Josée Savard Aude Caplette-Gingras Lucie Casault Jennifer Hains Treating Fear of Cancer Recurrence with Group Cognitive-Behavioral Therapy: A Step-by- Step Guide Treating Fear of Cancer Recurrence with Group Cognitive-Behavioural Therapy: A Step- by- Step Guide Josée Savard • Aude Caplette- Gingras Lucie Casault • Jennifer Hains Treating Fear of Cancer Recurrence with Group Cognitive-Behavioural Therapy: A Step-by-Step Guide Josée Savard Aude Caplette-Gingras School of Psychology, Université Laval Hôpital du St-Sacrement, CHU de Québec- CHU de Québec-Université Laval Université Laval Research Center CHU de Québec-Université Laval Québec, QC, Canada Research Center Québec, QC, Canada Lucie Casault Department of Multidisciplinary Services Jennifer Hains CHU de Québec-Université Laval CHU de Québec-Université Laval Québec, QC, Canada Québec, QC, Canada ISBN 978-3-031-07186-7 ISBN 978-3-031-07187-4 (eBook) https://doi.org/10.1007/978-3-031-07187-4 © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022 This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or part of the material is concerned, specifically the rights of reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland We would like to dedicate this book to our beloved children Clément, Estelle, Eva, Hugo, Nellie, Laurier, Olivier, and Romy. Acknowledgments The writing of this manual would not have been possible without the significant contribution of others to whom we wish to convey our warmest thanks. First of all, we would like to express our gratitude to all the patients who par- ticipated in our psychotherapy groups focusing on fear of cancer recurrence. Their involvement, the medical and personal experiences they shared, and their constructive comments have enabled us to continuously improve the program. We would also like to thank our fellow psychologists specialized in oncology at the CHU de Québec-Université Laval. Exchanging views with you on the con- tent of the program was extremely helpful. Also, a big thank you to our graduate students and interns in psychology who observed and co-animated the psycho- therapy groups. Teaching them the rationale for the interventions and how to use them allowed us to refine our ideas for this book which we hope will be use- ful in helping more patients dealing with fear of cancer recurrence. More particu- lary, we want to recognize the contribution of Marie-Hélène Savard, Véronique Massicotte, Catherine Banville and Catherine Filion. Finally, we would like to thank Humanov-is, who helped us structure the train- ing program to administer this psychotherapy, Université Laval for funding our dissemination efforts through a social innovation research program , and Mélanie Dixon who worked on the translation of the book. vii Contents Part I Psychotherapy Group on Fear of Cancer Recurrence: Therapist’s Manual 1 Session No. 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.1 I ntroduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.1.1 Slide #1: Fear of Cancer Recurrence . . . . . . . . . . . . . . . . . . . . . . 4 1.1.2 Slide #2: Psychotherapy Group on Fear of Cancer Recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 1.1.3 Slide #3: Warning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 1.2 C ontent of the Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 1.2.1 Slide #4: Content of the Sessions . . . . . . . . . . . . . . . . . . . . . . . . 8 1.2.2 Slide #5: Session No. 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 1.3 I nformation on Fear of Cancer Recurrence . . . . . . . . . . . . . . . . . . . . . . 10 1.3.1 Slide #6: Fear of Cancer Recurrence . . . . . . . . . . . . . . . . . . . . . . 11 1.3.2 Slide #7: The Vicious Circle of Fear of Recurrence . . . . . . . . . 12 1.4 B eliefs About the Influence of Psychological Factors on Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 1.4.1 Slide #8: The Vicious Circle of Fear of Recurrence . . . . . . . . . 15 1.4.2 Slide #9: The Power of Thought . . . . . . . . . . . . . . . . . . . . . . . . . . 16 1.4.3 Slide #10: Influence of Psychological Factors on Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 1.4.4 Slide #11: Popular Beliefs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 1.4.5 Slide #12: Clinical Cases vs. Scientific Research . . . . . . . . . . . 19 1.5 S tress = Cancer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 1.5.1 Slide #13: Stress → Cancer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 1.5.2 Slide #14: Multifactorial Model of Cancer . . . . . . . . . . . . . . . . 24 1.6 P ositive Thoughts = Cure? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 1.6.1 Slide #15: Mental Attitude and Cancer Survival – Study 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 1.6.2 Slide #16: Mental Attitude and Cancer Survival – Study 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 1.6.3 Slide #17: Why Is It Important to Let Go of These Beliefs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 1.6.4 Slide #18: Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 ix x Contents 1.7 The Cognitive Model of Emotions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 1.7.1 S lide #19: Cancer: A Distressing Experience . . . . . . . . . . . . . . 31 1.7.2 S lide #20: Cognitive Model of Emotions (Beck) . . . . . . . . . . . 32 1.8 The Vicious Circle of the Tyranny of Positive Thinking: The Case of Melissa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 1.8.1 S lides #21–22: The Case of Melissa . . . . . . . . . . . . . . . . . . . . . . . 33 1.8.2 S lide #23: The Case of Melissa (Continued) . . . . . . . . . . . . . . . 35 1.8.3 S lide #24: The Tyranny of Positive Thinking . . . . . . . . . . . . . . 36 1.8.4 S lide #25: Negative Thoughts vs. Positive Thoughts . . . . . . 37 1.8.5 S lide #26: Effects of Positive Thinking . . . . . . . . . . . . . . . . . . . . 38 1.9 What Does Research Say About the Effects of Positive Thinking? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 1.9.1 S lide #27: Effects of Optimism . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 1.9.2 S lide #28: Fighting Cancer? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 1.10 The Benefits of Realistic Thinking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 1.10.1 S lide #29: Dark Glasses vs. Rose-Coloured Glasses . . . . . . . . 44 1.10.2 S lide #30: Is There an Alternative? . . . . . . . . . . . . . . . . . . . . . . . 45 1.10.3 S lide #31: Realistic Thoughts or Clear Glasses . . . . . . . . . . . . 46 1.10.4 S lide #32: What Is Realistic Thinking? . . . . . . . . . . . . . . . . . . . . 47 1.10.5 S lides #33–34: The Case of Mary . . . . . . . . . . . . . . . . . . . . . . . . . 48 1.10.6 S lide #35: Mary and Realistic Thoughts . . . . . . . . . . . . . . . . . . 50 1.10.7 S lide #36: Benefits of Realistic Thinking . . . . . . . . . . . . . . . . . . 52 1.10.8 S lides #37–38: The Case of Louise . . . . . . . . . . . . . . . . . . . . . . . 53 1.10.9 S lide #39: Cancer and Realistic Thoughts . . . . . . . . . . . . . . . . 55 1.10.10 S lide #40: Do You Need to Change Your Way of Seeing Things? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 1.11 Cognitive-Behavioural Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 1.11.1 S lide #41: Cognitive-Behavioural Therapy . . . . . . . . . . . . . . . . 58 1.12 Recognizing Negative Thoughts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 1.12.1 S lide #42: Characteristics of Negative Thoughts . . . . . . . . . . 59 1.13 Thought Identification Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 1.13.1 S lide #43: Identification of Negative Thoughts . . . . . . . . . . . 61 1.13.2 S lide #44: Exercise to Do at Home . . . . . . . . . . . . . . . . . . . . . . . 62 1.14 Slide #45: End of Session Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 1.15 Slide #46: Tools in Brief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 2 Session No. 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 2.1 Session Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 2.1.1 S lide #3: Session No. 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 2.2 Review of the Previous Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 2.3 Review of Last Week’s Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 2.3.1 S lide #4: Review of the Thought Identification Exercise . . . 70 2.4 Fear of Cancer Recurrence Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 2.4.1 S lide #5: The Vicious Circle of Fear of Recurrence . . . . . . . . . 71 2.5 Cognitive Restructuring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Contents xi 2.5.1 S lide #6: Cognitive Restructuring Grid . . . . . . . . . . . . . . . . . . . 72 2.5.2 S lide #7: The Case of Elise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 2.5.3 S lide #8: Fear of Recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 2.5.4 S lide #9: The Case of Elise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 2.5.5 S lide #10: Questioning Your Thoughts . . . . . . . . . . . . . . . . . . . 76 2.5.6 S lide #11: The Case of Elise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 2.5.7 S lide #12: Recurrence ≠ Death . . . . . . . . . . . . . . . . . . . . . . . . . . 80 2.6 Interpreting Physical Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 2.6.1 S lide #13: Interpreting Physical Symptoms Realistically . . . 81 2.6.2 S lide #14: Interpreting Physical Symptoms Realistically (NILP) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 2.7 Information-Seeking Profiles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 2.7.1 S lide #15: The Importance of Seeking the Right Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 2.8 Being Well Informed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 2.8.1 S lide #16: Being Well Informed . . . . . . . . . . . . . . . . . . . . . . . . . . 89 2.9 Interpreting Probabilities and Statistics . . . . . . . . . . . . . . . . . . . . . . . . . 91 2.9.1 S lide #17: Interpreting Probabilities . . . . . . . . . . . . . . . . . . . . . 92 2.9.2 S lide #18: Interpreting Probabilities . . . . . . . . . . . . . . . . . . . . . 93 2.9.3 S lide #19: Interpreting Probabilities . . . . . . . . . . . . . . . . . . . . . 94 2.9.4 S lide #20: Interpreting Probabilities . . . . . . . . . . . . . . . . . . . . . 95 2.9.5 S lide #17: Interpreting Probabilities (Go Back to a Previous Slide) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 2.10 Cognitive Restructuring Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 2.10.1 S lide #21: Exercise to Do at Home . . . . . . . . . . . . . . . . . . . . . . . 98 2.10.2 S lides # 22-23: Cognitive Restructuring Grid and Questionning your Thoughts . . . . . . . . . . . . . . . . . . . . . . . 99 2.11 Slide #24: End of Session Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 2.12 Slide #25: Tools in Brief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 3 Session No. 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 3.1 Session Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 3.1.1 S lide #3: Session No. 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 06 3.2 Review of the Previous Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 3.3 Review of Last Week’s Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 3.3.1 S lide #4: A Look Back on Cognitive Restructuring . . . . . . . . 107 3.3.2 S lide #5: Cognitive Restructuring Grid . . . . . . . . . . . . . . . . . . . 108 3.3.3 S lide #6: Questioning Your Thoughts . . . . . . . . . . . . . . . . . . . . 109 3.4 Intolerance of Uncertainty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 3.4.1 S lide #7: The Vicious Circle of Fear of Recurrence . . . . . . . . . 110 3.4.2 S lide #8: Intolerance of Uncertainty . . . . . . . . . . . . . . . . . . . . . 111 3.4.3 S lide #9: What Do You Think of the Following Statements? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 3.4.4 S lide #10: Learning to Tolerate Uncertainty . . . . . . . . . . . . . . 116 xii Contents 3.5 Erroneous Beliefs about Worry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 3.5.1 S lide #11: The Usefulness and Impact of Worrying . . . . . . . 117 3.5.2 S lide #12: Behavioural Experiment . . . . . . . . . . . . . . . . . . . . . . 120 3.5.3 S lide #13: Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 3.6 Behavioural Avoidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 3.6.1 S lide #14: The Vicious Circle of Fear of Recurrence . . . . . . . . 123 3.6.2 S lide #15: Avoidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 3.6.3 S lide #16: Avoidance and Habituation Curves . . . . . . . . . . . . 125 3.6.4 S lide #17: Behavioural Exposure Rules . . . . . . . . . . . . . . . . . . . 127 3.6.5 S lide #18: Avoidance and Cancer . . . . . . . . . . . . . . . . . . . . . . . . 128 3.7 Behavioural Exposure Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 3.7.1 S lide #19: The Importance of Facing Your Fears . . . . . . . . . . 132 3.7.2 S lide #20: Exercise to Do at Home . . . . . . . . . . . . . . . . . . . . . . . 133 3.7.3 S lide #21: Behavioural Exposure . . . . . . . . . . . . . . . . . . . . . . . . . 134 3.8 End of Session Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 3.8.1 S lide #22: End of Session Discussion . . . . . . . . . . . . . . . . . . . . . 136 3.9 Slide #23: Tools in Brief . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 4 Session No. 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 4.1 Session Agenda . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 4.1.1 S lide #3: Session No. 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 41 4.2 Review of the Previous Session . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 4.3 Review of Last Week’s Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 4.3.1 S lide #4: Review of the Behavioural Exposure Exercise . . . . 143 4.3.2 S lide #5: The Vicious Circle of Fear of Recurrence . . . . . . . . . 144 4.4 Cognitive Avoidance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 4.4.1 S lide #6: Cognitive Avoidance - The Camel Exercise . . . . . . 145 4.4.2 S lide #7: Cognitive Avoidance . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 4.4.3 S lide #8: The Importance of Facing Your Thoughts . . . . . . . 150 4.5 Strategies to Counter Cognitive Avoidance . . . . . . . . . . . . . . . . . . . . . 151 4.5.1 S lide #9: Cognitive Restructuring . . . . . . . . . . . . . . . . . . . . . . . . 152 4.5.2 S lide #10: Planned “Worry Time” . . . . . . . . . . . . . . . . . . . . . . . . . 153 4.5.3 S lide #11: Tolerating Negative Thoughts and Emotions . . . 154 4.5.4 S lide #12: Cognitive Exposure . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 4.5.5 S lide #13: Avoidance and Habituation Curves . . . . . . . . . . . . 158 4.6 Seeking Reassurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 4.6.1 S lides #14–15: The Vicious Circle of Fear of Recurrence and Reassurance Seeking: A Form of Avoidance . . . . . . . . . 160 4.6.2 S lide #16: Reassurance Behaviour Examples . . . . . . . . . . . . . 161 4.6.3 S lide #17: Reassurance: Yes, But to What Extent? . . . . . . . . . 162 4.7 Seeking Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 4.7.1 S lide #18: Seeking Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 4.7.2 S lide #19: Seeking Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 4.8 What If Cancer Comes Back? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 4.8.1 S lide #20: What If Cancer Comes Back? . . . . . . . . . . . . . . . . . . 167 4.8.2 S lide #21: Recurrence ≠ Death . . . . . . . . . . . . . . . . . . . . . . . . . . 168