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Cited by 48Mindfulness and Compassion InterventionsCancer survivorship and carePediatric Pain Management Techniques

A single-session acceptance and commitment therapy intervention among women undergoing surgery for breast cancer: A randomized pilot trial to reduce persistent postsurgical pain.

Open access
Hadlandsmyth, Katherine, Dindo, Lilian N., Wajid, Roohina, Sugg, Sonia L., Zimmerman, M. Bridget, Rakel, Barbara A.·2019·Psycho-Oncology
DOI 10.1002/pon.5209PMC PMC8908355
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Abstract

Objective: Oncologic breast surgeries carry a risk for persistent postsurgical pain. This study was a randomized pilot and feasibility study of a single-session Acceptance and Commitment Therapy (ACT) intervention compared with treatment as usual among women undergoing surgery for breast cancer or ductal carcinoma in situ.Methods: Participants were recruited via letter of invitation and follow-up phone call from a single site in the United States from 2015 to 2017. Participants were at risk for persistent postsurgical pain, based on young age (<50), a preexisting chronic pain condition, or elevated anxiety, depression, or pain catastrophizing.Results: The 54 participants were female with a mean age of 52.91 years (SD=11.80). At 3-month postsurgery, 11% of the sample reported moderate-severe pain (>3 on a 0-10 numeric rating scale) in the operative breast or with arm movement. Written qualitative responses indicated that the majority of participants who received the intervention understood the concepts presented and reported continued practice of exercises learned in the session. The between group effect sizes for moderate-severe pain and elevated anxiety at 3-month post-surgery were small (Phi=0.08 and 0.16, respectively). The between group effect sizes for depression, pain acceptance, and pain catastrophizing at 3-month postsurgery were minimal.Conclusions: This study found small positive effects on postsurgical pain and anxiety for a single-session ACT intervention among women with breast cancer. This study supports the use of ACT with this population.

Integrity signals

Registry

Crossref · 10.1002/pon.5209

Cites

39 of 39 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

16 of 33 cited sources checked · 10 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Preoperative psychological distress, including depressive and anxious symptoms and pain catastrophizing, is an important risk factor for persistent postsurgical pain in this population.

    “Preoperative psychological distress (depressive and anxious symptoms as well as pain catastrophizing) has emerged as an important risk factor [7–9].”
    Quote in the paperSubstantial claim2 of 3 sources checked
    • cites [7] source
    • cites [8] source
    • cites [9] source

      The Results and Discussion report associations among pain, anxiety and depression during breast and prostate cancer treatment, but do not address whether preoperative distress predicts persistent postsurgical pain. Searches for preoperative distress, pain catastrophizing and postsurgical pain found no passage addressing that risk-factor claim. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
  • Premisecitation

    In those studies, the difference in pain between intervention and non-intervention groups was about 1 on average on a 0-10 scale.

    “However, the difference in pain between intervention and non-intervention groups was about 1 (on average) on a 0–10 scale [13].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [13] source

      The Persistent post-surgical pain section (page unavailable) reports a mean difference of 1.06 points on a 0–10 scale for active psychological interventions versus usual care. But the pooled difference across interventions was 0.56 points, while education or psychological support showed a 0.12-point difference. Thus, about 1 point describes the active-intervention subgroup, not the studies overall. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
  • Premisecitation

    Single-session ACT interventions are gaining empirical support.

    “Single session ACT interventions are gaining empirical support [23–26]”
    Quote in the paperSubstantial claim3 of 4 sources checked
    • cites [23] source

      The Discussion reports preliminary support for a one-day ACT workshop in at-risk Veterans, consistent with the claim that brief ACT interventions are gaining empirical support. However, the studied intervention also included an individualized postoperative booster session, so it was not strictly single-session. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [24] source
    • cites [25] source
    • cites [26] source
  • Premisecitation

    Education-only sessions did not improve post-surgical pain outcomes.

    “A meta-analysis of psychological studies during the perioperative period found that single-session educational interventions demonstrated the greatest patient adherence; however, education only sessions did not improve post-surgical pain outcomes [13].”
    Quote in the paperSubstantial claim1 of 1 sources checked
  • Premisecitation

    Cognitive behavioral therapy and relaxation therapy have demonstrated positive effects in pain reduction following orthopedic, cardiac, and colorectal surgeries.

    “Cognitive behavioral therapy and relaxation therapy have demonstrated positive effects in pain reduction following orthopedic, cardiac, and colorectal surgeries.”
    Quote in the paperSubstantial claim1 of 1 sources checked
  • Classified as probably not a substantial claim. 19
  • May combine two claims. 12
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Younger age is a risk factor for both persistent post-surgical pain and depression among women undergoing breast cancer surgery.

    “younger age is a risk factor for both persistent post-surgical pain and depression among women undergoing breast cancer surgery [3, 7, 8][5, 12].”
    Quote in the paperNot a substantial claim2 of 5 sources checked
    • cites [3] source
    • cites [7] source

      The Accepted Manuscript (p. 19) says younger age independently predicted persistent post-surgical pain after breast cancer surgery. It does not report that younger age predicted depression; the discussion of depression concerns its relationship to pain, not age as a risk factor for depression. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [8] source
    • cites [5] source
    • cites [12] source

      The Results (Trajectory differences; page not supplied) report that younger women had elevated depressive symptoms during radiation treatment, but that the age difference had dissipated by the final study waves. The paper does not establish younger age as a risk factor for persistent post-surgical pain, so it supports only the depression portion of the sentence, with a time-limited qualification. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Co-morbid chronic pain conveys risk for persistent postsurgical pain in multiple surgical populations.

    “Co-morbid chronic pain also conveys risk for persistent postsurgical pain in multiple surgical populations [11]”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [11] source

      The Introduction discusses pain as a symptom experienced by patients with cancer, while the Discussion reports predictors of depression and anxiety in breast cancer patients; neither addresses persistent postsurgical pain. Searches for persistent postsurgical pain and chronic pain as a risk factor after surgery found no supporting passage in our copy. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A feasibility trial of a 6-session telephone-based ACT intervention for symptom interference among patients with metastatic breast cancer found reductions in fatigue and sleep interference.

    “Another feasibility trial of a 6-session telephone-based ACT intervention for symptom interference among patients with metastatic breast cancer found reductions in fatigue and sleep interference [22].”
    Quote in the paperNot a substantial claim1 of 1 sources checked

  • May combine two claims.

    Interpretationcitation

    Average baseline depression, anxiety, and pain catastrophizing scores were well below clinical cut-offs, suggesting some restriction of range in this sample.

    “Average baseline depression, anxiety, and pain catastrophizing scores were well below clinical cut-offs indicating elevated symptoms [31–33], suggesting some restriction of range in this sample.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [31] source
    • cites [32] source
    • cites [33]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The target sample size was N=60 (30 per group), consistent with recommended pilot sample sizes.

    “Consistent with recommended pilot sample sizes derived from commonly-used approaches for pilot and feasibility trials [28–30], the target sample size was N=60 (30 per group).”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [28] source
    • cites [29] source
    • cites [30] source

  • May combine two claims.

    Interpretationcitation

    Baseline pain acceptance in this study was higher than previously reported in an orthopedic surgery sample and in samples of patients with chronic pain, suggesting good pain coping at baseline.

    “In addition, baseline pain acceptance found in this study was higher than previously reported in both an orthopedic surgery sample [23] and in samples of patients with chronic pain [17, 40], suggesting good pain coping at baseline.”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [23] source
    • cites [17]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [40] source

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). The quote only partly states this claim.

    Findingown data

    The between-group effect size for pain acceptance at three months after surgery was minimal (Cohen's d=0.10).

    “The between group effect sizes for depression, pain acceptance, and pain catastrophizing at 3-months post-surgery were minimal.”
    • Also stated in: § Intervention Effect at Three Months · plain
      “The effect size for difference between groups on pain catastrophizing was minimal: Cohen’s d=0.10.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Most participants who received the ACT intervention understood the concepts presented and reported continuing to practice exercises learned in the session, according to written qualitative responses.

    “Written qualitative responses indicated that the majority of participants who received the intervention understood the concepts presented and reported continued practice of exercises learned in the session.”
    • Also stated in: § Qualitative Feedback. · hedged
      “Written qualitative responses indicated that the majority of participants who received the intervention understood the concepts presented and reported continued practice of exercises learned in the session.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Neither median one-week post-operative breast pain nor movement pain was significantly different between ACT and TAU groups.

    “Median one-week post-operative breast pain was 2.00 (IQR: 1.00–3.00) and median postoperative movement pain was 3.00 (IQR: 1.00–5.00), neither were significantly different between ACT and TAU groups (Supplemental File 3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Median one-week post-operative breast pain was 2.00 (IQR 1.00-3.00) and median postoperative movement pain was 3.00 (IQR 1.00-5.00).

    “Median one-week post-operative breast pain was 2.00 (IQR: 1.00–3.00) and median postoperative movement pain was 3.00 (IQR: 1.00–5.00), neither were significantly different between ACT and TAU groups (Supplemental File 3).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The pilot study found that the majority of women undergoing surgery for breast cancer or DCIS found a single-session ACT intervention useful and continued to use content learned.

    “This pilot study found that the majority of women undergoing surgery for breast cancer or DCIS found a single session ACT intervention useful and continued to use content they had learned in the session.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The study was a randomized pilot and feasibility trial comparing a single-session ACT intervention with treatment as usual in women undergoing breast cancer or DCIS surgery.

    “This study was a randomized pilot and feasibility study of a single-session Acceptance and Commitment Therapy (ACT) intervention compared to treatment as usual among women undergoing surgery for breast cancer or ductal carcinoma in situ (DCIS).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Among breast cancer treatment completers, a pilot 8-session ACT group intervention decreased depressive and anxious symptoms.

    “Among breast cancer treatment completers, a pilot 8 session ACT group intervention decreased depressive and anxious symptoms [21].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Nearly 30% of women have persistent pain following breast cancer surgeries, with 14% reporting moderate to severe pain.

    “Nearly 30% of women have persistent pain following breast cancer surgeries [2], with 14% reporting moderate to severe pain [3].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [2] source
    • cites [3] source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency for the PCS in the current study was good (preoperative α=0.91; 3-months post-surgery α=0.93).

    “Internal consistency in the current study was good (preoperative α=0.91; 3-months post-surgery α=0.93).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency for the CPAQ-20 in the current study was good (preoperative α=0.87; 3-months post-surgery α=0.87).

    “Internal consistency in the current study was good (preoperative α=0.87; 3-months post-surgery α=0.87).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Randomization was stratified by surgery type (mastectomy and lumpectomy).

    “Randomization was stratified by surgery type (mastectomy and lumpectomy).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The therapist completed a fidelity checklist after each session to ensure all intervention domains were covered, and they were covered with each participant.

    “After each session, the therapist completed a fidelity checklist to ensure each of these domains was covered (which they were with each participant).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    Clinically, this study aligns with the broader literature supporting the use of ACT with this population.

    “Clinically, this study aligns with the broader literature supporting the use of ACT with this population.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was registered at clinicaltrials.gov (NCT03430765).

    “The study is registered at clinicaltrials.gov: NCT03430765.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Randomization was performed in permuted blocks of 4 and 6.

    “The randomization sequence was in permuted blocks of 4 and 6.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency for the GAD-7 in the current study was good (preoperative α=0.85; 3-months post-surgery α=0.86).

    “Internal consistency in the current study was good (preoperative α=0.85; 3-months post-surgery α=0.86).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency for the four pain severity items on the BPI was good (preoperative α=0.91; 3-months post-surgery α=0.93).

    “Internal consistency for the four pain severity items on this measure was good (preoperative α=0.91; 3-months post-surgery α=0.93).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The use of mean imputation on multi-item measures with at least 85% complete data may have reduced variance in these variables.

    “Another limitation is the use of mean imputation on multi-item measures with at least 85% complete, due to potentially reducing variance in these variables.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The sample was largely Caucasian and higher income, so findings may not generalize to other patient populations.

    “Finally, a significant limitation to this study was that the sample was largely Caucasian and higher income, so findings may not generalize to other patient populations.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given

    To increase intervention effects, a more intensive intervention may be needed in this population.

    “In addition, to increase intervention effects, a more intensive intervention may be needed in this population.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency for the PHQ-8 in the current study was good (preoperative α=0.80; 3-months post-surgery α=0.85).

    “Internal consistency in the current study was good (preoperative α=0.80; 3-months post-surgery α=0.85).”
    Quote in the paperNot a substantial claim
27 of 27

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Two different pain-catastrophizing cutoffs

    Major

    The Methods section defines elevated pain catastrophizing as PCS ≥30, but the later Measures section says the cutoff was 20. These statements cannot both be true within the same paper.

  • Overall depression rate conflicts with the group counts

    Minor

    The treatment-group counts give 7 participants with elevated depression out of 54, or 12.96%, not the reported 14.81%.

  • Pain-acceptance effect is mislabeled as pain catastrophizing

    Minor

    The Cohen's d value appears in the pain-acceptance results but is described as an effect on pain catastrophizing. The analysis plan assigns Cohen's d to pain acceptance and Phi to pain catastrophizing.

3 of 3

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Society AC, 2019, Cancer Facts & Figures 2019
  2. Sullivan MJ, 2009, The Pain Catastrophizing Scale: User Manual

Cited by

Sorted by citations

Related

Authors
Hadlandsmyth, K., Dindo, L. N., Wajid, R., Sugg, S. L., Zimmerman, M. B., & Rakel, B. A.
Affiliations
  • University of Iowa (US)
  • Michael E. DeBakey VA Medical Center (US)
Corresponding author
Hadlandsmyth, Katherine
ORCID
Venue
Psycho-Oncology
Publisher
Wiley
Published
2019-08-30
Volume
28
Issue
11
Pages
2210-2217
ISSN
  • 1057-9249 (ISSN-L)
  • 1099-1611
DOI
10.1002/pon.5209
PMC
PMC8908355
OpenAlex
W2969471105
Semantic Scholar
676b944e20b974570349a3049dc2dc966a6151db
Cited by
48
References
38
Citations by year
2026: 8 · 2025: 13 · 2024: 5 · 2023: 8 · 2022: 6 · 2021: 6 · 2020: 2
FWCI
4.08
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Psycho-Oncology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (54TR001013)
  • National Institute of Neurological Disorders and Stroke (T32 NS045549)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pediatric Pain Management Techniques
Keywords
acceptance and commitment therapy, breast cancer surgery, chronic postoperative pain, single-session intervention, ductal carcinoma in situ, anxiety, pain catastrophizing, pain acceptance, chronic pain
MeSH terms
Adaptation, Psychological, Adult, Anxiety, Breast Neoplasms, Depression, Female, Humans, Middle Aged, Postoperative Pain, Pilot Projects, Plastic Surgery Procedures, Catastrophization, Acceptance and Commitment Therapy

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