Examined attributions of behavioral and characterological self-blame and perceptions of control over disease progression and recurrence as predictors of symptoms of psychological distress (PSD) in 72 adults with cancer. Data were obtained near the time of diagnosis and at 4-mo follow-up. Initial levels of behavioral and characterological self-blame were unrelated to concurrent PSD. Initial characterological self-blame and the interaction of characterological and behavioral self-blame was predictive of PSD 4 mo later. Perceptions of control over cancer recurrence were unrelated to PSD near diagnosis or at follow-up, and control beliefs did not function as a mediator of self-blame. Initial levels of PSD predicted characterological but not behavioral self-blame at follow-up, suggesting a reciprocal relationship between characterological self-blame and distress.