Beyond outcomes: Assessing awareness of processes change in women with breast cancer enrolled in a contextual-behavioral RCT

BACKGROUND: The efficacy of Acceptance and Commitment Therapy (ACT) in improving distress and quality of life among cancer patients has been empirically shown. However, inconsistencies persist regarding measurable changes in its core processes. This study introduces and psychometrically examines a new instrument designed to address these limitations: the Awareness of Processes Post-Intervention (APPI). METHOD: The APPI was developed to assess perceived changes in awareness of contextual-behavioral processes. Data were collected from 76 women with breast cancer participating in two RCTs comprising two interventions - an 8-session group contextual-behavioral program that integrates ACT and compassion-focused practice (Mind) and a support group. RESULTS: Exploratory factor analyses supported a one-factor solution, demonstrating excellent internal consistency (α = 0.95). Participants in the Mind condition reported significantly higher APPI scores than those in the support group, particularly regarding awareness of the present moment and of (un)compassionate self-responding. Correlational analyses showed that higher APPI scores were associated with greater compassionate self-responding, valued action, lower psychopathology, and better quality of life at post-intervention, especially within the Mind condition. CONCLUSIONS: These findings support the psychometric soundness and theoretical relevance of the APPI for capturing awareness of targeted processes in contextual-behavioral interventions. The APPI may enhance research on process assessment and the implementation of contextual-behavioral approaches, particularly in psycho-oncology settings.