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Although a protective effect of reliable interpersonal relationships on existential distress has been established, evidence remains inconclusive for attachment insecurity as an underlying factor of persistent psychological distress. We tested a longitudinal model hypothesizing attachment avoidance as a mediator of high demoralization and anxiety over time. We studied 206 patients with advanced cancer (mean age=59.6, 61% female) participating in an intervention trial. Patients completed self-report measures for demoralization, anxiety, p

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