1
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• FCR-specific assessment;
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• Examine values identified in session and devise relevant goals (e.g. if identified value is “being physically fit” devise realistic ways to achieve this and identify barriers to achieving goal);
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• Model on which treatment is based is explained;
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• Discussion of existential changes brought about by cancer;
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• Values clarification exercise
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• Reflect on past experiences and how these have shaped response to cancer.
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2
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• Discuss impact of potential vulnerability factors (e.g., past traumatic events) on FCR;
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• Practice ATT on a daily basis throughout the remainder of the intervention and document in diary.
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• Discuss rationale and practice of the Attention Training Technique (ATT), a technique designed to help patients reduce their tendency to ruminate and shift their attention more flexibly when thoughts about recurrence occur.
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3
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• Introduce the practice of Detached Mindfulness, designed to enhance meta-awareness of cognition and the ability to become an objective observer of the content of thoughts without the need for evaluation or reaction.
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• Continue daily practice of ATT;
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• Practice application of detached mindfulness on response to thoughts which trigger FCR.
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4
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• Provide information about possible symptoms of recurrence of breast or colorectal cancer;
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• Continue daily practice of ATT;
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• Provide guidelines to help clients distinguish those from benign physical complaints;
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• Practice detached mindfulness in response to emerging thoughts about FC;
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• Reassess self-examination practices and medical surveillance;
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• Identify avoidant or excessive behaviours;
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• Devise an appropriate plan based on best available evidence about how to respond to new symptoms;
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• Develop a behavioural contract to help clients to engage in recommended levels of self-examination and follow-up tests (if needed);
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• Discuss beliefs that underpin FCR (eg. beliefs about the benefits of FCR, or beliefs about physical harm caused by FCR);
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• Practice worry postponement.
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• Test the validity of these beliefs through Socratic dialogue.
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• Introduce worry postponement as a technique for responding to residual worries
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5
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• Review goal setting task;
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• Consolidate skills learned throughout the program;
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• Develop relapse prevention plan. |
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