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Aplicación de la terapia de aceptación y compromiso en pacientes enfermos de cáncer
Abstract
En: Análisis y modificación de conducta Valencia 2001, v.27, n. 113; p. 503-523 En este trabajo se exponen los resultados de la aplicación de la Terapia de Aceptación y Compromiso (Hayes, Strosahl y Wilson, 1999) a un paciente varón de 50 años operado de cáncer de mama que presentaba niveles elevados de ansiedad y pensamientos obsesivos muy persistentes acerca de su enfermedad y de otros temas relacionados, que se ajustaban a la dimensión diagnóstica funcional denominada 'trastorno de evitación experiencial'. La intervención fue realizada por dos terapeutas sin experiencia en la aplicación de esta terapia, a lo largo de 20 sesiones incluyendo evaluación y seguimiento. Mediante este estudio de caso se ilustra la eficacia, mantenida durante el seguimiento, de una terapia que, frente a otras aproximaciones, persigue la aceptación de los eventos de este acercamiento en el campo de la psico-oncología. Además se sugieren posibles riesgos y errores susceptibles de pressentarse al implementar una terapia que, al haber sido propuesta desde una perspectiva analítico-funcional, requiere un conocimiento por parte del terapeuta no exclusivamente instruido así como de una supervisión que facilite la discriminación de la propia conducta terapéutica, p.518-521
... ACT mejora la calidad de vida de los pacientes promoviendo actuaciones acordes a los valores del paciente. Promueve la flexibilidad psicológica al alterar el patrón de evitación destructiva que le sitúa en una lucha infructuosa contra los propios sentimientos y sentimientos, alejándole de sus metas valiosas (14) . Los métodos clínicos de ACT se dirigen a clarificar los valores personales, contactar con la ineficacia de la lucha contra el malestar, y a aceptar los temores, preocupaciones o recuerdos del paciente de cáncer, orientándole al aquí y el ahora y a la acción como vía para volver a vivir una vida valiosa y una disminución del malestar emocional que constituía su motivo de consulta inicial. ...
... Este enfoque terapéutico ha tenido resultados eficaces en la intervención de pacientes con cáncer tal y como lo reportan diversos estudios con distintos tipos de diagnósticos de cáncer (10,(13)(14)(15) . Los resultados de dichas investigaciones han mostrado una mayor repercusión de la intervención basada en ACT, especialmente cuando se tienen en cuenta los cambios a largo plazo (al año de seguimiento). ...
This paper introduces the case of a woman with breast cancer who had developed a mixed depressive-anxiety disorder with avoidance behaviors. The patient presented depressive symptoms like listlessness, insomnia, weeping, food disorders and hopelessness though. Also, she exhibited physiological arousal and restlessness feelings. Additionally, the patient had an avoidance patron behavior in relation with all stimulus she believed could hurt her. Based on the Acceptance and Commitment Therapy (ACT) the intervention planted the following objectives: the patient will learn to accept her illness and the emotional distress that she was experiencing, also, the patient will recover the other areas of her life that she had abandoned. The treatment was developed in 14 sessions. The therapist used these techniques: creative hopelessness, disabling verbal functions, values clarification and loss of control over private events. In the results, it was observed a positive change in the behavior of the patient as well as a decrease in emotional distress that was his reason for initial consultation. © 2016, Spanish Association of Anglo-American Studies. All rights reserved.
... Although three articles discussing an ACT intervention in women with breast cancer were reported by Hulbert- Williams, Storey, and Wilson (2015), translated versions of the articles were not available to be included for the present review (Montesinos, Hernandez, & Luciano, 2001;Montesinos & Luciano, 2005;Pa´ez, Luciano, & Gutie´rrez, 2007). Studies were not included in the review if they used qualitative methodology (Nelson et al., 2015) or were of poor quality (i.e., reported the same data in multiple studies, used treatment protocols with substantial deviation from existing ACT protocols, and/or reported inadequate statistical analysis; Datta, Aditya, Chakraborty, Das, & Mukhopadhyay, 2016;Esmali & Alizadeh, 2016;Gholamhosseini & Mojtabaie, 2015;Mohabbat-Bahar, Maleki-Rizi, Akbari, & Moradi-Joo, 2015;Mojtabaie & Gholamhosseini, 2014;Najvani, Neshatdoost, Abedi, & Mokarian, 2015). ...
Various psychotherapeutic approaches have been developed to address the psychosocial stressors and distress associated with cancer diagnosis and treatment. One such approach, Acceptance and Commitment Therapy (ACT), may be particularly well suited to people with cancer as it offers a model of healthy adaptation to difficult circumstances. This paper provides a description and theoretical rationale for using ACT in psychosocial oncology care that emphasizes emotional distress and cancer-related pain and provides a narrative review of the current state of evidence for this setting. Six studies met eligibility criteria for inclusion in the review. The research designs included one case study, three pre-post cohort studies, and two randomized controlled trials. Cancer diagnoses of patients included breast cancer, ovarian cancer, colorectal cancer, and mixed cancer populations at various stages of disease progression or recovery. ACT interventions demonstrated significant improvements in symptoms including quality of life and psychological flexibility as well as reductions in symptoms including distress, emotional disturbances, physical pain, and traumatic responses. Overall, although there is limited published research currently available, there is some evidence to support ACT as an effective psychotherapeutic approach for cancer patients. Further research is needed for different cancer populations across the illness trajectory. Barriers to implementation are discussed.
... Sin embargo, los estudios realizados han mostrado de forma consistente que el incremento de la flexibilidad psicológica está asociado a mejores resultados terapéuticos. El primer trabajo en esta área fue publicado por Montesinos Marin et al. en el año 2001 (30) , y corresponde a un estudio de caso de aplicación de ACT a un hombre de 50 años diagnosticado con cáncer de mama. La intervención tuvo una duración de 20 sesiones, y estuvo asociada a reducciones en los niveles de evitación experiencial, ansiedad, y depresión. ...
Psychological flexibility has been related to a wide number of positive outcomes among individuals with mental health problems and chronic illnesses, and it has been identified as an important mechanism of change in psychotherapy. However, the attention given to psychological flexibility within psycho-oncology has been quite limited, even though it may offer new alternatives in the treatment of
cancer-related distress. The objective of the present descriptive review was to bring together the studies
that have examined the association between psychological flexibility and outcomes among cancer
patients, or have carried out interventions aiming to increase the level of psychological flexibility
among cancer patients. Even though the research base in this area is still small, the findings consistently
show that higher levels of psychological flexibility are associated with increased levels of wellbeing
among cancer patients, even in the presence of health deterioration. Implications for clinical practice in
psycho-oncology are discussed.
... Literature informing the use of ACT in cancer populations is rather nascent. However, of the studies and case reports available, ACT has demonstrated improvements in psychological flexibility, quality of life, and reduction of depression and anxiety symptoms [37][38][39]. Based on preliminary findings, ACT offers an important platform for oncogeriatric populations. ...
The last decade has evidenced a strong push by the interdisciplinary medical community to improve mental health service delivery with older adults. As this momentum grows, additional questions are raised regarding the utility of psychosocial interventions specifically aimed for chronically and terminally ill geriatric populations. Cancer diagnosis among those aged 65 and older is pervasive. Further understanding about the psychological, spiritual and existential issues older adults face when living with cancer is needed. Interventions that promote psychological growth and quality of life are also warranted. The following review article highlights clinical interventions designed to improve the psychosocial health of older adults with cancer. A focus is offered on interventions specifically designed for oncogeriatric populations, while also noting novel and viable treatments that promote meaning, acceptance, and values. Additionally, how these interventions have reached with caregivers and families is also addressed.
... Nevertheless, acceptance in ACT involves exposure not to avoided situations but to avoided private events (including thoughts or worries) which accompany the experience of cancer. Pos-sible benefits of ACT applied to cancer patients are being highlighted (25)(26)(27)(28)(29) . Promising preliminary data has been presented through case studies (30)(31) and clinical trials (29,(32)(33)(34) . ...
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.
... Dada su aproximación funcional, que no topográfica, a los trastornos psicopatológicos, ha sido aplicada a una pluralidad de entidades diagnósticas en estudios de caso único: agorafobia (Carrascoso, 1999;Zaldívar y Hernández, 2001), alcoholismo (Luciano, Gómez, Hernández y Cabello, 2001;Velasco y Quiroga, 2001), anorexia (Hayes y Pankey, 2002;Heffner, Sperry, Eifert y Detweiler, 2002;Orsillo y Batten, 2002;Wilson y Roberts, 2002), ansiedad (Luciano y Gutiérrez, 2001), ansiedad generalizada (Orsillo, Roemer y Barlow, 2003;Roemer y Orsillo, 2002), cáncer (Montesinos, Hernández y Luciano, 2001), depresión (Dougher y Hackbert, 1994;López y Arco, 2002), dolor crónico (Luciano, Visdómine, Gutiérrez y Montesinos, 2001), consumo de drogas (Forsyth, Parker y Finlay, 2003;Paul et al., 1999), trastornos por duelo , obsesiones (Ferro, 2000), psicosis (García y Pérez-Alvarez, 2001;García, Luciano, Hernández, y Zaldívar, 2004;Pankey y Hayes, 2003) y trastornos sexuales (Montesinos, 2003;Paul et al., 1999). ...
This theoretical study outlines and analyzes two therapeutic frameworks based on Skinner's early work on verbal behavior. The foundation of Functional-Analytic Psychotherapy (FAP) is the verbal shaping of patient's in vivo verbal responses during the therapeutic sessions. The client-therapist relationship is considered a model of interpersonal relationship to be generalized to the patient's daily-life. This model offers a behavioral analysis of the client-therapist relationship and outlines a theoretical framework to explain its relevance within the clinical process. The synergic effects of combining FAP with other traditional cognitive and cognitive-behavioral interventions are also discussed. On the other hand, Acceptance and Commitment Therapy (ACT) analyzes the avoidance of aversive private events (i.e., experiential avoidance) as a function for various «psychopathological» topographies. Certain rule-following behaviors may be adding to this phenomena by conveying the individual to control or change in different ways his emotions and cognitions. ACT depicts a number of clinical strategies in order to influence avoidance and rule-following phenomena that may be causing patient's distress. The likely continuity between this therapeutic frameworks and the traditional applied and functional analysis of behavior is discussed in the closing section of this manuscript.
... ISSN: 2182 -0290 Year 0, Vol. I, nº 2, 2013 2002), addictions (Hayes, Wilson, et al., 2004; Luciano, Gómez, Hernández, & Cabello, 2001), suicide (Hayes, Pistorello, & Biglan, 2008), as well as in the management of medical and family problems (Biglan, Lewin, & Hops, 1990; Montesinos, Hernandez, & Luciano, 2001). Additionally, one of the areas where ACT has shown great relevance is in pain, with extremely encouraging results about changes in acceptance on issues related to pain and psychological flexibility (Dahl, Wilson, & Nilsson, 2004; McCracken, Vowles, & Eccleston, 2005; Vowles, McCracken, & Eccleston, 2008). ...
This paper briefly describes what is the third generation of cognitive-behavioral therapies, focusing on Acceptance and Commitment Therapy (ACT), its underlying models and effectiveness, especially when combined with mindfulness techniques. This therapy, in anxiety disorders, focuses on the reduction of the function of anxiety concerning behavioral regulation and cognition, and strongly focuses on behavior modification centered on the values of the patient as well as in the promotion of psychological flexibility. A clinical case of a patient with panic disorder (with agoraphobia) is presented, treated with ACT processes, and showing promising outcomes.
This study aimed to analyse published studies regarding the usefulness of Acceptance and Commitment Therapy in the treatment of oncological patients. A systematic review of the literature was conducted using the Web of Science, Google Scholar and Dialnet (2000-2016). Nineteen articles fulfilled the inclusion criteria. Those patients who received interventions based on Acceptance and Commitment Therapy showed a better emotional state and quality of life and greater psychological flexibility. Acceptance and Commitment Therapy proved to be useful in the psychological treatment of oncological patients. However, the heterogeneity and limitations of the studies, principally with regard to sample characteristics, study design and manner in which mechanisms responsible for changes are evaluated, make further studies necessary with a view to ascertaining what patient and/or intervention characteristics might improve results. Randomized controlled trials comparing the efficacy of Acceptance and Commitment Therapy with no treatment, with treatment with placebo and with other efficacious therapies, including a study of medium- and long-term results, would be of particular interest.
A new psychotherapeutic approach from a behavioral view is considered: the Functional Analytic Psychotherapy. Its theoretical, methodological and applied foundations are described. Its functional characteristics are discussed from a contextual point of view.
Cancer is an illness affecting patients' physical and psychosocial well-being: high numbers report problematic levels of distress at many points through diagnosis, treatment and survivorship. Conclusive evidence for the long-term benefits of psychological interventions is lacking and this may be because (1) they employ a too limited scope of underlying therapeutic model; or (2) that they are too focused on improving psychopathological outcomes. Acceptance and Commitment Therapy (ACT) may add components not emphasised elsewhere and may provide a more suitable model of adjustment and coping. Following a comprehensive literature search a theoretical and conceptual discussion of the potential for ACT-based oncology interventions is presented. Only a small number of studies have purposively studied the application of ACT within the cancer setting, but this nonetheless presents useful pilot data. The data demonstrate potential clinical- and cost-effectiveness for a range of patients, including those with psychological comorbidity. Within the context of wider cancer adjustment, ACT offers an intervention framework to appropriately build upon the strong empirical base already established for Mindfulness within this specific patient population. The evidence available suggests that the underlying framework of ACT offers an intervention model that is potentially more suited to the individualistic nature of cancer adjustment.
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