Breast cancer is widely considered a complex condition that entails profound
psychological repercussions alongside physical challenges. In addition to the stress of
undergoing medical treatments, many patients develop an intense fear of cancer recurrence
(FCR), depressive and anxious states, and symptoms that may meet the criteria for
posttraumatic stress disorder (PTSD). Given these extensive emotional burdens, structured
psychological interventions have emerged as vital components of comprehensive oncological
care. While Cognitive Behavioral Therapy (CBT) is established as the gold standard for
reducing anxiety and depression, emerging trauma-focused therapies-such as Eye Movement
Desensitization and Reprocessing (EMDR)-are increasingly recognized for their efficacy in
addressing cancer-related traumatic stress.
Among EMDR-based interventions, the Flash Technique (FT) represents an innovative
adaptation designed to minimize the discomfort of processing traumatic memories. Unlike
traditional EMDR protocols, which may require individuals to recall and discuss
disturbing events in detail, the Flash Technique uses brief exposures to distressing
imagery, followed by rapid bilateral stimulation and positive recall. These "flashes" can
quickly desensitize the emotional intensity of cancer-related memories while reducing the
risk of re-traumatization. Early studies on the Flash Technique have shown promise in
alleviating traumatic symptoms in non-cancer populations, highlighting the method's
potential to offer quick, effective relief from emotionally charged recollections.
However, there is a notable lack of research exploring its efficacy specifically in
patients with breast cancer.
This randomized controlled trial (RCT) is the first known study to directly compare the
Flash Technique, adapted for online delivery (iEMDR-FT), with an internet-based CBT
program (iCBT) in breast cancer patients. Participants are randomly assigned to one of
two groups: a 7-week iCBT program or a 3-session iEMDR-FT protocol. The iCBT program
focuses on cognitive restructuring, stress management, and emotional regulation skills
tailored to address the unique challenges of cancer-related thought patterns (e.g.,
catastrophic thinking, fear of recurrence). In contrast, the iEMDR-FT group engages in
low-intensity trauma processing, wherein participants briefly recall cancer-related
distressing scenes, then undergo sets of rapid bilateral stimulation combined with
positive imagery ("flash" sets). This approach aims to swiftly reduce traumatic arousal
without requiring the prolonged confrontation of painful memories often associated with
traditional trauma therapies.
Both interventions are delivered online in a group format, guided by experienced
therapists. Assessments include measures of posttraumatic stress (PCL-5), fear of cancer
recurrence, depression-anxiety-stress (DASS-21), and quality of life (WHOQOL-BREF). Data
are collected at baseline, immediately post-intervention, and three months
post-intervention to evaluate both immediate and sustained changes in participants'
mental health status. By comparing these two distinct therapeutic modalities, the study
seeks to determine whether the rapid, minimal-exposure Flash Technique offers advantages
over-or is equivalent to-the more extended, structured cognitive framework of CBT.
The outcomes of this investigation may fill a critical gap in the current literature by
clarifying the practical utility, safety, and acceptability of online EMDR Flash
Technique in an oncology setting. If iEMDR-FT proves to be equally effective or superior
to iCBT in reducing traumatic stress, fear of cancer recurrence, and emotional distress,
it could represent a valuable, time-efficient option for treating psychological sequelae
in breast cancer. Conversely, if iCBT demonstrates better long-term gains in certain
domains-such as cognitive restructuring of illness-related beliefs-this will inform
clinicians about the relative strengths of each intervention. Ultimately, this study is
poised to provide evidence-based guidance for mental health professionals and oncology
teams in selecting or integrating internet-based interventions, thereby contributing to
more flexible and patient-centered psychosocial care for individuals coping with breast
cancer.