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Improving Psychological Adjustment Among Late-Stage Ovarian Cancer Patients: Examining the Role of Avoidance in Treatment

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Abstract

Data suggest that individuals dealing with a cancer diagnosis are less likely to suffer from depression, anxiety, and psychological distress when they cope with their condition from a stance of emotional and cognitive acceptance (e.g. Dunkel, et al., 1992; Stanton, et al., 2000). Although traditional CBT often includes some acceptance-oriented elements, recent variants of CBT, such as Acceptance and Commitment Therapy (ACT), have acceptance as a central focus. ACT targets emotional distress directly through acceptance of difficult thoughts and emotions. The current study is a preliminary comparison of ACT and treatment as usual (TAU) in the treatment of emotional distress among women with late-stage ovarian cancer. Forty-seven women diagnosed with Stage III or IV ovarian cancer were randomly assigned to one of two treatment conditions. Treatment consisted of 12 face-to-face meetings with a therapist, each following a TAU or ACT protocol. Results indicate that both groups showed improved mood and quality of life following the intervention. The ACT group showed significantly greater improvements compared to the TAU group. Furthermore, mediation analyses indicate that the effects of treatment were mediated by cognitive avoidance. Although the study is limited by the implementation of treatment in both conditions by a single therapist, the TAU group showed improvements that were consistent with effect sizes available in the literature, suggesting that the intervention was a credible and effective control treatment. These findings provide preliminary support for the use of ACT in ovarian cancer populations. Further work is needed to investigate the effectiveness in other oncology populations as well as investigate potential patient characteristics which may interact with these interventions.

Highlights

► We examined the efficacy of ACT in treating distress among patients with advanced cancer. ► ACT was at least as effective as TAU on all measures of psychological distress. ► Avoidance plays a significant mediating role in treatment outcomes.

Section snippets

Participants

Fifty-seven women with Stage III or IV ovarian cancer were invited to participate in the study. Ten declined to participate, either citing travel as an issue, as they were receiving their primary medical treatment elsewhere (n = 6), or a lack of interest (n = 4). Of the 47 participants, 31 completed the full treatment protocol and data collection. Twelve participants passed away during the course of the intervention protocol, and 4 transferred to home-based hospice care and were unable to continue.

Outcome Analytic Strategy

Hierarchical linear modeling (HLM) was the primary analytic method used to investigate outcomes and changes in processes using an intent-to-treat sample (Raudenbush and Bryk, 2001a, Raudenbush and Bryk, 2001b). The HLM analyses were conducted assuming a random intercept and slope, and allowing them to be correlated. Simpler models with uncorrelated slopes and intercepts and then a random intercept only model were tested and used if they were not significantly different from the more complex

Discussion

This study is one of few to attempt to evaluate and compare psychological interventions in the reduction of distress among women with late-stage ovarian cancer, and the only one to use an ACT treatment model. Our hypotheses were partially supported by the data. The ACT treatment group showed greater decreases in psychological distress compared to the TAU group, as well as higher reports of quality of life at the end of treatment. This change in quality of life is particularly notable, given

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