Acceptability and Effectiveness of an Adapted Internet-Delivered Cognitive Behavioural Therapy Programme for Depression and/or Anxiety in Breast Cancer Survivors
Citation:
Akkol Solakoglu, Selin, Acceptability and Effectiveness of an Adapted Internet-Delivered Cognitive Behavioural Therapy Programme for Depression and/or Anxiety in Breast Cancer Survivors, Trinity College Dublin.School of Psychology, 2022Download Item:
Selin_Akkol_Solakoglu_PhD_thesis_final.pdf (PDF) 3.332Mb
Abstract:
Depression and anxiety are the most common psychological problems experienced by breast cancer survivors. However, survivors need for psychosocial care is usually under-recognised; even when recognised, the lack of available mental health clinicians prevents them from accessing psychological services. Internet-delivered cognitive behavioural therapy (iCBT) is an easily accessible and evidence-based alternative that has been proven effective in reducing depression and anxiety symptoms in the general population. Studies for health conditions, especially for cancer survivors, are becoming more frequent, with studies showing promising improvements. However, no study to date has investigated the effectiveness of iCBT for depression and/or anxiety, specifically with breast cancer survivors in Europe. Although the inclusion of the social environment in the iCBT programmes designed for people with chronic illnesses is suggested as best practices in digital health interventions, no study has evaluated if including carers in an iCBT programme is acceptable. This thesis investigated an adapted 7-week iCBT programme s acceptability and effectiveness in reducing breast cancer survivors depression and/or anxiety.
A mixed-method approach combining qualitative and quantitative methods was used. Study I qualitatively evaluated the acceptability of iCBT programme and carer access to the iCBT programme with five breast cancer survivors and three carers. The findings of Study I and evidence from the literature informed Study II, in which an iCBT intervention was adapted considering the specific needs of breast cancer survivors and the carer access aspect. Study III evaluated the effectiveness of the adapted 7-week iCBT programme by comparing the iCBT and treatment-as-usual control (TAU) groups. Seventy-two breast cancer survivors living in Ireland and the UK who completed their medical treatment and were cancer-free, and four of their carers participated in the study. The iCBT group received the intervention online with weekly post-session feedback from a trained supporter. The Sociodemographic and Clinical History Questionnaire was used to assess demographic and clinical information of the participants. The Hospital Anxiety and Depression Scale (HADS) was used as the
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primary outcome measure. The secondary measures included the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire (EORTC-QLQ-C30), Breast Cancer Worry Scale (CWC), Brief Coping Orientation to Problems Encountered (Brief COPE), Medical Outcomes Study Social Support Survey (MOS-SSS), which were completed at baseline, post- intervention, and 2-month follow-up. Both survivors and carers completed Survivor-Carer Cancer Communication and Relationship Quality measures. Other measures included Helpful Aspects of Therapy Form (HAT) and Satisfaction with Online Treatment (SAT). Programme effectiveness was evaluated on an intention-to-treat and per-protocol basis using Linear-Mixed-Models. Study IV qualitatively investigated the experienced acceptability of the adapted iCBT programme as well as user experiences with it and provider experiences with their role.
Study I revealed a need for easily accessible, evidence-based psychological treatments for breast cancer survivors both shortly after diagnosis and medical treatment completion. Survivors and carers found the iCBT programme and carer access acceptable. Study III indicated that the guided iCBT group had lower distress than the TAU control group at post-intervention, t(55) = -1.81, p = .075. This difference was statistically significant at 2-month follow-up, t(45) = -3.16, p = .003. Survivors found the availability of the supporter very helpful and were highly satisfied with the programme. Study IV findings revealed that survivors found the adapted programme acceptable. User experiences findings revealed similar results with suggestions to improve the programme further. The findings also identified the reasons for low preference for carer access. Survivors and providers reported a lack of understanding of the tools such as the TFB Cycle. Following the discussion of the results based on the findings in the literature, strengths, limitations, and suggestions for future research are provided. It was concluded that the adapted guided iCBT programme can ease the adaptation to life after treatment and reduce breast cancer survivors psychological distress.
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https://tcdlocalportal.tcd.ie/pls/EnterApex/f?p=800:71:0::::P71_USERNAME:AKKOLSOSDescription:
APPROVED
Author: Akkol Solakoglu, Selin
Advisor:
Hevey, DavidPublisher:
Trinity College Dublin. School of Psychology. Discipline of PsychologyType of material:
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