The experience of anxiety is a common and understandable reaction to a diagnosis of and treatment for cancer. Patients of any age may experience negative psychological and physical symptoms during cancer treatment; older adults with cancer simultaneously face the impact of cancer and the effects of aging. Caregivers of older adults with cancer are also vulnerable to experiencing anxiety as their loved one navigates the physical and emotional sequelae of their illness and treatment. This paper describes the use of Managing Anxiety from Cancer (MAC), a 7-session telephone-delivered manualized cognitive-behavioral intervention that includes strategies from Acceptance and Commitment Therapy and Problem-Solving Therapy, with an older woman with cancer and her adult daughter. MAC includes a variety of techniques for patients and caregivers, who are encouraged to use these strategies individually or in different combinations to manage their anxiety. This brief treatment provided a parallel experience for the participants, as the older adult patient and her caregiver were taught the same anxiety-management techniques by their individual therapists. We will discuss the benefits and drawbacks of using a manualized psychotherapy intervention in this case, as well as MAC's impact on each member of this pair and on the dyad as a unit. Both the patient and her caregiver reported experiencing benefit from their participation in MAC and identified MAC-acquired skills they planned to use in the future to manage their anxiety and improve communication. While assessment data did not reflect a decrease in anxiety, it is possible that the stress of the COVID-19 pandemic confounded these data.
The coronavirus pandemic led to worldwide disruption in the delivery of face-to-face mental health services. This impact was marked for individuals with long-term health conditions and comorbid depression and anxiety. Many face-to-face mental health services switched to remote delivery or paused therapeutic input entirely, despite the lack of research on the efficacy of switching between modalities mid-therapy or having breaks in therapy. This paper presents the case of a patient with long-term health conditions who experienced both breaks in therapy and a switch in modalities from face-to-face to telephone delivery. The intervention used was based on transdiagnostic cognitive behavioral therapy and self-report measures were completed at the beginning and end of the twelve sessions. Despite the shift in modalities, the patient experienced clinically significant recovery on all measures, indicating the efficacy of therapy was not greatly affected by the shift in modalities. Long breaks in therapy were linked to deterioration in mental health, although this could be due to the deterioration in physical health that necessitated these breaks. This case highlights the benefits and challenges of a shifting modality of therapy during treatment and in response to a pandemic for a shielding population. From the work presented here, it seems beneficial for services to be able to work across multiple modalities to suit the needs of the patients and ensure continuity of treatment. It also indicates that pauses in therapy may risk deterioration. Further work is needed to prevent digital exclusion of patients.
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