Studies in Psychology

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Review Article


DOI :10.26650/SP2019-0025   IUP :10.26650/SP2019-0025    Full Text (PDF)

Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review

Samet Baş, Gülay Dirik

Cancer is a serious disease that brings with it important psychological problems as well as the negative effects on the physical health of survivors. Nowadays, psychological treatments reveal effective results on reducing such negative symptoms. Acceptance and Commitment Therapy (ACT) - one of the third wave behavioral and cognitive psychotherapies - is an important treatment approach in reducing the negative symptoms of cancer survivors. In particular, situations in which the disease itself and its adverse effects were accepted and the level of psychological flexibility was high were found to be associated with less negative symptoms and more positive outcomes such as adherence with the disease process. This study systemtically evaluated ACT based interventions on the psychological problems of cancer survivors. Fifteen studies that met the following criteria were examined in detail: using only a sample of cancer patients, having at least a pre-test and a post-test assessment, and an intervention involving basic components of ACT. The results showed that following the treatments, there were significant increases in psychological flexibility, posttraumatic growth, spirituality, quality of life and significant decreases in fear of recurrence, depression, anxiety, stress, emotional control, and thought suppression levels of patients when comparing both pre-treatment and control groups. Additionally, there were significant increases in mindfulness compared to pre-treatment results alone, but a significant decrease in pain and related symptoms, burnout, sleep problems and sedentary behaviors. ACT interventions, which can be applied both individually or in groups and over relatively short period of time, are promising as an alternative treatment for cancer patients to reduce their negative psychological symptoms as well as to increase their life expectancy and quality of life. However, in order to generalize the findings for different cancer patients and to increase the confidence of intervention, future studies should be more controlled, reliable and long-term.
Keywords: Cancer, acceptance and commitment therapy, psychological flexibility, systematic review
DOI :10.26650/SP2019-0025   IUP :10.26650/SP2019-0025    Full Text (PDF)

Kanser Tanısı Olan Kişilerde Kabul ve Kararlılık Terapisi Uygulamaları: Sistematik Bir Derleme

Samet Baş, Gülay Dirik

Kanser, bu hastalığa sahip olan kişilerin fiziksel sağlık durumları üzerindeki olumsuz etkilerin yanı sıra önemli psikolojik sorunları da beraberinde getiren ciddi bir hastalıktır. Günümüzde psikolojik tedaviler olumsuz belirtilerin azaltılmasında etkili sonuçlar ortaya koymaktadır. Üçüncü kuşak bilişsel davranışçı psikoterapilerden biri olan Kabul ve Kararlılık Terapisi kanser hastalarında belirtilerin azaltılmasında önemli bir tedavi yaklaşımıdır. Özellikle hastalığın kendisinin ve olumsuz etkilerinin kabul edildiği ve psikolojik esneklik düzeyinin yüksek olduğu durumlar daha az belirti ve hastalık sürecine uyum gösterme davranışında artış gibi olumlu sonuçlarla ilişkili bulunmaktadır. Bu çalışma kapsamında kanser hastalarının psikolojik sorunlarına yönelik uygulanmış Kabul ve Kararlılık Terapisi temelli tedavi yaklaşımları sistematik bir şekilde değerlendirilmiştir. Sadece kanser hastaları örneklemini, en az ön test ve son test ölçümleri ve Kabul ve Kararlılık Terapisinin temel bileşenlerini kapsayan bir müdahaleyi kullanmak gibi içleme kriterlerini karşılayan on beş çalışma detaylı olarak incelenmiştir. Sonuçlar, uygulanan tedaviler sonrasında hem tedavi öncesine hem de kontrol gruplarına kıyasla kanser hastalarının psikolojik esneklik, travma sonrası gelişim, maneviyat ve yaşam kalitesi düzeylerinde anlamlı artışlar olduğunu; hastalığın tekrar edeceği korkusu, depresyon, kaygı, stres, duygusal kontrol ve düşünceleri bastırma davranışlarında ise anlamlı azalmalar olduğunu göstermektedir. Ayrıca, sadece tedavi öncesine göre farkındalık düzeylerinde artış gözlenirken, ağrı ve ilişkili belirtiler, tükenmişlik, uyku sorunları ve hareketsiz yaşam tarzında anlamlı azalmalar görülmüştür. Hem bireysel hem de grup olarak nispeten kısa süreli bir şekilde uygulanabilen Kabul ve Kararlılık Terapisi temelli müdahale yöntemleriyle kanser hastalarının olumsuz psikolojik belirtileri azaltılabilir ve bunun yanında yaşama dair beklentilerinin ve yaşam kalitelerinin artması sağlanabilir. Ancak müdahalenin güvenirliğinin artması ve farklı kanser hastalarına genellenebilmesi için gelecekte yöntemsel açıdan daha kontrollü ve terapi kazanımlarının daha uzun dönemli olarak takip edileceği çalışmalara ihtiyaç duyulmaktadır. 
Keywords: Kanser, kabul ve kararlılık terapisi, psikolojik esneklik, sistematik derleme

EXTENDED ABSTRACT


Studies indicate that cancer causes a negative effect on both the physical and psychological health status of patients. Meta-analysis and review studies demonstrate that psychological therapies show promising effects on reducing the stress levels of cancer survivors and increasing their quality of life (De la Torre-Luque, Gambara, López & Cruzado, 2015; Linden & Girgis, 2012). The concept of acceptance has an important role in the course of the cancer disease. This concept includes acceptance of both the disease itself and the altered body image after treatment (e.g., as common in breast cancer patients). Research indicates that acceptance of the cancer disease increases the commitment to cancer and treatment process (Kamińska et al., 2014). Although Acceptance and Commitment Therapy (ACT) interventions are quite limited, they are promising as an important alternative treatment in reducing the symptoms of cancer survivors (Fashler, Weinrib, Azam ve Katz, 2018). More detailed studies such as systematic reviews or meta-analyses are needed to examine the existing studies in terms of methodological issues and study results. For this reason, a systematic review was carried out in examining the current status of ACT-based treatment studies in the context of cancer patients.

Method

The EBSCOhost, Web of Science, PubMed, Science Direct and Google Scholar, ULAKBIM, and TR Dizin databases were used to search examples of literature which included studies up to August 2018. The keywords “cancer” and “acceptance and commitment therapy” or “ACT” were used for studies in English and Turkish languages. A total of 205 studies were identified with this search, and then repeated articles were excluded. Following the title and summary review, articles which did not meet the inclusion criteria were excluded. The full text of the remaining 15 studies were examined in detail.

Results

In total, 1200 people with different types of cancer (mainly breast cancer), were included and various ACT based interventions were implemented through the remaining 15 studies. Almost two thirds of the participants were female (N = 745; 62%) and mainly adults between the ages 12-75 (M = 49.8). The findings were gathered according to their common goals such as psychological flexibility, psychological symptoms and fear of recurrence etc. Eight of the nine studies (89%) measuring psychological flexibility showed significant increases within the group compared to the pre-test and post-test and the gains were maintained for up to 12 months. In all four studies - including the control group - significant differences were observed between the groups and the gains of the treatment group were maintained for up to six months.

In eight studies measuring depression (89%), within group differences decreased significantly after ACT treatment and gains remained for up to three months. In addition, in four of the five studies (80%) using the control group, the differences between the groups decreased significantly for depression. The gains were maintained for up to three months after treatment. In seven of the eight studies (88%) measuring anxiety levels, significant differences were found within the group, while the gains were maintained in the three-month follow-up assessment. In the control group comparisons, in three of the five studies (60%), the differences between the groups significantly decreased in terms of anxiety level. The gains were maintained in follow up assessments up to three months later. For stress, significant improvements were observed within the group in four studies, while the gains were maintained for up to 12 months. However, in the comparison of the control group, differences between the groups were significant only in one study. These gains continued for up to three months.

Significant improvements were found in quality of life and related variables in all eight studies following the ACT treatment. In addition, treatment gains were maintained for up to 12 months. In terms of group differences, in three studies using no-treatment and treatment as the usual control conditions, significant differences were found between the groups in post-test and follow-up assessments for up to six months. Only in the study with normal care control groups, was there no significant difference between the groups in quality of life. In addition to these factors, studies showed that there were significant improvements in posttraumatic growth, spirituality, recurrence anxiety, emotional control and suppression of thoughts compared to both pre-treatment and control groups. Moreover, significant improvements were observed in mindfulness, pain and related symptoms, burnout, sleep problems, and sedentary behaviors compared to the only pre-treatment group. All the gains were maintained after the interventions for an average of 4.1 months for within groups and 5 months on a between-groups basis.

Discussion

As a result, ACT based intervention methods show effective results in reducing the psychological problems of survivors with different types of cancer as a new treatment approach. Although the results show that ACT is an effective treatment for many symptoms of cancer survivors, more controlled, randomized and long-term studies are needed.


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APA

Baş, S., & Dirik, G. (2019). Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review. Studies in Psychology, 39(2), 459-485. https://doi.org/10.26650/SP2019-0025


AMA

Baş S, Dirik G. Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review. Studies in Psychology. 2019;39(2):459-485. https://doi.org/10.26650/SP2019-0025


ABNT

Baş, S.; Dirik, G. Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review. Studies in Psychology, [Publisher Location], v. 39, n. 2, p. 459-485, 2019.


Chicago: Author-Date Style

Baş, Samet, and Gülay Dirik. 2019. “Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review.” Studies in Psychology 39, no. 2: 459-485. https://doi.org/10.26650/SP2019-0025


Chicago: Humanities Style

Baş, Samet, and Gülay Dirik. “Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review.” Studies in Psychology 39, no. 2 (May. 2024): 459-485. https://doi.org/10.26650/SP2019-0025


Harvard: Australian Style

Baş, S & Dirik, G 2019, 'Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review', Studies in Psychology, vol. 39, no. 2, pp. 459-485, viewed 21 May. 2024, https://doi.org/10.26650/SP2019-0025


Harvard: Author-Date Style

Baş, S. and Dirik, G. (2019) ‘Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review’, Studies in Psychology, 39(2), pp. 459-485. https://doi.org/10.26650/SP2019-0025 (21 May. 2024).


MLA

Baş, Samet, and Gülay Dirik. “Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review.” Studies in Psychology, vol. 39, no. 2, 2019, pp. 459-485. [Database Container], https://doi.org/10.26650/SP2019-0025


Vancouver

Baş S, Dirik G. Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review. Studies in Psychology [Internet]. 21 May. 2024 [cited 21 May. 2024];39(2):459-485. Available from: https://doi.org/10.26650/SP2019-0025 doi: 10.26650/SP2019-0025


ISNAD

Baş, Samet - Dirik, Gülay. “Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review”. Studies in Psychology 39/2 (May. 2024): 459-485. https://doi.org/10.26650/SP2019-0025



TIMELINE


Submitted14.03.2019
First Revision19.03.2019
Last Revision07.08.2019
Accepted12.08.2019
Published Online13.12.2019

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