Self-Conscious Emotions and Social Isolation Among Young Adult Cancer Survivors.
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OBJECTIVE: Young adults with cancer (YACs) experience psychological and psychosocial challenges related to cancer. In this qualitative study, we identified self-conscious emotions of guilt, shame and pride associated with psychosocial challenges in a sample of recent cancer survivors. We aim to inform the adaptation of psychotherapy interventions to support psychological adjustment to cancer through the regulation of self-conscious emotions. METHODS: We recruited 35 YACs (English-speaking, age 18-39, completed treatment 2-5 years prior) through YA cancer advocacy organizations. Participants completed a virtual semi-structured interview focused on personal identity, self-conscious emotions, and close relationships. We coded and analyzed the data using reflexive thematic analysis guided by the theory of self-conscious emotions and a narrative identity framework. RESULTS: Participants endorsed guilt, shame, and pride related to cancer and described the motivational impact of each on their relationships. Themes included: (1) Guilt, encompassing imposter syndrome, survivors' guilt, and guilt for perceived burden on caregivers, financial toxicity, disrupted milestones, and self-care. Guilt undermined relational closeness through the perception of "falling behind" peers and coping through social withdrawal. (2) Shame, centering on worsened body image and loss of physical function, was exacerbated by "body positivity" pressures. Effects of shame included reluctance toward intimacy and disclosure. (3) Pride emerged as a key driver in rebuilding personal identity, arising from awareness of resilience, recommitment to goals, and expansion of survivors' personal identity through empathy and advocacy. CONCLUSIONS: Based on these findings, we offer adaptations of psychotherapy tools to address guilt and shame, and to optimize pride.