tumours and benign skin cancers; (2) a life expectancy of at least 12 months; (3) aged
18 – 74 years; (4) no obvious intellectual impairments, psychotic illness or suicide risk;
(5) residence within 65km of the hospital; and (6) psychological morbidity defined above
a set of cut-off points for anxiety, depression, helplessness and below a cut-off point for
fighting spirit. Altogether, 153 subjects completed the baseline and eight-week measures
and 137 completed all measures.Design All subjects completed measures of their psychological state at baseline. They
were then allocated to either the experimental group (and received eight weeks of APT)
or the control group. The subjects then completed follow-up measures at eight weeks and
four months.Measures Subjects completed the following measures at baseline (before randomiza-
tion), at eight weeks and four months follow-up: The Hospital Anxiety and Depression scale.
The Mental Adjustment to Cancer scale: this measures four dimensions of adjustment –
fighting spirit, helplessness, anxious preoccupation, fatalism.
The Psychosocial Adjustment to Illness scale: this measures health care orientation,
work adjustment, domestic environment, sexual relationships, extended family
relationships, the social environment, psychological distress.
Rotterdam symptom checklist: this measures quality of life in terms of both physical
and psychological symptoms.The intervention The subjects were randomly allocated to either the experimental
(APT) or the control group. ATP is a cognitive behavioural treatment developed specific-
ally for cancer patients. Therapy involved approximately eight one-hour weekly sessions
with individual patients and their spouses (if appropriate). However, many patients
in the present study did not attend all these sessions and several received additional
sessions throughout the four months. The therapy focused on the personal meaning
of the cancer for the patient, examined their coping strategies and emphasized the
current problems defined jointly by the therapist and the patient. APT uses the following
cognitive behavioural techniques: Identifying the patient’s strengths and using these to develop self-esteem, overcome
feelings of helplessness, promote fighting spirit.
Teaching patients to identify any automatic thoughts underlying their anxiety and
depression and developing means to challenge these thoughts.
Teaching patients how to use imagination and role play as a means of coping with
stressors.
Encouraging patients to carry out activities that give them a sense of pleasure and
achievement in order to promote a sense of control.
Encouraging expression of emotions and open communication.
Teaching relaxation to control anxiety.346 HEALTH PSYCHOLOGY