The goal of this research study is to train psychotherapists to administer individualized evidence-based psychotherapies in a cancer care setting to patients and caregivers with elevated levels of distress.

The intervention will mirror clinical care in psycho-oncology in which the therapist, collaboratively with their supervisor, will choose specific components of the following evidence-based treatments to administer based on the clinical presentation of the patient or caregiver and referring problem.

• Cognitive Behavioral Therapy (CBT)
• Acceptance Commitment Therapy (ACT)
• Mindfulness-Based Cognitive Therapy (MBCT)
• Mindfulness-Based Stress Reduction (MBSR)
• Meaning-Centered Psychotherapy (MCP)
• Cognitive Behavioral Therapy for Insomnia (CBT-I)
• CBT for other cancer-related physical symptoms like pain, fatigue, and nausea.

Participation in this research study is expected to last about 26 weeks.

It is expected that about 75 patients, 25 caregivers, and 15 therapists will take part in this research study.

This is a single-arm, behavioral intervention study to train psychotherapists to administer individualized evidence-based psychotherapies in a cancer care setting to patients and caregivers with elevated levels of distress related to their illness, treatment and/or caregiving responsibilities. For participants with cancer and their caregivers, common treatment goals include improving health behaviors, reducing psychological symptoms that may exacerbate medical disability, and/or improving functional status.

Research procedures include screening for eligibility, completion of surveys and questionnaires, and virtual or in-person therapy sessions.

The intervention will mirror clinical care in psycho-oncology in which the therapist, collaboratively with their supervisor, will choose specific components of the following evidence-based treatments to administer based on the clinical presentation of the patient or caregiver and referring problem.

• Cognitive Behavioral Therapy (CBT)
• Acceptance Commitment Therapy (ACT)
• Mindfulness-Based Cognitive Therapy (MBCT)
• Mindfulness-Based Stress Reduction (MBSR)
• Meaning-Centered Psychotherapy (MCP)
• Cognitive Behavioral Therapy for Insomnia (CBT-I)
• CBT for other cancer-related physical symptoms like pain, fatigue, and nausea.

Participation in this research study is expected to last about 26 weeks.

It is expected that about 75 patients, 25 caregivers, and 15 therapists will take part in this research study.

Patient or caregiver participants will be those who a) are currently receiving oncology care, including active treatment and/or surveillance, or caring for someone currently receiving oncology care, b) report elevated levels of distress (≥ 3 on the NCCN Distress Thermometer), c) report that their distress or presenting concerns are related to their illness, their treatment(s), and/or their caregiving experience and d) have a clinical presentation that matches an evidence-based treatment (e.g., CBT-I for insomnia/sleep disturbance) for cancer-related distress per the therapist and the supervising therapist's discretion. The investigators aim to recruit up to 75 patient and 25 caregiver participants to this study over the course of 5 years. Therapist participants will be fellows or residents in the Mass General's Center for Psychiatric Oncology & Behavioral Sciences. The investigators aim to include up to 15 therapist participants over the course of this 5-year study. The study period for therapist participation would be up to 3 years, and would end either at a) 3 years, b) the point at which the therapist obtains licensure and transitions to faculty member, c) the time the therapist leaves MGH.

Patient Inclusion Criteria:

• Adults > 18 years of age.
• Currently receiving oncology treatment/care at the MGH Cancer Center, including active treatment and/or surveillance.
• Reports elevated levels of distress on the National Comprehensive Cancer Network (NCCN) Distress Thermometer > 3.
• Reports distress or presenting problem is related to patients' illness and/or treatment (e.g., cancer treatment).
• Has a clinical presentation that matches an evidence-based treatment (e.g., CBT-I for insomnia/sleep disturbance) for cancer-related distress per therapist and supervising therapist discretion.
• Located in the state of Massachusetts for the duration of sessions.

Caregiver Inclusion criteria:

• Adults > 18 years of age
• Currently caring for someone receiving oncology treatment/care at the MGH Cancer Center, including active treatment and/or surveillance
• Reports elevated levels of distress on the National Comprehensive Cancer Network (NCCN) Distress Thermometer > 3
• Reports distress or presenting problem is related to caregiving
• Has a clinical presentation that matches an evidence-based treatment (e.g., CBT-I for insomnia/sleep disturbance) for caregiving-related distress per therapist and supervising therapist discretion
• Located in the state of Massachusetts for the duration of sessions

Patient Exclusion Criteria:

• Has uncontrolled psychosis, active suicidal ideation, or psychiatric hospitalization within the past year (assessed through EHR review and screening session using the QuickSCID-5), indicating the need for tailored treatment referral to specialty mental healthcare outside of psycho-oncology or to a higher level of care such as an intensive outpatient program (IOP).
• Has a cognitive impairment that prohibits participation in the study (assessed through EHR review and screening session).
• Currently participating in group or individual evidence-based psychotherapy treatment or other psychosocial intervention trial.
• Has an alcohol or substance dependence (other than nicotine dependence) in the past 8 weeks (assessed through EHR review and screening session using the QuickSCID-5), indicating the need for tailored treatment referral to specialty mental healthcare outside of psycho-oncology or to a higher level of care such as an intensive outpatient program (IOP).

Therapist Inclusion criteria:

-Current appointment as a clinical psychology fellow or psychiatry resident at the Massachusetts General Hospital or equivalent designation.

Therapist Exclusion criteria:

-Obtained licensure as a clinical psychologist in any state.

The Dana-Farber / Harvard Cancer Center encourages and supports the responsible and ethical sharing of data from clinical trials. De-identified participant data from the final research dataset used in the published manuscript may only be shared under the terms of a Data Use Agreement. Requests may be directed to: [contact information for Sponsor Investigator or designee]. The protocol and statistical analysis plan will be made available on Clinicaltrials.gov only as required by federal regulation or as a condition of awards and agreements supporting the research.

Data can be shared no earlier than 1 year following the date of publication.

Contact the Partners Innovations team at http://www.partners.org/innovation

There will be two groups in this study- one is patient and caregiver participants (n=100) and the other is therapist participants (n=15). Therapist participants will deliver evidence-based therapy treatments to patients participants. Outcomes in each group will not be compared to each other.