An emotion-based online intervention for reducing anxiety and depression in cancer patients: Study protocol for a randomized controlled trial

“The two subscales reflect the items of the Patient Health Questionnaire-9 (PHQ9; Kroenke et al., 2001) and the Generalized Anxiety Disorder Scale (GAD-7; Spitzer et al., 2006).”

“Quality of Life is assessed through the EORTC Quality of Life questionnaire (EORTC-QLQ-C30; Aaronson et al., 1993).”

“Personal growth after cancer diagnosis is assessed with the Posttraumatic Growth Inventory which comprises five subscales: new possibilities, relating to others, personal strength, spiritual change, and appreciation of life (Tedeschi and Calhoun, 1996).”

“Previous research showed good internal consistency of the questionnaire (Norman and Skinner, 2006), also for older adult populations (Chung and Nahm, 2015).”

“The questionnaire shows sufficient psychometric properties (Laugwitz et al., 2008).”

“Further, the one-dimensional ZUF-8, which is the German adaptation of the Client Satisfaction Questionnaire (CSQ-8; Attkisson and Zwick, 1982), is used as a short and economic scale to assess overall satisfaction with the online self-help program (Schmidt et al., 1989).”

“Loneliness is assessed by a single item (Beutel et al., 2017): “I am frequently alone, resp.”

“A large body of psychological research demonstrates that web-based online interventions can be effective in improving symptoms of depression and anxiety disorders (Karyotaki et al., 2017; Olthuis et al., 2016).”

“Fifty-two percent of cancer patients experience psychological distress at some point (Mehnert et al., 2018).”

“The questionnaire has shown high validity in past research (Amireault and Godin, 2015). eHealth literacy, i.e. the ability to read, use computers, search for information, understand health information and put it into context, is assessed with the German adaptation of the eHealth Literacy Scale…”

“According to Kroenke et al. (2016), who validated the PHQ-ADS in three clinical populations including people with cancer, the minimum clinically relevant effect (MCID) was determined as MCID = 3.81 in the group of people with cancer, the standard deviation was SD = 11.0.”

“Every module starts with assessing the current level of distress over the last week (Mehnert et al., 2006), and a mindfulness exercise.”

“A large body of psychological research demonstrates that web-based online interventions can be effective in improving symptoms of depression and anxiety disorders (Karyotaki et al., 2017; Olthuis et al., 2016).”

“Previous research showed good internal consistency of the questionnaire (Norman and Skinner, 2006), also for older adult populations (Chung and Nahm, 2015).”

“In recent years, several online interventions have been developed in psycho-oncology to reduce cancer-related stress and improve QoL (Beatty et al., 2019; van den Berg et al., 2015; Ringwald et al., 2019; Beatty et al., 2016; Cockle-Hearne et al., 2018; Russell et al., 2018; Urech et al., 2018).”

“…high validity in past research (Amireault and Godin, 2015). eHealth literacy, i.e. the ability to read, use computers, search for information, understand health information and put it into context, is assessed with the German adaptation of the eHealth Literacy Scale (eHEALS; Soellner et al., 2014).”

“In the German translation, reliability and factor structure of the Posttraumatic Growth Inventory were largely confirmed (Maercker and Langner, 2001).”

“In a current analysis of a representative sample in Germany, 39.4% of cancer patients suffered from mental illnesses, with a 12-month prevalence for anxiety disorders of 15.8% and for depressive disorders of 12.5% (Kuhnt et al., 2016).”

“The questionnaire shows acceptable to good internal consistency (Schröder et al., 2015).”

“Several randomized controlled trials (RCT) have revealed promising results and suggest that cancer survivors can benefit from online interventions, with effect sizes ranging from small to medium (e.g. Beatty et al., 2019; van den Berg et al., 2015; Beatty et al., 2016; Willems et al., 2017; Urech et al., 2018).”

“13.5% in German studies; Vehling et al., 2012).”

“However, the use of psycho-oncological support is lower in the outpatient setting, with percentages of self-reported usage ranging from 3 to 24.2% for cancer counseling (Zeissig et al., 2015; Faller et al., 2017) to 13.4% for psychotherapy (Faller et al., 2017).”

“…interventions are feasible and effective (Zwerenz et al., 2017a, 2017b; Lindqvist et al., 2020; Johansson et al., 2013a, 2017), there is still a lack of psychodynamic online interventions compared to the large number of cognitive behavioral based online interventions (Johansson et al., 2013b).”

“In recent years, several online interventions have been developed in psycho-oncology to reduce cancer-related stress and improve QoL (Beatty et al., 2019; van den Berg et al., 2015; Ringwald et al., 2019; Beatty et al., 2016; Cockle-Hearne et al., 2018; Russell et al., 2018; Urech et al., 2018).”

“Although there is evidence that psychodynamic online interventions are feasible and effective (Zwerenz et al., 2017a, 2017b; Lindqvist et al., 2020; Johansson et al., 2013a, 2017), there is still a lack of psychodynamic online interventions compared to the large number of cognitive behavioral based…”

“With regard to the latter, existing interventions in cancer care predominantly follow a cognitivebehavioral or mindfulness-based rationale (Beatty et al., 2016; CockleHearne et al., 2018; Beatty et al., 2019; Urech et al., 2018; Chambers et al., 2017; Russell et al., 2018).”

“3% of all patients received psycho-oncological consultations (Singer et al., 2013).”

“The German translation of the ERQ demonstrated sufficient psychometric properties: reliability, factor structure and indicators for construct validity (Wiltink et al., 2011).”

“Although there is evidence that psychodynamic online interventions are feasible and effective (Zwerenz et al., 2017a, 2017b; Lindqvist et al., 2020; Johansson et al., 2013a, 2017), there is still a lack of psychodynamic online interventions compared to the large number of cognitive behavioral based…”

“…(Haun et al., 2018), e.g. by lack of transportation, living in a rural area, suffering from physical disabilities, or information deficits, which prevent cancer patients from taking advantage of face-to-face support (Zimmermann-Schlegel et al., 2017; Sakellariou et al., 2019; Neumann et al., 2010).”

“Resilience is assessed with the RS-5 Resilience Scale (von Eisenhart Rothe et al., 2013).”

“Although there is evidence that psychodynamic online interventions are feasible and effective (Zwerenz et al., 2017a, 2017b; Lindqvist et al., 2020; Johansson et al., 2013a, 2017), there is still a lack of psychodynamic online interventions compared to the large number of cognitive behavioral based…”

“…interventions are feasible and effective (Zwerenz et al., 2017a, 2017b; Lindqvist et al., 2020; Johansson et al., 2013a, 2017), there is still a lack of psychodynamic online interventions compared to the large number of cognitive behavioral based online interventions (Johansson et al., 2013b).”

“Although there is evidence that psychodynamic online interventions are feasible and effective (Zwerenz et al., 2017a, 2017b; Lindqvist et al., 2020; Johansson et al., 2013a, 2017), there is still a lack of psychodynamic online interventions compared to the large number of cognitive behavioral based…”

“In recent years, several online interventions have been developed in psycho-oncology to reduce cancer-related stress and improve QoL (Beatty et al., 2019; van den Berg et al., 2015; Ringwald et al., 2019; Beatty et al., 2016; Cockle-Hearne et al., 2018; Russell et al., 2018; Urech et al., 2018).”

“…(Haun et al., 2018), e.g. by lack of transportation, living in a rural area, suffering from physical disabilities, or information deficits, which prevent cancer patients from taking advantage of face-to-face support (Zimmermann-Schlegel et al., 2017; Sakellariou et al., 2019; Neumann et al., 2010).”

“Furthermore, they provide low-threshold treatment options complementing existing stepped care programs (Nicholas et al., 2019; National Institute for Clinical Excellence, 2009) and can reach patients rejecting psychotherapeutic help because of perceived barriers, such as reservations about psychotherapy or the fear of…”

“…(Haun et al., 2018), e.g. by lack of transportation, living in a rural area, suffering from physical disabilities, or information deficits, which prevent cancer patients from taking advantage of face-to-face support (Zimmermann-Schlegel et al., 2017; Sakellariou et al., 2019; Neumann et al., 2010).”

“In addition, barriers on the side of psychotherapists refer to uncertainties in the treatment of somatically ill patients, organizational problems, or lack of expertise, which are reflected in low proportions of patients in psychotherapeutic practices (Schwarz et al., 2006).”

“A large representative study found male cancer patients to be twice as likely to report a lifetime diagnosis of depression as men without cancer (Ernst et al., 2019).”

“The availability of cancer-related counseling for patients may be limited (Haun et al., 2018), e.g. by lack of transportation, living in a rural area, suffering from physical disabilities, or information deficits, which prevent cancer patients from taking advantage of face-to-face support…”

“In recent years, several online interventions have been developed in psycho-oncology to reduce cancer-related stress and improve QoL (Beatty et al., 2019; van den Berg et al., 2015; Ringwald et al., 2019; Beatty et al., 2016; Cockle-Hearne et al., 2018; Russell et al., 2018; Urech et al., 2018).”

“With regard to the latter, existing interventions in cancer care predominantly follow a cognitivebehavioral or mindfulness-based rationale (Beatty et al., 2016; CockleHearne et al., 2018; Beatty et al., 2019; Urech et al., 2018; Chambers et al., 2017; Russell et al., 2018).”

“With regard to the latter, existing interventions in cancer care predominantly follow a cognitivebehavioral or mindfulness-based rationale (Beatty et al., 2016; CockleHearne et al., 2018; Beatty et al., 2019; Urech et al., 2018; Chambers et al., 2017; Russell et al., 2018).”

“Participants of the IG have access to the emotion-based psychooncological online self-help program epos, which was developed based on a qualitative pre-study that assessed cancer patients' needs from different perspectives (Mayer et al., 2021).”

“cancer are specifically vulnerable to psychological distress due to the intersection of disease and young age.(4) Consequently, AYA cancer patients are more likely to report treatment disengagement, lower quality of life, and even suicidality.”

“Detailed information on the study design of the RCT has been provided elsewhere [22].”