Learning that you have been diagnosed with cancer can be a traumatic experience. Going through treatment can be a long and difficult process and when you finish treatment it can be difficult to fully accept that it is finally over. Others around you may feel relief and they might want to celebrate, but for someone who has actually endured the treatments, those reactions can differ greatly. Fear, anxiety and uncertainty are common feelings to experience after treatment has ended. Then there is the fear of cancer recurrence that can be easily triggered by follow-up appointments, hearing about others’ diagnoses and feeling the physical effects of post-treatment consequences. What can be done about these feelings? Is it possible to rid yourself of these feelings?
These feelings are normal, but that does not mean you have to accept that you will feel worried or anxious for the rest of your life. You can seize the opportunity to reduce these anxieties and improve your mental state of mind. Acceptance and Commitment Therapy for Fear or Recurrence (ACT), is a type of therapy that is used to help patients with cancer cope with anxiety and depression that accompany their diagnosis, treatment or recurrence. ACT uses strategies to help mitigate fear of cancer recurrence through mindful behavior, attention to personal values and commitment to action. These strategies can help you accept that, while your concerns are real and valid, you are still able to lead a meaningful life despite these concerns.
I sat down with Rachel Cox, an Oncology Social Worker, who has worked at Swedish for over 13 years to get insight on frequently asked questions about Acceptance and Commitment Therapy (ACT). Here’s what she had to say:
Q: What are the goals of ACT?
A: The goal is to take action in a way that reflects your values and to focus on what is important to you. It aims to maximize the quality of your life while at the same time handling the pain that goes with it. ACT helps to stop fighting your past and emotions and, instead, start practicing more confident and optimistic behavior based on your values and goals by accepting all thoughts, emotions and feelings – good or bad.
Q: How can ACT help patients with cancer cope with fear of recurrence?
A: ACT can help patients with cancer come to terms with their thoughts and feelings. Although they may always have fears of recurrence, ACT helps them live their best lives despite these worries. Fighting these thoughts will not make them disappear, it just results in lost time that could have been dedicated to doing something more meaningful—something that can improve their lives.
Q: How exactly does ACT work?
A: The practices involved in ACT are not linear, they are flexible—they help patients take actions that are guided by their own personal values rather than avoidance out of fear. ACT aims to help patients clarify their values so that they are able to take action to make their lives more meaningful, which increases their psychological flexibility. In other terms, this means holding our thoughts and emotions more lightly and acting on long term values and goals rather than short term thoughts and feelings. Studies that have analyzed the effect of ACT on patients with cancer found that the changes in psychological flexibility often predicted changes in the quality of life, level of distress, and mood.
Q: What is Cognitive Behavioral Therapy (CBT)? What are the similarities and differences between ACT and CBT?
A: Cognitive Behavioral Therapy (CBT) is a commonly used therapy that focuses on changing negative thought patterns and eliminating unpleasant feelings and emotions by recognizing your emotions, targeting how you feel by acknowledging your fears, and grounding yourself into the present. ACT and CBT are both behavior-based therapies and can help treat depression and anxiety.
ACT focuses on accepting and noticing your thoughts and feelings and then acting in a way that supports your longer-term values and goals.
National Cancer Institute. (2020). Helping Cancer Survivors Cope with Cancer-Related Anxiety and Distress. Retrieved from: https://www.cancer.gov/news-events/cancer-currents-blog/2020/cancer-survivors-managing-anxiety-distress
Harvard Health Publishing. (2019). Fear of Cancer Recurrence: Mind-Body Tools Offer Hope. Retrieved from: https://www.health.harvard.edu/blog/fear-of-cancer-recurrence-mind-body-tools-offer-hope-2019030716152
Cancer Care. (2020). Coping with Fear or Recurrence. Retrieved from: https://www.cancercare.org/publications/253-coping_with_the_fear_of_recurrence