Presence and predictors of anxiety disorder onset following cancer diagnosis among anxious cancer survivors

Arch, Joanna J.; Genung, Sarah R.; Ferris, Michelle; Kirk, Alex; Slivjak, Elizabeth; Fishbein, Joel N.; Schneider, Rebecca L.; Stanton, Annette L.

doi:10.1007/s00520-020-05297-0

Cited by 14 publications

(13 citation statements)

References 37 publications

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“…As noted, the professional research assistant who was unblinded to a given participant's condition assignment did not participate in the MINI discussion for that participant. Baseline MINI findings were published separately (Arch et al, 2020). This document is copyrighted by the American Psychological Association or one of its allied publishers.…”

Section: Outcome: Psychological Disordersmentioning

confidence: 99%

Randomized trial of acceptance and commitment therapy for anxious cancer survivors in community clinics: Outcomes and moderators.

Arch¹,

Mitchell

Genung³

et al. 2021

Journal of Consulting and Clinical Psychology

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Objective: Anxiety symptoms are common among cancer survivors. This study evaluated whether an acceptance-based group intervention delivered by social workers in community oncology clinics improved anxiety and related symptoms, and healthcare use, relative to enhanced usual care (EUC). Method: This multi-site trial included 135 survivors of various cancers with moderate to high anxiety about cancer/ survivorship, 1.5-24 months after treatment. Participants were randomized 1:1 to a 7-session acceptance and commitment therapy (ACT)-based group (Valued Living) or EUC (access to onsite supportive care plus resource list). Questionnaires were administered at baseline, 1, 2, 5, and 8 months post-randomization, diagnostic interviews at baseline, 2, and 8 months, and healthcare use tracked throughout. Outcomes included anxiety symptoms (primary), related symptoms, and healthcare use. Putative moderators included age, anxiety, and avoidance. Results: In intent-to-treat comparisons to EUC, Valued Living (VL) showed a nonsignificant pattern of greater improvement on anxiety symptoms ( p = .08), improved significantly more on cancer-related post-traumatic stress ( p = .002), fear of recurrence ( p = .003), and energy/fatigue ( p = .02), and missed significantly fewer medical appointments ( p < .05). Conditions improved similarly on depressive symptoms, sense of meaning, and most severe anxiety or depressive disorder. Effects were moderated: VL participants with higher baseline anxiety or avoidance (+1SD) improved more on anxiety, meaning ( p s ≤ .01), and disorder severity ( p = .05) than their EUC counterparts. Conclusions: An acceptance-based group intervention delivered in community oncology clinics enhanced psychological recovery and energy levels, and reduced missed medical appointments for anxious cancer survivors, with stronger effects for more distressed participants. Public Health SignificanceThis trial demonstrated that an acceptance and commitment therapy (ACT)-based group intervention for anxious cancer survivors, as delivered by clinical social workers in community cancer care clinics, accelerated psychological recovery and energy levels, and reduced missed medical appointments. The effects were stronger and broader for more anxious and avoidant participants, demonstrating that cancer survivors with more pronounced psychological symptoms benefitted most.

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Section: Outcome: Psychological Disordersmentioning

confidence: 99%

Randomized trial of acceptance and commitment therapy for anxious cancer survivors in community clinics: Outcomes and moderators.

Arch¹,

Mitchell

Genung³

et al. 2021

Journal of Consulting and Clinical Psychology

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“…The present study applies these methodological recommendations and advances in a mediation analysis of the Valued Living RCT (Arch et al, 2021). This RCT tested group-based ACT vs. minimally-enhanced usual care (MEUC) for anxious adults who recently completed cancer treatment and were transitioning into cancer survivorship, a challenging period wherein some cancer survivors experience a new onset or continuation of clinically significant anxiety disorders and related symptoms (e.g., Arch et al, 2020). The community oncology clinic setting where this study was conducted reflects the type of real-world setting where most U.S. cancer patients receive treatment (Petrelli, 2010) and thus would likely encounter cancer-specific supportive interventions.…”

Section: Intervention and Mediation Effects Of Target Processes In A Randomized Controlled Trial Of Acceptance And Commitment Therapy Formentioning

confidence: 99%

Intervention and Mediation Effects of Target Processes in a Randomized Controlled Trial of Acceptance and Commitment Therapy for Anxious Cancer Survivors in Community Oncology Clinics

Fishbein¹,

Judd²,

Genung³

et al. 2021

Preprint

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Objective: Acceptance and Commitment Therapy (ACT) is a promising intervention for cancer survivors, but its mechanisms in real-world settings are not fully understood. This study examined ACT-specific and broader target processes as mediators in the Valued Living randomized controlled trial, which compared ACT and usual care for anxious cancer survivors in a real-world community oncology setting.Method: Two ACT-specific target processes (experiential avoidance and values-aligned behavior, each measured with two validated instruments) and two broader target processes (emotional approach coping and self-compassion) were analyzed at Pre- and Post-intervention as predictors and mediators of anxiety symptoms, cancer-related trauma symptoms, and fear of cancer recurrence in a causal steps framework (n = 117). Results: During the intervention, ACT participants improved significantly more than usual care participants on the broader target processes (ps <= .035) but not the ACT-specific target processes (ps >= .080). Cancer-related emotional approach coping mediated cancer-related trauma symptoms and fear of recurrence (ps .043-.044). Self-compassion mediated fear of recurrence (p = .045), and showed marginal patterns for trauma symptoms (p = .059) and anxiety symptoms (p = .084).Conclusion: ACT may work in real-world settings for cancer survivors by promoting self-compassion and coping through emotional processing and expression.

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“…Por otro lado, las correlaciones efectuadas entre las variables corroboran que la ansiedad se asocia estadística y positivamente con la depresión [5][6][7] . En cuanto a la activación conductual, mostró una asociación negativa de magnitud moderada en ambas variables.…”

Section: Discussionunclassified

“…Padecer una enfermedad oncológica no solo conlleva un deterioro físico y el cese de las actividades de la vida cotidiana, propio de la actividad tumoral o los efectos secundarios del tratamiento médico, sino también enfrentar problemáticas sociales y limitaciones económicas, que propician síntomas de estrés, ansiedad, depresión e incluso mayor riesgo de mortalidad [1][2][3][4] . Aunque la ansiedad y la depresión son problemas que pueden llegar a presentar los pacientes a lo largo del proceso de enfermedad, aun queda mucho por conocer sobre estos trastornos, por ejemplo, identificar las variables predictoras relacionadas con su origen y gravedad, así como desarrollar estrategias de valoración psicológica para su detección oportuna previo y posterior a un diagnóstico de cáncer [5][6][7] . Si bien existen protocolos de intervención con evidencia de su eficacia como la terapia de activación conductual 8,9 , la identificación de las variables relacionadas al cáncer y su asociación con la depresión y la ansiedad, figurarán como elementos que, más allá de predecirlos, permitirán el desarrollo de intervenciones ajustadas a las problemáticas reales que viven en su día a día y como parte del proceso de la enfermedad.…”

Section: Introductionunclassified

Depresión, ansiedad y activación conductual en pacientes oncológicos mexicanos: comparaciones y factores predictores

Becerra-Gálvez¹,

Ortiz²,

Campos-González³

et al. 2023

GAMO

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Presence and predictors of anxiety disorder onset following cancer diagnosis among anxious cancer survivors

Cited by 14 publications

References 37 publications

Randomized trial of acceptance and commitment therapy for anxious cancer survivors in community clinics: Outcomes and moderators.

Randomized trial of acceptance and commitment therapy for anxious cancer survivors in community clinics: Outcomes and moderators.

Intervention and Mediation Effects of Target Processes in a Randomized Controlled Trial of Acceptance and Commitment Therapy for Anxious Cancer Survivors in Community Oncology Clinics

Depresión, ansiedad y activación conductual en pacientes oncológicos mexicanos: comparaciones y factores predictores

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