Joanna J. Arch

Cortical gradients have been shown to be an effective technique to study the functional organization of the brain by capturing patterns of functional similarities. Until now, most studies have focused on analyzing cortical gradients derived from resting‐state fMRI. With recent work highlighting the changes that functional brain networks undergo during various cognitive loads, there is a need to investigate whether cortical gradients are also sensitive to different cognitive demands, and to what degree. In this context, we collected a sample of 138 healthy individuals aged 12–25, each of whom completed a resting‐state fMRI scan as well as three task fMRI scans (social prospection, spatial working memory, and verbal working memory). All data were analyzed to examine the task dependence of cortical gradients' topological properties. By employing the measures of network gradient dispersions as well as networks centroid distances, we revealed that alterations specific to each task occurred in topological properties of gradients involving both transmodal and unimodal networks, such as the executive control network varying between each task condition and the resting‐state condition. This work highlights the promise of applying cortical gradients to task‐based fMRI data, revealing the condition‐sensitive nature of certain cortical gradients' topological properties.

Objectives: Self-compassion may benefit individuals with social anxiety disorder and serve as a mechanism of change within 3,4-Methylenedioxymethamphetamine (MDMA)-assisted therapy (MDMA-AT). Methods: In this secondary analysis of 20 adults with social anxiety disorder who underwent MDMA-AT for social anxiety disorder (NCT05138068), we examined whether both trait self-compassion changes across treatment (16-weeks) and state self-compassion experienced during MDMA (midomafetamine) dosing sessions contributed to post-treatment clinical outcomes—social anxiety, depression, internalized shame, functional impairment and (thwarted) belonging—beyond baseline levels of each respective variable.Results: Participants experienced high self-compassion levels during the two dosing sessions. Trait self-compassion increased most substantially after the first MDMA dosing session (ΔM=0.74, p<.001), though continued to increase after dose 2 (ΔM=0.43, p< .001). State self-compassion was not associated with trait self-compassion changes, though explained additional variance in reduced depressive symptoms (ΔR²=.19, p<.001) and internalized shame (ΔR²=.28, p=.02), beyond baseline symptom severity. Trait self-compassion increases following the second dosing session corresponded to reduced internalized shame (β=-.84, p<.001) and thwarted belonging (β=-.68, p=.01), beyond baseline self-compassion levels. Greater baseline self-compassion corresponded to reduced social anxiety, functional impairment, internalized shame, and thwarted belonging (βs<-0.41, ps<.05).Conclusions: MDMA-AT for social anxiety disorder appears capable of fostering both acute self-compassion experiences and enduring trait-level changes, each of which were associated with certain beneficial outcomes, especially reduced internalized shame. These constructs represent promising candidate mechanisms of change within MDMA-AT for social anxiety disorder, while baseline self-compassion may moderate treatment response,warranting investigation of self-compassion’s role in future larger psychedelic-assisted therapy trials.

Background: The sequence in which psychological interventions are delivered may influence their efficacy. Therefore, the current study investigated the sequencing effect of cognitive restructuring (CR) and detached mindfulness (DM), hypothesizing that only the sequence of CR-DM would lead to additional improvement. Methods: Across two experiments, 188 participants from a community sample underwent a speech (Experiment A) or worry (Experiment B) manipulation and were then introduced to CR and DM in a counterbalanced order. Primary outcomes were state anxiety (Experiment A) and worry (Experiment B). Results: Multilevel models revealed that when delivered alone, the two techniques produced similar changes in the outcome measures across both experiments. When delivered as the second technique, there was a statistically significant sequencing effect in Experiment B, t (93.0) = 2.0, p = .048, d = 0.42 in the predicted direction, showing further reduction in worry in participants receiving CR-DM but not those receiving DM-CR. Due to a lack of manipulation effect in the second speech of Experiment A, sequencing effects could not fully be explored here. Conclusions: The findings suggest that, in a worry context, there may be little reason to use the sequence of DM-CR, whereas there may be further benefit of the CR-DM sequence. For Experiment A, the lack of manipulation effects precludes conclusions regarding sequencing effects. The results should be understood in light of the community sample and lack of neutral control condition but offer a useful starting point for further examining sequencing effects in clinical populations.

Introduction: Four of five breast cancer survivors will be prescribed adjuvant endocrine therapy (AET), an oral anticancer medication that dramatically reduces cancer recurrence but is often poorly adhered to. Reviews show small to null effects for existing AET adherence interventions, limited innovation in intervention approaches and a dearth of studies that target depression or low positive affect—key modifiable risk factors for poor adherence. Research design and methods: Adapting behavioural innovations to the context of medication adherence, we developed and piloted THRIVE , a novel online positive affect intervention approach aimed at increasing AET adherence by reducing depression and increasing positive affect towards AET and broadly. Online THRIVE sessions were evaluated among breast cancer survivors prescribed AET (n=39) to assess: (1) acceptability and feasibility of this wholly novel approach; (2) patient-reported AET adherence, depression and affective outcomes; and (3) qualitative patient feedback, formally coded, to inform refinements. Results: From preintervention to postintervention, participants reported significant increases in positive affect, positive associations with AET and reported AET adherence, as well as significant decreases in negative affect, anxiety and depression, psTHRIVE sessions and outcome surveys. Mean acceptability and feasibility ratings exceeded goals. Qualitative coding led to future recommendations, including the need to integrate help for managing AET side effects. Conclusion: This study supports the promise of a novel positive affect intervention approach to supporting AET adherence among breast cancer survivors, particularly if combined with side effect support. Trial registration number: NCT06388304 .

Background: In the era of precision oncology, patients with advanced cancer are often living longer but are enduring years of fatiguing treatment. Fatigue is among the most common, chronic, and under-addressed side effects of advanced cancer treatment, and can lead to dose reductions, treatment interruptions, and discontinuation. Oral PolyADP-ribose polymerase (PARP) inhibitors have revolutionized the treatment of advanced ovarian cancer but are often accompanied by clinically-significant fatigue, and evidence-based treatments to cope with this side effect remain limited. A pilot trial suggests that telehealth acceptance and commitment therapy (ACT), a variant of cognitive behavioral therapy based on acceptance, mindfulness, and personal values, has potential to improve fatigue interference (i.e. disrupting activity and quality of life) among ovarian cancer patients on maintenance PARP inhibitors. This study protocol describes a fully-powered randomized controlled trial (RCT) of an innovative, remotely-delivered ACT intervention (‘ REVITALIZE ’) that aims to improve fatigue outcomes and PARP inhibitor adherence. Methods: This two-armed, prospective RCT randomizes 240 adults with advanced ovarian cancer who report moderate to severe fatigue while on PARP inhibitors 1:1 to either REVITALIZE or education-enhanced usual care. The REVITALIZE intervention includes eight weekly one-hour individual sessions delivered via videoconference, plus two booster sessions at one- and two-month intervals thereafter. Participants, recruited from both academic and community cancer care sites across three U.S. regions, will complete assessments at baseline, mid-intervention, post-intervention, and 20 and 28-week follow-up (FU). The primary patient-reported outcome is change in fatigue interference from baseline to week 20 (FU1). Secondary patient-reported outcomes include fatigue severity, catastrophizing, self-efficacy, and quality of life. The primary behavioral outcome is monthly PARP inhibitor adherence, assessed by wireless medication adherence monitors; dose interruptions, reductions, and persistence will also be evaluated using adherence monitors and medical chart review. Discussion: This paper describes a RCT that will evaluate the efficacy of the telehealth REVITALIZE intervention for improving fatigue-related outcomes and medication adherence among adults with advanced ovarian cancer taking PARP inhibitors. Findings will inform clinical practice and supportive care for adults with advanced ovarian cancer receiving treatments that cause fatigue. Trial registration: Clinicaltrials.gov NCT06710548 on November 29, 2024.

Background: Adults with advanced cancer often experience low engagement with advance care planning (ACP) and high levels of depression, anxiety, and fear of death/dying. Access to specialist palliative care is limited. This study tests Valued Living, a novel online acceptance‐based group intervention designed to increase ACP and improve psychological/spiritual well‐being among adults with advanced cancer screening positive for depression or anxiety. Valued Living was delivered online by social workers in community oncology settings. Methods: Adults with advanced solid tumor cancer ( N = 240) and significant depression or anxiety symptoms were randomized 1:1 within cohorts to Valued Living or usual care (UC). Valued Living provided five weekly group sessions by videoconference plus self‐paced online modules. Primary outcome was the total number of ACP behavioral steps completed of 12 potential steps (e.g., selecting health care proxy, advanced directives) by 3.5‐month follow‐up. Secondary outcomes included fear of death, rigid cognitive avoidance of death, depression, anxiety, and spiritual well‐being. Results: Valued Living participants completed 1.27 more ACP steps (95% CI, 0.36–2.18; d = 0.36; p = .006) than UC. Largest condition differences were identifying (97.4% vs. 84.2%) and documenting a health care proxy (83.3% vs. 64.9%). Valued Living participants improved more in cognitive avoidance of death ( d = 0.36; p = .005), and spiritual well‐being ( d = 0.42; p < .001) but not fear of death or anxiety. Conclusion: The online Valued Living intervention, implemented by social workers in community oncology clinics, increased ACP and well‐being among depressed and anxious adults with advanced cancer. Findings support this supportive care approach for the growing population living with advanced cancer. Trial Registration: The trial registration is ClinicalTrials.gov NCT04773639.

Background: A novel written exposure-based coping intervention (EASE) for distressed adults with advanced cancer focused on their cancer-related worst-case scenario and showed promise for reducing cancer-related trauma symptoms and fear of cancer progression (FoP). This study examines potential mechanisms of change, specifically linguistic features of participants' writing. Methods: Adults (N = 28) with advanced solid tumor (n = 23) or high-risk blood cancer (n = 5) reporting elevated trauma or FoP participated. Writing was collected during five weekly intervention sessions (three exposure, two coping) and analyzed using linguistic software (LIWC-22). Outcomes were assessed pre-intervention and one-week post-intervention. Results: More positive (trauma: ηp² = 0.64, p < 0.001; FoP: ηp² = 0.34, p = 0.011) and negative (FoP: ηp² = 0.38, p = 0.007) emotion words during exposure writing sessions predicted worse outcomes, while more death-related words predicted reduced FoP (ηp² = 0.22, p = 0.023). Positive tone in coping writing sessions predicted reduced FoP (ηp² = 0.31, p = 0.009), while negative tone predicted worse FoP (ηp² = 0.22, p = 0.026). Conclusions: Findings offer preliminary support for several proposed mechanisms of this novel written exposure intervention.

Background: Advancements in precision oncology have led to a growing community of adults with advanced cancer who live longer but face prognostic uncertainty, with corresponding fears of the future. Their worst future fears related to cancer remain understudied, hindering support efforts.Aims: This study aimed to characterize the presence, content, and predictors of imagined future worst‐case scenarios related to cancer (WCS) among distressed adults with advanced cancer.Methods: Two hundred fifteen distressed adults with advanced solid tumor cancer (mixed type) responded to survey questions regarding the presence (Yes/No) of a WCS related to cancer and if yes, to briefly describe it. Mixed methods were used to assess WCS prevalence, thematic content, and sociodemographic, psychological, and medical predictors.Results: Two thirds (66.5%) of advanced cancer survivors endorsed having a WCS. Content reflected four major themes of Death (52.2%), Suffering and Deterioration (47.1%), Cancer Progression and Future Uncertainty (28.7%), and Concern about Family (18.4%). WCS often contained more than one major theme, further distinguished by additional themes and sub‐themes that revealed distinct fears. Higher anxiety and lower life meaning/peace predicted the presence of a WCS whereas sociodemographic characteristics, depression, time since diagnosis, and physical symptom burden did not. Younger age and living with children predicted a WCS focused on loved ones.Conclusions: WCS are prevalent and diverse in content among distressed adults with advanced cancer. Assessing WCS offers a quick and straightforward way to solicit advanced cancer survivors' most intense fears about the future with cancer, thereby facilitating patient‐provider communication and support efforts.

Background: Self-affirmation theory (SAT) and acceptance and commitment therapy (ACT) embody competing approaches to leveraging personal values to motivate behavior change but are rarely compared in the domain of health behavior. This study compares these theory-driven values-based interventions for promoting medication adherence. Purpose: To compare affective and behavioral responses to competing values-based medication adherence interventions. Methods: In this three-armed randomized trial, participants with cancer (n = 95) or diabetes (n = 97) recruited online using Prolific and prescribed daily oral medication for that disease completed a one-session online writing intervention leveraging (1) a domain incongruent (DI) value, where the value was not connected to medication adherence; (2) a domain congruent (DC) value, where the value was connected to adherence; or (3) a control condition, focused on medication adherence procedures. Results: There were no main effects of conditions on reported medication adherence at the 1-month follow-up. During the intervention, positive affect was higher in the values conditions than control (p < .001), and trended higher in DI versus DC (p = .054). Negative affect did not vary between the values and control groups (p = .093) but was lower in DI versus DC (p = .006). Improvements in positive affect over the course of the intervention were associated with increased adherence behavior for individuals who started with low levels of positive affect (p = .003). Disease type did not moderate findings. Conclusions: Consistent with SAT, focusing on DI values led to more positive and less negative affect than connecting values directly to behavior in a threatening domain such as chronic illness. For some participants, increases in positive affect predicted greater adherence.