Cancer is the leading cause of death in the United States. The improvement of screening procedures and treatments have led to higher survival rates, and consequently to an increased number of individuals who fear that their cancer might come back.
Fear of cancer recurrence (FCR) is defined as the fear, worry, or concern that cancer may come back or progress. FCR has been found to be the number one unmet need of cancer survivors. High levels of FCR are associated with greater psychological distress, impaired functioning, decreased quality of life, and increased medical consultations, psychotropic usage and health-care costs. It is therefore crucial to offer these patients an appropriate and effective treatment. The books first propose a theoretical model of FCR that identifies the five main targets of intervention in this program: 1) cognitive interpretation; 2) behavioural avoidance; 3) cognitive avoidance; 4) reassurance and control seeking; 5) intolerance of uncertainty. Then, each target is discussed and specific cognitive-behavioural therapy strategies are suggested that focus on each of them based on the best available empirical evidence for the treatment of anxiety disorders (e.g., generalized anxiety disorder) and cancer-related anxiety.
This book will be of interest to clinicians working with cancer patients such as psychologists and other health care providers as well as cancer patients and survivors. Graduate students in clinical health psychology, and connecting disciplines such as psycho-oncology, psychiatry, nursing, social work, rehabilitation, spiritual care, and sexology might also find this text of value.

Josée Savard, PhD, is a psychologist and full professor in the School of Psychology at Université Laval and a researcher at the CHU de Québec-Université Laval Research Center. Her research interests are centered on the psychological aspects of cancer, more particularly insomnia, depression, and fear of cancer recurrence. She has published in French a book for the wider public (Faire face au cancer avec la pensée réaliste [Facing cancer with realistic thinking], Flammarion Quebec) of which some of the content was adapted for this book. In 2020, she also co-edited the Handbook of Sleep Disorders in Medical Conditions (Elsevier), which was awarded the PROSE award of the Association of American Publishers for the best handbook in medicine and clinical science.

Aude Caplette-Gingras, PhD, is a psychologist and a scientist-practitioner specialized in psycho-oncology. She is also in charge of professional practices development in psychology at the CHU de Québec-Université Laval. She works at the breast cancer clinic of the CHU de Québec-Université Laval (Hôpital du St-Sacrement). She has accumulated 13 years of experience using CBT in this population for a wide range of psychological problems, including fear of cancer recurrence. She also trains psychology interns in psycho-oncology. 

Lucie Casault, PhD, is a psychologist specialized in oncology. She is head of the Department of Multidisciplinary Services at the CHU de Québec-Université Laval (CHUL) and has practiced CBT among cancer patients and supervised psychology interns in psycho-oncology for 20 years.

Jennifer Hains, D.Ps. is a psychologist specialized in psycho-oncology. She worked at the breast cancer clinic of the CHU de Québec-Université Laval (Hôpital du St-Sacrement) and now works at L'Hotel-Dieu-de-Quebec part of the CHU de Québec-Université Laval with patients who have different types of cancers. She has provided psychological services to cancer patients using CBT for 5 years.

Therapist Manual Patient Manual

Introduction

- Welcoming and introduction of

leaders

- Authors and format of the

program

- Participants' introduction

Information about Fear of Cancer

Recurrence (FCR)

- Definition

- When is FCR normal or not?

- Characteristics associated with

FCR

- Vicious circle of FCR

Information about Fear of Cancer

Recurrence (FCR)

- Definition

- When is FCR normal or not?

- Characteristics associated with

FCR

- Vicious circle of FCR

Beliefs about the Influence of

Psychological Factors on Cancer

- Does stress cause cancer?

o Research evidence

Can Thoughts Influence Cancer?

- Beliefs about the influence of

psychological factors on cancer

- Multifactorial model of cancer

4

o Multifactorial model of

cancer

- Can the power of thought cure

cancer?

o Research evidence

- Does stress cause cancer?

- Does thought have the power to

cure cancer?

- Can positive thinking help you

cope with cancer?

The Cognitive Model of Emotions The Cognitive Model of Emotions

- Cancer: A distressing experience

- The cognitive model and

adjustment to cancer

- The tyranny of positive thinking

- Realistic thinking and cancer

o Analogy with glasses

o Effects

The Benefits of Realistic Thinking

- The tyranny of positive thinking

- Fighting cancer?

- Dark, rose-coloured, or clear

glasses?

- Realistic thinking and cancer

Cognitive-Behavioral Therapy

- Definition

- Research evidence

Identification of Negative Thoughts

End of Session Discussion Summary

Session 2

Therapist Manual Patient Manual

Content of the Session

Feedback on Last Treatment Session

Feedback on Exercise

Cognitive Restructuring

- The case of Elise

- Socratic questioning

Cognitive Restructuring

- The 5-column grid

- Socratic questioning

Realistic Interpretation of Somatic

Symptoms

- Using four objective criteria

- Finding balance between neglect

and hypervigilance

Realistic Interpretation of Somatic

Symptoms

- Using four objective criteria

- Finding balance between neglect

and hypervigilance

Information-Seeking Profiles

- Seeking the right amount of

information and from valid

sources

Information-Seeking Profiles

- Seeking the right amount of

information and from valid

sources

Realistic Interpretation of Probabilities

and Statistics

- Risk of recurrence

Realistic Interpretation of Probabilities

and Statistics

- Risk of recurrence

5

- Risk reduction with treatment

- Survival rate

- Risk reduction with treatment

Cognitive Restructuring Exercise

End of Session Discussion Summary

Session 3

Therapist Manual Patient Manual

Content of the Session

Feedback on Last Treatment Session

Feedback on Exercise

Intolerance of Uncertainty

- Cancer = Uncertainty

- Learning to better tolerate

uncertainty

- Cancer = Uncertainty

- Possible to be happy without

being certain that cancer will not

come back?

- Learning to better tolerate

uncertainty

Usefulness and Impact of Worries

- Revising erroneous beliefs about

the usefulness of worries (e.g.,

belief that worrying will increase

the probability of an event to

occur)

- Behavioral experiment: Thinking

that something bad will happen

- Revising erroneous beliefs about

the usefulness of worries (e.g.,

belief that worrying will increase

the probability of an event to

occur)

o Evidence that it is true/not

true

o Behavioral experiment

Behavioral Avoidance

- The importance of facing fears

- Avoidance and habituation curves

- Rules for an effective exposure

- Avoidance and cancer

- Behavioral exposure

Behavioral Avoidance

- The importance of facing fears

- Avoidance and habituation curves

- Avoidance and cancer

o Examples of avoidance

behaviors in the context of

cancer

- Behavioral exposure

Behavioral Exposure Exercises Behavioral Exposure Exercises

- List of cancer-related avoidant

behaviors

6

- Behavioral exposure procedure

and grid

End of Session Discussion

Therapist Manual Patient Manual

Content of the Session

Feedback on Last Treatment Session

Feedback on Exercise

Cognitive Avoidance

- The camel exercise

- The importance of facing fears

Cognitive Avoidance

- The camel exercise

Strategies to Reduce Cognitive Avoidance

- Cognitive restructuring

- Worry time

- Learning to tolerate negative

thoughts and emotions

Facing fears

- Cognitive restructuring

- Worry time

- Learning to tolerate negative

thoughts and emotions

- Cognitive exposure

Reassurance Seeking

- When is it too much?

- Tolerating the discomfort

Reassurance Seeking

- When is it too much?

Tolerating the discomfort

Control Seeking Behavior

- Drastic lifestyle changes may be

excessive control seeking behavior

- Make changes that are realistic

and are in accordance with own

values

Control Seeking Behavior

- Drastic lifestyle changes may be

excessive control seeking behavior

Make changes that are realistic and are in

accordance with own values

What if Cancer Returns?

- Recurrence ¿ death

What if Cancer Returns?

Recurrence ¿ death

Redefining Life Goals

- Why having life goals is

important?

- The Alfred case

- Redefining life goals in two steps

Redefining Life Goals

- Why having life goals is

important?

- Redefining life goals in two steps

(grids)

Summary of Treatment Program