The Validation of ICBT Clinical Trial: Disease Stress Adjustment in Breast Cancer Patients

Breast cancer survivors may continue to experience psychological distress after completing primary cancer treatment. Barriers such as limited access to psychological services, time constraints, and concerns about stigma may prevent patients from receiving timely mental health support. Internet-based cognitive behavioral therapy may provide a flexible and accessible approach to supporting psychological adjustment among this population.

This randomized, parallel-group study aims to evaluate the effectiveness of an 8-week culturally adapted Internet-based cognitive behavioral therapy program for adults with stage I-III breast cancer who have completed primary treatment. The program, titled "Healthy Steps: Women's Mental Well-Being," integrates cognitive behavioral therapy principles, psycho-oncology experience, and digital intervention technology.

Approximately 100 participants will be randomly assigned to one of two groups. Participants in the intervention group will continue to receive treatment as usual and will additionally complete the 8-week ICBT program through a mobile application developed by the National Health Research Institutes. The program includes content and exercises related to self-compassion, cognitive restructuring, emotional regulation, and stress management. The study system will be used to record learning progress, questionnaire completion, and program use.

Participants in the control group will receive treatment as usual without additional ICBT during the main comparative study period. After completing the study assessments, control-group participants may request access to the ICBT program.

Assessments will be conducted at baseline, week 5, week 9, and 3 months after completion of the intervention period. The primary analyses will compare changes in anxiety symptoms, depressive symptoms, post-traumatic stress symptoms, and quality of life between the intervention and control groups. Exploratory analyses will examine the relationships between attachment orientation and changes in psychological outcomes.

Inclusion criteria

• Adults aged 18-65 years.
• Diagnosis of stage I-III breast cancer.
• Completion of primary breast cancer treatment, including surgery, chemotherapy, radiation therapy, and/or targeted therapy. Participants currently receiving endocrine therapy are eligible.
• Ability to read and write Chinese and to use a mobile application and the Internet.
• Access to an Internet-enabled device and ability to independently participate in the online intervention.
• Willingness to complete the online intervention modules and study assessment questionnaires.

Exclusion criteria

• Diagnosis of stage IV breast cancer.
• Concurrent diagnosis of another type of cancer.
• Currently receiving surgery, chemotherapy, radiation therapy, or targeted therapy for breast cancer.
• Diagnosis of a psychiatric disorder within the past 6 months, including major depressive disorder, generalized anxiety disorder, or schizophrenia.
• No current psychiatric diagnosis but a Patient Health Questionnaire-9 (PHQ-9) score greater than 20 at screening.
• Current suicidal intent or a history of actual self-harm behavior.
• Currently receiving another form of psychotherapy or having recently received cognitive behavioral therapy.
• Inability to independently use the online intervention application because of insufficient Chinese literacy, Internet proficiency, or access to an Internet-enabled device.