The Use of Acceptance and Commitment Therapy in Oncology Settings: A Narrative Review

Abstract

Various psychotherapeutic approaches have been developed to address the psychosocial stressors and distress associated with cancer diagnosis and treatment. One such approach, Acceptance and Commitment Therapy (ACT), may be particularly well suited to people with cancer as it offers a model of healthy adaptation to difficult circumstances. This paper provides a description and theoretical rationale for using ACT in psychosocial oncology care that emphasizes emotional distress and cancer-related pain and provides a narrative review of the current state of evidence for this setting. Six studies met eligibility criteria for inclusion in the review. The research designs included one case study, three pre-post cohort studies, and two randomized controlled trials. Cancer diagnoses of patients included breast cancer, ovarian cancer, colorectal cancer, and mixed cancer populations at various stages of disease progression or recovery. ACT interventions demonstrated significant improvements in symptoms including quality of life and psychological flexibility as well as reductions in symptoms including distress, emotional disturbances, physical pain, and traumatic responses. Overall, although there is limited published research currently available, there is some evidence to support ACT as an effective psychotherapeutic approach for cancer patients. Further research is needed for different cancer populations across the illness trajectory. Barriers to implementation are discussed.

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

“…Theoretically, reducing avoidant coping promotes psychological flexibility, allowing individuals to pursue more adaptive strategies to handle cancer‐related and other challenges . This interpretation is supported by the improvements in physical and mental QOL reported by ACT participants, which likely resulted from a combination of reduced anxiety and increased psychological flexibility . Both the SE and EUC groups demonstrated relatively weak reductions in FCR severity and secondary outcomes compared with individuals in the ACT group.…”

“…43 This interpretation is supported by the improvements in physical and mental QOL reported by ACT participants, which likely resulted from a combination of reduced anxiety and increased psychological flexibility. [23][24][25][26] Both the SE and EUC groups demonstrated relatively weak reductions in FCR severity and secondary outcomes compared with individuals in the ACT group. Both offered resources to indirectly manage FCR but did not directly promote adaptive coping with fearful thoughts and emotions, which may be key in addressing comorbid distress and FCR.…”

“…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, [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.…”

A feasible and acceptable multicultural psychosocial intervention targeting symptom management in the context of advanced breast cancer

“…15,16 Reduction in symptom severity is important for patients 17 and is in line with best clinical practice guidelines, 15 but may not be sufficient for maintaining or improving overall quality of life for advanced cancer patients because symptoms are likely to fluctuate and are expected to worsen toward end of life. 19 Acceptance and Commitment Therapy (ACT) is one framework that encompasses mindfulness to increase psychological acceptance of uncomfortable experiences that cannot be completely changed or removed (eg, pain that may worsen over time with advanced disease), while also promoting engagement in meaningful activities directed by personally chosen values across life domains such as family relationships, work, health, and so on. 19 Acceptance and Commitment Therapy (ACT) is one framework that encompasses mindfulness to increase psychological acceptance of uncomfortable experiences that cannot be completely changed or removed (eg, pain that may worsen over time with advanced disease), while also promoting engagement in meaningful activities directed by personally chosen values across life domains such as family relationships, work, health, and so on.…”

“…18 Some evidence suggests that mindfulness-based behavioral protocols may be particularly engaging for women with advanced breast cancer, as they promote increased acceptance of uncomfortable thoughts, feelings, and body sensation experiences that are unlikely to change or be fully remediated. 19 Acceptance and Commitment Therapy (ACT) is one framework that encompasses mindfulness to increase psychological acceptance of uncomfortable experiences that cannot be completely changed or removed (eg, pain that may worsen over time with advanced disease), while also promoting engagement in meaningful activities directed by personally chosen values across life domains such as family relationships, work, health, and so on. Emerging evidence supports the use of ACT with advanced cancer patients.…”