A randomized pilot trial of a positive affect skill intervention (lessons in linking affect and coping) for women with metastatic breast cancer
Open accessAbstract
Background: We conducted a randomized pilot trial to examine the feasibility, acceptability, and preliminary efficacy of a 5 week positive affect skills intervention (LILAC: lessons in linking affect and coping) for women with metastatic breast cancer. Additionally, we examined whether online delivery of the intervention would offer comparable benefits as in‐person delivery. Methods: Women with metastatic breast cancer (N = 39) were randomized to an in‐person intervention, online intervention, or in‐person attention‐matched control. Psychological well‐being (depression [Center for Epidemiologic Studies Depression Scale], positive and negative affect [Differential Emotions Scale], cancer‐specific quality of life [Multidimensional Quality of Life Scale—Cancer Version]), and positive coping (mindfulness, positive‐affect skill use, and self‐compassion [Self‐Compassion Scale: Short‐Form]) were assessed at baseline, 1 week post‐intervention, and 1 month post‐intervention follow‐up. Results: The LILAC intervention showed good feasibility, acceptability, and retention. Although the study was not adequately powered to detect between‐group differences in change on preliminary efficacy outcomes, within‐group comparisons revealed that LILAC participants (in‐person and online combined) showed reductions in depression and negative affect by the 1 month follow‐up (d = −0.81). Notably, LILAC participants fell below the clinical threshold for depression (Center for Epidemiologic Studies Depression Scale = 16) by the 1 month follow‐up (t[17] = −2.22, P = .04, d = −0.52), whereas control participants did not differ from threshold (t[9] = 0.45, P = .66, d = 0.14). Conclusions: The LILAC intervention, regardless of delivery method, shows feasibility, acceptability, and preliminary efficacy for promoting psychological well‐being in women with metastatic breast cancer. This research provides support for a larger randomized trial to test more definitively the potential benefits of LILAC. A strength of the LILAC intervention includes its innovative focus on positive affect. The efficacy of the online delivery suggests the potential for widespread Internet dissemination.
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One previous trial reported that 77% of participants were retained through 1-month follow-up.
“For example, one previous trial reported that 77 % of participants were retained through 1-month follow up (Cheung et al., 2017).”
From An online acceptance, commitment, and self-compassion based treatment to decrease psychological distress in people with type 2 diabetes: A feasibility randomised-controlled trial (2023) · cites this paper as Cheung et al., 2017
Results §3.1.1 reports that 27 participants (77%) were retained through the 1-month follow-up. The 77% is calculated from the sample remaining after four participants died, not from all 39 randomized participants; the citing sentence omits that qualification. (LLM, conf=0.86)
Experimental — accuracy not yet measuredE-mental health interventions enable patients with cancer to better cope with psychological distress.
“E-mental health interventions try to overcome some of these barriers and the limitation of healthcare offers, enabling patients with cancer to better cope with psychological distress.”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [14]
The Results (§3.2, page unavailable) report reduced depression and negative affect among women with metastatic breast cancer who received the intervention, including online delivery. But this small pilot study does not establish that e-mental health interventions generally help patients with cancer cope better; its measured positive-coping changes were not statistically significant. (LLM, conf=0.86)
Experimental — accuracy not yet measuredE-mental health interventions have proven to be feasible and effective in improving quality of life.
“E-mental health interventions have proven to be feasible and effective in improving quality of life.”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [14]
The Conclusions describe the online LILAC intervention as feasible and preliminarily effective for psychological well-being in women with metastatic breast cancer. But the Results (§3.2) explicitly report no intervention effect on cancer-specific quality of life (P > .22), so the claimed improvement in quality of life is not supported. (LLM, conf=0.90)
Experimental — accuracy not yet measuredPatients with cancer who used e-mental health interventions experienced significantly reduced levels of distress, depression, pain, fatigue and anxiety.
“Patients with cancer who used e-mental health interventions experienced significantly reduced levels of distress, depression, pain, fatigue and anxiety.”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [14]
The Results (section 3.2, page unavailable) report significant reductions in depression and negative affect among women with metastatic breast cancer receiving LILAC, but the online and in-person groups were pooled for that analysis. The paper does not report significant reductions in distress, pain, fatigue, or anxiety as separate outcomes, and it found no significant between-group differences in change. (LLM, conf=0.90)
Experimental — accuracy not yet measuredRecent scientific findings suggest significant effects on well-being in terms of distress, depression and anxiety, especially for web-based interventions that included CBT, ACT and MBSR.
“Recent scientific findings extend their effectiveness by suggesting significant effects on well-being in terms of distress, depression and anxiety,11 16–20 especially for web-based interventions that included cognitive behavioural therapy (CBT) techniques, acceptance and commitment therapy (ACT) and mindfulness-based stress reduction (MBSR).”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [14]
The Results (§3.2; page not supplied) report significant reductions in depression and negative affect among women with metastatic breast cancer who received the intervention, pooling online and in-person participants. The paper does not report anxiety outcomes or establish significant effects for the online group separately. Its intervention taught positive-affect skills, not the cited combination of CBT, ACT and MBSR. (LLM, conf=0.88)
Experimental — accuracy not yet measured
Within these web-based interventions, different combinations such as CBT and MBSR, CBT and ACT or ACT and MBSR have been used.
“Within these web-based interventions, different combinations such as CBT and MBSR, CBT and ACT or ACT and MBSR have been used.”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [14]
The Method (section 2.2; page unavailable) describes an online intervention combining positive-affect skills, including mindfulness and positive reappraisal. It does not identify the intervention as combining CBT, MBSR, or ACT in any of the pairings claimed. (LLM, conf=0.83)
Experimental — accuracy not yet measuredPrevious research shows that web-based interventions to reduce psychological distress in patients with cancer including CBT, MBSR or ACT have been proven to be effective.
“Previous research shows that web-based interventions to reduce psychological distress in patients with cancer including CBT, MBSR or ACT have been proven to be effective.”
From Web-based mindfulness and skills-based distress reduction for patients with cancer: study protocol of the multicentre, randomised, controlled confirmatory intervention trial Reduct (2022) · cites this paper as [14]
The Methods (§2.2) describe an online positive-affect skills intervention for women with metastatic breast cancer, and the Results (§3.2) report reduced depression and negative affect for participants in the online and in-person groups combined. The paper does not establish the effectiveness of web-based CBT, MBSR, or ACT; its pilot study was not adequately powered to detect between-group differences in efficacy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFew web-based psycho-oncological interventions have been integrated with ACT approaches.
“So far, few web-based psycho-oncological interventions have been integrated with ACT approaches (43, 44).”
From Mindfulness and skills-based eHealth intervention to reduce distress in cancer-affected patients in the Reduct trial: Intervention protocol of the make it training optimized (2022) · cites this paper as [43]
The Method (§2.2) describes an online psychological intervention for women with metastatic breast cancer. It describes the intervention as teaching positive-affect skills, however, and does not identify it as an ACT intervention or assess how many web-based psycho-oncological interventions integrate ACT. The claim’s scarcity and ACT components are therefore unsupported by this paper. (LLM, conf=0.82)
Experimental — accuracy not yet measuredCognitive behavioral interventions have shown to be applicable, adaptable, and effective in online format, and adequate therapeutic alliance can be achieved.
“Las intervenciones cognitivo conductuales han mostrado ser aplicables, adaptables y eficaces en formato online (76,85) y puede lograrse una adecuada alianza terapéutica (86) .”
From AVANZACT: protocolo e intervención psicoterapéutica en cáncer avanzado basados en Terapia de Aceptación y Compromiso. (2025) · cites this paper as [76]
The Conclusions report that online delivery of the LILAC intervention offered comparable psychological-well-being benefits to in-person delivery. The Background and Methods describe LILAC as a positive-affect skills intervention for women with metastatic breast cancer, not as a general test of online cognitive-behavioral interventions. The therapeutic-alliance statement is attached to citation 86, not this source. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe anxiety effect size was comparable to that found in a meta-analysis of psychosocial support for cancer (effect size=0.42) and a positive psychology intervention for caregivers (effect size=0.33).
“Further, it was comparable to that found in a meta-analysis of psychosocial support for cancer (effect size=0.42) [49] and a positive psychology intervention for caregivers (effect size=0.33) [50].”
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References 39 · Cited by 90
- Authors
- Cheung, E. O., Cohn, M. A., Dunn, L. B., Melisko, M. E., Morgan, S., Penedo, F. J., Salsman, J. M., Shumay, D. M., & Moskowitz, J. T.
- Affiliations
- Northwestern University (US)
- University of California, San Francisco (US)
- Stanford Medicine (US)
- Wake Forest University Health Sciences (US)
- Corresponding author
- Cheung, Elaine O.
- ORCID
- Venue
- Psycho-Oncology
- Publisher
- Wiley
- Published
- 2016-12-27
- Volume
- 26
- Issue
- 12
- Pages
- 2101-2108
- ISSN
- 1057-9249 (ISSN-L)
- 1099-1611
- PMC
- PMC5550341
- OpenAlex
- W2549535846
- Cited by
- 90
- References
- 39
- Citations by year
- 2026: 4 · 2025: 9 · 2024: 10 · 2023: 8 · 2022: 12 · 2021: 11 · 2020: 12 · 2019: 12 · 2018: 6 · 2017: 6
- FWCI
- 4.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psycho-Oncology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R25MH060482)
- National Cancer Institute (K07CA158008)
- National Center for Complementary and Integrative Health (T32AT003997)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Social Psychology › Psychological Well-being and Life Satisfaction
- Keywords
- metastatic breast cancer, positive affect, lilac, depression, negative affect, positive coping, mindfulness, self-compassion, online intervention, psychological well-being, cancer-specific quality of life, feasibility and acceptability
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Breast Neoplasms, Depression, Emotions, Feasibility Studies, Female, Humans, Middle Aged, Neoplasm Metastasis, Patient Acceptance of Health Care, Pilot Projects, Quality of Life, Treatment Outcome, Internet, Mindfulness
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