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The effect of acceptance and commitment therapy on anxiety and depression in patients with cancer: A systematic review

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Abstract

Depression and anxiety are common problems in patients with cancer which may interfere with the daily activities of these patients. Acceptance and Commitment Therapy (ACT) is a type of third-wave behavioral that increases psychological flexibility in relation to personal events. The aim of this study was to investigate the effect of ACT on the psychological distress of patients with cancer. In this study, a systematic review was conducted by searching the PubMed, Embase, Science Direct, Cochrane, CINHAL, Google Scholar, Scopus, SID, Mag Iran databases with no lower time limit and until May 2020. A total of 15 studies entered the final review with the total sample size of 965 of which 470, and 495 were in the ACT, and the comparison groups respectively. The results of the study showed that ACT in all studies reduced the mean score of anxiety and depression after treatment, as well as during follow-up. This reduction was significant in most studies. The present systematic review study showed that ACT can be used as an appropriate intervention in improving the psychological state of patients with cancer. In most studies that measured the effect size, the effect of the intervention on anxiety and depression was observed.

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Abbreviations

ACT:

Acceptance and Commitment Therapy

RCT:

Randomized Controlled Trials

BDI:

Beck Depression Inventory

CONSORT:

Consolidated Standards of Reporting Trials

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis.

References

  • Akizuki, N., Akechi, T., Nakanishi, T., Yoshikawa, E., Okamura, M., Nakano, T., Murakami, Y., & Uchitomi, Y. (2003). Development of a brief screening interview for adjustment disorders and major depression in patients with cancer. Cancer, 97(10), 2605–2613.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56(6), 893–897.

    Article  PubMed  Google Scholar 

  • Beck, A. T., Steer, R. A., & Carbin, M. G. (1988). Psychometric properties of the Beck depression inventory: Twenty-five years of evaluation. Clinical Psychology Review, 8(1), 77–100.

    Article  Google Scholar 

  • Bultz, B. D., & Carlson, L. E. (2006). Emotional distress: The sixth vital sign—Future directions in cancer care. Psycho-Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 15(2), 93–95.

    Article  Google Scholar 

  • Caparso, C., Appel, J., & Benkert, R. (2020). Dying concerns in young parents with advanced cancer (PWAC): A scoping review. Palliative & Supportive Care, 19, 93–102.

    Article  Google Scholar 

  • Coto-Lesmes, R., Fernández-Rodríguez, C., & González-Fernández, S. (2020). Acceptance and commitment therapy in group format for anxiety and depression. A systematic review. Journal of Affective Disorders, 263, 107–120.

    Article  PubMed  Google Scholar 

  • Datta, A., Aditya, C., Chakraborty, A., Das, P., & Mukhopadhyay, A. (2016). The potential utility of acceptance and commitment therapy (ACT) for reducing stress and improving wellbeing in patients with cancer in Kolkata. Journal of Cancer Education: the Official Journal of the American Association for Cancer Education, 31(4), 721–729.

    Article  PubMed  Google Scholar 

  • Davies, K. S. (2011). Formulating the evidence-based practice question: A review of the frameworks. Evidence Based Library and Information Practice, 6(2), 75–80.

    Article  Google Scholar 

  • Fernández-Rodríguez, C. et al. (2020). Behavioral activation and acceptance and commitment therapy in the treatment of anxiety and depression in cancer survivors: a randomized clinical trial. Behavior Modification, 145445520916441.

  • Feros, D. L., Lane, L., Ciarrochi, J., & Blackledge, J. T. (2013). Acceptance and commitment therapy (ACT) for improving the lives of patients with cancer: A preliminary study. Psycho-Oncology, 22(2), 459–464.

    PubMed  Google Scholar 

  • González-Fernández, S., Fernández-Rodríguez, C., Paz-Caballero, M. D., & Pérez-Álvarez, M. (2018). Treating anxiety and depression of cancer survivors: Behavioral activation versus acceptance and commitment therapy. Psicothema, 30(1), 14–20.

    PubMed  Google Scholar 

  • Hajsadeghi, Z., BassakNejad, S., & Razmjoo, S. (2017). The effectiveness of acceptance and commitment group therapy on depression and anxiety among women with breast cancer. Pajouhan Scientific Journal, 15(4), 42–49.

    Google Scholar 

  • Hamer, M., Chida, Y., & Molloy, G. J. (2009). Psychological distress and cancer mortality. Journal of Psychosomatic Research, 66(3), 255–258.

    Article  PubMed  Google Scholar 

  • Hawkes, A. L., Pakenham, K. I., Chambers, S. K., Patrao, T. A., & Courneya, K. S. (2014). Effects of a multiple health behavior change intervention for colorectal Cancer survivors on psychosocial outcomes and quality of life: A randomized controlled trial. Annals of Behavioral Medicine, 48(3), 359–370.

    Article  PubMed  Google Scholar 

  • Hawkins, N. A., Soman, A., Buchanan Lunsford, N., Leadbetter, S., & Rodriguez, J. L. (2017). Use of medications for treating anxiety and depression in cancer survivors in the United States. Journal of Clinical Oncology, 35(1), 78–85.

    Article  PubMed  Google Scholar 

  • Hayes, S. C., & Hofmann, S. G. (2017). The third wave of cognitive behavioral therapy and the rise of process–based care. Word Psychiatry, 16(3), 245–246.

    Article  Google Scholar 

  • Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25.

    Article  PubMed  Google Scholar 

  • Hayes, S. C., Pistorello, J., & Levin, M. E. (2012). Acceptance and commitment therapy as a unified model of behavior change. The Counseling Psychologist, 40(7), 976–1002.

    Article  Google Scholar 

  • Hopko, D. R., Cannity, K., McIndoo, C. C., File, A. A., Ryba, M. M., Clark, C. G., & Bell, J. L. (2015). Behavior therapy for depressed breast patients with cancer: Predictors of treatment outcome. Journal of Consulting and Clinical Psychology, 83(1), 225–231.

    Article  PubMed  Google Scholar 

  • Johns, S. A., Stutz, P. V., Talib, T. L., Cohee, A. A., Beck-Coon, K. A., Brown, L. F., Wilhelm, L. R., Monahan, P. O., LaPradd, M. L., Champion, V. L., Miller, K. D., & Giesler, R. B. (2020). Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3-arm pilot randomized controlled trial. Cancer, 126(1), 211–218.

    Article  PubMed  Google Scholar 

  • Kangas, M., McDonald, S., Williams, J. R., & Smee, R. I. (2015). Acceptance and commitment therapy program for distressed adults with a primary brain tumor: A case series study. Support Care Cancer, 23(10), 2855–2859.

    Article  PubMed  Google Scholar 

  • Levin, M. E., Hildebrandt, M. J., Lillis, J., & Hayes, S. C. (2012). The impact of treatment components suggested by the psychological flexibility model: A meta-analysis of laboratory-based component studies. Behavior Therapy, 43(4), 741–756.

    Article  PubMed  Google Scholar 

  • Linden, W., Vodermaier, A., MacKenzie, R., & Greig, D. (2012). Anxiety and depression after cancer diagnosis: Prevalence rates by cancer type, gender, and age. Journal of Affective Disorders, 141(2–3), 343–351.

    Article  PubMed  Google Scholar 

  • Livheim, F., Tengström, A., Andersson, G., Dahl, J. A., Björck, C., & Rosendahl, I. (2020). A quasi-experimental, multicenter study of acceptance and commitment therapy for antisocial youth in residential care. Journal of Contextual Behavioral Science, 16, 119–127.

    Article  Google Scholar 

  • Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behaviour Research and Therapy, 33(3), 335–343.

    Article  PubMed  Google Scholar 

  • Mahdavi, A., et al. (2017). The effectiveness of acceptance-commitment therapy (ACT) on perceived stress, symptoms of depression, and marital satisfaction in women with breast cancer. Archives of Breast Cancer, 4, 16–23.

    Google Scholar 

  • Manne, S., Badr, H., Zaider, T., Nelson, C., & Kissane, D. (2010). Cancer-related communication, relationship intimacy, and psychological distress among couples coping with localized prostate cancer. Journal of Cancer Survivorship, 4(1), 74–85.

    Article  PubMed  Google Scholar 

  • Marcus, D. A. (2011). Epidemiology of cancer pain. Current Pain and Headache Reports, 15(4), 231–234.

    Article  PubMed  Google Scholar 

  • McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain model, process, and Progress. American Psychologist, 69(2), 178–187.

    Article  PubMed  Google Scholar 

  • Mitchell, A. J., Ferguson, D. W., Gill, J., Paul, J., & Symonds, P. (2013). Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: A systematic review and meta-analysis. The Lancet Oncology, 14(8), 721–732.

    Article  PubMed  Google Scholar 

  • Mohabbat-Bahar, S., Maleki-Rizi, F., Akbari, M. E., & Moradi-Joo, M. (2015). Effectiveness of group training based on acceptance and commitment therapy on anxiety and depression of women with breast cancer. Iranian Journal of Cancer Prevention, 8(2), 71–76.

    PubMed  PubMed Central  Google Scholar 

  • Moher, D., et al. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4(1), 1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Montesinos, F., & Luciano, F. (2016). Acceptance of relapse fears in breast patients with cancer: Effects of an act-based abridged intervention. Psicooncologia, 13(1), 7–21.

  • Mosher, C. E., Secinti, E., Hirsh, A. T., Hanna, N., Einhorn, L. H., Jalal, S. I., Durm, G., Champion, V. L., & Johns, S. A. (2019). Acceptance and commitment therapy for symptom interference in advanced lung Cancer and caregiver distress: A pilot randomized trial. Journal of Pain and Symptom Management, 58(4), 632–644.

    Article  PubMed  PubMed Central  Google Scholar 

  • Najvani, B. D., et al. (2015). The effect of acceptance and commitment therapy on depression and psychological flexibility in women with breast cancer. Zahedan Journal of Research in Medical Sciences, 17(4), e965.

    Google Scholar 

  • Niazi, S., et al. (2020). Barriers to accepting mental health care in patients with cancer with depression. Social Work in Health Care, 59, 351–364.

    Article  PubMed  Google Scholar 

  • Pitman, A., et al. (2018). Depression and anxiety in patients with cancer. British Medical Journal, 361, k1415.

    Article  PubMed  Google Scholar 

  • Powers, M. B., ZumVördeSiveVörding, M. B., & Emmelkamp, P. M. G. (2009). Acceptance and commitment therapy: A meta-analytic review. Psychotherapy and Psychosomatics, 78(2), 73–80.

    Article  PubMed  Google Scholar 

  • Rost, A. D., Wilson, K., Buchanan, E., Hildebrandt, M. J., & Mutch, D. (2012). Improving psychological adjustment among late-stage ovarian patients with cancer: Examining the role of avoidance in treatment. Cognitive and Behavioral Practice, 19(4), 508–517.

    Article  Google Scholar 

  • Sander, A. M., Clark, A. N., Arciniegas, D. B., Tran, K., Leon-Novelo, L., Ngan, E., Bogaards, J., Sherer, M., & Walser, R. (2020). A randomized controlled trial of acceptance and commitment therapy for psychological distress among persons with traumatic brain injury. Neuropsychological Rehabilitation, pp. 1–25.

  • Schulz, K. F., et al. (2010). CONSORT 2010 statement: Updated guidelines for reporting parallel group randomised trials. Trials, 11(1), 32.

    Article  PubMed  PubMed Central  Google Scholar 

  • Serfaty, M., Armstrong, M., Vickerstaff, V., Davis, S., Gola, A., McNamee, P., Omar, R. Z., King, M., Tookman, A., Jones, L., & Low, J. T. S. (2019). Acceptance and commitment therapy for adults with advanced cancer (CanACT): A feasibilityrandomised controlled trial. Psycho-oncology, 28(3), 488–496.

    Article  PubMed  Google Scholar 

  • Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.

    Article  PubMed  Google Scholar 

  • Tanhan, A. (2019). Acceptance and commitment therapy with ecological systems theory: Addressing Muslim mental health issues and wellbeing. Journal of Positive Psychology and Wellbeing., 3(2), 197–219.

    Article  Google Scholar 

  • Trindade, I. A., Ferreira, C., & Pinto-Gouveia, J. (2020). Acceptability and preliminary test of efficacy of the mind programme in women with breast cancer: An acceptance, mindfulness, and compassion-based intervention. Journal of Contextual Behavioral Science, 15, 162–171.

    Article  Google Scholar 

  • Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5), 705–716.

    Article  PubMed  PubMed Central  Google Scholar 

  • Vilardaga, J. C. P., et al. (2020). Coping skills training and acceptance and commitment therapy for symptom management: Feasibility and acceptability of a brief telephone-delivered protocol for patients with advanced Cancer. Journal of Pain and Symptom Management, 59(2), 270–278.

    Article  Google Scholar 

  • Villanueva, J., et al. (2019). “Choose change”: design and methods of an acceptance and commitment therapy effectiveness trial for transdiagnostic treatment-resistant patients. BMC Psychiatry, 19, Article number: 173.

    Article  PubMed  Google Scholar 

  • Wells-Di Gregorio, S. M., et al. (2019). Pilot randomized controlled trial of a symptom cluster intervention in advanced cancer. Psychooncology, 28(1), 76–84.

    Article  PubMed  Google Scholar 

  • Yeung, K. S., Hernandez, M., Mao, J. J., Haviland, I., & Gubili, J. (2018). Herbal medicine for depression and anxiety: A systematic review with assessment of potential psycho-oncologic relevance. Phytotherapy Research, 32(5), 865–891.

    Article  PubMed  Google Scholar 

  • Yi, J. C., & Syrjala, K. L. (2017). Anxiety and depression in Cancer survivors. The Medical Clinics of North America, 101(6), 1099–1113.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zarling, A., Bannon, S., & Berta, M. (2019). Evaluation of acceptance and commitment therapy for domestic violence offenders. Psychology of Violence, 9(3), 257–266.

    Article  Google Scholar 

  • Zemestani, M., & Mozaffari, S. (2020). Acceptance and commitment therapy for the treatment of depression in persons with physical disability: a randomized controlled trial. Clinical Rehabilitation, 34(7), 938–947.

    Article  PubMed  Google Scholar 

  • Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta psychiatrica Scandinavica, 67(6), 361–70.

    Article  PubMed  Google Scholar 

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Acknowledgements

By Student Research Committee of Kermanshah University of Medical Sciences.

Authors’contributions

NS and LR and HGH contributed to the design, MM statistical analysis, participated in most of the study steps. HKH and MM and SHB and BKH prepared the manuscript. All authors have read and approved the content of the manuscript.

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Datasets are available through the corresponding author upon reasonable request.

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By Deputy for Research and Technology, Kermanshah University of Medical Sciences (IR) (990532). This deputy has no role in the study process.

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Correspondence to Masoud Mohammadi.

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Ethics approval was received from the ethics committee of deputy of research and technology, Kermanshah University of Medical Sciences (IR.KUMS.REC.1399.548).

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Salari, N., Rezaie, L., Khazaie, H. et al. The effect of acceptance and commitment therapy on anxiety and depression in patients with cancer: A systematic review. Curr Psychol 42, 5694–5716 (2023). https://doi.org/10.1007/s12144-021-01934-x

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