., Choi, A. K., Kim, J. C., Garon, E. B., Shapiro, J. R., Irwin, M. R., ... & Stanton, A. L. (2018). A longitudinal investigation of internalized stigma, constrained disclosure, and quality of life across 12 weeks in lung cancer patients on active oncologic treatment. Journal of Thoracic Oncology, 13(9), 1284-1293.
Yalom, M. (1997). A History of the Breast. (No Title).
Yan, M. H., Fan, Y., Chen, M., & Zhang, J. (2022). The mediating role of self‐efficacy in the association between perceived stigma and psychosocial adjustment: a cross‐sectional study among nasopharyngeal cancer survivors. Psycho‐Oncology, 31(5), 806-815.