Examining the effects of prior Acceptance and Commitment Therapy (ACT) treatment among anxious cancer survivors during the COVID-19 pandemic: Evidence from a randomized controlled trial
Open accessAbstract
Introduction: The COVID-19 pandemic has presented population-wide novel stressors. Acceptance and Commitment Therapy (ACT) may be potent for coping with novel, unpredictable stressors, but it is unknown whether pre-pandemic ACT treatment conferred protective benefit during the COVID-19 pandemic. Methods: Participants (N = 73) from a previous randomized controlled trial of ACT (seven 2-h group sessions) versus minimally-enhanced usual care (MEUC) for anxious cancer survivors completed measures of anxiety symptoms, fear of cancer recurrence, and emotional approach coping during the trial and again during the pandemic in May, June/July, and November 2020, an average of 2.71 years after completing ACT or MEUC. We estimated hierarchical linear models to test overall and conditional differences over the trial timepoints, in the interval between the trial and May 2020, and between the pandemic timepoints. Results: Compared to MEUC, ACT led to greater improvement on the outcomes during the 8-month trial follow-up, consistent with the main trial findings. Across the entire sample, anxiety symptoms and emotional approach coping worsened from the final trial assessment timepoint to May 2020 (ps < .001). During this period, ACT participants worsened significantly more on emotional approach coping (p = .035) than MEUC participants. No significant condition differences emerged at later pandemic timepoints. Conclusions: Treatment with ACT several years earlier did not provide protective benefit to anxious cancer survivors during the pandemic, relative to MEUC. ACT interventions may need to be targeted to pandemic-specific stressors, or booster sessions may be required for prior ACT treatment completers when faced with novel stressors. © 2022 Association for Contextual Behavioral Science
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
4 of 14 cited sources checked · 2 supported · 0 flagged · accuracy not yet measured
- Premisecitation
ACT may be well suited to pandemic distress because it builds psychological flexibility when stressors are unpredictable and uncontrollable.
“Acceptance and Commitment Therapy (ACT) is a promising intervention for pandemic-related distress because it promotes psychological flexibility in the face of unpredictable, uncontrollable stressors (e.g., Kroska et al., 2020).”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Kroska et al., 2020 source
- Findingown data
Compared with non-consenting original trial participants, current participants more often had an initial diagnosis of Stage 0 or I cancer rather than a later stage.
“the only significant difference is that current study participants were more likely to have been initially diagnosed with Stage 0 or I cancer (p =.007) than later-stage cancer.”
Quote in the paperNot a substantial claim - Findingown data
During the original trial's five timepoints, GAD-7 anxiety scores declined significantly across both conditions.
“Over the five original trial timepoints, participants across conditions displayed significant declines in GAD-7 scores (p < .001; Table 3)”
Quote in the paperNot a substantial claim - Findingown data
Early-stage cancer survivors made up a larger share of the current sample than of the overall trial sample.
“The current sample has a greater proportion of early-stage cancer survivors than the overall trial sample”
Quote in the paperSubstantial claim - Findingown data
From the 8-month trial follow-up to May 2020, GAD-7 anxiety scores increased significantly across conditions.
“from the 8-month trial follow-up to May 2020, participants across conditions evidenced increased GAD-7 scores (p <.001).”
Quote in the paperNot a substantial claim
- Findingown data
During the original trial's five timepoints, ACT produced greater improvement in CARS scores than MEUC.
“and more so in the ACT condition (p = .027; Table 3).”
Quote in the paperSubstantial claim - Findingown data
ACT and MEUC did not differ in GAD-7 change from the 8-month trial follow-up to May 2020.
“ACT and MEUC did not differ in GAD-7 score change from the 8-month original trial follow-up to May 2020 (p = .093).”
Quote in the paperSubstantial claim - Findingown data
GAD-7 scores did not change from June/July to November 2020.
“but not from June/July to November 2020 (p =.924).”
Quote in the paperNot a substantial claim - Findingown data
Overall GAD-7 scores decreased from May to June/July 2020.
“Overall sample GAD-7 scores subsequently decreased from May to June/July 2020 (p = .027)”
Quote in the paperNot a substantial claim - Findingown data
Conditions did not significantly differ in CARS change from the 8-month trial follow-up to May 2020.
“and conditions did not significantly differ in CARS score change from the trial 8-month follow-up to May 2020 (p = .066).”
Quote in the paperSubstantial claim - Findingown data
CARS scores did not significantly change from the 8-month trial follow-up to May 2020 across conditions.
“Across conditions, CARS scores did not significantly change from the 8-month trial follow-up to May 2020 (p = .198)”
Quote in the paperSubstantial claim - Findingown data
The ACT effect on general anxiety was somewhat larger in the current sample than in the full original trial sample.
“the intervention effect on anxiety symptoms was significant in the current sample (p = .009) but marginal in the full RCT sample (p = .075). Thus, the intervention effect on general anxiety symptoms appears to have been somewhat stronger in the current study sample than the full RCT sample”
Quote in the paperNot a substantial claim - Findingown data
During the original trial's five timepoints, ACT produced greater improvement in GAD-7 anxiety scores than MEUC.
“with greater improvement in the ACT condition than the MEUC condition (p = .020).”
Quote in the paperSubstantial claim - Findingown data
EAC scores declined across the sample from the original trial 8-month follow-up to May 2020.
“From the original trial 8-month follow-up to May 2020, EAC scores declined across the sample as a whole (p < .001)”
Quote in the paperNot a substantial claim - Findingown data
There were no significant condition differences in GAD-7 change between pandemic timepoints.
“There were no significant condition differences in change between pandemic timepoints (ps ≥ .089)”
Quote in the paperSubstantial claim - Findingown data
EAC declined significantly more among ACT participants than MEUC participants from the original trial 8-month follow-up to May 2020.
“and declined significantly more among ACT participants (p = .035).”
Quote in the paperSubstantial claim - Findingown data
During the original trial's five timepoints, ACT participants increased significantly more on EAC than MEUC participants.
“and ACT participants increased significantly more than MEUC participants (p < .001).”
Quote in the paperSubstantial claim - Findingown data
Time since ACT treatment did not significantly moderate condition effects on distress during the pandemic.
“Time since ACT treatment did not significantly moderate condition effects on distress during the pandemic.”
Quote in the paperSubstantial claim - Findingown data
Emotional approach coping showed no further significant change over the pandemic period.
“and no further significant change occurred in emotional approach coping during the pandemic period.”
Quote in the paperSubstantial claim - Interpretationown data
Participants did not recover much of the clinical gains made during the original trial.
“Thus overall, participants appeared to lose, and not gain back, a considerable amount of the clinical improvement they had experienced during the original trial.”
Quote in the paperSubstantial claim - Premisecitation
In the original trial, gains in EAC either marginally or significantly mediated the intervention's effects.
“Improvement in EAC marginally or significantly mediated intervention effects in the original trial, indicating that it is mechanistically linked to anxiety maintenance in the current sample (Fishbein et al., 2021).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fishbein et al., 2021
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Study design and conductcitation
The available sample was probably too small to power follow-up mediation tests.
“we have refrained from conducting follow-up mediation analyses given that the current sample size would likely provide insufficient power for such analyses (Fritz & MacKinnon, 2007).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fritz & MacKinnon, 2007 source
- Interpretationown data
Prior ACT treatment did not shield anxious cancer survivors from worsening during the pandemic compared with MEUC.
“Treatment with ACT several years earlier did not provide protective benefit to anxious cancer survivors during the pandemic, relative to MEUC.”
Quote in the paperSubstantial claim - Study design and conductown data
By combining pre-pandemic and pandemic measurements, the study could directly estimate change from before to during the pandemic.
“this study used participants’ pre-pandemic data along with new data collecting during the pandemic, enabling direct estimation of how functioning changed pre-to post-pandemic.”
Quote in the paperSubstantial claim - Study design and conductown data
Moderated and unmoderated models produced the same pattern of overall and conditional change over time.
“Results of the moderated (Table 3 ) and unmoderated (Supplemental Table 2) models yielded the same patterns regarding overall and conditional change over time.”
Quote in the paperNot a substantial claim - Study design and conductreasoning
Using prior trial participants allowed causal conclusions about random assignment to ACT versus MEUC.
“Furthermore, the recruitment of previous trial participants enabled causal claims about the effects of being randomized to ACT versus minimally enhanced usual care.”
Quote in the paperSubstantial claim - Study design and conductown data
This follow-up study was completed by just 60% of those in the original trial.
“A key limitation of the current study is that only 60% of the original trial sample completed this follow-up study.”
Quote in the paperSubstantial claim - Study design and conductown data
The current study sample was broadly reflective of the full original RCT sample.
“Estimates and bootstrapped confidence intervals (Supplemental Table 1) of overall slopes and conditional slope differences yielded the same patterns of intervention effects in the full RCT sample and the current study sample”
Quote in the paperSubstantial claim - Interpretationcitation
EAC appears to play a mechanistic role in maintaining anxiety in this sample.
“indicating that it is mechanistically linked to anxiety maintenance in the current sample (Fishbein et al., 2021).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Fishbein et al., 2021
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationown data
ACT did not seem to guard against worsening during the pandemic.
“it did not appear to protect from deterioration during the pandemic.”
Quote in the paperSubstantial claim - Interpretationown data
ACT received before the pandemic did not protect the measured outcomes during the pandemic.
“Pre-pandemic ACT (received several years earlier in the original trial) did not confer a protective benefit during the pandemic on examined outcomes.”
Quote in the paperSubstantial claim - Interpretationown data
The findings imply that interventions finished years earlier might not protect cancer survivors from psychological decline when they face new stressors like the pandemic.
“the current results suggest that such prior interventions (completed several years earlier) may not be enough to shield them from worsened psychological functioning when encountering novel stressors such as the pandemic.”
Quote in the paperSubstantial claim - Interpretationown data
On average, participants lost more than half of the gains made during the original trial.
“meaning that the average participant (irrespective of condition) deteriorated by over half the improvement they had experienced during the original trial.”
Quote in the paperSubstantial claim - Premisecitation
The results are consistent with Forman and colleagues' (2012) report that ACT's anxiety benefits declined by 18 months.
“though our findings align with Forman and colleagues' (2012) observation of decay in ACT's effects on anxiety at 18 months.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Forman and colleagues' (2012)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Classified as probably not a substantial claim. 9
- Borderline: one of the tests for a substantial claim is unclear. 1
- The quote only partly states this claim. 2
- May combine two claims. 5
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationResearch on general North American groups reported that anxiety was higher in May 2020 than at later pandemic assessments.
“studies of general North American samples (e.g., Asmundson & Taylor, 2020; Shuster et al., 2021) found higher anxiety scores in May 2020 relative to subsequent pandemic assessment timepoints”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites Asmundson & Taylor, 2020 source
- cites Shuster et al., 2021 source
The Results report that anxiety scores declined across weekly assessments from April 2 to June 4, 2020, in a US adult sample. However, they identify early April—not May—as the period of highest anxiety and do not report a specific May-versus-later comparison. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAnxiety psychotherapy trials seldom report results past one year of follow-up.
“Relatively few anxiety psychotherapy clinical trials report outcomes beyond one-year follow-up (van Dis et al., 2020)”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites van Dis et al., 2020 source
The Key Points say few studies examined longer-term outcomes, and the Summary of Results says evidence for CBT outcomes at 12 months or more is scarce. This supports the general concern about long follow-up, but the review addresses cognitive behavioral therapy rather than anxiety psychotherapy trials as a whole. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationEarlier work found that cancer patients had more anxiety during the pandemic than before it.
“previous research by Yildirim et al. (2021) demonstrated increased anxiety symptoms in cancer patients during the pandemic relative to before.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Yildirim et al., 2021 source
Borderline on S4 (based): unclear from the text.
Findingnone givenNo significant condition differences emerged at later pandemic timepoints.
“No significant condition differences emerged at later pandemic timepoints.”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataDuring the original trial's five timepoints, CARS fear of cancer recurrence scores improved significantly across conditions.
“Over the five original trial timepoints, participants’ CARS (fear of cancer recurrence) scores improved overall (p < .001)”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataNo additional overall changes or condition differences in EAC emerged at later COVID-19 timepoints.
“No additional overall changes or condition differences emerged at later COVID-19 timepoints (ps ≥ .101)”
Quote in the paperNot a substantial claimThe quote only partly states this claim.
Findingown dataDuring the original trial's five timepoints, EAC scores increased significantly across conditions.
“Over the five original trial timepoints, participants showed overall increases on EAC (p < .001)”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataNo further overall change or change by condition in CARS was evident during the COVID-19 pandemic.
“No further overall change or change by condition was evident during the COVID-19 pandemic (ps ≥ .329)”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based).
Findingown dataFrom May to June/July 2020, GAD-7 scores rose by roughly one point on average.
“GAD-7 scores improved by only about one point on average from May to June/July 2020”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductown dataParticipants in the original trial were randomized to ACT or MEUC.
“participants were randomized to either a 7-week (one 2-h session per week) group ACT intervention delivered by clinical social workers in community oncology clinics or to MEUC.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataBoth the original trial and the follow-up received approval from the University of Colorado Boulder IRB.
“The original trial and the current follow-up study were approved by the University of Colorado Boulder institutional review board.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe EAC scale had good internal reliability at trial pre-intervention (ωTotal = 0.93).
“with the 8-item EAC scale (ωTotal = 0.93; Stanton et al., 2000)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Stanton et al., 2000 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationThe CARS Overall Fear Scale had good internal reliability at trial pre-intervention (ωTotal = 0.84).
“the four-item Overall Fear Scale from the Concerns About Recurrence Scale (CARS, ωTotal = 0.84; Vickberg, 2003)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Vickberg, 2003 source
May combine two claims.
Study design and conductcitationThe first pandemic survey occurred six to ten weeks after the pandemic began, and another was done when Colorado's COVID-19 cases peaked for that period.
“participants completed the first pandemic assessment just six to ten weeks into the pandemic, and again when COVID-19 case counts in Colorado were their highest to that point in the pandemic (November 2020; Colorado Department of Public Health and Environment, 2021).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Colorado Department of Public Health and Environment, 2021
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).
Study design and conductcitationThe GAD-7 had good internal reliability at trial pre-intervention (ωTotal = 0.90).
“the Generalized Anxiety Disorder-7 scale (GAD-7, ωTotal = 0.90; Spitzer et al., 2006)”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Spitzer et al., 2006 source
May combine two claims.
InterpretationcitationThe results imply that people treated with ACT might not transfer what they learned to novel situations without deliberate practice, or that benefits might diminish over time.
“Rather, empirically, these findings suggest that treated individuals may not generalize learning in treatment to new contexts (such as a global pandemic) in the absence of explicit practice (e.g. Mystkowski et al., 2002), or that treatment effects may wane.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Mystkowski et al., 2002 source
The paper relies on this without support.
Before this study, no research had compared pandemic outcomes for people who had received ACT or similar evidence-based psychotherapy with those of comparable people who had not.
“However, to our knowledge, no studies have evaluated how individuals treated with ACT or other evidence-based psychotherapies prior to the COVID-19 pandemic fared during the pandemic, relative to comparable individuals who did not receive the intervention.”
The paper relies on this without support.
The COVID-19 pandemic presented population-wide novel stressors.
“The COVID-19 pandemic has presented population-wide novel stressors.”
The paper relies on this without support.
A substantial number of people had undergone ACT or a similar behavioral treatment before the pandemic.
“Many people received ACT or a related behavioral intervention before the pandemic.”
The paper relies on this without support.
COVID-19 did not introduce new risks of cancer recurrence.
“and the pandemic did not present new cancer recurrence risks.”
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Sorted by citations
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- Authors
- Fishbein, J. N., & Arch, J. J.
- Affiliations
- University of Colorado Boulder (US)
- Corresponding author
- Fishbein, Joel N.
- Venue
- Journal of Contextual Behavioral Science
- Publisher
- Elsevier BV
- Published
- 2022-04
- Volume
- 24
- Pages
- 31-37
- ISSN
- 2212-1447 (ISSN-L)
- PMC
- PMC8917645
- OpenAlex
- W4220884614
- Semantic Scholar
- ec59ea51788455f8f76943f6cfffa0bd2fe70922
- Cited by
- 6
- References
- 28
- Citations by year
- 2026: 2 · 2025: 3 · 2022: 1
- FWCI
- 0.91
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Journal of Contextual Behavioral Science (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- PsyArXiv (OSF Preprints) (submittedVersion)
- Funders
- National Institutes of Health (R21CA218723)
- American Cancer Society (RSG-15-020-01–CPPB)
- AstraZeneca
- Topics
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- acceptance and commitment therapy, cancer survivors, anxiety, COVID-19 pandemic, fear of cancer recurrence, emotional approach coping, long-term treatment outcomes
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read under definition version 3 (extract-v3) on 2026-09-28.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.
Cited sources are checked by gpt-6-sol.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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