Space in Breast Cancer from Depression & Anxiety

The Space in Breast Cancer from Depression & Anxiety programme has been designed to support the mental health of individuals who are currently undergoing breast cancer treatment, or individuals who have survived breast cancer.

The programme aims to:

• educate survivors about breast cancer and its psychological impact, providing evidence-based strategies for users to develop and use, along with effective coping skills to deal with low mood and worries.
• promote a sense of personal agency and control, thereby improving the adjustment to life during and after treatment.

Who is the programme best suited for?  

Survivors of breast cancer and individuals currently receiving treatment for breast cancer, who are also experiencing low mood and worries.

How does it work?  

Psychoeducation - Guided internet-delivered treatment for depression and the provision of  psychoeducational information. This includes, information explaining CBT, the CBT cycle, the importance of behavioural activation, learning about emotions, learning about core beliefs, thinking styles, negative thoughts, and the relationship between behaviours, thoughts, and emotions).

Behavioural Techniques - Behavioural techniques in the programme aim to help survivors regain a sense of control with the use of self-help techniques. The behavioural techniques in the current intervention mainly focus on behavioural activation and include activity scheduling, distraction, and planning for the future. The goal of behavioural activation is to increase individuals’ overt behaviours that are likely to generate reinforcing environmental contingencies, which will improve their thoughts, mood and life quality (Hopko et al., 2011). The Boosting Behaviour module encourages individuals to increase their activity levels by planning both achievement and pleasurable activities and emphasizes the idea that action is the first step, rather than motivation. It also makes them aware of challenges they may face, such as cancer related fatigue or tiredness, which may then lead to avoidance. Users are then encouraged to tackle these challenges in different ways, for example by planning activities to reduce the fatigue. Scheduling activities can provide survivors with a structure for the day or the week, and these events can give them something to look forward to (Moorey & Greer, 2012), which may lead to improvements in their thoughts and mood.

Relaxation & Mindfulness Exercises - Relaxation and mindfulness exercises are also added as additional techniques for survivors to use, as they are simple and effective tools for gaining rapid control over anxiety (Moorey & Greer, 2012). Relaxation techniques are based on the premise that a state of muscle relaxation alleviates tension and anxiety. When one practices them regularly, rapid relaxation will be achieved more easily in anxiety-provoking situations (Padesky, 2020).

Progressive muscle relaxation aims to help people recognise physical tension and practice relaxation, by systematically tightening and then relaxing various muscles in their body. Staying in the present or mindfulness exercises aim to help survivors become aware of how they feel when they are anxious and help them live more fully in the present moment by practicing focusing on their breathing. Mindfulness predicts increased self-regulated behaviour and a positive emotional state (Brown & Ryan, 2003).

Cognitive Techniques - A variety of cognitive coping techniques are introduced, such as thought monitoring, identifying unhelpful thinking patterns, and searching for alternatives. The TFB cycle is used as a thought record tool, in which survivors are asked to identify their thoughts connected to a strong emotion and then to look within that specific situation for evidence that supports their thought and evidence that does not support it.

They are then asked to generate an alternative/balanced thought, considering all the evidence they have gathered and then to see if this new perspective leads to any changes in their feelings. Distraction techniques are introduced in the Coping with Difficult Situations section, where the program explores how some negative thoughts may have a realistic basis, (e.g. possibility of treatment failure or death) but may still be unhelpful. 

Programme Modules:

Getting Started	This module shows the user the basics of Cognitive Behavioural Therapy (or CBT) and introduces some of the key ideas of the programme.
Understanding Feelings	This module takes a closer look at moods and emotions. It explores different aspects of emotions, physical reactions, action and inaction, and examines how they are all connected.
Boosting Behaviour	This module looks at how doing things a little differently can be a really great way to start to lift the user’s mood.
Spotting Thoughts	This module looks at the impact of unhelpful automatic thinking on mood. It also helps the user tune in to their thoughts and to recognise any common thinking errors.
Challenging Thoughts	This module takes the next step in helping to tackle overly negative thinking patterns which can impact mood. The user will learn how to develop more rational and helpful alternative thoughts.
Managing Worries	This module introduces the role of worry in anxiety. It also explores how to cope with and manage worry more effectively.
Bringing it all Together	In this final module the user can bring together all the skills they have learned, and the ideas gathered so far.

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