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Acceptance and Commitment Therapy (ACT) has shown promise in improving psychological flexibility, but its role in targeting helplessness and enhancing QoL in breast cancer patients has not been fully established. This randomized controlled trial (RCT) examined the effects of ACT on helplessness, QoL, and their domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This two-arm, parallel, single-blind RCT recruited 80 breast cancer patients from a tertiary care center and randomly assigned them to either ACT (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940) or treatment-as-usual (TAU,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200940). Participants completed the Malay Illness Cognition Questionnaire (ICQ-M) and the Functional Assessment of Cancer Therapy (General and Breast Cancer modules) at baseline (T1), post-intervention at 4 weeks (T2), and follow-up at 12 weeks (T3). ACT was delivered in four weekly sessions between T1 and T2. Data were analyzed using repeated-measures analysis of variance (ANOVA).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty-six participants completed all assessments (ACT,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200932; TAU,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200934). Compared with TAU, ACT significantly reduced helplessness and improved overall QoL and all QoL domains across time points (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). Effects were maintained at 12-week follow-up.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>ACT is an effective psychosocial intervention for breast cancer patients, producing sustained improvements in QoL partly by reducing helplessness. Integrating ACT into supportive and palliative care may address critical psychological mechanisms affecting patient well-being.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov, NCT05327153. Registered on April 6, 2022.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12904-026-02049-5","type":"journal-article","created":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T04:15:45Z","timestamp":1772684145000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Acceptance and commitment therapy improves the quality of life of breast cancer patients by reducing helplessness: a randomized controlled trial"],"prefix":"10.1186","volume":"25","author":[{"given":"Wenjun","family":"Song","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurul Izzah","family":"Shari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Farris Iman Leong Bin","family":"Abdullah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasmah Binti","family":"Hussin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruiling","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nor Shuhada","family":"Mansor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,3,5]]},"reference":[{"issue":"3","key":"2049_CR1","first-page":"287","volume":"5","author":"Y Zhang","year":"2025","unstructured":"Zhang Y, et al. 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