Network intervention analysis of anxiety-related outcomes and processes of acceptance and commitment therapy (ACT) for anxious cancer survivors

Objective: Psychotherapies like Acceptance and Commitment Therapy (ACT) are thought to target multiple clinical outcomes by intervening on multiple mechanistic process variables. However, the standard mediation approach does not readily model the potentially complex associations among multiple processes and outcomes. The current study is one of the first to apply network intervention analysis to examine the putative change processes of a psychotherapy. Methods: Using data from a randomized trial of ACT versus minimally-enhanced usual care for anxious cancer survivors, we computed pre-to post-intervention (n = 113) residualized change scores on anxiety-related outcomes (general anxiety symptoms, cancer-related trauma symptoms, and fear of cancer recurrence) and putative processes of the intervention (experiential avoidance, self-compassion, and emotional approach coping). We estimated a network model with intervention condition and residualized change scores as nodes. Results: Contrary to the expectation that intervention effects would pass indirectly to outcomes via processes, network analysis indicated that two anxiety-related outcomes of the trial may have acted as primary mechanisms of the intervention on other outcome and process variables. Conclusions: Network intervention analysis facilitated flexible evaluation of ACT's change processes, and offers a new way to test whether change occurs as theorized in psychotherapies.</p

Lived experiences of women reporting fatigue during PARP inhibitor maintenance treatment for advanced ovarian cancer: A qualitative study

OBJECTIVE: Oral PARP inhibitors (PARPi) have dramatically changed the treatment landscape for patients with advanced ovarian cancer. However, a subset of patients discontinue PARPi due to treatment-related fatigue. The current study sought to explore patients' lived experiences with fatigue on PARPi. METHODS: We conducted individual semi-structured interviews with N = 23 women receiving PARPi for advanced ovarian cancer who reported moderate to severe fatigue. Audiotaped interviews were transcribed and we used thematic analysis to code transcripts for emergent themes. RESULTS: Four overarching themes emerged. First, participants described their fatigue as milder than what they experienced on intravenous chemotherapy, but noted it consistently limited their daily activities, including work, and interfered with participation in family and social events. Second, fatigue negatively impacted participants' sense of self and identity. Third, most wanted to continue treatment and believed discontinuing PARPi would lead to a cancer recurrence or death. Finally, many participants reported that their support networks were unaware of their ongoing cancer treatment or the resulting fatigue; a situation that may prove isolating and result in reduced social support. CONCLUSIONS: Our findings underscore patients' persistent experience of fatigue on PARPi, the impact of fatigue on multiple domains of functioning, and a lack of understanding of side effects resulting from oral maintenance treatments among patients' social networks. Our findings highlight the need for interventions to address treatment-related fatigue to limit the negative impacts of fatigue on ovarian cancer patients' well-being

A brief educational intervention using acceptance and commitment therapy: Four injured athletes' experiences

The purpose of this study was to research the experiences of four injured athletes during their rehabilitation from ACL injuries and to examine the potential usefulness of an adapted ACT intervention in addressing individuals' adherence to rehabilitation protocols and their general psychological well-being. We investigated the usefulness of a brief, 4-session ACT program adapted for educational purposes and presented data as case studies. The case studies suggested that (a) the injured athletes experienced a multitude of private events immediately following injury, throughout their recovery, and when approaching a full return to sport; (b) the injured athletes typically avoided these private events and engaged in emotion-driven behaviors; (c) an adapted ACT approach for educational purposes could be useful on at least a basic level to help injured athletes accept private events, commit to rehabilitation behaviors, and have some certainty about returning to sport; and (d) more could be done to address the needs of injured athletes beyond the structure of our 4-session educational intervention. We concluded that the ACT-based intervention, to a certain extent, educated injured athletes about how to meet the challenges of their recoveries and how to commit to their rehabilitations, as well as to exhibit behaviors that would potentially permit their successful reentries to sport