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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鈥檛 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.

鈥淢any 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鈥檚 less common for others. When cancer recurs, it tends to be harder to treat, if not incurable,鈥� says Joanna Arch, associate clinical professor in the Department of Psychology and Neuroscience at CU Boulder. 鈥淭here is a lot of anxiety.鈥�

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.听

鈥淭hey 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,鈥� Arch says. 鈥淎nxiety has been shown to be elevated among many cancer survivors, and can remain elevated even 10 years after treatment.鈥�

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.

鈥淚t鈥檚 a newer behavioral therapy that incorporates a lot of the principles of mindfulness, but doesn鈥檛 necessarily involve a formal mindfulness practice,鈥� Arch says. 鈥淎fter 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.鈥�

For the trial, 135 cancer survivors reporting elevated anxiety鈥攁bout half of whom came from the Boulder-Longmont area鈥攚ere randomly assigned to receive seven weeks of a group-based ACT intervention called 鈥淰alued Living鈥� or to receive a list of supportive community resources to pursue on their own.

鈥淲e tracked cancer survivors for eight months and found that the ACT 鈥榁alued Living鈥� group led to greater improvement over time in fear of cancer recurrence, in energy levels and in cancer-related traumatic symptoms,鈥� Arch says. 鈥淎CT 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.鈥�

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.

鈥淚t鈥檚 about aligning behavior with values, even when fear shows up,鈥� Arch says. 鈥淚t helps people to align to their inner compass of what鈥檚 most important to them.鈥�

A second aim of the study was to conduct the trial in a community setting鈥攖he Rocky Mountain Cancer Center at Boulder Community Health in the case of local participants鈥攗sing their onsite social-work staff, Arch says.

鈥淭hat might not sound like a big deal. But the overwhelming majority of clinical trials occur in academic settings, using providers from an academic setting,鈥� she says. 鈥淩arely has it been done in community clinics like this.鈥�

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.听

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).听

鈥淲e 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,鈥� Arch says.