• John M Galfin, Ed R Watkins, and Tim Harlow.
• School of Psychology, University of Exeter, Exeter, UK. jmg211@exeter.ac.uk
• Palliat Med. 2012 Apr 1;26(3):197-205.

BackgroundPrevious findings implicated rumination (recurrent dwelling on abstract concerns) in elevated psychological distress in palliative patients. We hypothesised that reducing rumination may be important in addressing psychological distress in palliative care.AimThis study tested the prediction that a brief guided self-help technique targeting abstract rumination would reduce psychological distress in palliative patients.DesignA randomised controlled trial evaluated 4 weeks of guided self-help that involved patients practising thinking more concretely by recalling specific and vivid memories of when they were completely absorbed in an activity or scene. Participants completed a combination of standardised questionnaires to assess anxiety, depression, and quality of life.Setting/ParticipantsPalliative care patients who were reporting clinically significant psychological distress, whilst also physically well enough to take part in the trial were recruited from hospices in Devon and Somerset and randomised to either a treatment condition (n = 19) receiving 4 weeks of guided self-help, or a waiting-list control condition (n = 15) receiving treatment as usual.ResultsAs predicted, the palliative patients receiving the intervention reported significantly greater reductions in anxiety than the waiting-list controls (F(1,23) = 20.55, p < 0.001, partial η (2) = 0.47). However, no significant effect was found on depression or quality of life.ConclusionThe findings suggest that a brief guided self-help intervention based on concreteness training can be effective in addressing anxiety in palliative care.

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