Introduction: It is necessary to identify the factors affecting the posttraumatic growth of cancer patients to minimize the consequences of its psychological trauma. Positive cognitive reassessment of trauma (cancer) may support positive posttraumatic outcomes by enhancing posttraumatic growth. Objective: This study aimed to determine the structural relationships of coping styles, the collapse of core beliefs, social support, spirituality/religious coping with posttraumatic growth variables, and the mediating role of positive reassessment and deliberate mental rumination within a causal pattern. Materials and Methods: This cross-sectional study was performed using causal modeling methods, including path analysis and Structural Equation Modeling (SEM). By conveniance sampling method, we selected 213 patients with breast cancer in Mashhad, Iran, in 2019. In this study, the pattern of variables relationships was tested in a conceptual model by SEM. We also used the partial least squares regression method to test the measurement pattern and research hypotheses. In the measurement model section, three convergent validity indices, i.e., Average Variance Extracted (AVE), Composite Reliability (CR), and the Cronbach α, and in the structural model section, two indicators of coefficient of determination (R2) and Stone-Geisser coefficient (Q²). Also, the overall indices of the goodness of fit, normed fit index, and standardized root mean square residual were used for the model’s overall structure. Results: The mean±SD age of the patients was 52±16 years. About 57.9% of patients had received all three treatments of surgical therapy, radiotherapy, and chemotherapy. Also, 27.4% had a university education, 69.6% were married, and 31.3% were employed. The standardized coefficients of the overall effect of core beliefs pathways, positive religious coping, search for meaning, presence of meaning, deliberate rumination over positive re-evaluation were 0.953, 0.386, -0.250, 0.248, and 0.238, respectively (P=0.001). The direct coefficient of the positive reassessment path to posttraumatic growth was 0.085 (P=0.01). On the other hand, the standardized coefficients of the total effect for the collapse of core beliefs and intrusive rumination over deliberate rumination were 0.833 and 0.235 (P=0.0001), and the standardized coefficient of the overall effect of total deliberate rumination on posttraumatic growth was 0.066 (P=0.001). Also, the coefficient of collapse path of core beliefs to intrusive rumination was 0.687, which was significant at the level of P=0.0001. Finally, the standardized coefficients of the overall effect of all paths for negative religious coping, the collapse of core beliefs, presence of meaning, problem-based coping style, search for meaning, deliberate rumination, social support, positive religious coping, emotion-based coping, intrusive rumination over posttraumatic growth were -0.481, 0.227, 0.182, 0.146, -0.136, 0.066, 0.060, 0.059, 0.056, and -0.043, respectively (P=0.0001). Conclusion: The results of the present study showed that in addition to confirming the direct paths of independent variables (social support, religious coping, presence and search for meaning, problem-oriented coping, and emotion-oriented coping) to the posttraumatic growth, positive reassessment had a mediating role between pathways of the presence and search of meaning, conscious rumination, religious coping, the collapse of core beliefs in posttraumatic growth. Finally, intrusive rumination mediated between the collapse of core beliefs and posttraumatic growth.

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