Interactive Companion

Managing the Fear of
Cancer Recurrence

A psychoeducational resource for cancer patients, survivors, and caregivers. All 8 graphics from the 90-minute presentation — fully interactive.

8 Interactive Graphics Evidence-Based APA-7 Citations Wilsea Human Performance
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Presenter & Attendee Guide

Click any highlighted node in the diagrams to explore deeper explanations. Use the navigation bar above to jump between sections. This page is optimized for both projection during the session and personal review afterward. Share this URL or print via File → Print for a static reference copy.

Slide 6 Lee-Jones et al., 1997; Simard et al., 2013

The FCR Cycle — Cognitive-Behavioral Model

Fear of cancer recurrence is maintained by a self-reinforcing cycle. Understanding each stage is the first step toward intervention. Click any node to explore further.

FCR cycle Trigger Scan · sensation · anniversary Threat appraisal "This means it's back" Fear response Anxiety · panic · dread Safety behavior Checking · avoiding · seeking Maintenance Fear stays active CBT · ACT · Mindfulness
Slides 4–5 Simard et al., 2013; PDQ, 2024

FCR Severity Spectrum

FCR exists on a continuum from brief, manageable worry to severe, clinically significant distress. Knowing where you fall on the spectrum helps match the right level of support to your needs.

FCR severity spectrum 0 3 6 10 Minimal Brief, passes quickly Moderate Disrupts mood, focus Severe — clinical level Impairs daily functioning ~70% of survivors experience some level of FCR ~33% experience severe, clinically significant FCR Simard et al., 2013; PDQ, 2024
Slide 10 Tauber et al., 2019 — meta-analysis of 19 RCTs

Evidence-Based Interventions for FCR

Four primary intervention modalities are supported by robust evidence. These are not mutually exclusive — most effective treatment programs integrate components from multiple frameworks.

Evidence-based interventions for FCR Tauber et al., 2019 meta-analysis — 19 RCTs FCR target CBT Cognitive restructuring Behavioral experiments ACT Defusion · acceptance Values-based action Mindfulness MBSR / MBCT Present-moment focus Performance psych Routines · process focus Attentional control Largest effects for CBT and mindfulness-based approaches
Slide 12 Hayes, Strosahl & Wilson, 2012

ACT — Psychological Flexibility Model

The six core ACT processes work together to build psychological flexibility: the ability to act toward one's values even in the presence of difficult thoughts and feelings. Click any process to explore its clinical application to FCR.

ACT — Psychological flexibility model Hayes et al., 2012 — 6 core processes Psychological flexibility Being present Mindful awareness of now Values What matters most to you Committed action Act toward your values Self-as-context Observer beyond thoughts Defusion See thoughts as thoughts Acceptance Allow fear without struggle Goal: act meaningfully in the presence of fear — not eliminate it
Slide 7 Siegel, 1999

Window of Tolerance

The window of tolerance describes the optimal zone of arousal in which learning, coping, and meaningful engagement are possible. FCR triggers can push us outside this window — both up into hyperarousal and down into hypoarousal.

Window of tolerance Siegel, 1999 — optimal zone for coping and learning Arousal level Hyperarousal zone Panic · Rumination · Racing thoughts · FCR escalation · Sleep disruption Window of tolerance — optimal zone Engaged · Flexible thinking · Able to cope · Learning is possible here Hypoarousal zone Numbness · Dissociation · Avoidance · Emotional shutdown FCR trigger pushes up Coping skills restore balance High Optimal Low Siegel, D. J. (1999). The developing mind. Guilford Press.
Slide 15 Carleton, 2016

Intolerance of Uncertainty and FCR

Intolerance of uncertainty (IU) is one of the most robust maintaining factors of FCR. Because medical certainty about recurrence is irreducible, learning to tolerate uncertainty is a core therapeutic target.

Intolerance of uncertainty and FCR Carleton, 2016 — how IU maintains fear / how tolerance builds resilience Maintaining pathway Irreducible uncertainty High intolerance of uncertainty Negative reactions Escalated FCR Rumination Reassurance-seeking Intervention pathway Graded uncertainty exposure Low → moderate → high Psychological flexibility Act despite not knowing Carleton, R. N. (2016). Clinical Psychology Review, 45, 88–101.
Slide 16 Tedeschi & Calhoun, 2004; Park, 2010

Post-Traumatic Growth Domains

Post-traumatic growth (PTG) is documented positive psychological change that emerges from the struggle with cancer. PTG does not deny suffering — it coexists with it. Click each domain to explore. Note: PTG should never be assumed or required of survivors.

Post-traumatic growth domains in cancer Tedeschi & Calhoun, 2004 — coexists with distress, never assumed or required Struggle with cancer Personal strength "I'm stronger than I knew" Relating to others Deepened connections New possibilities Reprioritized life goals Appreciation of life Heightened gratitude Existential change Deepened meaning and purpose PTG does not deny suffering — it coexists with distress. Never assume or require it.
Slide 19 + Skills Handout CBT · ACT · MBSR · Performance psychology

Practical Coping Toolkit

Select any skill to see step-by-step instructions and the clinical rationale. Start with one technique. Practice it. Build from there — consistency over intensity.

5-4-3-2-1 Grounding
Use this when FCR spikes to anchor yourself to the present moment. Works by activating the prefrontal cortex and interrupting the amygdala's threat-detection loop — shifting the nervous system away from fight-or-flight.
  • 5 — SEELook around and name 5 things you can see right now
  • 4 — FEELNotice 4 physical sensations (feet on the floor, fabric on skin)
  • 3 — HEARIdentify 3 sounds in your environment
  • 2 — SMELLNotice 2 scents, or recall 2 favorite smells
  • 1 — TASTENotice 1 taste currently present in your mouth