In human cancer, the role of genetic mutations, epigenetic alterations, and cellular repair mechanisms are becoming increasingly apparent. Recent studies have elucidated significant variations of the genetic codes that underpin cancer development in a variety of cancer subtypes. Genetic variations provide a backbone upon which cancer cells can adapt to overcome both intrinsic and extrinsic mechanisms designed to limit the growth of abnormal cells. This chapter provides an overview of the types of mutations, various epigenetic modifications, DNA repair mechanisms, and their relationship to the development of cancer, as well as various techniques utilized for the detection of these genetic alterations in cancer. With the development of new, advanced, and sensitive molecular techniques like next-generation sequencing and digital droplet polymerase chain reaction, our understanding of cancer biology is rapidly developing, and a critical appreciation and knowledge of these cancer-associated changes will likely lead to continued development of more effective therapies.

This chapter describes a systematic approach to intervention planning in performance psychology. It presents a case formulation method for a comprehensive understanding of the client, and an appropriate multilevel classification system for sport psychology (MCS-SP) classification that subsequently either guides the proper delivery of the mindfulness-acceptance-commitment (MAC) program or leads to the determination that the performer’s needs are beyond the scope of the MAC program. The MCS-SP categorizes the issues and barriers facing the performer into four classifications: performance development (PD), performance dysfunction (Pdy), performance impairment (PI), and performance termination (PT). In the case formulation method suggested in the chapter, the practitioner’s first goal is to conceptualize performance needs and barriers based on the information systematically collected during the assessment process.

This chapter presents a case study on performance dysfunction in the case of a 21-year-old African American female basketball player entering her senior year at a major Division I-level university. She described regret about not working out harder during the off-season, which she blamed for a poor start to her current season. In addition, she also reported feeling a great deal of worry over the possibility that she may have a poor season and ruin her chance to be drafted in the first round of the WNBA entry draft. According to the case formulation model, there are 10 elements that are necessary to consider prior to making an intervention decision contextual performance demands; skill level; situational demands; transitional and developmental issues; psychological characteristics/performance and nonperformance schemas; attentional focus; cognitive responses; affective responses; behavioral responses; and readiness for change and level of reactance.

The primary intent of mindfulness-acceptance-commitment (MAC) Module 2 is an expanded introduction to the importance of mindful awareness and mindful attention in promoting behavior change in general and enhanced performance in particular. This chapter suggests that Module 2 and all subsequent modules begin with the ‘Brief Centering Exercise’. During Module 2, the practitioner describes mindfulness as a process and points out that mindfulness exercises are a means to develop specific skills of self-regulated attention, cognitive defusion, and personal awareness. The primary means of promoting self-awareness throughout the MAC program is the during- and between-session use of a variety of mindfulness exercises intended to enhance awareness of internal and external events and enhance the self-regulation of attention. One of the key elements to the successful completion of the MAC protocol is adherence to the between-session exercises.

The primary purpose of Module 4 of the MAC protocol is the development of an understanding of the costs associated with experiential avoidance. This chapter highlights the contrasting benefits of experiential acceptance in pursuing performance desires within the context of a values-based life. The essential goal of the MAC program is to convey the idea that emotions are not the enemy of effective performance, but rather it is the things that people do to eliminate or otherwise control emotions that are counterproductive to high-level performance states. A consultant and client explore the workability of the client’s past efforts to control negative thoughts, emotions, and bodily sensations. Mindfulness exercises should be used as a means of enhancing the capacity to observe and describe internal processes and external events. The chapter concludes with a discussion on the issue of the consultant’s comfort with and understanding of the basic acceptance model.

The primary purpose of Module 3 of the MAC program is the understanding and exploration of values as a central orienting concept. In the context of understanding the important role of values in enhanced performance and quality of life, the functional and dysfunctional role of emotions is also considered. This chapter suggests to clients that their personal values will be the anchor point for all behavioral decisions that need to be made in the course of enhancing performance and achieving goals. The concepts of mindful awareness, mindful attention, and cognitive fusion and cognitive defusion become integrated with the concept of values-directed versus emotion-directed behavior. The Relevant Mindful Activity Exercise is intended to connect the mindfulness concept to a relevant performance situation in the client’s life. The question of personal values is particularly salient when confronted by the variety of emotions and internal rules that client confronts on a daily basis.

As with all structured psychological interventions, particularly those developed out of the cognitive-behavioral tradition, the first session of the mindfulness-acceptance-commitment (MAC) intervention is psychoeducational in nature. This chapter outlines the components of Module 1. It discusses the common obstacles faced during this critical module and addresses considerations for working with clients experiencing performance dysfunction. Performance is improved by learning to practice and train more efficiently and consistently and from the enhancement of psychological skills such as task-focused attention and poise. It is important to stress that a fundamental goal of MAC is to remove the effects of excessive cognitive activity from performance. Some clients may have been overtly or subtly coerced by family, coach, management, staff, or teammates/coworkers to seek out sport or performance psychology as a means of enhancing their performance. There are many possible psychological barriers to performance that do not reach clinical levels.

This chapter presents a case study on performance development with the case of a man who reported that he had been “ultra successful” in every facet of his business life and was happily married and living with his wife of three years in a large suburban home. He described himself as “feeling stuck”, which he described as the belief that he had gone as far as he could go without improving in fundamental areas in his life. The consequences of the avoidant behaviors led him to feel quite overwhelmed. Preintervention psychological functioning was assessed with a standard semi-structured interview and three self-report measures selected based on specific processes that appeared most likely to be relevant to the performer’s referral issue. The measures utilized included the Young Schema Questionnaire-Short Form, the Acceptance and Action Questionnaire-Revised, and the Profile of Mood States.

By the final mindfulness-acceptance-commitment (MAC) module, clients should be regularly engaged in exercises to promote MAC skills that are central to optimal human performance. These skills include: mindfulness, acceptance and commitment. The overarching purpose of Module 7 is to prepare the client for the completion of the MAC program by stressing the lifelong nature of these skills and exercises. When reviewing the entire MAC program, this chapter suggests that the consultant begin with a review of the initial stated purpose for the client’s participation in the program, including a discussion of the performance-related issues and goals that existed at the time the MAC program was initiated. The chapter presents the relationship between the formal consultant-guided MAC program and the less formal, self-guided MAC program. Prior to the completion of the MAC protocol, the chapter also suggests that the consultant discuss the unbreakable link between self-reflection and self-correction.