Exploring the utility of the metacognitive model in predicting and preventing emotional distress after cancer.
Lead Research Organisation:
University of Liverpool
Department Name: Clinical Psychology
Abstract
Emotional distress after cancer diagnosis is normal and most patients recover. However, some experience persistent or recurrent distress for which they need professional help. Why some people recover psychologically and others do not is not understood. Before we can begin to find ways to prevent emotional distress we need to identify the factors that cause it.
Recent research in mental health has shown that a particular style of thinking worsens and maintains emotional distress. This typically consists of repetitive and difficult-to-control thinking in the form of worry or rumination, the focussing of attention on threat and coping responses that unintentionally maintain or exacerbate emotional problems. The proposed study will explore whether and how this theory can be usefully applied in cancer.
Patients with cancer will be asked to complete questionnaires relating to their mood and thinking styles 3 and 12 months after diagnosis. This will help to identify the factors causing persistent distress. I will then seek the views of relevant patients about how to translate these findings into a practicable and acceptable intervention
The study will enable the early identification of patients ‘at risk‘ of persistent emotional distress and will provide self-help materials to prevent this occurring.
Recent research in mental health has shown that a particular style of thinking worsens and maintains emotional distress. This typically consists of repetitive and difficult-to-control thinking in the form of worry or rumination, the focussing of attention on threat and coping responses that unintentionally maintain or exacerbate emotional problems. The proposed study will explore whether and how this theory can be usefully applied in cancer.
Patients with cancer will be asked to complete questionnaires relating to their mood and thinking styles 3 and 12 months after diagnosis. This will help to identify the factors causing persistent distress. I will then seek the views of relevant patients about how to translate these findings into a practicable and acceptable intervention
The study will enable the early identification of patients ‘at risk‘ of persistent emotional distress and will provide self-help materials to prevent this occurring.
Technical Summary
Aims
To explore the utility of the metacognitive model in predicting emotional distress after cancer and in identifying causal factors that can be manipulated in an intervention to prevent persistent or recurrent distress.
Objectives
Specific objectives are to: (A) Test a theory of the role of the ‘cognitive-attentional syndrome‘ (CAS) in causing or maintaining emotional distress after cancer (B) Test the clinical utility of the CAS in predicting which individuals will develop clinically significant distress (C) Model an intervention to implement the findings and evaluate its acceptability to patients.
Design
The research spans the pre-clinical phase and phase 1 of the MRC framework for developing complex interventions. A mixed method approach will link (i) a prospective quantitative study to identify causal factors in the development of long-term emotional distress after cancer diagnosis with (ii) qualitative and quantitative methods to translate these finding into a preventative self-help intervention and to evaluate its feasibility and acceptability.
Methods
Study 1. In a prospective cohort study, 240 patients will be assessed psychologically 3 and 12 months after diagnosis of breast or prostate cancer to identify components of the CAS at 3 months that predict depression, anxiety or post-traumatic stress disorder at 12 months.
Study 2. About six patient focus groups (n=8) will be conducted in 3 phases to explore how findings from study 1 can be translated into a practicable and acceptable intervention. Group discussion and thematic analysis will focus on implementing variables implicated in Study 1, avoiding barriers to effectiveness.
Study 3. A randomised design will evaluate the feasibility and acceptability of the intervention. 80 patients identified through screening as ‘at risk‘ 3 months after diagnosis will be randomised to receive the intervention or care as usual. Patients will complete a questionnaire supplemented by a telephone interview after 1-2 weeks and again at 3 months to compare the groups on satisfaction with care as a whole and to analyse consumer evaluation of, and adherence with, the intervention in the group receiving it.
Scientific and Medical Opportunities
Identification of causal factors in long-term emotional distress after diagnosis of cancer will allow vulnerable patients to be identified as ‘at risk‘ early after diagnosis. The intervention will educate ‘at risk‘ patients about their own cognitive processes - what to look out for, and how to manage them - so that distress may be prevented or minimised before reaching levels requiring professional intervention.
To explore the utility of the metacognitive model in predicting emotional distress after cancer and in identifying causal factors that can be manipulated in an intervention to prevent persistent or recurrent distress.
Objectives
Specific objectives are to: (A) Test a theory of the role of the ‘cognitive-attentional syndrome‘ (CAS) in causing or maintaining emotional distress after cancer (B) Test the clinical utility of the CAS in predicting which individuals will develop clinically significant distress (C) Model an intervention to implement the findings and evaluate its acceptability to patients.
Design
The research spans the pre-clinical phase and phase 1 of the MRC framework for developing complex interventions. A mixed method approach will link (i) a prospective quantitative study to identify causal factors in the development of long-term emotional distress after cancer diagnosis with (ii) qualitative and quantitative methods to translate these finding into a preventative self-help intervention and to evaluate its feasibility and acceptability.
Methods
Study 1. In a prospective cohort study, 240 patients will be assessed psychologically 3 and 12 months after diagnosis of breast or prostate cancer to identify components of the CAS at 3 months that predict depression, anxiety or post-traumatic stress disorder at 12 months.
Study 2. About six patient focus groups (n=8) will be conducted in 3 phases to explore how findings from study 1 can be translated into a practicable and acceptable intervention. Group discussion and thematic analysis will focus on implementing variables implicated in Study 1, avoiding barriers to effectiveness.
Study 3. A randomised design will evaluate the feasibility and acceptability of the intervention. 80 patients identified through screening as ‘at risk‘ 3 months after diagnosis will be randomised to receive the intervention or care as usual. Patients will complete a questionnaire supplemented by a telephone interview after 1-2 weeks and again at 3 months to compare the groups on satisfaction with care as a whole and to analyse consumer evaluation of, and adherence with, the intervention in the group receiving it.
Scientific and Medical Opportunities
Identification of causal factors in long-term emotional distress after diagnosis of cancer will allow vulnerable patients to be identified as ‘at risk‘ early after diagnosis. The intervention will educate ‘at risk‘ patients about their own cognitive processes - what to look out for, and how to manage them - so that distress may be prevented or minimised before reaching levels requiring professional intervention.