DBT Skills Training for Lung Cancer

Overseen By Tamara Somers, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Duke University

Disqualifiers: Cognitive impairment, Untreated serious mental illness, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 8

Duration: 8 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a therapy called LiveWell, which uses adapted Dialectical Behavioral Therapy (DBT) Skills Training, can improve the quality of life for individuals with advanced lung cancer. The therapy teaches skills such as mindfulness, emotion regulation, and effective communication to help manage stress and symptoms like pain and fatigue. Delivered in eight one-on-one video sessions, it provides support without requiring travel. This trial may suit those with stage IV non-small cell lung cancer who experience significant distress. Participants should currently be undergoing cancer treatment. As an unphased trial, this study offers an opportunity to explore innovative therapies that could enhance quality of life.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on psychological skills training, so it's unlikely to require changes to your medication, but you should confirm with the trial coordinators.

What prior data suggests that this DBT Skills Training protocol is safe for patients with metastatic lung cancer?

Research has shown that Dialectical Behavioral Therapy (DBT) Skills Training is generally safe and well-tolerated by patients. In past studies, patients with advanced lung cancer who participated in DBT Skills Training reported very few negative effects. This therapy teaches practical skills to help manage emotions and stress, which can improve mental health.

DBT Skills Training has been used in various settings and with different groups, consistently demonstrating its safety. Unlike medication, it doesn't cause physical side effects. Instead, it helps patients address emotional challenges. Participants learn skills like mindfulness (staying present), distress tolerance (handling difficult emotions), emotion regulation (managing feelings), and interpersonal effectiveness (communicating well with others), which may help reduce anxiety and depression.

LiveWell, the version of DBT adapted for advanced lung cancer, is based on this well-established therapy and is expected to be safe. However, it is always important to monitor how one feels during any treatment and discuss it with healthcare providers. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about LiveWell: Adapted DBT Skills Training because it offers a fresh approach to supporting patients with metastatic lung cancer. Unlike traditional treatments that focus primarily on the physical aspects of cancer, LiveWell emphasizes mental and emotional well-being through Dialectical Behavioral Therapy (DBT). This intervention teaches patients mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness, all delivered via convenient telehealth sessions. By focusing on coping skills and emotional health, LiveWell aims to improve quality of life and help patients manage the challenges of living with metastatic cancer.

What evidence suggests that LiveWell: Adapted DBT Skills Training is effective for metastatic lung cancer?

Research has shown that Dialectical Behavioral Therapy (DBT) Skills Training can improve mental health by teaching ways to manage emotions and stress. Studies have found DBT effective in reducing anxiety, depression, and distress in various patient groups. In this trial, participants will receive the LiveWell program, which tailors DBT specifically for patients with metastatic lung cancer. It focuses on skills like mindfulness, managing emotions, and handling distress, helping patients cope with the emotional and physical challenges of their condition. Early results suggest these skills may enhance the quality of life for those with metastatic lung cancer. ^{1 2 3 6 7}

Who Is on the Research Team?

Tamara Somers

Principal Investigator

Professor in Psychiatry and Behavioral Sciences

Are You a Good Fit for This Trial?

This trial is for adults over 18 with stage IV non-small cell lung cancer, currently undergoing treatment without the aim of cure. Participants must experience distress levels of at least 3 out of 10 and be able to understand and communicate in English.

Inclusion Criteria

I am older than 18 years.

I have been diagnosed with stage IV non-small cell lung cancer.

I am receiving treatment for lung cancer that is not aimed at curing it.

Exclusion Criteria

Presence of untreated serious mental illness (e.g., schizophrenia) indicated by the medical chart or treating oncologist

Reported or suspected cognitive impairment

Expected survival <6 months

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention Refinement

Iterative refinement of the LiveWell protocol using qualitative exit interview data, advisory board input, and user testing

1 year

Treatment

Participants receive the LiveWell intervention, an 8-session Dialectical Behavioral Therapy Skills Training protocol delivered via videoconference

8 weeks

8 sessions (virtual)

Follow-up

Participants are monitored for changes in quality of life, psychological distress, and symptom burden

3 months

What Are the Treatments Tested in This Trial?

Interventions

• LiveWell: Adapted DBT Skills Training

Trial Overview

The LiveWell program, an adapted form of Dialectical Behavioral Therapy Skills Training delivered via videoconference, is being tested against Enhanced Usual Care to see if it improves quality of life and reduces psychological distress and physical symptoms in metastatic lung cancer patients.

How Is the Trial Designed?

Group I: LiveWell: Adapted Dialectical Behavioral Therapy Skills Training Experimental Treatment 1 Intervention

Participants randomized to LiveWell will receive the refined intervention protocol as informed by Aim 1 (K99). LiveWell is an 8-session protocol of Dialectical Behavioral Therapy Skills Training, adapted specifically for patients with metastatic lung cancer. Sessions are delivered one on one via telehealth, approximately weekly. Participants learn concrete, easy-to-use skills to: 1) tune into the present moment, and how they are thinking and feeling (mindfulness), understand emotions, how to change them, and how to experience more positive feelings (emotion regulation), tolerate distressing emotions and symptoms (e.g., fatigue, pain, dyspnea) and to accept reality as it is (distress tolerance), and tools to communicate wants and needs effectively with others (interpersonal effectiveness). The goal is to teach patients skills to live well, with metastatic cancer. All sessions follow a standardized structure that is customary in skills training and grounded in social cognitive theory.

Who Is Running the Clinical Trial?

Duke University

Lead Sponsor

Trials

2,495

Recruited

5,912,000+

National Cancer Institute (NCI)

Collaborator

Trials

14,080

Recruited

41,180,000+

Published Research Related to This Trial

Cognitive behavior therapy (CBT) significantly reduced anxiety and depression symptoms in pre-diagnosed lung cancer patients, with average decreases of 8.38 points in anxiety and 6.75 points in depression on standardized scales after 6 sessions.

Patients receiving CBT also reported a notable improvement in their quality of life, with an average increase of 16.80 points on the WHOQOL-BREF scale, compared to those who did not receive the therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Cognitive Behavioral Therapy on Improving Anxiety, Depression, and Quality of Life in Pre-Diagnosed Lung Cancer Patients. Sutanto, YS., Ibrahim, D., Septiawan, D., et al.[2022]

In a study of 604 lung cancer survivors, 60% reported using psychosocial services, with higher usage (69%) among those who received radiation therapy, indicating a significant interest in psychological and social support among these patients.

Factors influencing the use of psychosocial services included being female, having poor emotional functioning, and being younger, highlighting the need for targeted outreach to ensure these services are accessible to those who may benefit most.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Use of psychosocial services by lung cancer survivors in Germany : Results of a German multicenter study (LARIS). Eichler, M., Hechtner, M., Wehler, B., et al.[2020]

The Breathe Easier trial aims to improve physical and emotional health in survivors of localized non-small-cell lung cancer (NSCLC) and their supportive partners through a 12-week, home-based intervention focusing on physical activity, smoking reduction, and stress management.

This pilot study will involve 30 dyads (60 participants) and assess the feasibility and preliminary effects of the intervention, which includes educational content, breathing exercises, goal setting, and support from trained staff.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Study Protocol for the Breathe Easier Trial: A Pilot RCT of a Dyad-Based, Multiple-Behavior Intervention for Improving Physical and Emotional Health in Survivors Facing Lung Cancer. McDonnell, KK., Andrews, JO., Yang, CH., et al.[2023]

In a study of depressed cancer patients undergoing a brief 9-session behavioral activation therapy, 50% experienced significant sudden gains, averaging an improvement of 11.8 points on the BDI-II depression scale, which correlated with better treatment outcomes and sustained benefits at a 3-month follow-up.

Patients who experienced sudden gains tended to have less severe depression and anxiety, better physical functioning, and fewer daily activity problems, suggesting that certain baseline characteristics may influence the likelihood of achieving these gains.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Sudden gains in depressed cancer patients treated with behavioral activation therapy. Hopko, DR., Robertson, SM., Carvalho, JP.[2009]

Behavioral interventions, when combined with medical treatment for lung cancer, can significantly alleviate symptoms such as nausea, vomiting, pain, and anxiety, thereby improving patients' quality of life.

These mind/body approaches not only reduce emotional distress but also enhance coping mechanisms, promote a sense of control, and foster hopefulness among patients and their families.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychosocial issues and lung cancer: a behavioral approach. Ryan, LS.[2019]

Cognitive Behaviour Therapy (CBT) has proven effective for various psychological disorders, and there is increasing interest in its application for cancer patients, although it has not been extensively tested in this population.

This paper outlines a structured 12-session CBT program specifically designed for cancer patient groups, addressing the need for tailored interventions in psycho-oncology.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Description of a group Cognitive Behaviour Therapy programme with cancer patients. Edelman, S., Kidman, AD.[2018]

The telephone-delivered behavioral intervention for breast cancer survivors was implemented with high fidelity, achieving a global quality rating of 4.6, indicating effective delivery of the program.

Participants in the behavioral intervention reported significantly greater benefits in areas such as goal setting, adjusting habits, and increasing exercise compared to those in the attention control group, suggesting the intervention's efficacy in improving social role satisfaction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Process Evaluation of Intervention Delivery for a Cancer Survivorship Rehabilitation Clinical Trial Conducted during the COVID-19 Pandemic. Stevens, CJ., Wechsler, S., Ejem, DB., et al.[2023]

A systematic review of 27 studies on rehabilitation interventions for lung cancer and mesothelioma patients revealed that while many behavior change techniques (BCTs) were used, their application was not optimal, with only a few studies explicitly employing behavioral change theory.

The most commonly used BCTs focused on enabling behaviors, such as providing instructions and action planning, while techniques aimed at addressing barriers were less frequently utilized, suggesting that improving the use of BCTs could enhance participation and effectiveness of rehabilitation programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changing health behaviour with rehabilitation in thoracic cancer: A systematic review and synthesis. Bayly, J., Wakefield, D., Hepgul, N., et al.[2022]

The study assessed a self-regulation theory (SRT)-based intervention for 45 adults with advanced lung cancer undergoing chemotherapy, achieving a participation rate of 79% and a retention rate of 62%.

While the intervention was delivered with high fidelity and was well-accepted by participants, the feasibility findings suggest that it may not be suitable for replication in this population due to participant loss primarily from disease progression.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Nurse-Delivered Symptom Assessment for Individuals With Advanced Lung Cancer. Flannery, M., Stein, KF., Dougherty, DW., et al.[2023]

Behavioral interventions, such as breathing exercises that focus on diaphragm use and altering breathing rhythms, can significantly help lung cancer patients manage feelings of breathlessness and improve their quality of life.

Oncology professionals should incorporate these psychosocially oriented strategies alongside medical treatments to effectively address the debilitating symptom of breathlessness in lung cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Behavioral interventions for lung cancer-related breathlessness. Gallo-Silver, L., Pollack, B.[2019]

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