ACT for Post-Treatment Distress & Fear of Recurrence
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1 ACT for Post-Treatment Distress & Fear of Recurrence Jill Mitchell, PhD, LCSW, OSW-C Oncology Social Worker & Psychosocial Research Program Coordinator Rocky Mountain Cancer Centers & Joanna Arch, PhD Assistant Professor University of Colorado - Boulder
2 Graduation from active treatment 2
3 I had cancer?! Why am I crying NOW?! Who am I now? What if I can t keep up at work? My friends & family don t get it! I feel abandoned! I should be doing more! WHAT IF THIS RECURS!?!?!
4
5 Acceptance & Commitment Therapy (ACT) Accepting one s experience & being present Choosing a valued direction Taking action
6 Acceptance (vs. Avoidance)
7 Valued Living for Survivors Intervention Weekly psychoeducation group 7 weeks/2 hrs per week Practicing ACT-based skills using: Discussion Meditation Guided imagery Writing exercises Drawing / turning thoughts into characters Committing to valued behaviors Weekly home practice Mapping out and acting out what is going on in our minds
8 Results: Traumatic Impact of Cancer & Fear of Recurrence * Intrusion (IES-R) Hypervigilance (IES-R) Avoidance (IES-R) Fear of Recurrence (CARS) -1.2 Arch & Mitchell (2015) Psycho-Oncology Baseline 1 Baseline 2 Baseline 3 Post Follow Up
9 Results: Anxiety & Depression: nxiety and Depression Anxiety (STAI) Depression (CESD) * -1.2 Baseline 1 Baseline 2 Baseline 3 Post Follow Up Arch & Mitchell( 2015) Psycho-Oncology
10 Results: Vitality and Pain Improvement Results: Vitality & Pain Vitality (RAND SF-36) Pain improvement (RAND SF-36) * Baseline 1 Baseline 2 Baseline 3 Post Follow Up Arch & Mitchell (2015) Psycho-Oncology
11 Mindfulness & Awareness 11
12 Mindfulness Resources The Free Mindfulness Project FreeMindfulness.org UCLA s Mindful Awareness Resource Center Mindful.org
13 Compass (*Adapted from Dr. Kevin Polk s Matrix, see DrKevinPolk.com for more information) Toward Values What is important to you? (values) What could you DO to move toward what is important to you? Inside (thoughts/feelings) Challenging thoughts and feelings. What shows up inside of you that gets in the way of moving towards what you value? Outside (behaviors) What do you do to try to get rid of the stuff going on inside of you? Away from Values
14 Inside (thoughts/feelings) Outside (behaviors)
15 Toward Values Inside (thoughts/feelings) Outside (behaviors) Away from Values
16 Toward Values Inside (thoughts/feelings) Outside (behaviors) Challenging thoughts and feelings. What shows up inside of you that gets in the way of moving towards what you value? - Self-judgement that I m not doing enough - Fear of recurrence Away from Values
17 Toward Values Inside (thoughts/feelings) Outside (behaviors) Challenging thoughts and feelings. What shows up inside of you that gets in the way of moving towards what you value? - Self-judgement that I m not doing enough - Fear of recurrence Away from Values What do you do to try to get rid of the stuff going on inside of you? - Hide in bed and watch junk TV all day - Overeat
18 Toward Values Inside (thoughts/feelings) Outside (behaviors) Challenging thoughts and feelings. What shows up inside of you that gets in the way of moving towards what you value? - Self-judgement that I m not doing enough - Fear of recurrence Away from Values What do you do to try to get rid of the stuff going on inside of you? - Hide in bed and watch junk TV all day - Overeat
19 Cognitive Defusion - Label thoughts: I m having the thought that - Sarcasm: Thanks mind! / That s a good one mind! / Nice one! - Get off your BUT!: Use and not but Instead of: I could have lunch with a friend, but I m tired Try: My mind is saying I m tired AND I m going to have lunch with my friend anyway because that is of value to me. - Draw the thought as a character or caricature get playful!
20 Toward Values What is important to you? (values) - Health - Family - Exercising my creativity Inside (thoughts/feelings) Outside (behaviors) Away from Values
21 Toward Values What is important to you? (values) - Health - Family - Exercising my creativity Inside (thoughts/feelings) What could you DO to move toward what is important to you? - Take a 30 minute walk - Write a letter to my loved one - Paint a picture Outside (behaviors) Away from Values
22 Value-Based Commitments Value: What can I do in the next hour that would be consistent with this value? What can I do in the next day that would be consistent with this value? What can I do in the next week that would be consistent with this value? What can I do in the next few months that would be consistent with this value?
23 Toward Values What is important to you? (values) - Health - Family - Exercising my creativity Inside (thoughts/feelings) What could you DO to move toward what is important to you? - Take a 30 minute walk - Write a letter to my loved one - Paint a picture Outside (behaviors) Challenging thoughts and feelings. What shows up inside of you that gets in the way of moving towards what you value? - Self-judgement that I m not doing enough - Fear of recurrence Away from Values What do you do to try to get rid of the stuff going on inside of you? - Hide in bed and watch junk TV all day - Overeat
24 Toward Values What is important to you? (values) What could you DO to move toward what is important to you? Inside (thoughts/feelings) Challenging thoughts and feelings. What shows up inside of you that gets in the way of moving towards what you value? Outside (behaviors) What do you do to try to get rid of the stuff going on inside of you? Away from Values
25 Key Take Aways from ACT Identify & share your fears or challenging thoughts Work toward acceptance instead of avoidance Observe your mind (thoughts need not control our actions) Shift your relationship to your thoughts (instead of the content of the thought itself) Clarify your values & make value-based goals Embrace self-compassion
26 Some things to try? Explore mindfulness meditation Create your own personal compass using the chart I discussed today Find a group of post-treatment survivors & share your inner fears/thoughts Play with defusion strategies Get clear on what you VALUE (& write it down!) Set some small doable goals based on what you value Invite patience & compassion for yourself through this process!!! Consider finding an ACT therapist in your community can t control 26
27 Where to find more info on ACT? Find an ACT therapist at: Association for Contextual and Behavioral Science: ACT Matrix: DrKevinPolk.com Harris, Russ (2008) The Happiness Trap: How to Stop Struggling and Start Living Wilson, K. & T. Du Frene (2010) Things Might Go Terribly, Horribly Wrong: A Guide to Life Liberated from Anxiety 27
28 Thank-you! Supported by: University of Colorado-Boulder American Cancer Society Rocky Mountain Cancer Centers Key Collaborators and Contributors: Robert Fisher, MD, Rocky Mountain Cancer Centers Longmont David Andorsky, MD, Rocky Mountain Cancer Centers Boulder Annette Stanton, PhD, UCLA Mike Levin, PhD, Utah State University Sarah Genung Michele Ferris & of course, the 100+ survivors who have spent many hours exploring these processes with us! 28
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