Utilizing a Manualized Therapy to Provide Parallel Treatment to Older Adults With Cancer and Their Caregivers: A Case Study

May combine two claims.

Caregiver stress affects the caregiver's emotional and physical well-being, ability to help the care recipient, and the interpersonal relationship.

“The impact of caregiver stress is well documented; it not only impacts the emotional and physical well-being of the caregiver herself but may impact the caregiver’s ability to help the care recipient and can influence the interpersonal relationship between the caregiver and the care recipient (Sun et al., 2019).”

• cites Sun et al., 2019 sourcePartly supported

  The Conclusion says cancer caregiving is a major source of stress and burden that negatively affects caregiver health and quality of life. The ‘Interrelationship between Informal Caregiver and Dyadic Outcomes’ section says caregiver well-being may be associated with patients’ perceived quality of care, but it does not establish an effect on the caregiver’s ability to help or on the interpersonal relationship itself. Page numbers were not available in our copy. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

May combine two claims.

Psychosocial interventions reduce anxiety in adults with cancer and have positive long-term effects on quality of life.

“Psychosocial interventions have been found to be efficacious in reducing anxiety in adults with cancer, as well as having positive long-term effects on quality of life (Osborn et al., 2006; Greer et al, 2012; Jacobsen & Jim, 2008).”

• cites Osborn et al., 2006 sourceNot checked — no full text of the source
• cites Greer et al, 2012 sourcePartly supported

  The Results report greater anxiety reductions with brief CBT in adults with terminal cancer. They found no difference in overall quality of life between groups, although some quality-of-life subscales improved; the Discussion says further work is needed to determine whether benefits persist long term. The claimed long-term quality-of-life effect is therefore not supported. (LLM, conf=0.91)

  Experimental — accuracy not yet measured
• cites Jacobsen & Jim, 2008 sourceNot checked — no full text of the source

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

The HADS is valid for use with an older adult population.

“and is valid for use with an older adult population (Djukanovic et al., 2017).”

• cites Djukanovic et al., 2017 sourceSupported

May combine two claims.

Shirley's depression score was below the HADS cut-off at both time points, and her quality-of-life change did not meet the three-point minimally important difference threshold.

“In addition, Shirley’s depression score fell below the HADS cut-off at both time points and the change in her quality of life score did not meet the three-point threshold for a minimally important difference (Webster, Cella, & Yost, 2003).”

• cites Webster, Cella, & Yost, 2003 sourcePartly supported

  Table 1 in the review section on meaningful FACIT score changes gives a minimally important difference of 3–7 points for total FACT-G, so three points is a possible lower bound, not a universal quality-of-life threshold. The paper does not address HADS cut-offs or report Shirley’s scores; it cannot verify those case-specific statements. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

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

Shirley found identifying anxiety triggers, deep breathing, and information about developing new thoughts particularly useful.

“Shirley reported that identifying triggers of anxiety, deep breathing and information about developing new thoughts were all particularly useful to her.”

May combine two claims.

Melissa experienced significant anxiety about her mother's health and her own caregiving abilities.

“Melissa experienced significant anxiety related to both concerns for her mother’s health as well as worries related to her abilities as a caregiver.”

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

At baseline, Shirley had a HADS score of 10, with HADS-Anxiety 7 and HADS-Depression 3.

“At the baseline assessment, Shirley reported minimal symptoms on the HADS with a score of 10 (HADS-Anxiety = 7, HADS-Depression = 3).”

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

Melissa was Shirley's 50-year-old adult Caucasian daughter.

“and Melissa was her 50-year-old adult Caucasian daughter.”

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

Shirley chose mindful self-talk to manage fear of recurrence.

“Shirley selected the solution of utilizing mindful self-talk to manage the fear, saying to herself “I’m in a situation I want to be in right now and, in this moment, I’m feeling good. That’s all that matters.””

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

Shirley reported increased anxiety over several months, noted by her oncologist.

“Shirley endorsed increased anxiety over several months, which was noted by her oncologist.”

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

Shirley found deep breathing helpful and noticed immediate benefits.

“Shirley found the deep breathing helpful and noticed immediate benefits.”

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

Shirley reported that using coping statements and modified thoughts was very useful for managing and reducing anxiety.

“She reported that this strategy was very useful in helping her manage and reduce anxiety.”

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

Melissa reported anxiety related to her mother's illness and her caregiving responsibilities.

“Melissa reported anxiety related to her mother’s illness and the caregiving responsibilities she faced.”

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

Shirley was prescribed Wellbutrin 150mg daily three months before MAC and found it helpful.

“Shirley was prescribed the antidepressant Wellbutrin 150mg daily by her internist 3 months before beginning MAC and found it helpful”

May combine two claims.

Cognitive restructuring was useful before a medical test, deep breathing during it, and communication strategies and cognitive restructuring after it.

“Cognitive restructuring was found to be useful prior to a medical test, deep breathing most effective during the test, and both communication strategies and cognitive restructuring proved helpful following the test.”

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

Shirley selected the problem of fear of recurrence when people ask how she is doing.

“Shirley selected the problem of “when people ask me how I’m doing, I experience a fear of recurrence.””

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

Shirley did not use her planned I-statement during a doctor's appointment, but having it in mind helped her feel more confident.

“Shirley reported that she did not in fact use her pre-conceived I-statement during her doctor’s appointment; nonetheless, she felt that having this statement in mind helped her feel more confident during the appointment.”

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

Shirley rated MAC as very helpful on the treatment satisfaction question.

“Shirley’s response to the treatment satisfaction question “Overall, how helpful was MAC to you?” was “very helpful.””

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

Shirley felt ambivalent about Willingness and doubted she could allow anxiety to be, but planned to try it.

“Shirley felt ambivalent about the notion of Willingness and felt she might not be able to “allow the anxiety to be” but made a practice plan to try over the upcoming week.”

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

Shirley reported nervousness, muscle tension, and stomach pain associated with visits to doctors' offices.

“Shirley detailed her anxiety-provoking visits to doctors’ offices and reported experiencing nervousness, muscle tension and stomach pain associated with these visits.”

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

Shirley tolerated or accommodated her anxiety in most circumstances and coped well with prior stressors.

“She was able to tolerate or accommodate her anxiety in most circumstances and coped well with prior stressors.”

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

Shirley reported engaging in Willingness naturally by doing activities despite anxiety, but had difficulty imagining anxiety as an object and letting it be.

“Shirley reported that she found herself engaging in Willingness naturally simply by doing activities despite having anxiety, but she remarked on the difficulty of imagining her anxiety as an object and letting it be.”

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

Both Shirley and Melissa expressed heightened anxiety related to the COVID-19 pandemic and potential virus exposure.

“Consequently, both women expressed heightened anxiety related to this global health crisis and the potential dangers associated with contracting this virus.”

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

Shirley had a prescription for Xanax 0.25mg taken as needed but infrequently for increased anxiety.

“Shirley had a prescription for the anti-anxiety medication Xanax 0.25mg that she took as needed but infrequently for episodes of increased anxiety.”

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

Melissa was on a stable regimen of Wellbutrin and Xanax for depression and anxiety.

“She had been in therapy before for a specific problem in the past and was on a stable psychotropic medication regimen of Wellbutrin and Xanax for depression and anxiety (dosages of medication unknown).”

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

At baseline, Shirley had a FACT-G summed score of 87, indicating high perceived quality of life.

“On the Functional Assessment of Cancer Therapy - General (FACT-G) she had a summed score of 87, indicating a high perceived quality of life (the highest possible rating on the scale is 108)”

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

Shirley's lymphoma was in remission after weekly infusions early in 2020.

“After resolution of these issues, she resumed treatment for her lymphoma early in 2020, receiving weekly infusions that successfully put the lymphoma in remission.”

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

Shirley identified PET scans as an anxiety trigger and experienced heightened anxiety before, during, and after scans.

“For example, Shirley quickly identified PET scans as a trigger of anxiety and noted that she experienced heightened anxiety prior to a scheduled scan (thinking about it beforehand), during (undergoing the test) and following (waiting for the results).”

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

Shirley was a 78-year-old Caucasian woman diagnosed with lymphoma and lung cancer two years before MAC.

“Shirley was a 78-year-old Caucasian woman diagnosed with lymphoma and lung cancer two years prior to her participation in the MAC treatment”

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

Shirley reported lifelong anxiety and saw it as part of her way of being.

“Shirley reported experiencing lifelong anxiety and perceived it as part of her way of being.”

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

Melissa found cognitive restructuring helpful.

“Melissa also noted that cognitive restructuring was helpful for her.”

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

Melissa rated MAC overall as very helpful.

“Melissa responded “very helpful” to the question “Overall how helpful was MAC to you?””

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

Shirley found the Session 2 deep breathing exercises helpful and used them weekly while learning other strategies.

“For example, Shirley reported that deep breathing exercises learned in Session 2 were helpful and she used them weekly while learning other new strategies.”

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

Melissa felt less anxiety about attending her mother's medical appointments and reported that both she and her mother had changed their communication.

“Melissa felt she had less anxiety related to attending her mother’s medical appointments and that both she and her mother had changed how they communicated with each other.”

Classified as probably not a substantial claim. May combine two claims.

Melissa noticed a change in how she and her mother communicated, describing it as easier and using a shared language acceptable to both.

“Melissa commented to her therapist that she noticed a change in the way both she and her mother communicated with each other, stating it was “easier” and they were using the same “language” that was acceptable to both of them.”

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

Melissa identified communication as the most significant and useful MAC strategy.

“She identified communication as the most significant and useful strategy from MAC.”

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

Melissa used MAC audio recordings at work, found they reduced her start-of-workday anxiety, and noticed being more patient with others.

“She was using the MAC audio recordings at work and found they reduced her anxiety at the beginning of the workday and she noticed being more patient with others as a result.”

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

Melissa connected her inadequacy belief to her relationship with her father and was surprised by the link, having thought she had addressed it in prior counseling.

“Melissa linked this belief about her inadequacy to her relationship with her father and was surprised by this connection, as she believed she had worked though this issue previously in counseling.”

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

Requests for tangible help from Shirley, such as attending a doctor's appointment, also triggered Melissa's anxiety.

“Tangible requests for assistance by Shirley, such as when Shirley asked her to attend a doctor’s appointment were also triggers for Melissa’s anxiety.”

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

Melissa recognized no evidence supported her belief about her mother's expectations, and her worthlessness feelings related to wanting her father's approval rather than meeting her mother's requests.

“Melissa realized there was no evidence to support this belief about her mother’s expectations and her feelings of worthlessness were in fact related to wanting her father’s approval rather than fulfilling her mother’s requests.”

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

As COVID-19 escalated, Melissa became increasingly concerned about her mother's health and safety and about social isolation's effect on her mother's mood.

“Further, as the COVID pandemic escalated, Melissa experienced increasing concern over her mother’s health and safety, as well as worry about the impact of social isolation on her mother’s mood.”

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

Using MAC worksheets, Melissa identified weekly self-care activities in physical, emotional, social, and spiritual health.

“Using MAC worksheets, Melissa identified weekly self-care activities in four areas: physical, emotional, social, and spiritual health.”

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

Melissa continued to feel guilty about engaging in self-care.

“However, Melissa still experienced feelings of guilt associated with doing something to care for herself.”

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

Melissa's baseline quality-of-life score was 89, in the moderate range on a scale with a maximum of 140.

“On the QOL scale, Melissa scored an 89 (in the moderate range, with the highest possible rating a 140).”

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

Melissa reported a shift in how she valued and prioritized self-care over the course of MAC.

“Melissa also reported a shift in perspective regarding the value and importance of self-care over the course of MAC.”

May combine two claims.

These strategies reduced Melissa's anger and resentment and weakened her belief that she alone was responsible for her mother's emotional well-being.

“These strategies reduced her feelings of anger and resentment and decreased her belief she was solely responsible for her mother’s emotional well-being.”

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

Melissa did not walk to work as planned but recognized it could become a future goal.

“She was not able to walk to work as she had discussed in the first session but was able to recognize that this could be added as a future goal.”

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

Melissa chose deep breathing and guided imagery in Session 2 and reported immediate physical relief from anxiety during deep breathing.

“Melissa selected deep breathing and guided imagery to learn during the session. She expressed feeling immediate physical relief from her anxiety during the deep breathing exercise.”

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

Melissa planned to listen to the MAC deep breathing audio for five minutes each morning at her desk to reduce work anxiety.

“she developed a plan to listen to the MAC deep breathing exercise audio recording for five minutes each morning at her desk.”

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

In Session 4, Melissa reported using the modified thoughts and coping statements, thought about the prior session often, and was comforted that thought errors are normal.

“At the next session, Melissa reported using the modified thoughts and coping statements. She reported thinking about that session often during the week and was comforted by knowing that thought errors are normal.”

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

Melissa struggled to prioritize her mother's needs and wants, feeling pressured to answer every request.

“She had difficulty prioritizing her mother’s needs and wants which made her feel pressured to respond to all of her mother’s requests.”

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

At the start of Session 6, Melissa reported improved communication with her mother and that the relationship felt easier.

“Melissa began the sixth session by remarking that she experienced improved communication with her mother and that the relationship felt “easier.””

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

Melissa believed her mother expected her to be available for all medical appointments even though her mother never made that request.

“Melissa shared her belief that her mother expected her to be available for all medical appointments, despite the fact her mother never made this request.”

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

In Session 3, Melissa reported difficulty walking to work; she stood more often but found morning walking time challenging.

“Melissa reported difficulty implementing her plan to move more during the day, specifically to walk to work. She stated that she was standing more often during the day but that finding time to walk in the morning was challenging.”

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

Melissa's primary anxiety trigger was the belief that she could never do enough for her mother.

“The primary trigger of Melissa’s anxiety was the belief that she could never do enough for her mother.”

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

Melissa found that hearing therapist prompts during breathing exercises helped her stay focused.

“She noted during the session that hearing the therapist prompts throughout the breathing exercises helped her stay focused.”

May combine two claims.

At the end of the intervention, Melissa's HADS total was 6, with anxiety 5 and depression 1.

“At the conclusion of the intervention, Melissa scored a 6 on the HADS (HADS-Anxiety = 5, HADS-Depression = 1)”

May combine two claims.

At baseline and conclusion, Melissa's anxiety and depression scores were below the clinical cutoff, indicating low and stable distress.

“At both time points, Melissa’s anxiety and depression scores fell below the cut-off for clinically significant distress, indicating low and stable distress levels over time.”

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

Melissa valued her increased understanding of how caregiving affected her well-being and her relationship with her mother.

“Melissa stated that she valued her increased understanding of the impact of caregiving on her well-being and her relationship with her mother.”

May combine two claims.

Melissa often discussed her relationship with her mother, her expectations of herself as a caregiver, and her imagined expectations of her mother.

“Melissa’s therapist revealed that Melissa talked often about her relationship with her mother, her expectations of herself as a caregiver and her imagined expectations of her mother.”

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

During COVID-19, Melissa had to return in person to her workplace, which produced significant anxiety about exposure and negatively affected her quality of life.

“Further, during COVID, Melissa was required to return in person to her workplace. This produced significant anxiety regarding potential exposure to COVID that directly and negatively impacted her quality of life.”

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

Melissa saw Willingness as a tool for trying to control her emotions, which she considered a central issue.

“Melissa viewed Willingness as a tool to try and gain control over her emotions, which she viewed as a central issue for her.”

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

Melissa's thoughts about whether she was meeting her mother's needs worsened her anxiety.

“Finally, Melissa had specific thoughts about how well she was meeting her mother’s needs such as, “Did I call enough during the day?” and “Did my mother want me to visit next weekend?” These thoughts further exacerbated her anxiety.”

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

Melissa discussed her mother's cancer diagnosis and treatment, her caregiver role, challenges meeting her mother's expectations, and significant job stress.

“During the first session, Melissa discussed her mother’s cancer diagnosis and treatment. She focused on her role as a caregiver, the challenges she felt meeting her mother’s expectations and the significant stress she felt from her job.”

May combine two claims.

Shirley and Melissa's therapists first discussed the dyad during this case study and discovered that each participant perceived their role and circumstances very differently.

“For example, not until the development of this case study did Shirley and Melissa’s therapists discuss this dyad, and in doing so discovered how very differently each participant perceived their role and circumstances.”

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

Melissa developed I-statements to communicate her needs and wants about visits, including a statement about feeling stressed and tired on weekends.

“Melissa developed I-Statements to communicate her needs and wants in these situations. For example, Melissa developed the statement “I feel stressed when I can’t visit because I know how much it means to you. I am often tired on the weekends because work is so busy, and I am not always able to come over as much as I would like.””

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

Melissa's baseline HADS total was 3, with anxiety 3 and depression 0, indicating minimal symptoms.

“Melissa’s baseline HADS score was a 3 (HADS-Anxiety = 3, HADS-Depression = 0), reporting only minimal symptoms.”

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

In Session 2, Melissa asked a co-worker to stand with her every 20 minutes, which improved her accountability.

“Melissa had asked a co-worker to stand every 20 minutes with her, which helped her to be accountable.”

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

Melissa reported physical anxiety symptoms including neck pain and tension, difficulty staying asleep, and racing thoughts.

“She endorsed numerous physical symptoms of anxiety such as neck pain and tension, difficulty staying asleep, and racing thoughts.”

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

Melissa continued deep breathing at her desk at the start of the workday, which further improved her mood.

“Melissa stated that she also continued the self-care activity of deep breathing at her desk at the beginning of the workday, which further improved her mood.”

May combine two claims.

Melissa's work-related anxiety thoughts matched her caregiving thoughts; she believed she was not doing enough at work, which triggered worthlessness.

“The thoughts driving her work-related anxiety were consistent with those that emerged in her caregiving role. Melissa continuously struggled with the belief that she was not doing enough at work, similar to her thoughts about her role as a caregiver. These thoughts triggered feelings of worthlessness.”

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

Melissa's second solution was to ask two other family members to call her mother at a scheduled, consistent weekly time.

“The second solution she identified was to ask two other family members to call her mother at a scheduled, consistent time each week.”

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

In Session 5 problem-solving, Shirley's plan included both deep breathing and alternative thoughts.

“When discussing problem-solving steps in Session 5, both deep breathing and the use of alternative thoughts were pieces of her problem-solving plan.”

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

Melissa became aware that encouragement and permission helped her engage in self-care, and she identified a colleague as a possible support.

“She developed an awareness that she was better able to engage in self-care if someone encouraged and gave her permission to do so and identified a colleague as a possible support for self-care.”

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

In the final session, Melissa reported an increased ability to notice her anxiety and its triggers.

“Melissa identified an increased ability to notice anxiety in herself and the associated triggers.”

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

Melissa chose her mother's depression and isolation as a problem, feeling she needed to compensate for her mother's lost interaction due to COVID-19, which increased her caregiving anxiety.

“Melissa selected the problem of her mother being depressed and isolated. When considering why this was a problem for her, Melissa stated that she felt the need to compensate for her mother’s loss of interaction due to COVID-19 which increased her anxiety about her caregiving role.”

May combine two claims.

Using I-statements increased Melissa's confidence and comfort in communicating with her mother.

“The use of I-statements also increased her confidence in and comfort with communication with her mother.”

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

Melissa did deep breathing at her desk three times that week and continued standing throughout her workday.

“She had engaged in deep breathing at her desk as planned three times that week and continued to stand throughout her workday.”

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

In Session 5, Melissa reported using I-statements with her mother throughout a recent visit and felt this reduced anxiety for both of them.

“She described using the I-statement format to speak with her mother throughout their recent visit and felt it reduced anxiety for both of them.”

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

Melissa said that although prior therapy helped, MAC's practice assignments and interactive style were enjoyable and productive.

“Overall, Melissa stated that while previous therapy had been helpful, the practice assignments and interactive therapeutic style of the MAC intervention was enjoyable and productive.”

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

Melissa identified a distressing thought that if she was not doing something for her mother she was worthless, reflecting a core belief of never being good enough.

“Melissa identified the distressing thought, “if I am not doing something for my mother, I am a piece of shit”. This thought was extremely powerful for Melissa and reflected the core belief of “never being good enough” that she had expressed in earlier sessions.”

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

Melissa's practice plan focused on physical health: moving more by walking to work and standing more, with initial goals of a 20-minute standing alarm and walking to work at least one day per week.

“For the practice plan, Melissa chose to focus on physical health, specifically to move more by walking to work and to stand more during the workday. Her initial goals were to set an alarm to stand every 20 minutes during the workday and to walk to work at least one day during the week.”

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

Melissa often named work responsibilities as a major self-care obstacle and identified barriers and strategies to overcome them.

“She often cited work responsibilities as a major obstacle to self-care and was able to identify these barriers and strategies for overcoming them.”

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

Melissa found her Session 3 coping statement so meaningful that she typed, framed, and placed it on her work desk.

“The coping statement she developed in Session 3 was so meaningful that she had typed it, framed it, and placed on her work desk where she would see it every day.”

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

Melissa experienced work-related anxiety and felt compelled to complete all daily work, a self-imposed and unrealistic expectation.

“Melissa also experienced anxiety related to her work. As she described it, she felt compelled to complete all her daily work, a self-imposed and unrealistic expectation.”

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

By the end of Session 3, Melissa felt she understood the thought, distortion, and meaning more clearly.

“By the end of the session Melissa felt she had a clearer understanding of the thought, distortion, and meaning.”

May combine two claims.

Shirley liked cognitive restructuring in Session 3 and independently created coping statements and modified thoughts for anxiety-provoking situations later.

“She also expressed an affinity for cognitive restructuring in Session 3, and independently constructed coping statements and modified thoughts for anxiety-producing situations in subsequent sessions.”

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

Melissa reported nearly constant work anxiety linked to thoughts such as having too much to do.

“Melissa also noted that she experienced nearly constant anxiety at work associated with thoughts such as, I have so much to do.””

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

Melissa identified multiple possible solutions, including an I-statement to express concern to her mother.

“she identified multiple potential solutions including use of an I-statement to convey concern to her mother.”

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

Melissa created a modified thought that she has done and continues to do a lot for her mother and is a good person, plus a coping statement that she is doing her best and that is good enough.

“resulting in the modified statement “I have done and continue to do a lot for my mother. I am a good person.” She developed a coping statement, “I am doing the best I can, and that is good enough.””

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

Melissa felt guilty about considering self-care because she believed free time should go to calling or visiting her mother.

“Melissa endorsed guilt for considering self-care because she felt she should use free time to call or visit her mother.”

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

Melissa integrated self-care into her work routine by standing every 20 minutes and doing guided imagery at her desk for five minutes.

“Melissa’s new view of self-care was particularly notable when she began to integrate self-care into her daily work routine by standing every 20 minutes and practicing guided imagery at her desk for five minutes.”

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

For Melissa, Session 3 brought up deep feelings and negative core beliefs, and she described it as difficult.

“For Melissa, Session 3 opened up deep feelings and negative core beliefs. Melissa stated at the time that it was a difficult session.”

May combine two claims.

Assigning separate therapists allows each dyad member to express concerns independently, and the therapists do not confer to maintain confidentiality.

“Assigning separate therapists for the OAC and caregiver allows each dyad member to express concerns independent of their partner, and the two therapists do not confer during the course of the intervention to maintain this confidentiality.”

• cites Trevino et al., 2020Not matched

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

Classified as probably not a substantial claim.

The HADS uses a subscale cut-off of 8 or higher to indicate clinically significant anxiety and depression.

“The HADS uses a subscale cut-off score of ≥8 to indicate clinically significant anxiety and depression.”

• cites Zigmond & Snaith, 1983 sourceNot checked — no full text of the source

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

The FACT-G is a reliable and valid 27-item self-report scale assessing health-related quality of life.

“The FACT-G is a reliable and valid 27-item self-report scale that assesses health-related quality of life (Cella et al., 1993; Victorson et al., 2008).”

• cites Cella et al., 1993 sourceNot checked — no full text of the source
• cites Victorson et al., 2008 sourceNot checked — no full text of the source

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

The HADS is a 14-item measure of anxiety and depression symptoms.

“The HADS (Zigmond & Snaith, 1983) consists of 14 items measuring symptoms of anxiety (7 items) and depression (7 items).”

• cites Zigmond & Snaith, 1983 sourceNot checked — no full text of the source

May combine two claims.

Giving Shirley and Melissa the same anxiety-management tools let them manage their own anxiety and gave them a shared cognitive-behavioral language.

“Providing them with the same arsenal of anxiety-management tools, as indicated by the treatment manual, not only gave them the means to manage their own anxiety but also provided a common cognitive-behavioral language.”

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

The Caregiver Quality of Life-Cancer scale is a reliable and valid 35-item measure of quality of life in cancer caregivers.

“The Caregiver Quality of Life – Cancer scale is a reliable and valid 35-item measure of quality of life in cancer caregivers (Weitzner et al. 1999; Edwards & Ung, 2002).”

• cites Weitzner et al. 1999 sourceNot checked — no full text of the source
• cites Edwards & Ung, 2002 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

CBT is a recommended treatment for cancer patients with anxiety.

“Cognitive Behavioral Therapy (CBT) is a recommended treatment approach for cancer patients with anxiety (Andersen et al., 2014)”

• cites Andersen et al., 2014 sourceNot checked — no full text of the source

May combine two claims.

MAC is a 7-session telephone-delivered manualized cognitive-behavioral intervention that includes ACT and PST strategies.

“Managing Anxiety from Cancer (MAC), a 7-session telephone-delivered manualized cognitive-behavioral intervention that includes strategies from Acceptance and Commitment Therapy and Problem-Solving Therapy”

• cites Trevino et al., 2020Not matched

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

• AssumptionRests on an assumption: There is a need for psychosocial interventions tailored for older adults with cancer.

May combine two claims.

This case study illustrates benefits of MAC's manualized therapy, parallel treatment of a family dyad, and varied cognitive behavioral strategies for anxiety management.

“This case study highlights the benefits of several aspects of the Managing Cancer in Anxiety intervention, including 1) utilizing a manualized therapy, 2) providing parallel treatment to two members of familial dyad and 3) introducing a variety of cognitive behavioral strategies for patients and caregivers to use alone or in combination to manage anxiety.”

May combine two claims.

Each MAC session introduces a new technique, letting clinicians teach a range of anxiety-management tools quickly.

“Finally, each MAC session introduces a new therapeutic technique; this approach allows the clinician to teach a range of anxiety-management tools in a short period of time.”

May combine two claims.

The clinicians acknowledged Melissa's insight and then returned to session content, preserving rapport and intervention fidelity.

“Therefore, a clinical decision was made to acknowledge Melissa’s insight then return focus back to the session content, which allowed for preservation of the therapeutic rapport and fidelity to the intervention.”

May combine two claims.

Cancer caregivers report clinically significant anxiety and general psychological distress.

“Research shows that cancer caregivers report clinically significant anxiety and general psychological distress (Rossi Ferrario, 2003; Dumont, 2006; Selamat Din, 2017).”

• cites Rossi Ferrario, 2003Not matched

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

• cites Dumont, 2006Not matched

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

• cites Selamat Din, 2017Not matched

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

May combine two claims.

Shirley did not have an overall mental health decline but may have had a specific reaction to the COVID-19 pandemic.

“These findings indicate that Shirley did not experience an overall decline in her mental health but may have had a specific reaction to the COVID pandemic.”

May combine two claims.

Consistent self-care discussion raised its importance and encouraged Melissa to integrate it into daily life.

“The consistent discussion of self-care elevated its importance and encouraged integration into her daily routine.”

Classified as probably not a substantial claim. May combine two claims.

MAC is structured but intended to be flexible so therapists can integrate their style and personality, supporting a strong therapeutic alliance.

“Despite the structured nature of the MAC manual, the implementation is intended to be flexible to allow the psychotherapist to integrate their own practice style and personality into the administration of the therapy, thereby supporting the development of a strong therapeutic alliance.”

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

MAC aims to introduce many anxiety-management strategies, but its scope prevents in-depth exploration of each technique.

“Further, while the intent of MAC is to introduce OACs and caregivers to an array of anxiety management strategies, the scope of topics covered prohibits an in-depth exploration of each technique.”

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

An experienced clinician or insightful participant can integrate earlier themes and skills into each week's new material.

“An experienced clinician and/or an insightful participant can integrate themes and skills discussed in previous sessions into each week’s new material.”

May combine two claims.

Completing a practice plan and expecting its review created accountability and likely encouraged between-session use of MAC skills.

“The completion of a practice plan and the anticipation of its review the following week created a sense of expectation and accountability, and likely encouraged engagement with the MAC skills in-between sessions.”

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

Completely ignoring the father relationship could have harmed rapport and possibly reinforced a thought error.

“However, not addressing it at all could have negatively impacted rapport and potentially reinforced a thought error.”

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

Participating in MAC may have increased Shirley's anxiety by increasing her focus on distress.

“Alternatively, participating in MAC may have increased Shirley’s anxiety by increasing her focus on her distress.”

May combine two claims.

The no-communication protocol protects participant confidentiality and prevents one therapist's perspective from influencing the other's intervention.

“This protocol ensures maintenance of confidentiality between the two participants and protects against the possibility of one therapist’s perspective influencing the nature of the intervention of the other.”

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

Teaching a new strategy each week provides variety but may increase the risk that material becomes siloed across sessions.

“While the model of teaching new strategies each week provides a range of anxiety management strategies, it also potentially increases the risk of material being siloed from session to session.”

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

The manual's repeated self-care focus validated Melissa's experience and showed concern for her well-being.

“The manual’s focus on self-care during each session validated Melissa’s experience and demonstrated concern for her well-being.”

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

Having multiple tools let Shirley combine techniques to optimize their impact.

“Having multiple tools at her disposal allowed her to apply techniques in different combinations to optimize their impact.”

May combine two claims.

OAC and caregiver sessions mirror each other weekly and cover the same material with minor customization for each role.

“As previously mentioned, the OAC sessions and caregiver sessions mirror one another week to week and cover the same material with minor customization to address either the OAC or caregiver experience.”

Classified as probably not a substantial claim. May combine two claims.

Although MAC was developed in a controlled trial, its application shows how treatment manuals can be valuable in clinical practice.

“MAC was developed and implemented as part of controlled trial, but the application of this intervention demonstrates how treatment manuals can be of value in clinical practice.”

May combine two claims.

The therapists in this case study adhered to the manual while using their own style to build rapport and individualize MAC for each patient and caregiver.

“The experience of the therapists in this case study is consistent with these findings in that the therapists were able to adhere to the manual while using their unique style to develop rapport and individualize MAC for each patient and caregiver.”

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

For Melissa and other MAC participants, initial exposure to cognitive-behavioral strategies may encourage longer-term psychotherapy after MAC.

“However, for Melissa and other MAC participants, this initial exposure to cognitive-behavioral strategies may prompt engagement in longer-term psychotherapy following completion of the MAC sessions.”

May combine two claims.

Both therapists in this case study were experienced and received thorough training and supervision from MAC's developer, and their comfort let them adhere to the manual without being stifled.

“Both therapists from this case study are experienced clinicians who underwent thorough training and supervision with the psychologist who developed the MAC intervention; comfort with the material gave the therapists the freedom to adhere to the structure of the manual without being stifled in their approach.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

A well-designed manual can give treatment structure that keeps participant and therapist focused on goals.

“A well-designed manual may provide a structure to treatment that keeps both the participant and therapist focused on treatment goals.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

MAC allows review of prior material, but Melissa might have benefited from more than one session on cognitive reappraisal and the core beliefs that emerged.

“MAC does allow time to review and re-visit previous material in depth, for Melissa it may have been beneficial to have had more than one session dedicated to cognitive reappraisal techniques and the core beliefs that emerged.”

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

Covering a broad topic like cognitive restructuring in one session can be therapeutically challenging.

“For example, it can be therapeutically challenging to cover a topic as broad as cognitive restructuring during a single session.”