How Emotional Granularity Helps Build Resilience in Young and Middle-Aged Colorectal Cancer Survivors

Overview

This study aims to understand how the ability to identify and describe specific emotions (called "emotional granularity") influences coping and adaptation ("resilience") in young and middle-aged colorectal cancer survivors. The main questions to be answer are: 1. How does emotional granularity help build resilience during cancer recovery? 2. How does emotion regulation contribute to resilience building? 3. What specific emotional needs and challenges do survivors experience? This is an observational study where no experimental treatments are provided. Participants will complete an online questionnaire about background, emotions, ways of managing emotions, and ability to cope with stress. A subset of participants will then be invited to take part in a private, 30-60 minute interview to share personal experiences and feelings in more detail.

Colorectal cancer (CRC) is a major global public health concern with rising incidence and mortality rates globally. While advances in treatment have improved survival rates, young and middle-aged survivors face unique and complex challenges, including severe emotional distress, disrupted social networks, work-related economic toxicity and concerns regarding fertility, that necessitate tailored psychosocial interventions. Resilience, defined as a dynamic psychosocial outcome enabling individuals to adapt to adversity, has emerged as a crucial determinant of quality of life among CRC survivors. Adaptive emotion regulation is fundamental to fostering resilience, yet existing emotional interventions have predominantly provided general emotion regulation strategies without addressing patients' proficiency in effectively applying these strategies. Emotional granularity, the ability to differentiate and label subtle emotional experiences, is posited to enhance emotion regulation efficacy. Therefore, to generate an evidence-based blueprint for emotion-focused psychosocial programs designed to strengthen resilience and enhance quality of life among young and middle-aged colorectal cancer survivors. This sequential mixed-methods investigation aims to clarify how emotional granularity influences resilience through emotion regulation, to explore survivors' emotional needs, and to provide evidence for the future intervention design. The inclusion criteria are (1) young and middle-aged adult patients (18-60 years); (2) patients diagnosed with CRC; (3) patients have completed primary treatments without experiencing a recurrence of CRC; and (4) patients able to use a smartphone and agree to participate in the study. The exclusion criteria are (1) patients who have not been informed of their cancer diagnosis due to family decision to withhold information; and (2) patients suffering from severe conditions that may affect participation or assessment. A cross-sectional questionnaire will first be employed to examine the mediating role of emotion regulation in the relationship between emotional granularity and resilience after providing informed consent. Measures will include demographic information and the Chinese versions of the Range and Differentiation of Emotional Experience Scale, the Difficulties in Emotion Regulation Scale and the 10-item Connor-Davidson Resilience Scale. A total of 236 participants will be recruited from teaching hospitals of Soochow University and Jiangsu University, Suzhou, Jiangsu province. Mediation analysis will examine whether emotion regulation channels the effect of emotional granularity on resilience. The second phase will involve individual, semi-structured interviews lasting thirty to sixty minutes each, purposively sampling 20-25 participants with high, medium and low scores from the first phase.