Impact of Acceptance and Commitment Therapy on Salivary Cortisol in Breast Cancer

接受和承诺疗法对乳腺癌唾液皮质醇的影响

• 批准号: 7813421
• 负责人: Jennifer Gregg
• 金额: $ 6.3万
• 依托单位: SAN JOSE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-28 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7813421
• 关键词: Accounting; Address; Aftercare; Area; Behavior; Cancer Patient; Climacteric; Clinic; Clinical Oncology; Control Groups; Diagnosis; Distress; Effectiveness; Emotional; Evaluation; Goals; Growth; Health behavior; Hormones; Hydrocortisone; Immune system; Individual; Intervention; Intervention Studies; Life Stress; Malignant Neoplasms; Measures; Mediating; Neurosecretory Systems; Outcome; Outpatients; Participant; Patients; Pattern; Process; Psychosocial Assessment and Care; Quality of life; Randomized; Randomized Controlled Trials; Recurrence; Regulation; Relative (related person); Research; Role; Salivary; Services; Stress; Support Groups; Testing; Waiting Lists; Woman; base; behavior change; biological adaptation to stress; coping; emotional distress; experience; follow-up; improved; malignant breast neoplasm; mindfulness; mortality; oncology; psychologic; psychosocial; public health relevance; therapy design

DESCRIPTION (provided by applicant): The purpose of this randomized controlled trial is to evaluate the effectiveness of an empirically supported psychosocial treatment, Acceptance and Commitment Therapy, in facilitating improved quality of life, benefit-finding, and cortisol rhythm in breast cancer patients in an outpatient clinical oncology setting. Previous research indicates that breast cancer patients may demonstrate disrupted diurnal cortisol rhythms compared to healthy individuals, and that these disrupted rhythms may be related to recurrence and earlier mortality in some patients. Interestingly, improvements in cortisol regulation in previous intervention studies for cancer patients have not necessarily been related to decreased distress. Rather, improvements in post-traumatic growth, benefit-finding, and meaningfulness have also accounted for improved neuroendocrine and immunological changes. Traditional breast cancer groups, however, may not adequately address these areas because existing interventions often target the reduction of distress as the primary vehicle to improve psychosocial, quality of life, and biophysical outcomes. Acceptance and Commitment Therapy (ACT) is an empirically-supported, mindfulness-based psychological treatment that has been shown to enhance meaningful behavior change thorough increasing emotional acceptance of difficult psychological experiences such as distress, without the goal of changing or eliminating them. The current study seeks to determine the preliminary effect of an 8-week ACT group in increasing positive life changes and corresponding increase in salivary cortisol slope in 40 distressed breast cancer patients, who will be randomly assigned to ACT or a wait list control group. The hypotheses for the present study include: 1) that patients receiving ACT will demonstrate improvements in Quality of Life (QoL), Benefit-finding (BF), and health behavior compared to control group participants; 2) ACT participants will demonstrate improvements in mean cortisol levels and cortisol reactivity compared to control group participants, and 3) these changes will be the result of increased mindful acceptance of cancer-related distress and meaningful behavior changes, rather than a reduction in distress. Psychosocial outcomes for these patients will include differences in QoL, BF, and health behaviors and will be assess pre-treatment, post-treatment, and at 3-month follow-up. Stress reactivity will be measured by assessing diurnal cortisol patterns over three days before treatment and at 3-month follow-up. Analyses will be conducted to determine the relative contribution of distress reduction versus acceptance on psychosocial and cortisol outcomes. This study provides an opportunity to perform a pilot evaluation of an empirically-supported psychosocial treatment for breast cancer patients, while examining whether patients in this distressing situation can achieve psychological and diurnal cortisol rhythm changes through engaging in meaningful behaviors, rather than distress reduction. PUBLIC HEALTH RELEVANCE: Being diagnosed with and treated for breast cancer is often a distressing experience. Recent research has demonstrated that benefits in quality of life, stress hormone reactivity, and immune system functioning can be achieved by helping women with breast cancer find benefit and growth through the cancer process, even though the experience is stressful. This study examines the impact of a treatment designed to target meaningful life changes on quality of life and stress responses in the body.

描述（由申请人提供）：本随机对照试验的目的是评估经验支持的心理社会治疗（接受和承诺疗法）在促进乳腺癌患者生活质量、获益发现和皮质醇节律改善方面的有效性。门诊临床肿瘤学环境。先前的研究表明，与健康个体相比，乳腺癌患者可能表现出昼夜皮质醇节律紊乱，并且这些节律紊乱可能与某些患者的复发和早期死亡有关。有趣的是，之前针对癌症患者的干预研究中皮质醇调节的改善并不一定与痛苦的减少有关。相反，创伤后成长、利益发现和意义的改善也解释了神经内分泌和免疫学变化的改善。然而，传统的乳腺癌群体可能无法充分解决这些领域的问题，因为现有的干预措施通常以减少痛苦为目标，将其作为改善社会心理、生活质量和生物物理结果的主要手段。接受与承诺疗法（ACT）是一种基于经验的、基于正念的心理治疗，已被证明可以通过增加对痛苦等困难心理经历的情感接受来增强有意义的行为改变，而不是改变或消除它们。目前的研究旨在确定 8 周 ACT 组对 40 名痛苦的乳腺癌患者增加积极生活变化和唾液皮质醇斜率相应增加的初步效果，这些患者将被随机分配到 ACT 组或等待名单对照组。 本研究的假设包括：1) 与对照组参与者相比，接受 ACT 的患者将表现出生活质量 (QoL)、获益发现 (BF) 和健康行为的改善； 2) 与对照组参与者相比，ACT 参与者将表现出平均皮质醇水平和皮质醇反应性的改善，3) 这些变化将是由于更加认真地接受与癌症相关的痛苦和有意义的行为改变，而不是减少痛苦的结果。这些患者的心理社会结果将包括生活质量、BF 和健康行为的差异，并将在治疗前、治疗后和 3 个月随访时进行评估。将通过评估治疗前三天和三个月随访时的昼夜皮质醇模式来测量压力反应性。将进行分析以确定减轻痛苦与接受心理社会和皮质醇结果的相对贡献。这项研究提供了一个机会，对乳腺癌患者的实证支持的心理社会治疗进行初步评估，同时检查处于这种痛苦情况下的患者是否可以通过参与有意义的行为而不是减少痛苦来实现心理和昼夜皮质醇节律的变化。 公共卫生相关性：被诊断出患有乳腺癌并接受治疗通常是令人痛苦的经历。最近的研究表明，通过帮助乳腺癌女性在癌症过程中找到益处和成长，可以实现生活质量、应激激素反应性和免疫系统功能方面的益处，即使这种经历充满压力。这项研究探讨了旨在实现有意义的生活改变的治疗对生活质量和体内压力反应的影响。