Nick Hulbert-WilliamsUsing acceptance and commitment therapy (ACT) to promote mindfulness, acceptance and value-based living may be especially appropriate for cancer-related distress, and for helping cancer patients in general, according to new research.

Psychological distress high in cancer patients, but the evidence for the effectiveness of psychological interventions in reducing distress is currently unclear. Limited research has been carried out on newer types of psychological therapies, such as ACT, in helping to support the needs of cancer survivors. 

But a new study, published in the journal Supportive Care in Cancer, by Nick Hulbert-Williams, Professor of Behavioural Medicine at the University of Chester and Dr Lesley Storey, lecturer in the School of Psychology at Queen's University Belfast, has investigated ACT’s effectiveness. 

ACT is a psychological intervention approach which uses acceptance and mindfulness processes to accept what is out of a person’s control; crucially, it is not about accepting the inevitability of illness or death, but the internal psychological experiences (thoughts, emotions) that go along with these kinds of significant life events. ACT encourages people to commit to take action towards living valued lives as a way to improve quality of life despite their experience, psychological distress and suffering. Its goals can sometimes be explained in more simple terms as Accept, Choose, Take action. It is one of a range of newer ‘third wave’ therapeutic interventions that rely far less on changing the content of troubling thoughts than does traditional cognitive behavioural therapy (CBT).

ACT is known to increase people’s levels of psychological flexibility – how people are able to use mindfulness techniques to hold their thoughts and emotions lightly, while committing to living a valued life.

CBT is recognised as a problem-focused therapy, which focuses on attempting to fix a specific psychological problem, rather than helping a client to develop more generalised coping skills, which means it may not necessarily be the best therapy for cancer patients and survivors.

Professor Hulbert-Williams said: “We want to understand better the process of psychological adjustment to stressful life events, such as cancer.

“Clinical studies demonstrate that challenging, suppressing or attempting to control unpleasant thoughts and emotions can actually increase and worsen psychological distress. By contrast, ACT helps individuals to become resilient to suffering and distress, and less likely to develop significant psychological disorders.” 

In the study, a mix of 129 male and female adult patients with the 4 most common cancers – breast, colorectal, prostate or lung cancer – and at various stages of their illness and diagnosis were asked to voluntarily complete a postal questionnaire. This assessed individuals’ levels of psychological flexibility and a range of patient-reported outcomes, for example, anxiety, depression, quality of life and benefit finding. The intention was to explore how variation in psychological flexibility associated with similar variation in these outcomes.

When analysed, the study data supported the hypothesis that those demonstrating psychological flexibility had made a more positive psychological adjustment to cancer. “This might mean that interventions which modify psychological flexibility, such as ACT, may also be successful in improving things like anxiety, depression, quality of life and stress where they have become problematic for people affected by cancer,” said Professor Hulbert-Williams.

“Furthermore, ACT is potentially a more cost-effective option, as the therapy can be given in a number of cost-effective ways, including group therapy, brief interventions and even potentially online.

“With such broad effects on psychological wellbeing demonstrated, we believe that our study provides evidence to support the development of an ACT-based intervention for cancer patients. In our research, we have built on previous studies on this subject and explored a wider range of psychosocial outcomes. These provide a baseline and rationale for the development of interventions that could improve people’s psychological wellbeing and reduce the possibility of future distress and psychological disorders.

“The literature on the effectiveness of psychological interventions for cancer patients is inconsistent. The development of innovative, evidence-based and more effective interventions is therefore imperative. We believe that now is the time to call for funding agencies to respond to this by providing the means for high quality research and well-designed controlled trials to be carried out, to establish the effectiveness of such interventions.”