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

Joel N Fishbein; Charles M Judd; Sarah Genung; Annette L Stanton; Joanna J Arch

doi:10.1016/j.brat.2022.104103

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

Behav Res Ther. 2022 Jun:153:104103. doi: 10.1016/j.brat.2022.104103. Epub 2022 Apr 28.

Authors

Joel N Fishbein¹, Charles M Judd², Sarah Genung², Annette L Stanton³, Joanna J Arch⁴

Affiliations

¹ Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO, 80309, USA. Electronic address: joel.fishbein@colorado.edu.
² Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO, 80309, USA.
³ Department of Psychology, University of California, 502 Portola Plaza, Los Angeles, CA, 90095, USA; Jonsson Comprehensive Cancer Center, University of California, 10833 Le Conte Ave, Los Angeles, CA, 90024, USA; Cousins Center for Psychoneuroimmunology, University of California, 300 Medical Plaza Driveway, Los Angeles, CA, 90095, USA; Department of Psychiatry and Biobehavioral Sciences, University of California, 757 Westwood Plaza #4, Los Angeles, CA, 90095, USA.
⁴ Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO, 80309, USA; Division of Cancer Prevention and Control, University of Colorado Cancer Center, 1665 Aurora Court, Aurora, CO, 80045, USA.

PMID: 35504144
DOI: 10.1016/j.brat.2022.104103

Abstract

Objective: Acceptance and Commitment Therapy (ACT) is a promising psycho-oncological intervention, but its mechanisms in real-world settings are not fully understood. This study examined core theorized ACT and broader ACT-consistent target processes as mediators of ACT versus minimally-enhanced usual care within a randomized trial for anxious cancer survivors in a community oncology setting.

Method: Two core theorized ACT target processes (experiential avoidance and values-aligned behavior, each measured with two instruments) and two broader ACT-consistent target processes (emotional approach coping and self-compassion) were analyzed at pre- and post-intervention as mediators of general anxiety symptoms, cancer-related trauma symptoms, and fear of cancer recurrence (N = 134).

Results: ACT led to greater increases on emotional approach coping (ps ≤ .001) and one measure of values-aligned behavior (ps ≤ .031), and marginal or greater improvement on self-compassion (ps ≤ .055), but not other core ACT target processes. Self-compassion and emotional approach coping mediated ACT's effects on cancer-related trauma symptoms (ps ≤ .037). Additionally, self-compassion, emotional approach coping, and values-aligned behavior marginally mediated fear of recurrence and general anxiety symptoms improvement (ps ≤ .088).

Conclusion: ACT reduced cancer survivors' anxiety-related symptoms, and especially cancer-related trauma symptoms, most consistently by promoting self-compassion and emotional approach coping.

Keywords: Acceptance and commitment therapy; Anxiety; Coping style; Experiential avoidance; Neoplasms; Self-compassion.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Acceptance and Commitment Therapy*
Adaptation, Psychological
Anxiety / therapy
Anxiety Disorders
Cancer Survivors* / psychology
Humans
Neoplasms* / psychology
Neoplasms* / therapy