Acceptance and Commitment Therapy for Demoralization Syndrome and Cancer-related Trauma: A Randomized Clinical Trial Study

Abstract

Background: Many women with breast cancer in the process of diagnosing, treating, and surviving show psychological distress such as hopelessness and cancer-related stress. On the other hand, Acceptance and Commitment Therapy (ACT) as a psychological intervention provides a good model for coping with the disease. Objectives: This study aimed at investigating the effectiveness of ACT on demoralization syndrome and cancer-related trauma in patients with breast cancer and survivors. Methods: The present study was a clinical trial with pre-test and post-test. It was performed on 52 patients with breast cancer and survivors referred to the Golestan Cancer Patients Association in Gorgan in 2020. Initially, participants were selected by convenient sampling and randomly divided into two treatment groups (patients group and survivors group) and two control groups (patients group and survivors group). Then, the treatment groups underwent ACT for 8 consecutive weekly sessions, but the control groups did not receive any intervention. The data were obtained, using the Demoralization Scale (DS) and Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) and analyzed by multivariate analysis of covariance (MANCOVA). Results: The results of the study showed a significant difference in demoralization syndrome components and PCL-5 between the treatment groups of patients and survivors with control groups of patients and survivors (P < 0.05). Also, there was no significant difference between the treatment groups of patients and survivors in the components of demoralization and PCL-5 (P > 0.05) except for the feeling of failure component (P = 0.048). Conclusions: According to the results, using ACT as a complementary treatment along with medical treatment to prevent and reduce demoralization syndrome and cancer-related trauma is recommended in patients with breast cancer and survivors.

Systematic Review of Interventions for Demoralization in Patients With Cancer

“…The 14 included studies were conducted in the United States (Agin-Liebes et al, 2020; Nelson et al, 2019; Ross et al, 2016, 2021), Germany (Fraguell-Hernando et al, 2020; Mehnert et al, 2020), China (Li et al, 2020; Sun et al, 2021), Spain (Soto-Rubio et al, 2020), Ireland (Sarizadeh et al, 2021), Italy (Iani et al, 2020), Portugal (Juliao et al, 2017), Australia (Kissane et al, 2019), and Canada (Rodin et al, 2018). Nine studies were RCTs (Agin-Liebes et al, 2020; Iani et al, 2020; Juliao et al, 2017; Mehnert et al, 2020; Rodin et al, 2018; Ross et al, 2016, 2021; Sarizadeh et al, 2021; Soto-Rubio et al, 2020), four studies were pilot studies (Fraguell-Hernando et al, 2020; Kissane et al, 2019; Nelson et al, 2019; Sun et al, 2021), and one study was quasi-experimental study (Li et al, 2020). The sample size of each study ranged from 11 to 305 participants, with a total sample size of 1049 patients with cancer.…”

“…Only five studies described the method of generating allocation order. Three studies had an unclear bias in blinding of participants and personnel (Iani et al, 2020; Juliao et al, 2017; Sarizadeh et al, 2021). Two studies had an unclear bias in blinding of outcome measures (Iani et al, 2020; Soto-Rubio et al, 2020).…”

“…Two studies had an unclear bias in blinding of outcome measures (Iani et al, 2020; Soto-Rubio et al, 2020). Three studies had unclear risks in selective reporting (Iani et al, 2020; Juliao et al, 2017; Sarizadeh et al, 2021). Pilot and quasi-experimental studies have more sources of risk of bias compared with RCT studies.…”

“…Ireland (Sarizadeh et al, 2021), Italy (Iani et al, 2020), Portugal (Juliao et al, 2017), Australia (Kissane et al, 2019), and Canada (Rodin et al, 2018). Nine studies were RCTs (Agin-Liebes et al, 2020;Iani et al, 2020;Juliao et al, 2017;Mehnert et al, 2020;Rodin et al, 2018;Ross et al, 2016Ross et al, , 2021Sarizadeh et al, 2021;Soto-Rubio et al, 2020), four studies were pilot studies (Fraguell-Hernando et al, 2020;Kissane et al, 2019;Nelson et al, 2019;Sun et al, 2021), and one study was quasi-experimental study (Li et al, 2020).…”

“…The content of psychological interventions to improve demoralization in other studies varied widely, and the studies assessing these individualized interventions were relatively single and the sample sizes in the studies were small; thus, the significant effects of these interventions on improving demoralization should be considered with caution (Sarizadeh et al, 2021; Soto-Rubio et al, 2020). ACT is a third-generation cognitive and behavioral therapy (Ducasse and Fond, 2015).…”