Table 1.

LABC Intervention Content

Session 1	Key points	Skills
Survivorship Trajectory-Overview	BC survivorship is not just end of treatment, but beginning of new trajectory with unique phases and challenges	Locate self within trajectory and identify the specific challenges each participant is navigating
Review of Stress Cycle	Experience of stress is biological process that is mediated by different parts of the brain, and is worsened or improved by different coping strategies	Identify how stress is triggered for them and their default coping strategies Name different strategies that can be employed that would be more effective
Discussion of Stress in the Context of Cancer Survivorship	BC survivorship adds ongoing triggers for feelings of fear/vulnerability (loss of control) as well as clarity about life priorities/values (choices within one’s control)	Discussion of how feelings of both fear/vulnerability and clarity about what is important are experienced
Review of Vulnerability/Values Matrix	Most stress triggers for BC survivors are intersection of these dimensions. Individuals can choose thoughts that either reinforce feelings of loss of control or reinforce feelings of efficacy in making choices that reflect one’s values/priorities	Group exercise in which participants diagram thoughts that reflect either reinforcement of fear/vulnerability or highlight values/priorities about relationships, exercise, nutrition, work, etc.
Reinforcing Values-Based Behaviors - Exercise	Healthy survivors choose more behaviors in day to day life that reflect values than those that reinforce fears	Engage in individual written exercises to translate values into 2 tangible behaviors that reflect the value, and identify 1 behavior that gets in the way Share through discussion
Healthy Goal Setting Plan	For values to become behaviors that last and become ongoing habits, the behaviors must be practiced and become automatic	Create a written plan to operationalize 2 values into 3 weekly behaviors and seek social support for follow through
Conclusion Module 1	Review	Discussion to integrate key concepts
Session 2
Survivorship Trajectory – Sexuality & Intimacy	Stages of survivorship each come with unique issues of sexuality and intimacy	Identify relevant intimacy issues at participants’ own stage of survivorship
Multiple Facets of Sexuality & Intimacy	BC affects multiple areas of sexuality and intimacy, incl. emotional, psychological, physical, relational, and spiritual	Identify facets of sexuality and intimacy that are most affected by BC for each woman
Priorities and Satisfaction	Self-reflection on sexuality and intimacy issues is necessary to identify what’s going well and what needs attention	Identify current level of priority that sex and intimacy occupy in life; identify current level of satisfaction with sex & intimacy in life
New Models of Sexuality and Intimacy	Rosemary Basson’s model of sexual response may be helpful for conceptualizing sexual activity for young BCS	Conceptualize sexual activity flexibly, including activities other than intercourse Consider that sexual activity can develop from a neutral feeling of desire
Intimate Partner Communication	Talking and listening are essential parts of sex and intimacy Unresolved issues can get in the way of feeling close to a partner Unspoken concerns don’t tend to go away on their own	Identify feelings, thoughts, habits, or patterns that gets in the way of feeling close to a partner Learn communication “ground rules” for having sensitive conversations
Dating	Dating after cancer may feel vulnerable but each woman chooses when, how, and whom to date	Cognitive and behavioral tools for coping with fears about dating Tools for talking with a dating partner about cancer
Body Image	The experience of breast cancer profoundly affects body image Cognitive and behavioral tools can be helpful for coping with body image challenges	Identify how breast cancer has affected body image Identify what contributes to feeling sexy, esp. aspects that don’t have to do with appearance or youth Learn cognitive and behavioral tools for coping with body image changes
Getting Back to Sexual Activity	Re-engaging in sexual activity after breast cancer may take some mental, physical, and relational preparation	Understand what contributes to low desire and learn tools to counter or cope with it Expand the range of activities that “count” as intimacy other than intercourse Learn about “sensate focus” as an exercise for re- establishing touching without pressure to have intercourse Understand vaginal moisturizers and lubricants and their uses