Sauer Christina, Maatouk Imad
Klinik für Allgemeine Innere Medizin und Psychosomatik, UniversitätsKlinikum Heidelberg.
Psychother Psychosom Med Psychol. 2021 Feb;71(2):90-98. doi: 10.1055/a-1174-0283. Epub 2020 Jul 7.
Cancer is associated with many psychosocial stressors that lead to high psychological distress in over 50% of patients. About one third of patients make use of psycho-oncological services. Acceptance and Commitment Therapy (ACT), a transdiagnostic approach of the third wave of cognitive behavioral therapy, represents a promising approach for psycho-oncological interventions. However, the German-speaking area lacks a manualized ACT-based group intervention that is tested for feasibility and effectiveness.
To bridge this gap, we developed and preliminarily tested an ACT group intervention in this one-arm monocentric pilot study. It targets psychological burdened cancer patients in all disease stages. During 8 sessions, the ACT core processes mindfulness, values and acceptance are worked out by means of metaphors and experience-oriented exercises.
Pre-Post-Data of our pilot study with n=25 patients indicate reductions in fear of progression, depression and psychological inflexibility, as well as an increase in psychological health-related quality of life and well-being. Regression analyses showed that changes in psychological flexibility predicted changes in all psychological outcome measures. The very high adherence underlines the feasibility of the intervention for the integrated outpatient clinic setting.
Our pilot study provides first evidences for the good feasibility and effectiveness of an ACT-based group intervention in the German-speaking area. These results on effectivness should be interpreted with caution due to the lack of an experimental control group.
Future studies should test the effectiveness of the intervention in randomized controlled trials (RCTs) with longer follow-up periods.
癌症与许多心理社会应激源相关，超过50%的患者会因此产生高度心理困扰。约三分之一的患者会寻求心理肿瘤学服务。接纳与承诺疗法（ACT）是认知行为疗法第三波的一种跨诊断方法，是心理肿瘤学干预的一种有前景的方法。然而，德语区缺乏一种经过可行性和有效性测试的基于ACT的团体干预手册。
为弥补这一差距，我们在这项单臂单中心试点研究中开发并初步测试了一种ACT团体干预。它针对所有疾病阶段有心理负担的癌症患者。在8次疗程中，通过隐喻和体验式练习来阐述ACT的核心过程正念、价值观和接纳。
我们对25名患者进行的试点研究的前后数据表明，患者在疾病进展恐惧、抑郁和心理灵活性方面有所降低，与心理健康相关的生活质量和幸福感有所提高。回归分析表明，心理灵活性的变化预测了所有心理结果指标的变化。极高的依从性突出了该干预在综合门诊环境中的可行性。
我们的试点研究为德语区基于ACT的团体干预的良好可行性和有效性提供了首个证据。由于缺乏实验对照组，这些有效性结果应谨慎解读。
未来的研究应在随访期更长的随机对照试验（RCT）中测试该干预的有效性。
