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ACT THERAPY

A psychological strategy for ovarian cancer

Written by Dr Julie Angiola Morris, Clinical Assistant Professor of Psychiatry & Human Behaviour at the Alpert Medical School of Brown University in Providence, Rhode Island.

Dr Morris is a Staff Psychologist at the Lifespan Cancer Institute, where she provides evidence-based assessment and psychotherapy to patients during their cancer experience. Dr. Morris also operates a private telehealth practice, Present Mind Therapy, providing ACT-based psychotherapy for women struggling with cancer, infertility adjustment issues, and other concerns.

Cancer

When you receive a diagnosis of cancer – when you hear that word – your stomach drops, the world stops and dread or numbness washes over you. A diagnosis of cancer is often unsettling, upsetting, angering and sad.

The emotional response to cancer

The medical members of your oncology team offer treatments to reduce tumour size or spread, alleviate symptoms such as pain and fatigue, and prolong life. At the same time, this physical process is happening, another process is happening in tandem – the emotional process. Shock, confusion, and worry are a natural reaction to a diagnosis of cancer as is longing and sadness. The majority of people who receive a diagnosis of cancer will move through the following three phases: the initial reaction, some level of distress, and eventual adjustment.

When pain turns to suffering

In some instances, worry and sadness become overwhelming and interfere with activities of daily life – for some, experiencing depression makes it feel difficult to get out of bed in the morning and experiencing anxiety makes it feel like life is never going to be alright again. Some people will experience a feeling of extensive and deep guilt and some will experience a pervasive feeling of hopelessness. When the feelings that you experience take you away from being present and from living the life you want to be living – in other words, when your psychological pain turns into psychological suffering – that’s when working with a Mental Health Clinician – such as a Psychiatrist and/or a Clinical Psychologist, is warranted.

Letting go of suffering: acceptance and commitment therapy (ACT)

While there are numerous research-supported psychological treatments, one such treatment that can be especially helpful when psychological suffering arises in the context of cancer, is called Acceptance and Commitment Therapy (Hayes, Strosahl, & Wilson, 2012). Acceptance and Commitment Therapy, said as one word – ACT – is a mindfulness-based “contextual cognitive behavioural therapy” (Hayes, Villatte, Levin, & Hildebrandt, 2011). Acceptance and Commitment Therapy’s aim is to accept the things that are outside of your control and commit to engaging in actions that bring greater meaning and richness to your life.

A course of ACT psychotherapy provides skills to change your relationship to your thoughts and feelings so that they overwhelm and interfere to a lesser extent. ACT also helps you build a transcendent self – a self that is more than the physical and psychological suffering caused by cancer and other aspects of your life and histories. Exercises in ACT help guide you toward revisiting what really matters to you (i.e., your values) and help you take steps toward a more inspired and full life, in spite of the quantity of life remaining. In order to do all of this, ACT employs a combination of mindfulness techniques, metaphors, paradoxes and parables, experiential exercises done in session, and values-guided behavioural practices. A course of ACT therapy is collaborative, interesting, evocative, and often very rewarding.

Due to the ongoing adoption of ACT in healthcare centres and elsewhere, there are a myriad of resources available including from ACT’s scientific and clinical organisation, the Association for Contextual Behavioural Science (ACBS). The ACBS website is full of resources, free to the public, including mindfulness audio recordings and worksheets; and if you are looking for an ACT-based clinician, the ACBS website is a helpful place to start!

ACT exercises to help you become open, centered, and engaged

Speaking of places to start, here are just a few ACT-based exercises that I have found to be particularly helpful in my practice working with people with cancer. My hope is that they are helpful for you, as well.

Open: gaining separation from thoughts

Becoming more open involves, in part, building acceptance of our internal experiences (i.e., thoughts, emotions, memories, predictions). We can begin to create acceptance by first finding distance from our internal experiences. Through Mindfulness and Cognitive Defusion exercises, we are able to practise seeing our internal experiences as psychological phenomena that are ever changing. We can begin to adopt a posture of acceptance for all that we experience and all that we are.

Mindfulness of the Breath

Leaves on a Stream

Dropping Anchor

Centered: being present

Becoming more present involves actively contacting psychological experiences (i.e., thoughts, feelings, images, memories, etc.) directly, fully and without unnecessary defence. The process of being more present allows us to observe and accept our experiences – both psychological and physical – as ever-changing phenomena. From this place, a transcendent sense of self develops. The transcendent self is sometimes referred to as The Observing Self, or pure awareness; it is not a thing or endpoint as much as it is a process – an awareness of awareness.

Blowing Bubbles

Willingness- the Painful Object

Willingness- the Dirty Swamp

Engaged: living your values

Living your values involves first identifying the type of person you want to be, the quality of relationships you wish to have, and the life you would love to craft – one that would bring richness and meaning to your world. It can be helpful to pause here and reflect on how your values may or may not have changed and where in your life you could stand to engage more fully with your values. The next step is often identifying observable behaviours that you can engage in that are aligned with your values.

Clarifying Your Values

Values Bulls Eye

Values Based Goal Setting

Finding help in New Zealand

Find information about the support services we offer including our counsellor facilitated peer support groups.

Many District Health Boards offer counselling and psychology services for oncology patients. You can ask your GP or cancer specialists for a referral.

If you wish to see a psychologist privately you do not need a referral. Some regions have long waits for psychologists. If you struggle to find a psychologist you could see a counsellor.

Counsellors are unregulated and their level of qualifications vary. You should look for one belonging to an association. A well-trained counsellor will facilitate change through listening and helping you see what’s happening to you.

In contrast clinical psychologists hold doctorate degrees and have specialised training in evidence-based talk therapies like Acceptance and Commitment Therapy (ACT) and Cognitive Behavioural Therapy (CBT) that can help reduce and relieve psychological suffering.

Note: this content has been reviewed by a gynaecological cancer specialist in New Zealand. Information is provided for general use and should not be a substitute for professional medical advice.

Last reviewed: 16 January 2024