Comparing the effectiveness of Emotional Awareness and Expression Therapy (EAET) and Acceptance and Commitment Therapy (ACT) on Cancer-related Fatigue and Pain Intensity in Women with Breast Cancer

Document Type : Original Article (s)

Authors

1 PhD Student in Clinical Psychology, Department of Psychology, Azad University of Roodehen, Tehran, Iran

2 Professor, Department of Psychology, School of Educational Sciences and Psychology, Shahid Chamran University of Ahvaz, Ahvaz, Iran

3 Professor, Department of Psychology, School of Educational Sciences and Psychology, Azad University of Roodehen, Tehran, Iran

Abstract

Background: Breast cancer is the most common cancer in women. Cancer-related pain and fatigue are some of the most frequent and debilitating consequences that affect the quality of life of these patients. Therefore, this research aimed to compare the effectiveness of Emotional Awareness and Expression Therapy (EAET) and Acceptance and Commitment Therapy (ACT) on cancer-related fatigue and pain intensity in women with breast cancer.
Methods: The present study utilized a semi-experimental design featuring a pre-test and post-test and a control group with a two-month follow-up. The study population consisted of women with breast cancer referred to the Mehre Soheila Charity Center in Alborz province. Participants participated in the study with informed consent. Through purposive sampling, 75 eligible individuals were selected and randomly assigned to two experimental groups: awareness and emotional expression therapy (25 individuals) and acceptance and commitment therapy (25 individuals), along with a control group (25 individuals). For each experimental group, the awareness and emotional expression therapy and acceptance and commitment therapy were separately conducted in group sessions over eight sessions of 90 minutes. It was performed as a group therapy between the winter and the spring of 2024, and data was collected through cancer-related fatigue questionnaires and a pain severity scale. The data were analyzed using covariance analysis with repeated measurements.
Findings: The results indicated that both therapeutic methods were significantly effective, but awareness and emotional expression therapy had a more significant effect than acceptance and commitment therapy on the overall score of cancer-related pain and fatigue intensity, and this effect continued until the follow-up stage (P < 0.05).
Conclusion: Emotional Awareness and Expression Therapy and Acceptance and Commitment Therapy are effective in reducing pain and fatigue in breast cancer patients. In breast cancer patients, due to the lack of knowledge about the nature of the disease and the determining role of psychological factors in the rate of recovery and the treatment process, it is necessary to provide conditions so that their feelings and emotions are well-regulated and expressed. Therefore, it is recommended that, in addition to drug treatments, health psychologists in therapeutic centers and psychological clinics use treatment based on acceptance and commitment, especially awareness and emotional expression therapy, to help breast cancer patients accept the disease and make efforts to treat it and to release and regulate their emotions and reduce the pain and fatigue caused by the disease.

Highlights

Najmeh Hamid: Google Scholar  

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References

  1. Soldato D, Arecco L, Agostinetto E, Franzoi MA, Mariamidze E, Begijanashvili S, et al. The future of breast cancer research in the survivorship field. Oncol Ther 2023; 11(2): 199-229.
  2. Doan LV, Yoon J, Chun J, Perez R, Wang J. Pain associated with breast cancer: etiologies and therapies. Front. Front Pain Res (Lausanne) 20233: 4: 1182488.
  3. Cascella M: Introductory Chapter: The Rationale for a Multimodal Approach to Pain Treatment. In: Cascella M, editor. From Conventional to Innovative Approaches for Pain Treatment. London, UK: IntechOpen; 2019.
  4. Spivey TL, Gutowski ED, Zinboonyahgoon N, King TA, Dominici L, Edwards RR, et al. Chronic pain after breast surgery: a prospective, observational study. Ann Surg Oncol 2018; 3(25): 2917-24.
  5. Kasper D, Fauci A, Hauser S, Longo D, Jameson J, Loscalzo J. Harrison’s principles of internal medicine. New York: McGraw-Hill; 2022.
  6. Liu D, Weng JS, Ke X, Wu XY, Huang ST. The relationship between cancer-related fatigue, quality of life and pain among cancer patients. Int J Nurs Sci 2023; 1(10): 111-6.
  7. National Coalition for Cancer Survivorship. (2019). Cancer survivorship survey: findings from an online survey of adult cancer patients. [16 Oct 2019]. Available from: https://www.canceradvocacy.org/wp-content/uploads/2019/09/NCCS-Survivorship-Survey-Final-Report.pdf.
  8. Safaei A, Tabatabaei SH, Dehkordi Moghimi B, Zeyghami B. Cancer-related fatigue in breast cancer patients undergoing chemotherapy [in Persian]. J Semnan Uni Med Sci 2010; 11(4): 117-30.
  9. Adam S, van de Poll-Franse LV, Mols F, Ezendam NPM, de Hingh I, Arndt V, et al. The association of cancer-related fatigue with all-cause mortality of colorectal and endometrial cancer survivors: results from the population-based PROFILES registry. Cancer Med 2019; 8(6): 3227-36.
  10. Thong MSY, Cornelis JF, Noorden V, Steindorf K, Arndt V. Cancer-related fatigue: causes and current treatment options. Curr Treat Options Oncol 2020; 21(2): 17.
  11. Li H, Jin X, Marques N N, Mann K F, Wang N, Wong C. Effects of Acceptance and Commitment Therapy on fatigue interference and health-related quality of life among patients with advanced lung cancer: A pilot randomized controlled trial. Asia Pac J Oncol Nurs 2022; 9(8): 100102.
  12. García-Torres F, García2 SR, Ruíz-Ruano VG, Moriana JA, Jaén-Moreno MJ, Gálvez-Lara M, et al. Efficacy of a Combined Acceptance and Commitment Intervention to Improve Psychological Flexibility and Associated Symptoms in Cancer Patients: Study Protocol for a Randomized Controlled Trial. Front Psychol 2022; 13(9).
  13. Ehde DM, Dillworth TM, Turner JA. Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. Am Psychol 2014; 69(2): 153-66.
  14. Lin J, Paganini S, Sander L, Lüking M, Ebert DD, Buhrman M, et al. An internet-based intervention for chronic pain. Dtsch Arztebl Int 2017; 114(41): 681-8.
  15. Martin S, Wolters P L, Toledo-Tamula M A, Schmitt S H N, Baldwin A, et al. 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. Am J Med Genet A 2016; 17 (6): 1462-70.
  16. Hadlandsmyth K, Dindo ML, Wahid R, Sugg SL, Zimmerman, MB, Rake BA. A single-session acceptance and commitment therapy intervention among women undergoing surgery for breast cancer: A randomized pilot trial to reduce persistent postsurgical pain. Psychooncology 2019; 28(11): 2210-17.
  17. Izadi R, Abedi MR. Acceptance and commitment therapy [in Persian]. Tehran: Iran: Kavoshiar Publications; 2014.
  18. Haris R. Acceptance and commitment therapy [in Persian]. 4th ed. Tehtan, Iran: Arjmand Publications; 2015.
  19. Lumley MA, Schubiner H. Emotional awareness and expression therapy for chronic pain: rationale, principles and techniques, evidence, and critical review. Curr Rheumatol Rep 2019; 21(7): 30.
  20. Lumley MA, Schubiner H, Lockhart NA, Kidwell KM, Harte SE, Clauw D, et al. Emotional awareness and expression therapy, cognitive-behavioral therapy, and education for fibromyalgia: a cluster-randomized controlled trial. Pain 2017; 158(12): 2354-63.
  21. Lumley M A, Keefe F J, Mosley-Williams A, Rice J R, McKee D, Waters S J, et al. The effects of written emotional disclosure and coping skills training in rheumatoid arthritis: a randomized clinical trial. J Consult Clin Psychol 2014; 82(4): 644-5.
  22. Lumley M A, Sklar ER, Carty JN. Emotional disclosure interventions for chronic pain: from the laboratory to the clinic. Transl Behav Med 2012; 2(1): 73-81.
  23. Hayes SC, Pistorello J, Levin ME. Acceptance and Commitment Therapy as a Unified Model of Behavior Change. Counsel Psychol 2012; 40(7): 976-1002.
  24. Onyedibe MCC, Chidebe RCW, Ugwu LE, et al. Cognitive emotion regulation moderates the relationship between anxiety, depression and cancer-related fatigue in cancer patients. Curr Psychol 2024; 43: 19225-35.
  25. Rosendahl J, Gawlytta R, Ressel E, Rodeck J, Strauss B, Mehnert-Theuerkauf A, et al. Efficacy of group therapy to reduce mental distress in women with non-metastatic breast cancer: a systematic review and meta-analysis of randomized controlled trials. Psychoncology 2023; 32(3): 331-41.
  26. Khatibi A, Dehghani M, Sharpe L, Asmundson GJG, Pouretemad H. Selective attention towards painful faces among chronic pain patients: evidence from a modified version of dot-probe. Pain 2009; 142(48): 42-7.
  27. Boonstra AM, Preuper RS, Reneman MF, Posthumus JB, Stewart RE. Reliability and validity of the visual analogue scale for disability in patients with chronic musculoskeletal pain. Int J Rehabil Res 2008; 31(2): 165-9.
  28. Thakur ER, Holmes HJ, Lockhart NA, Carty, JN, Ziadni MS, Doherty HK, et al. Emotional awareness and expression training improves irritable bowel syndrome: A randomized controlled trial. Neurogastroenterol Motil 2017; 29(12): 10.
  29. Okuyama T, Akechi T, Kugaya A, Okamura H, Shima Y, Maruguchi M, et al. Development and validation of the cancer fatigue scale: a brief, threedimensional, self-rating scale for assessment of fatigue in cancer patients. J Pain Symptom Manage 2000; 19(1): 5-14.
  30. Tavakkoli A, Norouzi M, Hajizadeh A. Patients Satisfaction of Pain Relief After Surgery in Kerman Educational Hospitals [in Persian]. J Kermanshah Univ Med Sci 2005; 11(2): e80689.
  31. Orang S, Sabri H, Taheri A. Development of emotion-based therapy and its effectiveness on cognitive regulation of emotion and death anxiety in elderly women with cancer [in Persian]. Scientific and Cultural Educational Quarterly of Women and Family 1402; 63(18): 135-53.
  32. Zhang Y, Ding Y, Chen X, Li Y, Li J, Hu X. Effectiveness of acceptance and commitment therapy on psychological flexibility, fatigue, sleep disturbance, and quality of life of patients with cancer: A meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs 2023; 20(6): 582-92.
  33. Molavi P, Mikaeili N, Daneshvar S, Narimani M, Mehri S. The role of denial and alexithymia on pain perception in women with breast cancer [in Persian]. J Urmia Univ Med Sci 2015; 26(2): 102-11.
  34. Jafari A, Shiralizadeh S. Prediction of pain intensity based on emotional expression in women with breast cancer during the covid-19 pandemic: the mediating role of lifestyle [in Persian]. Cancer Care 2023; 2(2): 13-23.
  35. Thomas N, Shawyer F, Castle DJ, Copolov D, Hayes SC, Farhall J. A randomized controlled trial of acceptance and commitment therapy (ACT) for psychosis: study protocol. BMC Psychiatry 2014; 14(1): 198.
  36. Castanhel FD, Liberali R. Mindfulness-based stress reduction on breast cancer symptoms: systematic review and meta-analysis. Einstein (Sao Paulo) 2018; 16(6): eRW4383.
  37. Ikeuchi K, Ishiguro H, Nakamura Y, Izawa T, Shinkura N, Nin K. The relation between mindfulness and the fatigue of women with breast cancer: path analysis. Biopsychosoc Med 2020; 14: 1.
Journal of Isfahan Medical School
Volume 42, Issue 798
2nd Week, March
March and April 2025
Pages 1174-1186

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History

  • Receive Date: 24 July 2024
  • Accept Date: 14 December 2024

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