Iris Kanera

68 Chapter 3 Mood The Mood module focuses on feelings of anxiety and depression. More specifically, the module discusses common anxiety and depression provoking thoughts and how to cope with these thoughts more effectively. Based on the answers of the screening questionnaire, participants receive feedback on their current state of anxiety, depression, and adjustment to cancer. When there is an indication that the participant is experiencing severe levels of psychological distress, a recommendation is given to visit one’s general practitioner to get a referral for help. In the module, participants first set a goal they want to achieve (e.g., to reduce feelings of sadness). Then, psycho-education and assignments are given concerning non-helpful or anxiety provoking thoughts, such as feelings of failure or fear of cancer recurrence. Participants are encouraged to monitor their inefficient thoughts for one week. Then, these thoughts are challenged by discussing their credibility and usefulness and advice is given on how to replace these thoughts with helpful thoughts. Furthermore, advice and assignments are given concerning planning pleasant activities, how to deal with rumination, and how to reduce feelings of anxiety or sadness by means of relaxation and mindfulness. Relationships The Relationships module addresses coping with difficult social situations and intimacy problems. Difficult social situations are discussed, such as receiving inadequate help from others, social isolation, experiencing social pressure, and talking about having had cancer. Based on the answers of the screening questionnaire, participants receive an overview of social situations in which they wish change. After selecting such a social situation, psycho- education is given on how to constructively deal with this situation. Concerning intimacy, psycho-education is given on discussing intimacy and sexuality with significant others and how to cope with sexuality with respect to physical and functional changes due to cancer treatment. Coping with physical and functional changes is tailored to gender. For example, men receive information on how to cope with issues such as erectile dysfunction or dry orgasms, while for women advice is given on how to cope with issues such as menopausal symptoms or vaginal problems. Physical Activity In the PA module, participants are encouraged to increase their level of PA. Based on the answers of the screening questionnaire in combination with the Dutch PA guidelines, participants receive feedback on their own level of PA and to which extent it reaches the recommended level. Then, participants are encouraged to set a goal, for example, increasing PA during commuting, daily activities, leisure time, or sports. Subsequently, advice is given