Kanser Tanısı Olan Kişilerde Kabul ve Kararlılık Terapisi Uygulamaları: Sistematik Bir Derleme

Öz

Kanser, bu hastalığa sahip olan kişilerin fiziksel sağlık durumları üzerindeki olumsuz etkilerin yanı sıra önemli psikolojik sorunları da beraberinde getiren ciddi bir hastalıktır. Günümüzde psikolojik tedaviler olumsuz belirtilerin azaltılmasında etkili sonuçlar ortaya koymaktadır. Üçüncü kuşak bilişsel davranışçı psikoterapilerden biri olan Kabul ve Kararlılık Terapisi kanser hastalarında belirtilerin azaltılmasında önemli bir tedavi yaklaşımıdır. Özellikle hastalığın kendisinin ve olumsuz etkilerinin kabul edildiği ve psikolojik esneklik düzeyinin yüksek olduğu durumlar daha az belirti ve hastalık sürecine uyum gösterme davranışında artış gibi olumlu sonuçlarla ilişkili bulunmaktadır. Bu çalışma kapsamında kanser hastalarının psikolojik sorunlarına yönelik uygulanmış Kabul ve Kararlılık Terapisi temelli tedavi yaklaşımları sistematik bir şekilde değerlendirilmiştir. Sadece kanser hastaları örneklemini, en az ön test ve son test ölçümleri ve Kabul ve Kararlılık Terapisinin temel bileşenlerini kapsayan bir müdahaleyi kullanmak gibi içleme kriterlerini karşılayan on beş çalışma detaylı olarak incelenmiştir. Sonuçlar, uygulanan tedaviler sonrasında hem tedavi öncesine hem de kontrol gruplarına kıyasla kanser hastalarının psikolojik esneklik, travma sonrası gelişim, maneviyat ve yaşam kalitesi düzeylerinde anlamlı artışlar olduğunu; hastalığın tekrar edeceği korkusu, depresyon, kaygı, stres, duygusal kontrol ve düşünceleri bastırma davranışlarında ise anlamlı azalmalar olduğunu göstermektedir. Ayrıca, sadece tedavi öncesine göre farkındalık düzeylerinde artış gözlenirken, ağrı ve ilişkili belirtiler, tükenmişlik, uyku sorunları ve hareketsiz yaşam tarzında anlamlı azalmalar görülmüştür. Hem bireysel hem de grup olarak nispeten kısa süreli bir şekilde uygulanabilen Kabul ve Kararlılık Terapisi temelli müdahale yöntemleriyle kanser hastalarının olumsuz psikolojik belirtileri azaltılabilir ve bunun yanında yaşama dair beklentilerinin ve yaşam kalitelerinin artması sağlanabilir. Ancak müdahalenin güvenirliğinin artması ve farklı kanser hastalarına genellenebilmesi için gelecekte yöntemsel açıdan daha kontrollü ve terapi kazanımlarının daha uzun dönemli olarak takip edileceği çalışmalara ihtiyaç duyulmaktadır. 

Anahtar Kelimeler

• Kanser,kabul ve kararlılık terapisi,psikolojik esneklik,sistematik derleme

Acceptance and Commitment Therapy Interventions in Patients Diagnosed with Cancer: A Systematic Review

Öz

Cancer is a serious disease that brings with it important psychological problems as well as the negative effects on the physical health of survivors. Nowadays, psychological treatments reveal effective results on reducing such negative symptoms. Acceptance and Commitment Therapy (ACT) - one of the third wave behavioral and cognitive psychotherapies - is an important treatment approach in reducing the negative symptoms of cancer survivors. In particular, situations in which the disease itself and its adverse effects were accepted and the level of psychological flexibility was high were found to be associated with less negative symptoms and more positive outcomes such as adherence with the disease process. This study systemtically evaluated ACT based interventions on the psychological problems of cancer survivors. Fifteen studies that met the following criteria were examined in detail: using only a sample of cancer patients, having at least a pre-test and a post-test assessment, and an intervention involving basic components of ACT. The results showed that following the treatments, there were significant increases in psychological flexibility, posttraumatic growth, spirituality, quality of life and significant decreases in fear of recurrence, depression, anxiety, stress, emotional control, and thought suppression levels of patients when comparing both pre-treatment and control groups. Additionally, there were significant increases in mindfulness compared to pre-treatment results alone, but a significant decrease in pain and related symptoms, burnout, sleep problems and sedentary behaviors. ACT interventions, which can be applied both individually or in groups and over relatively short period of time, are promising as an alternative treatment for cancer patients to reduce their negative psychological symptoms as well as to increase their life expectancy and quality of life. However, in order to generalize the findings for different cancer patients and to increase the confidence of intervention, future studies should be more controlled, reliable and long-term.

Anahtar Kelimeler

• Cancer,acceptance and commitment therapy,psychological flexibility,systematic review

Kaynakça

1. Arch, J. J. ve Mitchell, J. L. (2016). An Acceptance and Commitment Therapy (ACT) group intervention for cancer survivors experiencing anxiety at re-entry. Psycho-Oncology, 25(5), 610–615. https:// doi.org/10.1002/pon.3890.
2. Bach, P., Hayes, S. C. ve Gallop, R. (2012). Long term effects of brief Acceptance and Commitment Therapy for psychosis. Behavior Modification, 36, 165-181.
3. Backmann, M. (2017). What’s in a gold standard? In defence of randomised controlled trials. Medicine, Health Care and Philosophy, 20(4), 513–523.
4. Bluett, E. J., Homan, K. J., Morrison, K. L., Levin, M. E. ve Twohig, M. P. (2014). Acceptance and commitment therapy for anxiety and OCD spectrum disorders: An empirical review. Journal of Anxiety Disorders, 28(6), 612–624. https://doi.org/10.1016/j.janxdis.2014.06.008.
5. Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., … ve Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behavior Therapy, 42(4), 676–688.
6. Buki, L. P., Reich, M. ve Lehardy, E. N. (2016). “Our organs have a purpose”: body image acceptance in Latina breast cancer survivors. Psycho-Oncology, 25(11), 1337–1342.
7. Carver, C. S., Scheier, M. F. ve Weintraub, K. J. (1989). Assessing coping strategies: A theoretically sased approach. Journal of Personality and Social Psychology. https://doi.org/10.1037/00223514.56.2.267.
8. Chen, S., Liu, J., Zhang, Z. ve Li, Z. (2017). Self-acceptance and associated factors among Chinese women with breast cancer. Journal of Clinical Nursing, 26(11–12), 1516–1523.

9. Cuijpers, P., Weitz, E., Cristea, I. A. ve Twisk, J. (2017). Pre-post effect sizes should be avoided in meta-analyses. Epidemiology and Psychiatric Sciences, 26(4), 364–368.
10. Datta, A., Aditya, C., Chakraborty, A., Das, P. ve Mukhopadhyay, A. (2016). The potential utility of Acceptance and Commitment Therapy (ACT) for reducing stress and improving wellbeing in cancer patients in Kolkata. Journal of Cancer Education, 31(4), 721–729. https://doi.org/10.1007/ s13187-015-0935-8.
11. De la Torre-Luque, A., Gambara, H., López, E. ve Cruzado, J. A. (2015). Psychological treatments to improve quality of life in cancer contexts: A meta-analysis. International Journal of Clinical and Health Psychology, 16(2), 211–219. https://doi.org/10.1016/j.ijchp.2015.07.005.
12. Dunne, S., Mooney, O., Coffey, L., Sharp, L., Timmons, A., Desmond, D., … ve Gallagher, P. (2017). Self-management strategies used by head and neck cancer survivors following completion of primary treatment: A directed content analysis. Psycho-Oncology, 26(12), 1–7. https://doi. org/10.1002/pon.4447.
13. Faraji, J., Mahdavi, A., Samkhaniyan, E., Asadi, S. H. ve Dezhkam, N. (2015). A review of the effectiveness of cognitive-behavioral group therapy on the reduction of body image concern in patients with breast cancer. Journal of Medicine and Life, 8(4), 82-86.
14. Fashler, S. R., Weinrib, A. Z., Azam, M. A. ve Katz, J. (2018). The use of Acceptance and Commitment Therapy in oncology settings: A narrative review. Psychological Reports, 121(2), 229–252.
15. Feros, D. L., Lane, L., Ciarrochi, J. ve Blackledge, J. T. (2013). Acceptance and Commitment Therapy (ACT) for improving the lives of cancer patients: a preliminary study. Psycho-Oncology, 22(2), 459–464. https://doi.org/10.1002/pon.2083.
16. Forman, E. M., Shaw, J. A., Goetter, E. M., Herbert, J. D., Park, J. A. ve Yuen, E. K. (2012). Longterm follow-up of a randomized controlled trial comparing Acceptance and Commitment Therapy and Standard Cognitive Behavior Therapy for anxiety and depression. Behavior Therapy, 43(4), 801–811. https://doi.org/10.1016/j.beth.2012.04.004.
17. Ghasemi, F., Dehghan, F., Farnia, V., Tatari, F. ve Alikhani, M. (2016). Effectiveness of Acceptance and Commitment Therapy on life expectancy of female cancer patients at Tehran’s Dehshpour Institute in 2015. Asian Pacific Journal of Cancer Prevention, 17(8), 4113–4116. Erişim adresi: http://www. ncbi.nlm.nih.gov/pubmed/27644670.
18. Gonzalez-Fernandez, S., Fernandez-Rodriguez, C., Paz-Caballero, M. D. ve Perez-Alvarez, M. (2018). Treating anxiety and depression of cancer survivors: Behavioral activation versus acceptance and commitment therapy. Psicothema, 30(1), 14–20. https://doi.org/10.7334/psicothema2017.396.
19. Graham, C. D., Gouick, J., Krahé, C. ve Gillanders, D. (2016). A systematic review of the use of Acceptance and Commitment Therapy (ACT) in chronic disease and long-term conditions. Clinical Psychology Review, 46, 46–58. https://doi.org/10.1016/j.cpr.2016.04.009.
20. Gregurek, R., Bras, M., Dordević, V., Ratković, A.S. ve Brajković, L. (2010). Psychological problems of patients with cancer. Psychiatria Danubina, 22(2), 227–30. Erişim adresi: http://www.ncbi.nlm. nih.gov/pubmed/20562751.
21. Harris, R. (2016). ACT’ı kolay öğrenmek: İlkeler ve ötesi için hızlı bir başlangıç. (Kollektif çev.). İstanbul: Litera Yayıncılık.
22. Hawkes, A. L., Pakenham, K. I., Chambers, S. K., Patrao, T. A. ve Courneya, K. S. (2014). Effects of a multiple health behavior change intervention for colorectal cancer survivors on psychosocial outcomes and quality of life: A randomized controlled trial. Annals of Behavioral Medicine, 48(3), 359–370. https://doi.org/10.1007/s12160-014-9610-2.
23. Hawkes, A. L., Pakenham, K. I., Courneya, K. S., Gollschewski, S., Baade, P., Gordon, L. G., ... ve Chambers, S. K. (2009). A randomised controlled trial of a tele-based lifestyle intervention for colorectal cancer survivors (‘CanChange’): Study protocol. BMC Cancer, 9(1), 1-8.
24. Hayes, S. C. (2004). Acceptance and commitment therapy, relational frame therapy, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35(4), 639-665.
25. Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., … Mccurry, S. M. (2004). Measuring experiential avoidance: A preliminary test of a working model. Psychological Record, 54(4), 553–578. https://doi.org/10.1007/BF03395492.
26. Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A. ve Lillis, J. (2006) Acceptance and commitment therapy: Model, processes and outcomes. Behavior Research and Theraphy, 44(1),1–25. https://doi. org/10.1016/j.brat. 2005.06.006.
27. Hayes, S. C. ve Strosahl, K. D. (2010). A practical guide to acceptance and commitment therapy. New York: Springer.
28. Hayes, S. C., Strosahl, K. D. ve Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behaviour change. New York: The Guilford Press.
29. Hayes, S. C., Strosahl, K. D. ve Wilson, K. G. (2011). Acceptance and Commitment Therapy: The process and practice of mindful change. New York: Guilford.
30. Hayes, S. C., Strosahl, K. ve Wilson K. G. (2014). Terapia de aceptación y compromiso. Proceso y práctica del cambio consciente (Mindfulness). Bilbao: Desclée de Brouwer.
31. Heins, M. J., Korevaar, J. C., Rijken, P. M. ve Schellevis, F. G. (2013). For which health problems do cancer survivors visit their General Practitioner? European Journal of Cancer, 49(1), 211–218. https://doi.org/10.1016/j.ejca.2012.07.011.
32. Higgins, J. P. T., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., … Sterne, J. A. C. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 343, 1-9. https://doi.org/10.1136/bmj.d5928.
33. Hulbert-Williams, N. J., Storey, L. ve Wilson, K. G. (2015). Psychological interventions for patients with cancer: Psychological flexibility and the potential utility of Acceptance and Commitment Therapy. European Journal of Cancer Care, 24(1), 15–27.
34. Johns, S. A., Brown, L. F., Beck-Coon, K., Monahan, P. O., Tong, Y. ve Kroenke, K. (2016). Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psycho-Oncology, 24(8), 885-893.
35. Kamińska, M., Ciszewski, T., Bronikowska, A., Ferańska, M., Pawlak-Warszawska, A. ve Paśnik, E. (2014). Acceptance of the illness and the quality of life of patients with breast cancer. Polish Journal of Public Health, 124(1), 5–9.
36. Kangas, M. ve McDonald, S. (2011) Is it time to act? The potential of acceptance and commitment therapy for psychological problems following acquired brain injury. Neuropsychological Rehabilitation, 21(2), 250–276.
37. Kangas, M., McDonald, S., Williams, J. R. ve Smee, R. I. (2015). Acceptance and commitment therapy program for distressed adults with a primary brain tumor: A case series study. Supportive Care in Cancer, 23(10), 2855–2859. https://doi.org/10.1007/s00520-015-2804-8.
38. Köhle, N., Drossaert, C. H. C., Jaran, J., Schreurs, K. M. G., Leeuw, I. M. V. ve Bohlmeijer, E. T. (2017). User-experiences with a web-based self-help intervention for partners of cancer patients based on acceptance and commitment therapy and self-compassion: A qualitative study. BMC Public Health, 17(1), 225. https://doi.org/10.1186/s12889-017-4121-2.
39. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6(7), e1000100.
40. Linden, W. ve Girgis, A. (2012). Psychological treatment outcomes for cancer patients: What do meta-analyses tell us about distress reduction? Psycho-Oncology, 21(4), 343–350. https://doi.org/10.1002/pon.2035.
41. Lynch, B. M., Courneya, K. S., Sethi, P., Patrao, T. A. ve Hawkes, A. L. (2014). A Randomized controlled trial of a multiple health behavior change intervention delivered to colorectal cancer survivors. Cancer, 120(17), 2665–2672. https://doi.org/10.1002/cncr.28773.
42. Martin, S., Wolters, P. L., Toledo-Tamula, M. A., Schmitt, S. N., Baldwin, A., Starosta, A., … Widemann, B. (2016). Acceptance and Commitment Therapy in youth with neurofibromatosis type 1 (nf1) and chronic pain and their parents: A pilot study of feasibility and preliminary efficacy. American Journal of Medical Genetics Part A, 170(6), 1462–1470. https://doi.org/10.1002/ajmg.a.37623.
43. Miovic, M. ve Block, S. (2007). Psychiatric disorders in advanced cancer. Cancer, 110(8), 1665–1676. https://doi.org/10.1002/cncr.22980.
44. Mohabbat-Bahar, S., Maleki-Rizi, F., Akbari, M. E. ve Moradi-Joo, M. (2015). effectiveness of group training based on Acceptance And Commitment Therapy on anxiety and depression of women with breast cancer. Iranian Journal of Cancer Prevention, 8(2), 71–76.
45. Montazer, A., Nemati, F., Dehghani, F. ve Fallah, T. (2017). Efficacy of Acceptance and Commitment Therapy on breast cancer female patients’ hope. Iranian Journal of Cancer Prevention, 10(2). https://doi.org/Artn E552610.5812/Ijcp.5526.
46. Montesinos, F. ve Luciano, C. (2016). Acceptance of relapse fears in breast cancer patients: Effects of an ACT-based abridged intervention. Psicooncología, 13(1), 7-21.
47. Mosher, C. E., Secinti, E., Li, R. H., Hirsh, A. T., Bricker, J., Miller, K. D., … Johns, S. A. (2018). Acceptance and commitment therapy for symptom interference in metastatic breast cancer patients: a pilot randomized trial. Supportive Care in Cancer, 26(6), 1993–2004. https://doi.org/10.1007/s00520-018-4045-0.
48. Najvani, B. D., Neshatdoost, H. T., Abedi, M. R. ve Mokarian, F. (2015). The effect of acceptance and commitment therapy on depression and psychological flexibility in women with breast cancer. Zahedan Journal of Research in Medical Sciences, 17(4), 2383-2894).
49. Nenova, M., Morris, L., Paul, L., Li, Y., Applebaum, A. ve DuHamel, K. (2013). Psychosocial interventions with cognitive-behavioral components for the treatment of cancer-related traumatic stress symptoms: A review of randomized controlled trials. Journal of Cognitive Psychotherapy, 27(3), 258–284. https://doi.org/10.1891/0889-8391.27.3.258.
50. Ogden, J. (2016). HIV ve kanser: hastalık sürecinde psikoloji. G. Dirik (Ed.), Sağlık psikolojisi kitabı içinde (s. 369–390). Ankara: Nobel Akademik Yayıncılık.
51. Peoples, A. R., Garland, S. N., Perlis, M. L., Savard, J., Heckler, C. E., Kamen, C. S., … Roscoe, J. A. (2017). Effects of cognitive behavioral therapy for insomnia and armodafinil on quality of life in cancer survivors : a randomized placebo-controlled trial, Journal of Cancer Survivorship, 11(3) 401–409. https://doi.org/10.1007/s11764-017-0597-0.
52. Politi, M. C., Enright, T. M. ve Weihs, K. L. (2007). The effects of age and emotional acceptance on distress among breast cancer patients. Supportive Care in Cancer, 15(1), 73–79.
53. Ream, E., Gargaro, G., Barsevick, A. ve Richardson, A. (2015). Management of cancer-related fatigue during chemotherapy through telephone motivational interviewing: Modeling and randomized exploratory trial. Patient Education and Counseling, 98(2), 199–206. https://doi.org/10.1016/j.pec.2014.10.012.
54. Rost, A. D., Wilson, K., Buchanan, E., Hildebrandt, M. J. ve Mutch, D. (2012). Improving psychological adjustment among late-stage ovarian cancer patients: Examining the role of avoidance in treatment. Cognitive and Behavioral Practice, 19(4), 508–517. https://doi.org/DOI 10.1016/j. cbpra.2012.01.003.
55. Schulz, K. F., Altman, D. G. ve Moher, D. (2010). CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Medicine, 8, 1-9. https://doi.org/10.1136/bmj.c332.
56. Spencer, J. C. ve Wheeler, S. B. (2016). A systematic review of Motivational Interviewing interventions in cancer patients and survivors. Patient Education and Counseling, 99(7), 1099–1105. https://doi. org/10.1016/j.pec.2016.02.003.
57. Swain, J., Hancock, K., Hainsworth, C. ve Bowman, J. (2013). Acceptance and Commitment Therapy in the treatment of anxiety: A systematic review. Clinical Psychology Review, 33(8), 965–978. https://doi.org/10.1016/j.cpr.2013.07.002.
58. Şencan, İ. ve Keskinkılıç, B. (Ed.). (2017). Türkiye kanser istatistikleri. Ankara: Türkiye Halk Sağlığı Kurumu.
59. Türkiye İstatistik Kurumu. (2018). Ölüm nedeni istatistikleri, 2017. Erişim adresi: http://www.tuik.gov. tr/PreHaberBultenleri.do?id=27620
60. Veehof, M. M., Oskam, M. J., Schreurs, K. M. G. ve Bohlmeijer, E. T. (2011). Acceptance-based interventions for the treatment of chronic pain: A systematic review and meta-analysis. Pain, 152(3), 533–542. https://doi.org/10.1016/j.pain.2010.11.002.
61. Watson, M., White, C., Lynch, A. ve Mohammed, K. (2017). Telephone - delivered individual Cognitive Behavioural Therapy for cancer patients : An equivalence randomised trial. Psycho-Oncology, 26(3), 301–308. https://doi.org/10.1002/pon.4338.
62. Wootten, A. C., Meyer, D., Abbott, J.-A. M., Chisholm, K., Austin, D. W., Klein, B., … Costello, A. J. (2016). An online psychological intervention can improve the sexual satisfaction of men following treatment for localized prostate cancer: outcomes of a Randomised Controlled Trial evaluating My Road Ahead. Psycho-Oncology, 26(7), 975–981. https://doi.org/10.1002/pon.4244.
63. World Health Organisation. (2018). The top 10 causes of death. Erişim adresi: https://www.who.int/ news-room/fact-sheets/detail/the-top-10-causes-of-death
64. Xiao, F., Song, X., Chen, Q., Dai, Y., Xu, R., Qiu, C. ve Guo, Q. (2016). Effectiveness of psychological interventions on depression in patients after breast cancer surgery: A meta-analysis of randomized controlled trials. Clinical Breast Cancer, 17(3), 171–179. https://doi.org/10.1016/j.clbc.2016.11.003.
65. Yaman, Ş. ve Ayaz, S. (2016). Psychological problems experienced by women with gynecological cancer and how they cope with it: A phenomenological study in Turkey. Health and Social Work, 41(3), 173–181. https://doi.org/10.1093/hsw/hlw030.
66. Yastıbaş, C. ve Dirik, G. (2018). Kanser ve farkındalık temelli müdahale programları: sistematik derleme. Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry, 10(3), 375-393.
67. Yavuz, K. F. (2015). Kabul ve Kararlılık Terapisi (ACT): Genel bir bakış. Türkiye Klinikleri Journal of Psychiatry Special Topics, 8(2), 21-27.