An Acceptance and Commitment Therapy (ACT) group intervention for cancer survivors experiencing anxiety at re‐entry

Arch, Joanna J.; Mitchell, Jill

doi:10.1002/pon.3890

Cited by 87 publications

(131 citation statements)

References 33 publications

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“…Reducing avoidance and replacing it with more effective cognitive and emotional processing strategies may be particularly helpful soon after diagnosis. Studies suggest that acceptance‐based interventions improve the quality of life of individuals with cancer (Arch & Mitchell, ; Bower et al ., ; Feros, Lane, Ciarrochi, & Blackledge, ), as do approaches targeting stressor‐related emotional expression and reappraisal (e.g., Antoni et al ., ; Stanton, Danoff‐Burg, Sworowski, et al ., ). Future studies could investigate the effectiveness of similar interventions for resolution of unwanted intrusions and avoidance for women coping with a recent breast cancer diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Stuck in the spin cycle: Avoidance and intrusions following breast cancer diagnosis

Bauer

Wiley

Weihs

et al. 2017

British J Health Psychol

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These findings provide empirical support for the theoretical contention that avoidance and intrusive thoughts and emotions reciprocally influence one another following stressful events. Additionally, in the months shortly after breast cancer diagnosis, intrusions and avoidance are positively related. However, the relationships attenuate over time, which could indicate resolved cognitive and emotional processing of the cancer experience. Statement of contribution What is already known on this subject? Following stressful life events, individuals often experience intrusive thoughts and feelings related to the event and they report avoidance of such reminders. Many studies demonstrate that greater intrusions predict more subsequent use of avoidance coping, and other studies show that greater use of avoidance predicts more intrusions. Their reciprocal relation has not been examined, however. What does this study add? This is the first examination of the concurrent, reciprocal influence of intrusions and avoidance. Findings suggest that accounting for the bidirectional influence of avoidance and intrusions best estimates hypothesized models. Higher intrusions and avoidance predicted each other for the first 3 months after study entry, but the relationship diminished 6 months after study entry, perhaps due to productive mental processing of the stress of breast cancer diagnosis and treatment.

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Section: Discussionmentioning

confidence: 99%

Stuck in the spin cycle: Avoidance and intrusions following breast cancer diagnosis

Bauer

Wiley

Weihs

et al. 2017

British J Health Psychol

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“…The Reassurance Seeking subscale (3 items) and Coping Strategies subscale (9 items) measure coping responses that may influence FCR severity. Cancer‐related avoidant coping was measured using the 17‐item Cancer Acceptance and Action Questionnaire with items rated on a 7‐point scale (with 1 indicating never true and 7 indicating always true) . Distress measures included the Generalized Anxiety Disorder 7‐item scale and 8‐item Patient Health Questionnaire‐8 depression scale, both of which are rated on a 4‐point scale (with 0 indicating not at all and 3 indicating nearly every day), and the 22‐item Impact of Event Scale–Revised to assess post‐traumatic stress as rated on a 5‐point scale (with 0 indicating not at all and 4 indicating extremely).…”

Section: Methodsmentioning

confidence: 99%

“…Unlike CBT, which aims to change unhelpful thoughts and feelings, ACT emphasizes acceptance while living mindfully according to one's values. Although research has suggested that ACT may improve distress symptoms and QOL in patients with cancer, to the best of our knowledge only 3 studies to date have applied ACT to FCR . Although effect sizes were promising (range, 0.33‐0.66), 2 studies were nonrandomized, 2 studies used a resource‐intensive individual format, and 1 study was an ACT‐metacognitive therapy hybrid .…”

Section: Introductionmentioning

confidence: 99%

“…Although research has suggested that ACT may improve distress symptoms and QOL in patients with cancer, [23][24][25][26] to the best of our knowledge only 3 studies to date have applied ACT to FCR. [27][28][29] Although effect sizes were promising (range, 0.33-0.66), 2 studies were nonrandomized, 27,28 2 studies used a resource-intensive individual format, 27,29 and 1 study was an ACT-metacognitive therapy hybrid. 29 The current randomized controlled pilot trial assessed the feasibility and preliminary efficacy of group-based ACT for FCR in BCS compared with survivorship education (SE) and enhanced usual care (EUC).…”

Section: Introductionmentioning

confidence: 99%

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Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3‐arm pilot randomized controlled trial

Johns

Stutz

Talib

et al. 2019

Cancer

102

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Background Fear of cancer recurrence (FCR) has a profound negative impact on quality of life (QOL) for many cancer survivors. Breast cancer survivors (BCS) are particularly vulnerable, with up to 70% reporting clinically significant FCR. To the authors' knowledge, evidence‐based interventions for managing FCR are limited. Acceptance and commitment therapy (ACT) promotes psychological flexibility in managing life's stressors. The current study examined the feasibility and preliminary efficacy of group‐based ACT for FCR in BCS. Methods Post‐treatment BCS (91 patients with stage I‐III disease) with clinical FCR randomly were assigned to ACT (6 weekly 2‐hour group sessions), survivorship education (SE; 6 weekly 2‐hour group sessions), or enhanced usual care (EUC; one 30‐minute group coaching session with survivorship readings). FCR severity (primary outcome) and avoidant coping, anxiety, post‐traumatic stress, depression, QOL, and other FCR‐related variables (secondary outcomes) were assessed at baseline (T1), after the intervention (T2), 1 month after the intervention (T3), and 6 months after the intervention (T4) using intent‐to‐treat analysis. Results Satisfactory recruitment (43.8%) and retention (94.5%) rates demonstrated feasibility. Although each arm demonstrated within‐group reductions in FCR severity over time, only ACT produced significant reductions at each time point compared with baseline, with between‐group differences at T4 substantially favoring ACT over SE (Cohen d for effect sizes, 0.80; P < .001) and EUC (Cohen d, 0.61; P < .01). For 10 of 12 secondary outcomes, only ACT produced significant within‐group reductions across all time points. By T4, significant moderate to large between‐group comparisons favored ACT over SE and EUC with regard to avoidant coping, anxiety, depression, QOL, and FCR‐related psychological distress. Conclusions Group‐based ACT is a feasible and promising treatment for FCR and associated outcomes in BCS that warrants testing in larger, fully powered trials.

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“…A recent literature review by Hulbert-Williams, Storey & Wilson (2015) suggested that the inconsistency in effectiveness of interventions for cancer-related distress may be due to a reliance on problem-focussed intervention frameworks, and that third-wave approaches such as Acceptance and Commitment Therapy (ACT) may hold potential. In cancer samples specifically, interventions that utilise ACT-based techniques have been shown to feasible for delivery in community care settings (Arch & Mitchell, 2015) and of benefit in improving mood and quality of life (e.g. Rost et al, 2012;Feros et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Unmet psychosocial supportive care needs and psychological distress in haematological cancer survivors: The moderating role of psychological flexibility

Swash

Bramwell

Hulbert‐Williams

2017

Journal of Contextual Behavioral Science

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BackgroundThe period immediately after the end of cancer treatment is a time when supportive care for the cancer patient decreases; this is known to increase risk of psychological distress and poor wellbeing.While there is broad recognition that unmet psychological and supportive care needs correlate with psychological wellbeing, little is understood about the factors that influence this relationship. This study explores the role of psychological flexibility, with a particular focus on its potential moderating role between unmet needs and psychological distress in haematological cancer survivors. Materials and MethodHaematological cancer survivors were recruited for this cross-sectional study through two major UK blood cancer charities. Participants (n=91) were all over the age of 16 and had been diagnosed with any sub-type of haematological cancer more than 18 months previously. Participants completed selfreport questionnaires assessing unmet psychological and supportive care needs (SCNS SF34), anxiety and depression (HADS), quality of life (EORTC QLQ-C30) and psychological flexibility (AAQ II). ResultsHigh levels of both unmet need and distress were present in the sample, indicating on-going care needs for these cancer survivors. Statistically significant correlations between unmet needs, psychological flexibility and all outcome variables (anxiety, depression, quality of life) were found.Using regression analysis based on Hayes' methodology (Hayes, 2013), psychological flexibility was found to act as a moderator between unmet need and distress in four out of 15 models; specifically, the statistical relationship between need and distress emerged only when levels of psychological flexibility were at average level or above. DiscussionHaematological cancer survivors have on-going supportive care needs that persist well beyond the end of active treatment. Unmet needs can, in turn, increase levels of anxiety and depression, and reduce quality of life in this patient group. The understanding offered by our data that psychological flexibility plays a moderating relationship between need and psychological distress creates opportunities for the development of theoretically-informed interventions to reduce both unmet need and distress in cancer patients. As such, these findings support the growing emphasis on Acceptance and Commitment based interventions for cancer patients.

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An Acceptance and Commitment Therapy (ACT) group intervention for cancer survivors experiencing anxiety at re‐entry

Cited by 87 publications

References 33 publications

Stuck in the spin cycle: Avoidance and intrusions following breast cancer diagnosis

Stuck in the spin cycle: Avoidance and intrusions following breast cancer diagnosis

Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3‐arm pilot randomized controlled trial

Unmet psychosocial supportive care needs and psychological distress in haematological cancer survivors: The moderating role of psychological flexibility

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