Study
Survival rates in breast cancer continue to improve, with an estimated 570,000 breast cancer survivors in the UK, expected to double by 2030. Despite survivor rate improvements, approximately 25% of BCa survivors require treatment for clinical levels of emotional distress (anxiety & depressive disorders). Reviews of well-controlled studies indicate that current psychological approaches achieve only modest effects. Reflecting this limited efficacy, a critical research gap, highlighted by National Cancer Survivorship Research Workstream and Breast Cancer Campaign, is the need to develop more effective and practically feasible psychological interventions for depression and anxiety in cancer survivors. In order to improve the efficacy of psychological interventions, a better understanding of the psychological processes associated with the development and maintenance of emotional distress in BCa survivors is required. Worry is a central process in the development and maintenance of emotional distress, therefore it is important to identify the psychological processes which cause people to worry. In physical health settings, it is important to capture the variability in emotional distress and worry experienced by patients. We will use a diary method called experience sampling methodology (ESM) that will enable us to obtain a more complete picture of the factors that cause distress and worry to fluctuate on a daily basis.
Design
The study design will be an ESM study of BCa survivors.
Baseline assessment: Self-report questionnaires will measure emotional distress, metacognitive beliefs, intolerance of uncertainty, and perseverative thinking.
ESM assessment: Daily assessments will measure emotional distress, perseverative thinking, threat monitoring, and other coping strategies.
Daily assessments will be conducted using ESM. The ESM Software will be downloaded onto participants’ smartphones to enable the daily assessments to take place. The software will signal participants to complete 6 assessments a day at random times, with a minimum of 60 minutes between each assessment. Each participant will be asked to complete ESM assessments for 8 days. Participants will be prompted to complete assessments during average waking hours. For example, if a participant informs us their average waking hours are 10:00- 23:00, the participant will only be prompted during this time. Each assessment should take approximately 90 seconds to complete. If a participant does not respond to a prompt, a reminder prompt will be sent after 5 minutes. If a participant does not respond after an additional 10 minutes, the assessment will be classed as a missed response. If participants’ consent, the researcher will arrange to speak to the participant by telephone at least once during the study to check how they are getting on. We have chosen an assessment schedule to ensure that sufficient data is collected to allow appropriate statistical analysis to be conducted, whilst minimizing the demands placed on the participants. At the end of the 8 day ESM assessment schedule the researcher will speak to the participant by telephone to thank them for their time and answer any questions they may have.
The primary aim is to further our understanding of the psychological processes associated with emotional distress in breast cancer survivors.
Our objective is to:
Investigate whether metacognitive beliefs and/or intolerance of uncertainty significantly predict worry in daily life.
Below are the questions that will be used in the ESM diary:
How much time since the last beep have you felt sad?
From none of time to all of the time
. . . . .
0 1 2 3 4
How much time since the last beep have you felt anxious?
From none of time to all of the time
. . . . .
0 1 2 3 4
How much time since the last beep have you felt dissatisfied with yourself?
From none of time to all of the time
. . . . .
0 1 2 3 4
How much time since the last beep have you found yourself dwelling or worrying about your problems (e.g. health, family, finances)?
From none of time to all of the time
. . . . .
0 1 2 3 4
How much time since the last beep have you found yourself analyzing your feelings/symptoms or questioning why did this happen to me?
From none of time to all of the time
. . . . .
0 1 2 3 4
How much time since the last beep have you been focusing attention on the things you find threatening (e.g. symptoms, thoughts, body checking)?
From none of time to all of the time
. . . . .
0 1 2 3 4
How much time since the last beep have you avoided activity or certain situations?
From none of time to all of the time
. . . . .
0 1 2 3 4
How much time since the last beep have you tried not to think certain thoughts?
From none of time to all of the time
. . . . .
0 1 2 3 4
How much time since the last beep have you used alcohol to cope with thoughts/feeling?
From none of time to all of the time
. . . . .
0 1 2 3 4
