A randomized pilot trial of a positive affect skill intervention (lessons in linking affect and coping) for women with metastatic breast cancer

Psychooncology. 2017 Dec;26(12):2101-2108. doi: 10.1002/pon.4312. Epub 2016 Dec 27.


Background: We conducted a randomized pilot trial to examine the feasibility, acceptability, and preliminary efficacy of a 5 week positive affect skills intervention (LILAC: lessons in linking affect and coping) for women with metastatic breast cancer. Additionally, we examined whether online delivery of the intervention would offer comparable benefits as in-person delivery.

Methods: Women with metastatic breast cancer (N = 39) were randomized to an in-person intervention, online intervention, or in-person attention-matched control. Psychological well-being (depression [Center for Epidemiologic Studies Depression Scale], positive and negative affect [Differential Emotions Scale], cancer-specific quality of life [Multidimensional Quality of Life Scale-Cancer Version]), and positive coping (mindfulness, positive-affect skill use, and self-compassion [Self-Compassion Scale: Short-Form]) were assessed at baseline, 1 week post-intervention, and 1 month post-intervention follow-up.

Results: The LILAC intervention showed good feasibility, acceptability, and retention. Although the study was not adequately powered to detect between-group differences in change on preliminary efficacy outcomes, within-group comparisons revealed that LILAC participants (in-person and online combined) showed reductions in depression and negative affect by the 1 month follow-up (d = -0.81). Notably, LILAC participants fell below the clinical threshold for depression (Center for Epidemiologic Studies Depression Scale = 16) by the 1 month follow-up (t[17] = -2.22, P = .04, d = -0.52), whereas control participants did not differ from threshold (t[9] = 0.45, P = .66, d = 0.14).

Conclusions: The LILAC intervention, regardless of delivery method, shows feasibility, acceptability, and preliminary efficacy for promoting psychological well-being in women with metastatic breast cancer. This research provides support for a larger randomized trial to test more definitively the potential benefits of LILAC. A strength of the LILAC intervention includes its innovative focus on positive affect. The efficacy of the online delivery suggests the potential for widespread Internet dissemination.

Keywords: cancer; metastatic breast cancer; oncology; online; positive Affect; well-being.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adaptation, Psychological*
  • Adult
  • Aged
  • Breast Neoplasms / complications*
  • Breast Neoplasms / pathology
  • Breast Neoplasms / psychology*
  • Breast Neoplasms / therapy
  • Depression / psychology
  • Emotions
  • Feasibility Studies
  • Female
  • Humans
  • Internet
  • Middle Aged
  • Mindfulness*
  • Neoplasm Metastasis
  • Patient Acceptance of Health Care*
  • Pilot Projects
  • Quality of Life*
  • Treatment Outcome