2022 ACBS Foundation Grant

2022 Grant Recipient:

Wenqian ZHAO, PhD Candidate of The Chinese University of Hong Kong (Hong Kong SAR, China) and her supervisors (Prof. Wai Tong CHIEN and Prof. Yuen Yu CHONG) are proud to be the recipients of the 2022 ACBS Foundation Grant for Miss ZHAO’s PhD research on Effectiveness of online ACT-based program for breast cancer survivors on improving body image disturbance.

"We combined the nursing techniques (i.e., health education) with ACT techniques in our intervention to examine the effectiveness of ACT-based intervention on improving body image disturbance of breast cancer survivors. This grant will support our ongoing research to help breast cancer survivors on improving their perceived body image, emotional problems and dysfunctions during the treatment and/or rehabilitation. As a video-conferencing program, the Foundation Grant will strengthen feasibility and acceptability of the intervention (especially the internet utilization) during the whole research, to establish an accessible, sustainable online platform for telemedicine nursing service; promote the physical, psychological and social rehabilitation of breast cancer survivors; and attract more attention and funding resources for future research on those patients and also other populations with the similar body image concerns."

Grant Report - October 2023

Objectives:

This study aimed to assess the immediate (T1) and three-month (T2) post-intervention effectiveness of a video-conferencing Acceptance and Commitment Therapy (ACT)-based group intervention program, conducted in real-time, on improving body image disturbance among breast cancer survivors. The intervention program was compared to a control group receiving breast cancer education only. The specific objectives of the study were to evaluate the effectiveness of the video-conferencing ACT-based group intervention program on the following outcomes at T1 and T2:

• Perceived body image, including measures of body dissatisfaction and body appreciation.
• Psychological flexibility, which refers to the ability to adaptively respond to internal experiences and engage in values-based actions.
• Body image-related emotions, encompassing depressive and anxiety symptoms.
• Body image-related dysfunctions, including sexual function and overall quality of life.

Outputs and Deliverables:

With the support of this grant, Dr. ZHAO completed the main RCT in her Ph.D. programme in Feb 2023. A PhD thesis containing the findings in this RCT was completed and submitted to the Chinese University of Hong Kong in July 2023. 

The results showed no significant interaction effects in overall and all dimensions of body dissatisfaction, body appreciation, depressive and anxiety symptoms, and psychological flexibility in both the ITT and PP analyses. Only a significant interaction effect was found in the orgasm dimension of sexual function in PP analysis at three-month post-intervention and the general social well-being dimension of quality of life in ITT analysis at immediate post-intervention when compared with the control group. These non-significant results were likely to be explained by 1) the lack of involvement of their significant person (e.g., partner) that had impacts on the participants' body image, 2) the additional psychological burdens caused by the COVID-19 pandemic, 3) stigma and avoiding attitudes to mental problems in Chinese culture; and 4). weakness in group counselling skills of the interventionist. 
We are preparing a manuscript of this RCT for publication to an international peer-reviewed journal. The abstract of this manuscript is going to be submitted to the coming 2024 ACBS world conference.

Impact and benefits to the researchers, CBS, and society at large?

This project demonstrates the advantages of multidisciplinary cooperation. The experts engaged in the intervention development of this project include psychotherapists, oncologists, and nurses. Their valuable advice and participation provided different angles to observe the same question, increasing the feasibility and acceptability of our intervention protocol. 

In this project, students participated and were encouraged to apply CBS to more fields. For example, two research assistants (undergraduate students) expressed great interest in CBS and would like to design a CBS-based programme as  their master's projects in hypertension and diabetes patients:  "Psychological flexibility may help patients maintain health-promoting behaviours with less stress and worries. "

Clinical nurses who participated in our program were also encouraged to receive related CBS training, for example, mindfulness therapy and use these strategies in their daily work: "I have been trying to help patients ease their pre-surgery anxiety through conversations, but it doesn't seem to work. Maybe I can try taking them with me to do mindful breathing and meditation exercises in the future. "

In addition to patients, their families also received help from our health booklets and expressed willingness to do CBS exercises together: "I read the booklets you gave my mother and I feel like some of the exercises are perfect for us to do together. This can help me understand more about her inner thoughts and feelings. I thought I could do something for her too. "

For the development and extension of CBS, this project provides evidence and support for nurses on the feasibility of applying CBS-based approaches in their areas, such as oncology nursing care. Supervised by the supervisors and ACT trainer, the self-rating ACT Core Competency score of Dr. ZHAO (i.e., registered nurse) ranged from 4.0 (i.e., Distinguishing the Conceptualized Self from Self-as-context) to 6.5 (i.e., Defining Valued Directions).  This demonstrated a medium level of intervention competency of a nurse in implementing a group ACT-based intervention, which was feasible to reach significant intervention results but needed further improvement in more practices. We also recommended involving psychotherapy and psychoeducation in the oncology nursing speciality training to provide mental health care and support.

For society at large, this project attracted more attention from not only the patients themselves, but also the medical workers, families, and even society such as workplaces to breast cancer patients' body image problems. On the one hand, breast cancer patients pay more active attention to and improve their mental health and can achieve comprehensive physical and psychological recovery better and faster. On the other hand, this can help promote related research and policies, such as how to solve the re-employment difficulties and social discrimination faced by breast cancer patients due to physical disabilities after treatment. If these issues receive more attention and are well addressed, it will help reduce the burden of breast cancer faced by society as a whole.