Fishbein Joel N, Judd Charles M, Genung Sarah, Stanton Annette L, Arch Joanna J
Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO, 80309, USA.
Department of Psychology and Neuroscience, University of Colorado Boulder, 345 UCB, Boulder, CO, 80309, USA.
Behav Res Ther. 2022 Jun;153:104103. doi: 10.1016/j.brat.2022.104103. Epub 2022 Apr 28.
Acceptance and Commitment Therapy (ACT) is a promising psycho-oncological intervention, but its mechanisms in real-world settings are not fully understood. This study examined core theorized ACT and broader ACT-consistent target processes as mediators of ACT versus minimally-enhanced usual care within a randomized trial for anxious cancer survivors in a community oncology setting.
Two core theorized ACT target processes (experiential avoidance and values-aligned behavior, each measured with two instruments) and two broader ACT-consistent target processes (emotional approach coping and self-compassion) were analyzed at pre- and post-intervention as mediators of general anxiety symptoms, cancer-related trauma symptoms, and fear of cancer recurrence (N = 134).
ACT led to greater increases on emotional approach coping (ps ≤ .001) and one measure of values-aligned behavior (ps ≤ .031), and marginal or greater improvement on self-compassion (ps ≤ .055), but not other core ACT target processes. Self-compassion and emotional approach coping mediated ACT's effects on cancer-related trauma symptoms (ps ≤ .037). Additionally, self-compassion, emotional approach coping, and values-aligned behavior marginally mediated fear of recurrence and general anxiety symptoms improvement (ps ≤ .088).
ACT reduced cancer survivors' anxiety-related symptoms, and especially cancer-related trauma symptoms, most consistently by promoting self-compassion and emotional approach coping.
接纳与承诺疗法（ACT）是一种很有前景的心理肿瘤学干预方法，但其在现实环境中的作用机制尚未完全明确。本研究在一项针对社区肿瘤环境中焦虑癌症幸存者的随机试验中，检验了ACT的核心理论目标过程以及更广泛的与ACT一致的目标过程，作为ACT与最低限度强化常规护理相比的中介因素。
在干预前后，分析两个核心理论ACT目标过程（经验性回避和价值观一致行为，均用两种工具测量）以及两个更广泛的与ACT一致的目标过程（情绪接近应对和自我同情），作为一般焦虑症状、癌症相关创伤症状和癌症复发恐惧（N = 134）的中介因素。
ACT导致情绪接近应对有更大程度的增加（p值≤.001）以及一项价值观一致行为测量指标有更大程度的增加（p值≤.031），自我同情有轻微或更大程度的改善（p值≤.055），但其他核心ACT目标过程没有变化。自我同情和情绪接近应对介导了ACT对癌症相关创伤症状的影响（p值≤.037）。此外，自我同情、情绪接近应对和价值观一致行为对复发恐惧和一般焦虑症状的改善有轻微的中介作用（p值≤.088）。
ACT通过促进自我同情和情绪接近应对，最一致地减轻了癌症幸存者的焦虑相关症状，尤其是癌症相关创伤症状。
