Psychosocial support interventions for cancer caregivers: reducing caregiver burden.

PURPOSE OF REVIEW: Informal caregivers of individuals affected by cancer undertake a range of activities and responsibilities throughout the course of the cancer care trajectory. This role is often undertaken alongside employment and other caring roles and can contribute to caregiver burden, which may be ameliorated through psychosocial intervention. RECENT FINDINGS: Fifteen new studies investigating the potential of psychosocial interventions for reducing caregiver burden were identified from the period January 2019 to February 2020. Studies were mostly quasi-experimental or randomised controlled trials (RCTs). Psychoeducation was the main intervention identified, though content varied, psychoeducation was associated with improvements in burden, quality of life (QoL) domains and psychological symptoms for caregivers. A small number of counselling/therapeutic interventions suggest that caregivers supporting patients with advanced cancer or cancers with high symptom burden may experience reduced psychological symptoms and QoL benefits. There was a paucity of evidence for other psychosocial interventions (e.g. mindfulness, acceptance and commitment therapy) and methodological quality was variable across all intervention types. SUMMARY: Psychosocial interventions may help to reduce burden for informal caregivers of individuals affected by cancer, though there remains a need for rigorously designed, multicentred RCTs and to examine the long-term impact of psychosocial interventions for caregivers.

Optimising the acceptability and feasibility of acceptance and commitment therapy for treatment-resistant generalised anxiety disorder in older adults.

BACKGROUND: generalised anxiety disorder (GAD) is common in later life with a prevalence of 3-12%. Many only partially respond to cognitive behavioural therapy or pharmacotherapy and can be classified as treatment resistant. These patients experience poor quality of life, and are at increased risk of comorbid depression, falls and loneliness. Acceptance and commitment therapy (ACT) is an emerging therapy, which may be particularly suited to this population, but has not been tailored to their needs. OBJECTIVES: to optimise the acceptability and feasibility of ACT for older adults with treatment-resistant GAD. DESIGN: a person-based approach to ground the adapted ACT intervention in the perspectives and lives of those who will use it. METHODS: first, we conducted qualitative interviews with 15 older adults with GAD and 36 healthcare professionals to develop guiding principles to inform the intervention. Second, we consulted service users and clinical experts and interviewed the same 15 older adults using 'think aloud' techniques to enhance its acceptability and feasibility. RESULTS: in Stage 1, older adults' concerns and needs were categorised in four themes: 'Expert in one's own condition', 'Deep seated coping strategies', 'Expert in therapy' and 'Support with implementation'. In Stage 2, implications for therapy were identified that included an early focus on values and ACT as a collaborative partnership, examining beliefs around 'self as worrier' and the role of avoidance, validating and accommodating individuals' knowledge and experience and compensating for age-related cognitive changes. DISCUSSION: Our systematic approach combined rigour and transparency to develop a therapeutic intervention tailored to the specific needs of older adults with treatment-resistant GAD.

Promoting positive youth development: a psychosocial intervention evaluation / La promoción del desarrollo positivo en la juventud: evaluación de una intervención psicosocial

Convergence among treatment, prevention, and developmental psychosocial intervention approaches has led to the recognition of the need for evaluation models and research designs that employ a full range of evaluation information to provide an empirical basis for enhancing the efficiency, efficacy, and effectiveness of prevention and psychosocial positive youth development interventions (PYD). This study reports an investigation of a PYD psychosocial program using an Outcome Mediation Cascade (OMC) evaluation model, which is an integrated model for evaluating the empirical intersection between intervention and developmental processes. The Changing Lives Program (CLP) is a community engaged PYD psychosocial intervention for multi-ethnic, multi-problem at risk youth in urban alternative high schools. Findings indicated that the hypothesized model fit the data, χ2 (7) = 6.991, p= .43, RMSEA = .00, CFI = 1.00, WRMR = .459. Findings also provided preliminary evidence consistent with the hypothesis that, in addition to having effects on targeted positive outcomes, PYD interventions are likely to have progressive cascading effects on untargeted problem outcomes (in this case, behavioral outcomes) that operate through effects on positive outcomes

La convergencia entre enfoques de tratamiento, prevención e intervención psicosocial evolutiva ha dado lugar a que se reconozca que se necesitan modelos de evaluación y diseños de investigación que utilicen una gama completa de información sobre evaluación que siente la base empírica para mejorar la eficiencia, la eficacia y la efectividad de la prevención y de las intervenciones psicosociales en el desarrollo positivo de la juventud (DPJ). Este estudio trata de la investigación sobre un programa psicosocial sobre DPJ utilizando el Outcome Mediation Cascade (OMC), modelo integrado para evaluar la intersección empírica entre la intervención y los procesos de desarrollo. El Changing Lives Program (CLP) es una intervención psicosocial de DPJ en la que está implicada la comunidad para jóvenes multiétnicos en riesgo en colegios urbanos de secundaria alternativos. Los resultados indican que el modelo postulado se ajusta a los datos, χ2 (7) = 6.991, p= .43, RMSEA = .00, CFI = 1.00, WRMR = .459. Igualmente, los resultados aportan pruebas preliminares consistentes con la hipótesis de que además de tener influencia en los resultados positivos planeados es probable que las intervenciones DPJ tengan efectos progresivos en cascada en los resultados no previstos de los problemas (en este caso, resultados en el comportamiento) que operan a través de sus efectos en los resultados positivos

Body-Image Acceptance and Action Questionnaire: Its deleterious influence on binge eating and psychometric validation / Body-Image Acceptance and Action Questionnaire: su nociva influencia en la ingesta compulsiva y validación psicométrica

Background/Objectives: This study aimed to explore the psychometric properties of BI-AAQ (Body-Image Acceptance and Action Questionnaire) and the body image psychological flexibility role as a mediator in a pervasive path towards binge eating in Brazilian samples. Method: This cross-sectional study was conducted in clinical (overweight or obese women currently in treatment for weight loss; n= 330) and non-clinical (general population; n= 682) groups of women. Results: BI-AAQ has one-factor structure, excellent internal consistency, ability to detect differences between groups and measurement invariance across samples. It was also negatively associated with self-compassion and positively associated with binge eating severity, drive for thinness and self-criticism. Conclusions: This study provides data confirming the robust psychometric properties of BI-AAQ in qualitatively different samples. Furthermore, an additional study conducted in a clinical sample of women with overweight or obesity revealed that body image psychological inflexibility has emerged as a partial and significant mediator of the effect of self-criticism and drive for thinness on binge eating severity (AU)

Antecedentes/Objetivo: Este estudio tuvo como objetivo explorar las propiedades psicométricas del BI-AAQ (Body-Image Acceptance and Action Questionnaire) y el papel mediador de la inflexibilidad psicológica relacionada con la imagen corporal en una trayectoria nociva hacia la ingesta compulsiva en muestras brasileñas. Método: Este estudio transversal se llevó a cabo en grupos clínicos (mujeres con sobrepeso u obesidad actualmente en tratamiento para la pérdida de peso; n= 330) y no clínicos (grupo de población general; n= 682) de mujeres. Resultados: BI-AAQ presenta la estructura de un factor, excelente consistencia interna, capacidad para detectar diferencias entre grupos e invariancia de medida entre diferentes muestras. Sus puntuaciones se asociaron negativamente con la autocompasión y positivamente con la severidad de la compulsión alimentaria, búsqueda de la delgadez y autocrítica. Conclusiones: Este estudio proporcionó datos que confirman que el BI-AAQ tiene propiedades psicométricas sólidas en muestras cualitativamente diferentes. Además, un estudio adicional efectuado en una muestra clínica de mujeres con sobrepeso u obesidad reveló que la inflexibilidad psicológica relacionada con la imagen corporal emergió como mediadora parcial y significativa del efecto de la autocrítica y de la búsqueda de la delgadez sobre la severidad de la compulsión alimentaria (AU)

Acceptance of relapse fears in breast cáncer patients: effects o fan act-based abridged intervention / Aceptación de miedos a la recaída en pacientes con cáncer de mama: efectos de una intervención abreviada basada en la ACT

Objective: Relapse fear is a common psychological scar in cancer survivors. The aim of this study is to assess the effects of an abridged version of Acceptance and Commitment Therapy (ACT) in breast cancer patients. Method: An open trial was developed with 12 non-metastatic breast cancer patients assigned to 2 conditions, ACT and waiting list. Interventions were applied in just one session and focused on the acceptance of relapse fears through a 'defusion' exercise. Interference and intensity of fear measured through subjective scales were collected after each intervention and again 3 months later. Distress, hypochondria and 'anxious preocupation' were also evaluated through standardized questionnaires. Results: The analysis revealed that 'defusion' contributed to decrease the interference of the fear of recurrence, and these changes were maintained three months after intervention in most subjects. 87% of participants showed clinically significant decreases in interference at follow-up sessions whereas no patient in the waiting list showed such changes. Statistical analysis revealed that the changes in interference were significant when comparing pre, post and follow-up treatment, and also when comparing ACT and waiting list groups. Changes in intensity of fear, distress, anxious preoccupation and hypochondria were also observed. Conclusions: Exposure through 'defusion' techniques might be considered a useful option for treatment of persistent fears in cancer patients. This study provides evidence for therapies focusing on psychological acceptance in cancer patients through short, simple and feasible therapeutic methods

Objetivo: El miedo a la recidiva es una secuela psicológica habitual en supervivientes de cáncer. El objetivo de este estudio es valorar los efectos de una versión breve de la Terapia de Aceptación y Compromiso (ACT) en pacientes de cáncer de mama. Método: Se realizó un ensayo abierto en el que participaron 12 pacientes no-metastásicas distribuidas en 2 condiciones, ACT y lista de espera. La intervención se aplicó en una única sesión individual y se centró en la aceptación del miedo por medio de un ejercicio de «defusión». Después de cada intervención y en el seguimiento trimestral se midieron la interferencia y la intensidad del miedo mediante escalas subjetivas. Además, las participantes completaron las escalas HADS, MINIMAC e IBQ. Resultados: El 87% de pacientes que recibieron la intervención mostró disminuciones clínicamente significativas en interferencia del miedo a la recidiva en el seguimiento trimestral, lo que no ocurrió en ninguna paciente en lista de espera. Los cambios en interferencia fueron estadísticamente significativos en las comparaciones pre, post y seguimiento, y también en la comparación con lista de espera. Asimismo se observaron cambios en intensidad, malestar emocional, preocupación ansiosa e hipocondría. Conclusiones: La exposición mediante técnicas de «defusión» puede ser considerada una alternativa terapéutica para el tratamiento de miedos persistentes en pacientes de cáncer. El estudio aporta evidencia de la utilidad de técnicas orientadas a promover la aceptación psicológica en pacientes oncológicos aplicadas mediante métodos terapéuticos breves y sencillos que son bien admitidos por los pacientes

A feasibility study of brief group-based acceptance and commitment therapy for chronic pain in general practice: recruitment, attendance, and patient views.

BACKGROUND: Acceptance and commitment therapy (ACT), a form of cognitive-behavioral therapy, may help meet a need for accessible and cost-effective treatments for chronic pain. ACT has a growing evidence base, but has not yet been tested within general practice settings. AIM: The purpose of the present study was to examine the feasibility of conducting a full-scale randomized controlled trial of ACT in general practice. METHODS: A total of 481 potential participants with chronic pain identified from general practice in southwest England were invited into a treatment trial. Subsequently, 102 (21.2%) of those invited were screened, and 73 (71.6%) of those screened were allocated to ACT plus usual care or usual care alone. The ACT treatment included four, four-hour group-based sessions over two weeks. RESULTS: Twenty-six (70.3%) of the patients allocated to ACT attended three or four sessions. Those who received ACT rated it as credible in a short survey, with Mdn rating 7.0 on a 0-10 scale, across five credibility items. During a post-treatment interview considering 12 aspects of the study from invitation to treatment termination, a median of 79.2% of participants rated the aspects 'acceptable.' Qualitative data from the interviews showed a mixed picture of patient experiences, revealing possible tensions between patients' wishes to avoid discomfort and confusion, and treatment methods that explicitly ask patients to, in essence, 'live with' some discomfort and confusion. CONCLUSIONS: These data suggest that further study of ACT, as a treatment for chronic pain, is feasible in general practice and it may be possible to further optimize the treatment experience.