Acceptance and commitment therapy in adult cancer survivors: a systematic review and conceptual model
Open accessAbstract
Purpose: People with cancer experience significant physical and psychological symptoms, during as well as after primary treatment. Acceptance and Commitment Therapy (ACT), a psychological intervention, reduces both types of symptoms among individuals with chronic pain and emotional distress. Due to the unique challenges of cancer survivorship, this systematic review critically evaluates and synthesizes the literature on the context, mechanisms, and effect of ACT among adult cancer survivors. Methods: Articles were retrieved from the CINAHL, MEDLINE via Ovid, Web of Science, PsycInfo, Scopus, Embase, Google Scholar, and Cochrane databases. Selected grey literature portals, clinical trial registries, and conference proceedings were also searched. The NIH tools were used to assess study quality and the revised Cochrane Risk-of-Bias tool to assess risk of bias Results: Thirteen articles, reporting on 537 cancer survivors with various cancer types, were included. ACT significantly reduced anxiety, depression, and fear of cancer recurrence and improved psychological flexibility and quality of life. Outcomes such as pain and insomnia were understudied. Lack of participant blinding and non-random assignment were the most common methodological issues. A conceptual model is proposed that describes the possible influencing factors of an ACT-based intervention in cancer survivors. Conclusion: Review findings suggest that ACT is an effective intervention to improve some of the common concerns among cancer survivors. While all the studies in the review were recent (published 2015–2019), they examined only a limited number of outcomes. Hence, more methodologically rigorous studies which examine the effect of ACT on other troubling symptoms among cancer survivors are warranted. Implications for Cancer Survivors: Incorporating ACT into comprehensive post-treatment survivorship care can enhance psychological flexibility and reduce anxiety, depression, and fear. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.
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Claims the paper makes
10 of 27 cited sources checked · 6 supported · 0 flagged · accuracy not yet measured
- Method
The authors defined cancer survivor for this review as an individual who has received a cancer diagnosis and completed primary treatment excluding maintenance treatment.
“For the purpose of this review, cancer survivor is defined as an individual who has received a cancer diagnosis and completed their primary treatment (excluding maintenance treatment) [27].”
Quote in the paperNot yet classified1 of 1 sources checked- cites [27] Moser EC, Meunier F. Cancer survivorship: a positive side effect of more successful cancer treatment. EJC Suppl. 2014;12(1):1–4. source
- Background
The six core therapeutic processes of ACT are acceptance, cognitive defusion, contact with present moment, self-as-context, values, and committed action.
“Specifically, the six core therapeutic processes of ACT are acceptance, cognitive defusion, contact with present moment, self-as-context, values, and committed action.”
Quote in the paperNot yet classified3 of 3 sources checked- cites [18] Hayes SC, Hofmann SG. The third wave of cognitive behavioral therapy and the rise of process-based care. World Psychiatry. 2017;16(3):245–6. source
The Abstract identifies acceptance, cognitive defusion, and values as concepts central to third-wave interventions and names ACT among those interventions. It does not identify six core ACT processes or list contact with the present moment, self-as-context, and committed action as such. (LLM, conf=0.80)
Experimental — accuracy not yet measured - cites [19] Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J. Acceptance and commitment therapy: Model, processes and outcomes. Behav Res Ther. 2006;44(1):1–25. source
- cites [20] Hayes SC, Levin ME, Vilardaga JP, Villatte JL, Pistorello J. Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther. 2013;44(2):180–98. source
- Finding
Strong evidence of feasibility and acceptability was reported, with high accrual and retention or enrollment rates and high satisfaction with the sessions.
“Strong evidence of feasibility and acceptability was reported, with high accrual and retention or enrollment rates [44, 45], high ratings for essentialness and effectiveness of the intervention [47], moderate to high ratings for usefulness or expected benefits from the intervention [48, 52, 54], and high degree of satisfaction with the sessions [45, 46, 48, 51] (see Table 4 for details).”
Quote in the paperNot yet classified2 of 6 sources checked- cites [44] Johns SA, Stutz PV, Talib TL, Cohee AA, Beck-Coon KA, Brown LF, et al. Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3-arm pilot randomized controlled trial. Cancer. 2020;126(1):211–8. source
The Discussion reports strong evidence of feasibility, citing high accrual and retention, and Results > Feasibility gives the corresponding rates. Our copy does not report participant satisfaction with the sessions, so that part of the attributed claim is unsupported. (LLM, conf=0.86)
Experimental — accuracy not yet measured - cites [45] Kinner EM, Armer JS, McGregor BA, Duffecy J, Leighton S, Corden ME, et al. Internet-based group intervention for ovarian cancer survivors: Feasibility and preliminary results. JMIR Cancer. 2018;4(1):e1. source
The Results (Acceptability) report high session satisfaction, averaging 9.0 out of 10. But the Results (Feasibility) report 32% enrollment and 68% retention, and the Discussion (Limitations) explicitly identifies both rates as limitations. The source therefore supports high satisfaction, not the characterization of its enrollment and retention rates as high. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [47] Smith A, Thewes B, Turner J, Gilchrist J, Fardell J, Sharpe L, et al. Pilot of a theoretically grounded psychologist-delivered intervention for fear of cancer recurrence (conquer fear). Psychooncology. 2015;24(8):967–70. source
- cites [48] Butow PN, Turner J, Gilchrist J, Sharpe L, Smith AB, Fardell JE, et al. Randomized Trial of ConquerFear: A Novel, Theoretically based psychosocial intervention for fear of cancer recurrence. J Clin Oncol. 2017;35(36):4066–77. source
- cites [52] Kangas M, McDonald S, Williams JR, Smee RI. Acceptance and commitment therapy program for distressed adults with a primary brain tumor: A case series study. Support Care Cancer. 2015;23(10):2855–9. source
- cites [54] Montesinos F, Luciano C. Acceptance of relapse fears in breast cancer patients: effects of an ACT-based abridged intervention. Psicooncologia. 2016;13(1):7–21.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Finding
Quality of life significantly improved following ACT-based interventions.
“Studies reported significant improvement in QoL following the ACT-based interventions, post-intervention [44, 45, 48], and at follow-up periods of 1 and 6 months [44].”
Quote in the paperNot yet classified2 of 3 sources checked- cites [44] Johns SA, Stutz PV, Talib TL, Cohee AA, Beck-Coon KA, Brown LF, et al. Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3-arm pilot randomized controlled trial. Cancer. 2020;126(1):211–8. source
- cites [45] Kinner EM, Armer JS, McGregor BA, Duffecy J, Leighton S, Corden ME, et al. Internet-based group intervention for ovarian cancer survivors: Feasibility and preliminary results. JMIR Cancer. 2018;4(1):e1. source
The Results (Preliminary Outcomes) report a statistically significant postintervention improvement in ovarian cancer-specific quality of life (P=.01), but the increase in total quality of life was not statistically significant (P=.08). Methods (Field Trial Testing) describes the intervention as adapted from cognitive-behavioral stress management, with ACT-based exercises incorporated, rather than as an ACT-based intervention alone. This citation supports the postintervention finding, not the follow-up periods attributed to another citation. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [48] Butow PN, Turner J, Gilchrist J, Sharpe L, Smith AB, Fardell JE, et al. Randomized Trial of ConquerFear: A Novel, Theoretically based psychosocial intervention for fear of cancer recurrence. J Clin Oncol. 2017;35(36):4066–77. source
- Finding
Most studies used ACT processes exclusively, while others used ACT as a hybrid therapy with CBT, relaxation, metacognitive therapy, or other models.
“ACT processes were used exclusively in about 64% of the studies [44, 46, 52–55] (unpublished thesis). The other studies used ACT as a hybrid therapy, where the intervention involved both ACT and other therapies, such as CBT and relaxation [51], metacognitive therapy [47, 48, 51], cognitive-behavioral stress management and mindfulness-based stress reduction [45], and processes of the Common-Sense Model of illness and the Self-Regulatory Executive Function model [47, 48].”
Quote in the paperNot yet classified2 of 9 sources checked- cites [44] Johns SA, Stutz PV, Talib TL, Cohee AA, Beck-Coon KA, Brown LF, et al. Acceptance and commitment therapy for breast cancer survivors with fear of cancer recurrence: A 3-arm pilot randomized controlled trial. Cancer. 2020;126(1):211–8. source
- cites [46] Arch JJ, Mitchell JL. An acceptance and commitment therapy (ACT) group intervention for cancer survivors experiencing anxiety at re-entry. Psychooncology. 2016;25(5):610–5. source
- cites [52] Kangas M, McDonald S, Williams JR, Smee RI. Acceptance and commitment therapy program for distressed adults with a primary brain tumor: A case series study. Support Care Cancer. 2015;23(10):2855–9. source
- cites [53] Gonzalez-Fernandez S, Fernandez-Rodriguez C, Paz-Caballero MD, Perez-Alvarez M. Treating anxiety and depression of cancer survivors: Behavioral activation versus acceptance and commitment therapy. Psicothema. 2018;30(1):14–20. source
- cites [54] Montesinos F, Luciano C. Acceptance of relapse fears in breast cancer patients: effects of an ACT-based abridged intervention. Psicooncologia. 2016;13(1):7–21.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [55] Mohabbat-Bahar S, Maleki-Rizi F, Akbari ME, Moradi-Joo M. Effectiveness of group training based on acceptance and commitment therapy on anxiety and depression of women with breast cancer. Iran J Cancer Prev. 2015;8(2):71–6.
- cites [51] Heiniger LE, Smith AB, Olver I, Grimison P, Klein B, Wootten A, et al. E-TC: Development and pilot testing of a web-based intervention to reduce anxiety and depression in survivors of testicular cancer. Eur J Cancer Care. 2017;26(6):e12698. source
- cites [47] Smith A, Thewes B, Turner J, Gilchrist J, Fardell J, Sharpe L, et al. Pilot of a theoretically grounded psychologist-delivered intervention for fear of cancer recurrence (conquer fear). Psychooncology. 2015;24(8):967–70. source
- cites [48] Butow PN, Turner J, Gilchrist J, Sharpe L, Smith AB, Fardell JE, et al. Randomized Trial of ConquerFear: A Novel, Theoretically based psychosocial intervention for fear of cancer recurrence. J Clin Oncol. 2017;35(36):4066–77. source
- Finding
The review proposes a conceptual model describing possible influencing factors of ACT-based interventions in cancer survivors.
“A conceptual model is proposed that describes the possible influencing factors of an ACT-based intervention in cancer survivors.”
Quote in the paperNot yet classified - Finding
Thirteen articles reporting on 537 cancer survivors with various cancer types were included in the review.
“Thirteen articles, reporting on 537 cancer survivors with various cancer types, were included.”
Quote in the paperNot yet classified - Finding
The review is the first to summarize evidence on the effects of ACT on symptoms among people with cancer after primary treatment.
“This review is the first to provide a summary of evidence regarding the effects of ACT on symptoms among persons with cancer post-primary treatment.”
Quote in the paperNot yet classified - Finding
Fear of cancer recurrence significantly decreased after ACT-based interventions at post-intervention and follow-up assessments.
“FCR was another outcome that had significant reduction following an ACT-based intervention.”
Quote in the paperNot yet classified - Finding
All studies reported use of the core ACT processes of acceptance, cognitive defusion, values, and committed action.
“All studies reported use of the core ACT processes of acceptance, cognitive defusion, values, and committed action (Table 2).”
Quote in the paperNot yet classified - Finding
Pain and insomnia were understudied outcomes in the reviewed ACT literature.
“Outcomes such as pain and insomnia were understudied.”
Quote in the paperNot yet classified - Finding
The authors found emerging evidence that ACT can improve symptoms among cancer survivors specifically.
“There is emerging evidence that ACT can improve these symptoms among cancer survivors specifically.”
Quote in the paperNot yet classified - Finding
The reviewed studies reported significant reductions in anxiety, depression, and fear of cancer recurrence and improvements in quality of life and psychological flexibility.
“the reviewed studies report significant reductions in anxiety, depression, and FCR and improvements in QoL and psychological flexibility.”
Quote in the paperNot yet classified - Finding
ACT significantly reduced anxiety, depression, and fear of cancer recurrence and improved psychological flexibility and quality of life.
“ACT significantly reduced anxiety, depression, and fear of cancer recurrence and improved psychological flexibility and quality of life.”
Quote in the paperNot yet classified - Finding
The final synthesis included 13 articles, which represented 11 different research studies.
“Thus the 13 included articles reported on 11 different research studies.”
Quote in the paperNot yet classified - Finding
Anxiety, distress, stress, and depression generally improved after ACT interventions, including at several follow-up time points.
“Studies also reported significant improvements in depression at post-intervention [46, 53, 55] and at 3-month follow-up [46]. The case-series study also found improvements in anxiety and depression, but due to its study design did not report statistical analyses [52].”
Quote in the paperNot yet classified0 of 4 sources checked- cites [46] Arch JJ, Mitchell JL. An acceptance and commitment therapy (ACT) group intervention for cancer survivors experiencing anxiety at re-entry. Psychooncology. 2016;25(5):610–5. source
- cites [53] Gonzalez-Fernandez S, Fernandez-Rodriguez C, Paz-Caballero MD, Perez-Alvarez M. Treating anxiety and depression of cancer survivors: Behavioral activation versus acceptance and commitment therapy. Psicothema. 2018;30(1):14–20. source
- cites [55] Mohabbat-Bahar S, Maleki-Rizi F, Akbari ME, Moradi-Joo M. Effectiveness of group training based on acceptance and commitment therapy on anxiety and depression of women with breast cancer. Iran J Cancer Prev. 2015;8(2):71–6.
- cites [52] Kangas M, McDonald S, Williams JR, Smee RI. Acceptance and commitment therapy program for distressed adults with a primary brain tumor: A case series study. Support Care Cancer. 2015;23(10):2855–9. source
- Finding
Only four studies assessed psychological flexibility, and all five studies that examined change processes observed increased psychological flexibility.
“Only four studies assessed the effect of intervention on psychological flexibility, which is characterized by reduction in experiential avoidance.”
Quote in the paperNot yet classified - Method
The review searched multiple bibliographic databases, grey literature portals, clinical trial registries, and conference proceedings.
“Selected grey literature portals, clinical trial registries, and conference proceedings were also searched.”
Quote in the paperNot yet classified - Method
A meta-analysis could not be performed because the studies differed in design and outcomes.
“A meta-analysis could not be performed due to the differing study designs and outcomes.”
Quote in the paperNot yet classified - Method
The review recommends more methodologically rigorous studies to assess ACT effects on other troubling symptoms among cancer survivors.
“Hence, more methodologically rigorous studies which examine the effect of ACT on other troubling symptoms among cancer survivors are warranted.”
Quote in the paperNot yet classified - Method
The review used NIH tools to assess study quality and the revised Cochrane Risk-of-Bias tool to assess risk of bias.
“The NIH tools were used to assess study quality and the revised Cochrane Risk-of-Bias tool to assess risk of bias”
Quote in the paperNot yet classified - Method
This systematic review evaluates and synthesizes the literature on the context, mechanisms, and effects of ACT among adult cancer survivors.
“this systematic review critically evaluates and synthesizes the literature on the context, mechanisms, and effect of ACT among adult cancer survivors.”
Quote in the paperNot yet classified - Method
The review included only studies available in English.
“This review includes only studies available in English.”
Quote in the paperNot yet classified - Background
The National Comprehensive Cancer Network guidelines for survivorship advocate psychological support and a multimodal approach to pain management.
“The National Comprehensive Cancer Network guidelines for survivorship also advocate psychological support and a multimodal approach to pain management [14].”
Quote in the paperNot yet classified0 of 1 sources checked- cites [14] National Comprehensive Cancer Network(NCCN). NCCN guidelines for survivorship. Version 2.2019. https://www.nccn.org/professionals/physician_gls/pdf/survivorship.pdf. Accessed 15 Jan 2020.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
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?
The majority of survivorship intervention research has involved face-to-face sessions delivered by clinical psychologists, psychiatrists, and social workers in clinic- or hospital-based settings, supplemented with intervention booster sessions via phone or internet.
“The majority of survivorship intervention research has involved face-to-face sessions delivered by clinical psychologists, psychiatrists, and social workers in clinic- or hospital-based settings, supplemented with intervention booster sessions via phone or internet [9, 12].”
From A digital, coach-assisted intervention to address the psychosocial needs of young adult cancer survivors: Randomized controlled trial protocol and intervention adaptation process (2024) · cites this paper as [9]
The Results > Intervention characteristics section reports that 72.7% of the reviewed ACT interventions were delivered in hospitals or clinics and that, among the seven studies reporting therapist information, about 86% used clinical psychologists, psychiatrists, or oncology social workers. It does not establish that the sessions were predominantly face-to-face or that phone or internet booster sessions supplemented them. Its findings also concern ACT interventions in adult cancer survivors, not survivorship intervention research generally; page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThere is limited use of scalable approaches, like digital health and health coaching, in interventions for YA survivors.
“limited use of scalable approaches, like digital health [9, 12, 46] and health coaching [48]”
From A digital, coach-assisted intervention to address the psychosocial needs of young adult cancer survivors: Randomized controlled trial protocol and intervention adaptation process (2024) · cites this paper as [9]
The Results section on intervention delivery reports that most reviewed ACT interventions for adult cancer survivors took place in hospitals or clinics, while only two studies used web-based delivery. That supports limited digital delivery within this review, but the paper does not establish the claim specifically for young adult (YA) survivors or for survivor interventions generally. The citing sentence assigns health coaching to a separate citation [48]. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAnother systematic review showed moderate to high effect-sizes of ACT on FCR, while CBT had low to moderate effect-sizes.
“Another systematic review showed moderate to high effect-sizes of ACT on FCR, while CBT had low to moderate effect-sizes.13,14”
From A randomized clinical trial: Efficacy of group-based acceptance and commitment therapy program for breast cancer patients with high fear of progression (2024) · cites this paper as [13]
The Results section (‘Fear of cancer recurrence’; page unavailable) reports significant reductions in FCR following ACT-based interventions. It does not characterize ACT’s FCR effect sizes as moderate to high or report low-to-moderate CBT effect sizes; the Discussion notes that only six included studies reported effect sizes. (LLM, conf=0.85)
Experimental — accuracy not yet measuredTwo meta-analytic studies found ACT beneficial for reducing anxiety and improving QOL in cancer patients.
“Additionally, two meta-analytic studies found ACT beneficial for reducing anxiety and improving QOL in cancer patients.13,15”
From A randomized clinical trial: Efficacy of group-based acceptance and commitment therapy program for breast cancer patients with high fear of progression (2024) · cites this paper as [13]
The Results report reduced anxiety and improved quality of life after ACT-based interventions in adult cancer survivors. However, the Methods (Data extraction and synthesis; page unavailable) say this paper used a narrative, descriptive synthesis because the studies were heterogeneous—not a meta-analysis. This source also cannot establish what the other cited study found. (LLM, conf=0.90)
Experimental — accuracy not yet measuredA systematic review has shown moderate to high effect sizes of ACT on FCR among breast cancer survivors.
“A systematic review has shown moderate to high effect sizes of ACT on FCR among breast cancer survivors.13”
From A randomized clinical trial: Efficacy of group-based acceptance and commitment therapy program for breast cancer patients with high fear of progression (2024) · cites this paper as [13]
The Results (Effect of intervention on outcomes; page unavailable) report significant reductions in fear of cancer recurrence after ACT, and the Study and participant characteristics section includes breast-cancer-only studies. However, the retrieved passages do not establish moderate to high effect sizes for FCR among breast cancer survivors; the Discussion notes that only six studies reported effect sizes at all. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Systematic and meta-analytic reviews have indicated limited studies on the efficacy of ACT on FOP among cancer patients.
“Systematic and meta-analytic reviews have indicated limited studies on the efficacy of ACT on FOP among cancer patients too.8,13,30”
From A randomized clinical trial: Efficacy of group-based acceptance and commitment therapy program for breast cancer patients with high fear of progression (2024) · cites this paper as [13]
The Discussion reports that only 13 articles met the review’s criteria, supporting the claim that studies of ACT in cancer survivors were limited. The Results report reductions in fear of cancer recurrence (FCR), not specifically fear of progression (FOP). The Limitations also state that this review could not perform a meta-analysis. (LLM, conf=0.84)
Experimental — accuracy not yet measuredMindfulness-Based Interventions improve anxiety, depression, FCR, and fatigue in people with various chronic health conditions, including cancer.
“Accumulating evidence indicates that MBIs improve anxiety, depression, FCR, and fatigue in people with various chronic health conditions, including cancer,28-32”
From Mindfulness and Psychosocial Symptoms in People with Cancer: Testing Rumination and Experiential Avoidance as Mediators, and Sex as a Moderator. (2025) · cites this paper as [29]
The Results and Conclusions report reductions in anxiety, depression, and fear of cancer recurrence after acceptance and commitment therapy (ACT) in adult cancer survivors. The paper describes mindfulness as one component of ACT, not evidence for mindfulness-based interventions generally or for people with various chronic conditions. Its Conclusions say that ACT’s efficacy for fatigue requires further investigation. Page numbers were not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPsychoeducation and Acceptance and Commitment Therapy elements have been shown to reduce anxiety, depression, and fatigue.
“These methods have been shown to reduce anxiety,21-26 depression,21,22,25-29 and fatigue.30-33”
From Effects of a Video Sequence Based Intervention on Anxiety, Fatigue and Depression in Cancer Patients: Results of a Randomized Controlled Trial. (2023) · cites this paper as [29]
The Results section (Effect of intervention on outcomes; page unavailable) reports significant improvements in anxiety and depression after ACT-based interventions in adult cancer survivors. The Conclusions section says further investigation is needed to determine whether ACT reduces fatigue, and the cited passages do not establish an effect of psychoeducation. (LLM, conf=0.88)
Experimental — accuracy not yet measuredA 2019 systematic review of 11 studies of ACT in 537 PLWC in the post-treatment phase reported the most promising findings as improvements in anxiety, depression, FCR, and QL.
“A 2019 systematic review of 11 studies of ACT included all study designs, pilot and single-arm as well as randomized controlled trials (RCTs), in 537 PLWC in the post-treatment phase (Mathew et al. 2021).It reported the most promising findings as improvements in anxiety, depression, FCR, and QL.”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Mathew et al. 2021
The Results (Study and participant characteristics) report 11 studies enrolling 537 cancer survivors, and the Discussion identifies improvements in anxiety, depression, fear of cancer recurrence, and quality of life as the most promising findings. The Methods (Search strategies and data sources) date the literature search to 2019, but the cited review is identified as a 2021 paper, not a 2019 review. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTwo systematic reviews have indicated that ACT-based interventions effectively improve symptoms of fear of cancer recurrence in cancer survivors.
“Two systematic reviews have indicated that ACT-based interventions effectively improve symptoms of FCR in cancer survivors (Mathew et al., 2021;Wei et al., 2024b).”
From Acceptance and commitment therapy effectiveness for fear of cancer recurrence: A systematic review and meta-analysis. (2025) · cites this paper as Mathew et al., 2021
Research has shown Acceptance and Commitment Therapy to improve various outcomes, including fear of cancer recurrence, anxiety, depression, emotional distress, and quality of life.
“research has shown ACT to improve various outcomes, including fear of cancer recurrence, anxiety, depression, emotional distress, and quality of life [9-11].”
ACT as a therapeutic treatment modality for survivors has a growing evidence base, supporting survivors in cultivating present-moment awareness and disentangling from rigid thoughts about themselves and their cancer.
“ACT as a therapeutic treatment modality for survivors has a growing evidence base [37,57-59], supporting survivors in cultivating present-moment awareness and disentangling from rigid thoughts about themselves and their cancer [60].”
From Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach (2024) · cites this paper as [59]
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“No significant change in FCR during the month-long baseline period - Increases in cancer-related psychological flexibility partially mediated 8 outcomes; predicted (p < .05) subsequent changes in depression, pain, traumatic impact of cancer, vitality, life meaning and manageability and nearly predicted anxiety (p = .0…”
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Using Online Survey Software to Enhance Rigor and Efficiency of Knowledge Synthesis Reviews
Lopez, K. D., Gephart, S. M., & Hershberger, P. E. (2020) · Western Journal of Nursing Research · doi:10.1177/0193945920904442 · Cited by 5 · see citing works
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Management of common clinical problems experienced by survivors of cancer
Emery, J., Butow, P., Lai-Kwon, J., Nekhlyudov, L., Rynderman, M., & Jefford, M. (2022) · The Lancet · doi:10.1016/s0140-6736(22)00242-2 · Cited by 326 · see citing works
Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory.
Carlson, L. E. (2023) · Annual Review of Psychology · doi:10.1146/annurev-psych-032620-031757 · Cited by 56 · see citing works
“Small effects of MBIs on biomarkers including indices of inflammation, specifically T cell and natural killer (NK) cell activity as well as cytokine counts and function,have also been reported in a number of studies, but in one meta-review effect sizes could not be estimated (Pedro et al. 2021).…”
BackgroundFawson, S., Moon, Z., Novogrudsky, K., Moxham, F., Forster, K., Tribe, I., Moss-Morris, R., Johnson, C., & Hughes, L. D. (2024) · Health Psychology Review · doi:10.1080/17437199.2023.2261518 · Cited by 40 · see citing works
“…with cancer diagnosis and treatment which can cause signi fi cant distress to patients, including increased medical appointments and unpleasant procedures, psychological and physical symptoms and fears around recurrence, spread and the future (Mathew et al., 2021; Niedzwiedz et al., 2019).”
BackgroundFlynn, D. M., McQuinn, H. M., Burke, L., Steffen, A. D., Fairchok, A., Snow, T. J., & Doorenbos, A. Z. (2021) · Pain Medicine · doi:10.1093/pm/pnab326 · Cited by 37 · see citing works
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Cancer-Related Lymphedema and Psychological Distress
Lau, K., Patel, S. R., Rogers, K., Smith, S. R., & Riba, M. (2024) · Current Psychiatry Reports · doi:10.1007/s11920-024-01543-y · Cited by 29 · see citing works
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“Compared with alternative methods, the ACT had supporting findings on the effectiveness on patients’ problems, such as depression, anxiety, chronic pain and cancer adaptation (Du et al., 2021; Mathew et al., 2021; Twohig & Levin, 2017).”
MethodBeygi, Z., Tighband Jangali, R., Derakhshan, N., Alidadi, M., Javanbakhsh, F., & Mahboobizadeh, M. (2023) · Iranian Journal of Psychiatry · doi:10.18502/ijps.v18i2.12373 · Cited by 28 · see citing works
“38, 40, 41, 44), patients with different cancers or multiple sclerosis (25, 31, 34, 37, 42), people with”
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Sadeghi-Bahmani, D., Esmaeili, L., Mokhtari, F., Sadeghi Bahmani, L., Afsharzadeh, M., Shaygannejad, V., Mirmosayyeb, O., Goldstein-Piekarski, A. N., & Gross, J. J. (2022) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2022.104029 · Cited by 22 · see citing works
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Addressing Suffering in Patients With Psychiatric Disorders
Yager, J. (2021) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000001348 · Cited by 20 · see citing works
“, acceptance and commitment therapy) (Mathew et al., 2021) merit attention.”
BackgroundWang, T., Tang, C., Jiang, X., Guo, Y., Zhu, S., & Xu, Q. (2024) · Journal of Medical Internet Research · doi:10.2196/47704 · Cited by 20 · see citing works
“MBIs can include additional mental training, such as mindfulness-based stress reduction (MBSR) [9], and acceptance and commitment therapy [10], which addresses psychological issues by increasing psychological flexibility [11].”
Zhang, X., Ma, H., Lam, C. Y., Ho, G. W., & Mak, Y. W. (2023) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2023.05.007 · Cited by 17 · see citing works
Arem, H., Duarte, D. A., White, B., Vinson, K., Hinds, P., Ball, N., Dennis, K., McCready, D. M., Cafferty, L. A., & Berg, C. J. (2024) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2024.0021 · Cited by 19 · see citing works
“43 Thus, integrating a hope-based perspective, with its speci fi c focus on goals across life domains and navigating barriers, alongside the processes and tools offered by ACT, may represent a promising opportunity to address some unmet psychosocial needs of young adult cancer survivors.”
Duarte, J., Björkstrand, F. K., McCracken, L. M., & Perrin, S. G. (2022) · European Journal of Pain · doi:10.1002/ejp.2067 · Cited by 16 · see citing works
“Results for physical distress (pain, fatigue), have been inconsistent, particularly due to the small number of studies to date (Mathew et al., 2021; Zhao et al., 2021).”
BackgroundResultInfluentialCancer and Stress: Understanding the Connections and Interventions
D’Andre, S. D., Ellsworth, L. L., Kirsch, J. L., Montane, H. N., Kruger, M. B., Donovan, K. A., Bronars, C. A., Markovic, S. N., & Ehlers, S. L. (2024) · American Journal of Lifestyle Medicine · doi:10.1177/15598276241304373 · Cited by 13 · see citing works
Lahousse, A., Ivakhnov, S., Nijs, J., Beckwée, D., Cools, W., César Fernández de las Peñas, P., Roose, E. C. S., & Leysen, L. (2022) · Pain Medicine · doi:10.1093/pm/pnac006 · Cited by 16 · see citing works
Hassani Alimolk, F., McDonald, F. E. J., Asghari‐Jafarabadi, M., Ahmadi, F., Zenoozian, S., Lashkari, M., & Patterson, P. (2024) · Psycho-Oncology · doi:10.1002/pon.6339 · Cited by 13 · see citing works
“13,15 However, a recent longitudinal study indicated that a quarter of patients required psychotherapy at every point in their medical treatment course.”
BackgroundInfluentialAssessing Psychological Flexibility in Chronic Illness
Tyndall, I., Vagos, P., Cano, S., Pinto, H., & Trindade, I. A. (2023) · The Psychological Record · doi:10.1007/s40732-023-00572-y · Cited by 12 · see citing works
“Cognitive fusion appears to be central to conceptual models of psychological well-being or psychological distress in chronic ill-health domains such as chronic pain (e.g., Vowles et al., 2014) and cancer (e.g., Mathew et al., 2021).”
BackgroundInfluentialMoschopoulou, E., Brewin, D., Ridge, D., Donovan, S., Taylor, S. J., Bourke, L., Eva, G., Khan, I. U., Chalder, T., on behalf of the SURECAN Grant Investigators, et al. (2022) · BMC Cancer · doi:10.1186/s12885-022-09745-4 · Cited by 12 · see citing works
“Taking into account the emerging evidence base for the use of ACT in cancer [15, 17, 18] and other patients groups [14, 16], training healthcare practitioners to incorporate ACT into their supportive care practice is likely to be useful.”
BackgroundYuyan, Y., Jiaqi, L., Ting, W., Juan, X., Jinfeng, W., & Jing, L. (2025) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2025.102862 · Cited by 11 · see citing works
Miller, L. J., Halliday, V., Snowden, J. A., Aithal, G. P., Lee, J., & Greenfield, D. (2024) · Journal of Human Nutrition and Dietetics · doi:10.1111/jhn.13315 · Cited by 10 · see citing works
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Hulbert-Williams, N., Hulbert‐Williams, L., Patterson, P., Suleman, S., & Howells, L. (2021) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2020-002786 · Cited by 11 · see citing works
“…Acceptance and Commitment Therapy (ACT) 9 is advocated as a conceptually suitable intervention framework for cancer-related distress 10 ; trial-based evidence is building 11 across a range of outcomes, 12 including in those with incurable cancer who are being treated in palliative care settings.”
McCready, D. M., Arem, H., Duarte, D. A., Dennis, K., Ball, N., Cafferty, L. A., Hinds, P. S., Howlader, A., & Berg, C. J. (2024) · Contemporary Clinical Trials · doi:10.1016/j.cct.2024.107545 · Cited by 8 · see citing works
Senger, A. R., Ratcliff, C. G., Semelsberger, R., Chaoul, A., & Cohen, L. G. (2023) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-023-09977-x · Cited by 8 · see citing works
“…encourage behaviors in keeping with what is important to a person, and there is considerable evidence that both approaches improve QOL among cancer survivors (Zhang et al., 2022; Zhao et al., 2021; Mathew et al., 2021) and some evidence that they improve PTG (Hawkes et al., 2014; Li et al., 2020).”
Maas, A., Westerweel, A., Maurice‐Stam, H., Kremer, L. C. M., Delden, A. M. V. D. A., Zwerus, D., van Dalen, E. C., & Grootenhuis, M. A. (2025) · Psycho-Oncology · doi:10.1002/pon.70101 · Cited by 9 · see citing works
“Various psychological and physical interventions like cognitive behavioral therapy (CBT), relaxation techniques, meditation, physical exercise [53, 54] and Acceptance and Commitment Therapy‐based (ACT) interventions [55], have shown promise in mitigating fear of cancer recurrence in this population.”
Al‐Abbadey, M., Tomescu‐Stachie, S., Kaklamanou, D., Jarrett, N., Merwood, A., Tyndall, I. T., & McCracken, L. M. (2025) · British Journal of Health Psychology · doi:10.1111/bjhp.12807 · Cited by 9 · see citing works
“Similar to the Fang et al. ( 2023) and Jiang et al. (2024) reviews and meta-analyses in advanced cancer patients, Mathew et al. (2021) noted the small sample sizes in the studies they reviewed and called for more larger-scale research to determine the utility of ACT in oncology settings and whether…”
InfluentialWang, Q., Wu, Q.-Y., Wang, Y., Yang, T., Chen, Q.-Y., & Yang, K. (2025) · Journal of Evaluation In Clinical Practice · doi:10.1111/jep.70175 · Cited by 9 · see citing works
Consensus statement on chronic pain treatment in cancer survivors
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Depression: Screening, Assessment, and Interventions in Oncology Nursing
Decker, V. B., & Tofthagen, C. (2021) · Clinical journal of oncology nursing · doi:10.1188/21.cjon.413-421 · Cited by 6 · see citing works
Group-based mindfulness interventions in prisons: a selective critical review
Harding-White, M. F., Mojtahedi, D., & Carson, J. (2024) · The Journal of Forensic Practice · doi:10.1108/jfp-10-2022-0054 · Cited by 5 · see citing works
Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach
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Prevalence and correlates of fear of recurrence among oral and oropharyngeal cancer survivors
Manne, S. L., Hudson, S. V., Preacher, K. J., Imanguli, M. M., Pesanelli, M., Frederick, S., Singh, N., Schaefer, A. A., & Cleave, J. H. V. (2023) · Journal of Cancer Survivorship · doi:10.1007/s11764-023-01449-3 · Cited by 5 · see citing works
“Many of these are modifiable risk factors that could be addressed with multifocal, tailored survivorship care interventions that incorporate cognitivebehavioral or acceptance-based therapies [46].”
Zu, W., Li, F., Ma, X., Zhang, S., Nie, W., & Wang, L. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100843 · Cited by 4 · see citing works
Akzeptanz- und Commitment-Therapie (ACT) in der Psychoonkologie
Sauer, C., & Weißflog, G. (2022) · Der Onkologe · doi:10.1007/s00761-022-01127-6 · Cited by 4 · see citing works
Mental health and treatment challenges in older adults
Laidlaw, K., Charlesworth, G. M., & Bhar, S. S. (2025) · Nature Reviews Psychology · doi:10.1038/s44159-025-00500-7 · Cited by 4 · see citing works
Distinct Dysphagia Profiles in Patients With Oral Cancer After Surgery
Mathew, A. E. (2023) · Oncology nursing forum · doi:10.1188/23.onf.201-214 · Cited by 4 · see citing works
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“All items from the World Health Organization Trial Registration Data Set for this protocol can be found in Additional file 2 Table S1. cancer survivors looking at QoL, where the intervention is delivered to participants one-to-one by trained therapists [11, 14].”
BackgroundMethodEsiason, D. C., Smith, P. J., Peppers, C. L., Wakschal, E. S., Andrews, L. A., Nurse, C. N., Kushner, H. M., Drescher, C. F., Bruschwein, H. M., Erler, W., et al. (2025) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2025.106630 · Cited by 3 · see citing works
The effect of acceptance commitment therapy on the mental health of elderly breast cancer patients
Ruan, Y., Xie, W. Y., & Xu, F. (2025) · World Journal of Surgical Oncology · doi:10.1186/s12957-025-04056-x · Cited by 3 · see citing works
Li, X., Jia, F., Wu, P., & Wen, Q. (2026) · Current Oncology Reports · doi:10.1007/s11912-026-01734-1 · Cited by 3 · see citing works
Lai, J., Liu, K., Lin, Y., Chen, Z., Ji, X., & Wen, J. (2025) · CNS Neuroscience & Therapeutics · doi:10.1111/cns.70516 · Cited by 3 · see citing works
Mendes-Santos, C. (2021) · Linköping studies in arts and science · doi:10.3384/9789179291143 · Cited by 3 · see citing works
Bowman, C., Baydoun, M., & Carlson, L. E. (2023) · Journal of Psychosocial Oncology Research and Practice · doi:10.1097/or9.0000000000000098 · Cited by 3 · see citing works
Kroemeke, A., Dudek, J. E., Kijowska, M., Owen, R., & Sobczyk‐Kruszelnicka, M. (2024) · Trials · doi:10.1186/s13063-024-08235-1 · Cited by 2 · see citing works
Ma, H., Cariola, L. A., & Gillanders, D. T. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-025-09229-8 · Cited by 3 · see citing works
“One such adaptive process supported by research is psychological flexibility, which may explain how couples cope with PCa distress [64, 103].”
Kolokotroni, P., & Anagnostopoulos, F. (2025) · Journal of Health Psychology · doi:10.1177/13591053251324249 · Cited by 2 · see citing works
“…(CBT) and Acceptance and Commitment Therapy (ACT) have been studied for their effectiveness in relieving physical symptoms, managing symptoms such as anxiety and depression, and improving quality of life (QoL) across the cancer continuum to survival (Mamiya et al., 2024; Mathew et al., 2021).”
Espinoza-Salgado, F. S., García, R. R., Wakefield, C. E., Kelada, L., Sansom‐Daly, U. M., McGill, B. C., Tusie, A. Z., García, L. J., Cardos, R. D. S. C., & Zapata‐Tarrés, M. (2022) · Psicooncología · doi:10.5209/psic.80798 · Cited by 2 · see citing works
Fishbein, J. N., Judd, C. M., Genung, S. R., et al. (2021) · doi:10.31234/osf.io/4uzg3 · Cited by 2 · see citing works
Acceptance of Illness Among Patients Pursuing Transplantation or Left Ventricular Assist Device
Miller-Matero, L. R., Hecht, L. M., Elsiss, F., Miller, M. K., Son, J., Ling, S., Segal, A., & Bryce, K. (2022) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-021-09793-1 · Cited by 1 · see citing works
Conradi, H. S. W., Nguyen, T., Lawal, O. A., & Carlson, L. E. (2025) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130251367051 · Cited by 1 · see citing works
Berg, C. J., Schubel, L. C., McCready, D. M., Shajan, S., Bhanot, P., Dopke, C., Howlader, A., Hinds, P. S., Levine, J., Lyon, M. E., et al. (2025) · Quality of Life Research · doi:10.1007/s11136-025-04010-0 · Cited by 1 · see citing works
“ACT aims to increase psychological flexibility through acceptance, mindfulness, commitment, and behavior change [39], and may improve various outcomes (e.g., mental health symptoms, fear of recurrence) [40–43].”
Placer García, L. D., Torrijos Zarcero, M., Rocamora González, C., Muñoz San José, A., & Palao Tarrero, Á. I. (2025) · Psicooncologia · doi:10.5209/psic.102233 · Cited by 1 · see citing works
COVID ‐19 and beyond: A systematic review of adaptations to psychosocial support in oncology
Martin, M., Rice, K., Murray, C., Thorsteinsson, E., & Usher, K. J. (2024) · Journal of Advanced Nursing · doi:10.1111/jan.16175 · Cited by 1 · see citing works
Qin, F., Zhu, Y., Wang, S., Zhang, L., Wang, Z., & Wan, H. (2025) · Supportive Care in Cancer · doi:10.1007/s00520-024-09126-6 · Cited by 2 · see citing works
“Other reviews also highlight the limited number of studies evaluating the efficacy of ACT in managing psychological issues among cancer patients [19, 22].”
Moschopoulou, E., Donovan, S., Brewin, D., Taylor, S. J., Ridge, D., Bourke, L., Khan, I. U., Roche, M., & Chalder, T. (2025) · Health Expectations · doi:10.1111/hex.70237 · Cited by 1 · see citing works
Reynolds, D. P., Tordesillas, S., Denison, A., & Legg, A. (2025) · Oral Oncology Reports · doi:10.1016/j.oor.2025.100761 · Cited by 1 · see citing works
Batchelor, R., Cogings, N., McCormack, C., & Hotton, M. (2026) · Children · doi:10.3390/children13050672 · Cited by 1 · see citing works
“…LTCs have provided preliminary support for ACT on several psychosocial outcomes, including reducing anxiety, depression and psychological distress, and improving quality of life and symptom control [15,21–24], with clinical guidelines for chronic pain management in adults recommending ACT [25,26].”
Defer, C., & Bernatchez, M. S. (2022) · Psycho-Oncologie · doi:10.3166/pson-2022-0184 · Cited by 1 · see citing works
Bibby, H., McDonald, F. E. J., Ciarrochi, J., Allison, K. R., Hulbert-Williams, N., Konings, S., Wright, A., Tracey, D., & Patterson, P. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100813 · Cited by 1 · see citing works
Acceptance and Commitment Model of Borderline Personality Disorder
Salavati, M., & Selby, E. A. (2024) · Springer eBooks · doi:10.1007/978-3-031-75503-3_11 · Cited by 1 · see citing works
Ryan, A., Ferreira, N. B., Moffat, H., Eugenicos, M. P., Howson, W., Casburn-Jones, A., Moroni, F., Stevens, P., Wolters, M. K., & Gillanders, D. T. (2025) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2025.100887 · Cited by 1 · see citing works
Utilizing Acceptance and Commitment Therapy Within Oncology
Meltzer, K. J., Sharp, K. J., & Howe‐Martin, L. (2022) · Journal of Health Service Psychology · doi:10.1007/s42843-022-00065-6 · Cited by 1 · see citing works
“A recent systematic review found ACT significantly reduced symptoms of anxiety, depression, fear of recurrence, and increased psychological flexibility and quality of life in patients with a variety of cancer diagnoses (Mathew et al., 2021).”
BackgroundKang, Z., Xu, Y., Li, H., Arbing, R., Chen, W.-T., Ke, X., & Huang, F. (2026) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2026.103141
Η επίδραση της συμβουλευτικής και της άσκησης στην ποιότητα ζωής των καρκινοπαθών
Papastergiou, D. (2021) · doi:10.12681/eadd/50901
ACT for Chronic Health Conditions
Dindo, L. N., Liew, J. R., & Arch, J. J. (2022) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780197550076.013.21 · Cited by 2 · see citing works
Kapfhammer, H. (2022) · Springer eBooks · doi:10.1007/978-3-662-65873-4_12
Reder, M., Hofheinz, C., Melzner, L., Prinz, G., & Kröger, C. B. (2024) · Trials · doi:10.1186/s13063-024-07953-w · Cited by 1 · see citing works
“The concept of values in life (according to Acceptance and Commitment Therapy [18]) will be introduced.”
王, 文. (2024) · Advances in Psychology · doi:10.12677/ap.2024.144252
Bourgognon, F., Béchet, D., Huin‐Schohn, C., Strelow, A., Demarche, L., Guillou, M., Adam, V. S., Fall, E., & Omorou, A. Y. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1409308
Small steps, big impact: redefining cancer survival through lifestyle
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Cancer Pain and Supportive Care: Assessment, Evaluation, and Treatment
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“16,37 Education on adaptive CS may help these individuals better accept their condition, commit to value-based action, and improve self-management.”
Liu, X., Bian, J., Mitani, S., Doorenbos, A. Z., Yoshinaga, N., & Fukahori, H. (2025) · Aging & Mental Health · doi:10.1080/13607863.2025.2568160
“Several systematic reviews have reported the effectiveness of ACT for cancer survivors (Mathew et al., 2021) and on negative emotions of caregivers (Atefi et al., 2023; Han et al., 2021; Sun et al., 2022).”
Self-citationDennis, K., Arem, H. E., McCready, D. M., Howlader, A., Shajan, S., Bhanot, P., Shaffer, L., Schubel, L., & Berg, C. J. (2025) · Journal of Psychosocial Oncology · doi:10.1080/07347332.2025.2602620
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“Although ACT is effective for anxiety, depression, posttraumatic stress, psychological flexibility, fear of concurrent cancer, and quality of life in cancer survivors, PTG has not been widely assessed in many randomized controlled trials (RCTs) [35].”
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“ACT has been confirmed to support cancer patients’ emotional well-being, quality of life and greater psychological flexibility (e.g., Gon-zález-Fernández & Fernández-Rodríguez, 2019; Mathew et al., 2021).”
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- Authors
- Mathew, A., Doorenbos, A. Z., Jang, M. K., & Hershberger, P. E.
- Affiliations
- Christian Medical College, Vellore (IN)
- University of Illinois Chicago (US)
- Corresponding author
- Mathew, Asha
- Venue
- Journal of Cancer Survivorship
- Published
- 2020-09-19
- Volume
- 15
- Issue
- 3
- Pages
- 427-451
- ISSN
- 1932-2259 (ISSN-L)
- 1932-2267
- PMC
- PMC10960234
- OpenAlex
- W3087709441
- Cited by
- 91
- References
- 69
- Citations by year
- 2026: 11 · 2025: 24 · 2024: 22 · 2023: 13 · 2022: 14 · 2021: 7
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Cancer Survivorship (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NINR,NIH (K24NR015340)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Keywords
- acceptance and commitment therapy, cancer survivors, psychological flexibility, anxiety, depression, fear of cancer recurrence, quality of life, survivorship care, psychological distress, conceptual model
- MeSH terms
- Cancer Survivors, Psychological Distress, Adult, Anxiety, Humans, Neoplasms, Quality of Life, Acceptance and Commitment Therapy
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