CU Boulder study finds Acceptance and Commitment Therapy reduces symptoms of anxiety in cancer survivors
It should come as no surprise that receiving a cancer diagnosis and going through treatment can cause considerable anxiety in patients. But even after successful treatment, for many patients, that feeling doesn’t go away. A new kind of cognitive-based therapy may help alleviate those symptoms, though, according to a new study from the University of Colorado Boulder.
“Many cancer survivors live with anxiety in a number of areas, most prominently a fear that the cancer will come back. Some types of cancer recur commonly, while it’s less common for others. When cancer recurs, it tends to be harder to treat, if not incurable,” says Joanna Arch, associate clinical professor in the Department of Psychology and Neuroscience at CU Boulder. “There is a lot of anxiety.”
Recurrence of the disease is not the only worry for patients, according to Arch. Their bodies and minds may have been changed by treatment, and now they are looking at re-entering life, even going back to work. Diagnosis and treatment may have altered family roles, so that a former caregiver now receives care from his or her family. Financial worries.
“They are done with treatment; now what? They may go from being in the chemotherapy infusion room every week to seeing a doctor every three to six months and being largely on their own,” Arch says. “Anxiety has been shown to be elevated among many cancer survivors, and can remain elevated even 10 years after treatment.”
Arch and colleague Jill Mitchell, a clinical social worker at Rocky Mountain Cancer Centers in Boulder, recently concluded a clinical trial, now under peer review, which found that Acceptance and Commitment Therapy (ACT) can help address fear and anxiety in cancer survivors by helping them realize and respond to inaccurate or negative thinking.
The objective of ACT is not to eliminate unpleasant feelings, but rather to teach patients to be honest and be present with the discomfort, not to overreact and orient their behavior to reflect their values.
“It’s a newer behavioral therapy that incorporates a lot of the principles of mindfulness, but doesn’t necessarily involve a formal mindfulness practice,” Arch says. “After cancer treatment, there is a whole range of complicated feelings about what you just went through, and what the future holds. ACT cultivates a sense of acceptance of the full range of feelings and thoughts.”
For the trial, 135 cancer survivors reporting elevated anxiety—about half of whom came from the Boulder-Longmont area—were randomly assigned to receive seven weeks of a group-based ACT intervention called “Valued Living” or to receive a list of supportive community resources to pursue on their own.
“We tracked cancer survivors for eight months and found that the ACT ‘Valued Living’ group led to greater improvement over time in fear of cancer recurrence, in energy levels and in cancer-related traumatic symptoms,” Arch says. “ACT orients and supports, in this case, cancer survivors, to who they are and what they most care about, reorienting them to moving in the direction of their values.”
For example, a survivor may be terrified to go back for a scan to see if the cancer has recurred. But through ACT, the survivor recognizes that one of her core values is taking care of her health. So, she accepts her anxiety and goes for the scan.
“It’s about aligning behavior with values, even when fear shows up,” Arch says. “It helps people to align to their inner compass of what’s most important to them.”
A second aim of the study was to conduct the trial in a community setting—the Rocky Mountain Cancer Center at Boulder Community Health in the case of local participants—using their onsite social-work staff, Arch says.
It’s about aligning behavior with values, even when fear shows up"
“That might not sound like a big deal. But the overwhelming majority of clinical trials occur in academic settings, using providers from an academic setting,” she says. “Rarely has it been done in community clinics like this.”
Arch recently received a grant from the National Institutes of Health for a five-year clinical trial that will use ACT as an intervention for people experiencing anxiety or depression after being diagnosed with incurable cancer.
The primary focus of this new research will be completing advance directives (a written statement of wishes for medical treatment, like a living will), legal documents specifying what actions should be taken should the person become incapacitated, including designation of a durable power of attorney to ensure their wishes are carried out (requirements and forms vary from state to state).
“We hope to help anxious and depressed people with metastatic cancer take charge and complete advance directives in a way that reflects their core values, communicate their wishes to others and stimulate conversation,” Arch says.