The Role of Emotional Entitlement, Gratitude, and Social Support in Psychological Adjustment During Radiotherapy: A Longitudinal Study.

A cancer diagnosis is frequently accompanied by significant psychological distress, particularly during radiotherapy (RT). Given that many established risk factors for distress are largely immutable, identifying resilience resources that promote adjustment during RT is a central clinical priority. The present longitudinal study examined whether emotional entitlement, gratitude, and perceived social support predict end-of-treatment anxiety, depression, and life satisfaction beyond baseline psychological status. Participants were 146 cancer patients undergoing RT (Mean age = 56.17 years, SD = 11.65; 89.9% female). Data were collected at three time points across the RT regimen: at the pre-treatment RT simulation session, during the first RT session, and at treatment completion, approximately 3-6 weeks later. Measures included anxiety and depression symptoms, life satisfaction, emotional entitlement, gratitude, and perceived social support. Results indicated that anxiety decreased and life satisfaction increased from baseline to treatment completion, whereas depressive symptoms remained stable over time. Hierarchical regression analyses were performed to predict post-treatment outcomes while controlling baseline levels of the respective variables. Across all models, baseline psychological status emerged as a robust predictor of end-of-treatment outcomes. However, resilience resources contributed additional explanatory power for depression and life satisfaction. Higher emotional entitlement to positive emotions predicted greater life satisfaction and lower depressive symptoms, whereas reduced perceived friend support was associated with higher depression. Unexpectedly, higher gratitude was associated with lower life satisfaction at treatment completion. In contrast, anxiety was predicted exclusively by baseline anxiety. These findings suggest distinct predictive patterns across psychological outcomes during RT. Whereas end-of-treatment anxiety was predicted primarily by initial anxiety levels, depression and life satisfaction were also associated with modifiable emotional and interpersonal resources. The results underscore the importance of early psychological screening and targeted psychosocial interventions aimed at strengthening emotional resources and peer support during radiotherapy.