To date, previous research has elucidated the impact of adult attachment type on marital relationships. However, the mechanisms underpinning the relationship between attachment type and marital adjustment in breast cancer patients remain unclear. In this study, a cohort of 272 breast cancer patients was surveyed using several instruments: the General Information Questionnaire, Revised Marital Adjustment Scale (RDAS), Adult Attachment Scale (AAS), Interpersonal Reactivity Indicator Scale (IRI), and Regulated Emotional Self-Efficacy Scale (RESS). We conducted moderated mediation analyses using the SPSS macro program PROCESS plug-in. Empathy was found to mediate the association between attachment type (attachment anxiety/attachment avoidance) and marital adjustment, with indirect effects of −0.141 (95% CI [−0.260, −0.063]) and 0.157 (95% CI [0.073,0.289]), respectively. Additionally, affect regulation self-efficacy was found to mediate the subsequent impact of attachment type (attachment anxiety/attachment avoidance) on marital adjustment via empathy, with moderated effects of 0.380 (95% CI [0.236, 0.525]) and 0.374 (95% CI [0.240, 0.509]), respectively. Consequently, the presence of insecure attachment in breast cancer patients appears to influence their empathy levels, thereby negatively impacting marital adjustment. Encouragingly, enhancing emotional regulation self-efficacy in patients holds the potential to mitigate these adverse effects. These findings contribute not only to a deeper theoretical understanding but also lay a solid foundation for practical interventions aimed at enhancing marital relationships among breast cancer patients.

The role of empathy and emotional regulation self-efficacy in adult attachment type and marital adjustment in breast cancer patients–a moderated mediation model