Compassion, Social Support, Flexibility, and Resilience Program for Women Surviving Breast Cancer

Intervention studies aiming to increase psychological resilience in women with breast cancer after mastectomy are gaining increasing attention in the literature. Various studies highlight the positive effects of social support and psychological flexibility on the mental health of cancer patients. In particular, social support enhances the stress-coping capacity of cancer patients and strengthens their psychological resilience (Hulbert-Williams et al., 2015).

Acceptance and Commitment Therapy (ACT)-based interventions are considered an effective approach for coping with chronic illnesses. Studies on cancer patients emphasize that ACT increases psychological flexibility, helping patients accept challenging emotions and focus on meaningful areas of life (Hayes et al., 2006).

The innovative aspect of this study is the evaluation of both social support and ACT-based flexibility interventions together, examining their combined effects on psychological resilience after breast cancer. Research that comprehensively explores the interaction between social support and psychological flexibility remains limited. This study offers a more effective model for enhancing resilience in cancer patients by assessing the combined impact of components such as social support and psychological flexibility.

In this context, the research contributes significantly to the literature by presenting an integrated approach to increasing psychosocial resilience in the post-breast cancer period and offering a new perspective for intervention studies in this field.

The study includes a total of 20 female participants, aged between 18 and 65, who have undergone mastectomy and voluntarily agree to participate. Participation is voluntary, and participants may withdraw at any time without consequence.

The following scales are used in the study: Sociodemographic and Clinical Information Form, Interpersonal Support Evaluation List-12 (ISEL-12), Self-Compassion Scale-Short Form (SCS-SF), Acceptance and Action Questionnaire-II (AAQ-II), Brief Resilience Scale (BRS), and PROMIS Scales - Global Health Scale, Social Roles and Activities Participation - Short Form 4a, Depression - Short Form 4a, Anxiety - Short Form 4a.

Program Sessions

Session 1: Introduction, Introduction to ReACT Program Purposes, ReACT Matrix, Identifying Values, Defusion

Goal: Introduce the program to participants. They explore their values using the Matrix, identify thoughts that distance them from their values, explore their behaviors, focus to observe their thoughts, practice a present moment awareness exercise, and learn cognitive defusion.

Content:

Psychoeducation: Discuss the importance of psychological resilience, social support, and compassion after breast cancer (Hayes et al., 2006).

Exercise: Participants practice the "Present Moment Exercise" to ground themselves in the here and now with openness and awareness. This practice helps them observe thoughts without becoming entangled in them, supporting more intentional and values-based actions.

Session 2: Acceptance of Anxiety, Compassion, and Action

Goal: Help participants manage difficult emotions and understand how they can move forward while accepting difficult emotions.

Content:

Psychoeducation: Participants explore the questions "What are emotions?" and "What is the function of emotions?" They learn that emotions serve as signals of what matters in life. The idea of making space for emotions instead of fighting them is introduced, along with the insight that this can help reveal underlying values. The link between emotions and values is explored with examples.

Exercise: The sky metaphor is introduced to support acceptance of difficult emotions. If it is not effective, an alternative acceptance exercise is offered.

Session 3: Value-Driven Actions, Sustainability, and Committed Action Toward Receiving and Giving Compassion

Goal: Explore values, value-oriented behaviors, and action planning related to giving and receiving compassion.

Content:

Action Plan: Participants identify daily behaviors that align with their values and develop an action plan (Moreno et al., 2022).

Group Sharing: Participants share their experiences and what they have learned throughout the sessions (Hayes et al., 2006).

Exercise: Participants receive a guide to monitor their progress and maintain value-driven actions (Kabat-Zinn, 1990).

Monitoring and Evaluation

Goal: Evaluate the effects of the intervention and support sustainability.

Content:

Post-Program Evaluation: Final assessments are conducted immediately after the program ends.

Follow-Up: A Zoom group monitoring session is held four weeks later.

Review: During follow-up, changes in psychological resilience, psychological flexibility, compassion, value-based living, and PROMIS scales are reviewed (Neff, 2003; Moreno et al., 2022).

• Resilience-Focused Acceptance and Commitment Therapy (ReACT) Program (Behavioral): The Resilience-Focused Acceptance and Commitment Therapy (ReACT) program is a structured, group-based psychological intervention specifically designed for women who have undergone mastectomy following breast cancer. The program consists of three weekly 90-minute sessions integrating core ACT processes, including acceptance, defusion, mindfulness, values clarification, and committed action, with an emphasis on building psychological resilience, self-compassion, and enhancing perceived social support. The program uniquely combines evidence-based ACT techniques with group exercises focused on post-cancer psychosocial adjustment.
• No intervention (Other): Standard Care

Primary outcomes

• Resilience [three weeks]: Psychological resilience will be assessed using the Brief Resilience Scale (BRS). The outcome will measure changes from baseline (pre-intervention) to post-intervention (immediately after the 3-week program). The Brief Resilience Scale evaluates the individual's ability to recover from stress and adversity.

Secondary outcomes

• Self Compassion [three weeks]: Self-compassion will be assessed using the Self-Compassion Scale - Short Form (SCS-SF). The outcome will measure changes from baseline (pre-intervention) to post-intervention (immediately after the 3-week program). The SCS-SF evaluates an individual's ability to treat themselves with kindness, understanding, and non-judgmental awareness during times of difficulty or failure.
• Psychological Flexibility [Three weeks]: Psychological flexibility will be assessed using the Acceptance and Action Questionnaire-II (AAQ-II). The outcome will measure changes from baseline (pre-intervention) to post-intervention (immediately after the 3-week program). The AAQ-II evaluates an individual's ability to accept difficult thoughts and feelings without unnecessary struggle and to engage in values-based actions despite internal discomfort.
• Well-being [Three weeks]: Overall well-being and quality of life will be assessed using the PROMIS Global Health Scale. The outcome will measure changes from baseline (pre-intervention) to post-intervention (immediately after the 3-week program). The PROMIS Global Health Scale evaluates physical, mental, and social health to provide a comprehensive picture of an individual's perceived general health and life satisfaction.

Sex: Female, ages: 18 Years to 65 Years

Inclusion Criteria:

* Female participants aged between 18 and 65 years.
* Participants who have undergone a mastectomy.
* Participants who voluntarily agree to participate in the study.

Exclusion Criteria:

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• Ela Arı, Assistant Professor, Principal investigator, Medipol University