ACTIVA. Behavioral Activation and Acceptance and Commitment Therapy in the treatment of anxiety and depression in cancer survivors

Behavioural Activation (BA) and Acceptance and Commitment Therapy (ACT) aim to reduce the inflexible avoidance of painful thoughts, feelings, and memories and to encourage involvement in relevant activities, objectives which are clearly relevant to the situation of cancer survivors with emotional problems. With a view to evaluating and comparing the efficacy of both therapies, applied on a group basis, a randomized controlled trial was developed. Participants had to meet the following criteria: (a) between 18 and 65 years of age; (b) finished oncological treatment with surgery, chemotherapy and/or radiotherapy for any type of malignant tumour; (c) currently be free of any type of oncological disease; (d) scores ≥ 8 in at least one of the subscales of the HADS (Zigmond, & Snaith, 1983). Participants were excluded if they (a) receiving another type of psychological therapy; (b) suffer physical or cognitive deterioration which might hinder participation in the therapy. Upon informed consent, participants completed the assessment instruments and were subsequently randomized to two experimental groups (BA/ACT) and a waiting list control group (WL). Content of the sessions is shown in Table (see attached file). Ninety-eight people were evaluated, seventy-one of whom fulfilled the inclusion criteria of the study. Of these, sixty-six were randomly assigned to two experimental groups (BA, n=17; ACT, n=12) and a waiting list control group (n=17). See CONSORT diagram (attached file). The emotional state, experiential avoidance and behavioural activation of the participants was evaluated in the pre- and post-treatment and in a 3-month follow-up using the following standardized instruments: (a) Hospital Anxiety and Depression Scale (HADS; Zigmond, & Snaith, 1983); (b) Short form of the 1978 Beck Depression Inventory (BDI-IA) based on the cognitive-affective subscale (BDI-IA-SCA; Beck, & Steer, 1993); (c) Environmental Reward Observation Scale (EROS; Armento, & Hopko, 2007); (d) Acceptance and Action Questionnaire-II (AAQ-II; Bond et al., 2011) ; (e) Behavioral Activation for Depression Scale (BADS) (Kanter, Mulick, Busch, Berlin, & Martell, 2007); (f) on completion of the treatment, the participants in the experimental groups also filled out the Client Satisfaction Questionnaire-8 (CSQ-8; Larsen, Attkisson, Hargreaves, & Nguyen, 1979). The attached database contains the data of all participants at the three assessment moments. Additionally, demographic and disease-related data collected at baseline are included. Both treatment groups showed statistically significant changes, indicating an improvement in all the result variables in the post-treatment and follow-up as compared to the pre-treatment. Both therapies proved to be efficacious. Nevertheless, BA showed better results than ACT regarding the impact on anxiety and activation. This greater efficacy may have been due to factors such as the emphasis placed in BA on behavioural activation.