A self-help coping intervention can reduce anxiety and avoidant health behaviours whilst waiting for cancer genetic risk information: results of a phase III randomised trial Ceri Phelps 1 *, Paul Bennett 2 , Kerenza Hood 3 , Kate Brain 4 and Alexandra Murray 5 1 School of Psychology and Counselling, Swansea Metropolitan University, Wales, UK 2 Psychology Department, Swansea University, Wales, UK 3 South East Wales Trials Unit, School of Medicine, Cardiff University, Wales, UK 4 Institute of Medical Genetics, School of Medicine, Cardiff University, Wales, UK 5 Institute of Medical Genetics, Cardiff and Vale University Health Board, UK *Correspondence to: School of Psychology and Counselling, Swansea Metropolitan University, Wales, UK, SA2 0UT. E-mail: ceri. phelps@smu.ac.uk Received: 25 May 2011 Revised: 15 February 2012 Accepted: 24 February 2012 Abstract Objective: The objective of this study is to evaluate the effectiveness of a self-help coping intervention in reducing intrusive negative thoughts while waiting for cancer genetic risk information. Methods: Between August 2007 and November 2008, 1958 new referrals for cancer genetic risk assessment were invited to participate in a randomised trial. The control group received standard information. The intervention group received this information plus a written self-help coping leaflet. The primary outcome measure was the intrusion subscale of the Impact of Event Scale. Results: The intervention significantly reduced intrusive thoughts during the waiting period in those reporting moderate baseline levels of intrusion (p = 0.03). Following risk provision, those in the inter- vention group reporting low and moderate intrusive worries at baseline reported less intrusive thoughts than those in the control group (p = 0.04 and p = 0.03, respectively). The intervention had no adverse impact in the sample as a whole. Participants in the intervention group with high baseline avoidance and negative affect scores were significantly more likely to remain in the study than those in the control group (p = 0.05 and p = 0.004). Conclusions: Findings that the intervention both reduced distress in those with moderate levels of distress and had no adverse effects following notification of cancer genetic risk suggest that this simple intervention can be implemented across a range of oncology settings involving periods of waiting and uncertainty. The intervention may also reduce the number of individuals dropping out of cancer genetic risk assessment or screening. However, those with clinically high levels of psychological distress are likely to require a more intensive psychological intervention. Copyright © 2012 John Wiley & Sons, Ltd. Introduction From the point of referral into cancer genetics services in the UK, individuals may be faced with a waiting period of several weeks or months before they learn their genetic risk of developing cancer, often with minimal contact from genetic specialists. During and immediately after this time, around one quarter of those involved report high levels of worry and distress [1–4]. This is not only inher- ently undesirable but also can affect the comprehension of risk information and influence decisions related to surveil- lance and other clinical options [5–7]. There is also an evidence to suggest that those with high levels of distress may decline or drop out of such assessments [8,9], losing access to specialist support. This paper reports the results of a definitive randomised controlled trial of a written self-help coping intervention, designed to help individuals control unwanted intrusive worries while waiting for can- cer genetic risk information. This theory-based interven- tion was guided by coping theory and empirical evidence suggesting that the structured use of distraction in combination with controlled exposure to any worries or concerns may be an effective coping strategy whilst waiting for genetic risk information. Our intervention was previously found to be acceptable and potentially effective in developmental work including a pilot trial. This paper reports the definitive effectiveness trial of the intervention, which to our knowledge is the first type of intervention to specifically target the early stages of the assessment process rather than following the provision of risk information as in previous studies [10–14]. The transactional model of stress and coping [15] and the related intervention of coping effectiveness training [16] emphasise the importance of matching coping strate- gies to the specific demands of the situation. According to this approach, when faced with short-term situations involving waiting and uncertainty with limited options for problem-focused coping, the use of distraction can be an effective coping strategy [17,18]. Being instructed to engage in specific cognitive and/or behavioural distraction techniques has been shown to be more effective at control- ling intrusive thoughts and physiological distress than receiving general instructions to distract from the stressful situation [19,20]. In addition, encouraging individuals to plan when and how they are going to engage in specific distraction techniques has been found to increase the like- lihood of them engaging in that behaviour [21]. However, one of the most documented concerns about distraction is that attempts to suppress intrusive thoughts about a stressful event can subsequently result in more intrusive Copyright © 2012 John Wiley & Sons, Ltd. Psycho-Oncology Psycho-Oncology (2012) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3072