Psychotherapy and Cancer

Receiving a Cancer diagnosis can be scary and difficult. Suddenly, your days may be filled with challenging medical appointments. Your attention will become focused on your body, with goals of becoming well and maintaining health while you navigate medical treatment.

The process of fighting cancer can also create emotional turmoil. As you tend to your body, it is important to tend to your mental health as well. Research shows there may be good reasons for adding psychotherapy to the cancer treatment plan.

Benefits of Therapy for Cancer Patients

If you have received a cancer diagnosis, you may be experiencing a complex soup of emotions, as well as physical symptoms and treatment side effects. At diagnosis and during the course of treatment, many people experience normal stages of grief and loss—denial, anger, bargaining, depression, and acceptance. It is also possible to experience more severe symptoms of anxiety and depression during this time.

Psychotherapy is one tool that can help to navigate these challenging emotions and improve your quality of life. It can provide you with the support and increase your coping skills and resilience during this difficult time.

Supported Types of Therapy for Patients

• Traditional Talk Therapy: Talk therapy provides a safe space for patients to talk openly and receive support [NOT A GREAT REFERENCE]. One of the benefits of this type of therapy is the presence and help of a third party who can hold space for your emotions and experiences, and who is not directly involved in your day-to-day life. This is especially helpful when your loved ones may also be struggling.

• Cognitive Behavioral Therapy (CBT): CBT is the gold standard of therapeutic approaches. It teaches individuals how to relax during stressful situations, control negative thoughts, think more positively, and engage in the helpful behaviors associated with recovery.

• Acceptance and Commitment Therapy(ACT): This approach helps individuals learn to acknowledge their physical pain and emotions, while working to accept what is and commit towards moving forward. Shifting from wrestling with emotional pain to accepting it helps to reduce suffering.

Mind Body Approaches

• Mindfulness Based Stress Reduction (MBSR): MBSR works by shifting thoughts away from stressors and emotional distress in order to maintain focus on the present moment. This helps patients find more joy in their day-to-day life and early research shows that it also improves their psychological health.

• Art Therapy and Expressive Arts Therapies: These modalities rely less on talking and more on creative self-expression through drawing, painting, or music. It allows you tap into and use the parts of your body and spirit that remain whole and unharmed.

• Mind Body Therapies: Research shows that integrating other adjunct Mind-Body approaches such as Meditation, Yoga, and Massage Therapy can also be helpful for patients during cancer treatment. Utilizing these techniques and incorporating them into one’s lifestyle can improve medical treatment outcomes, quality of life, mental health, and reduce fatigue in cancer patients.

Recommendations

If you are dealing with cancer, an integrative approach to treatment can provide support for whole mind-body health.

(1) Psychosocial interventions for advanced cancer patients: A systematic review. (full)

• 2018; Teo et Al

• 68 studies; Jan 2007- June 2018

• objective: “summarise the current and growing body of research in psychosocial interventions for advanced cancer patients without focusing solely on intervention effectiveness. Thus, we did not exclude studies based on methodological quality. The aim was to provide a synthesis of evidence from studies with robust results together with preliminary findings to obtain a broad snapshot of the field. “

• range of psychosocial intervention studies included; formats, duration, and resources were varied

  • Types: CBT based; meaning enhancing; dignity, life review, narrative based; other counseling; education only; music writing, others

  • CBT: 20 studies

    • positive change in patients’ attitudinal barriers, competence, and self efficacy

    • 60% of trials showed improvement in at least one specified primary outcome: (1) quality of life (QOL) and (2) symptoms such as pain, fatigue, breathlessness, distress related to breathlessness for patients receiving CBT intervention compared w/ control and/ or usual care

    • Meaning Enhanced: 11 studies

      • psychotherapeutic intervention emerging from existential theories; seeks to enhance meaning for patients

      • meaning centered psychotherapy and supportive expressive therapy

      • 6/9 studies showed its effectiveness

      • meaning centered psychotherapy increased spiritual wellbeing, sense of meaning and QOL

      • supportive expressive group therapy showed decreased in pain and suffering among participants

      • Dignity Therapy, Life Review, Narrative Interventions

        • Patient has opportunity to reflect on life, tell their story, and derive personal meaning

        • patient guided by framework of questions

        • 4/5 studies showed effectiveness of therapy

          • dignity therapy: decreased stress, improved generativity, improved ego integrity

          • life review: improved sense of meaning and QOL

(2) Psychotherapy for cancer patients: A systematic review and meta-analysis (summary)

• Ng Chong Guan et Al

• 2016

• psychotherapy is a common non- pharmaceutical approach to helping cancer patients with psychological distress

• many types of psychotherapeutic interventions, but benefit among all is well documented

• review: 17 trials included

• 6 types of psychotherapy

• Each study demonstrated that psychotherapy improved QOL and coping skills in cancer patients

• reduction in distress, anxiety, and depression after psychotherapeutic intervention

• limitations: number and quality of clinical trials is poor for each type of psychotherapy studied

• in a meta- analysis of 4 adjunct psychotherapy trials, researchers found no change in depression scores and significant short term improvement in anxiety only, but not up to a year.

• More well designed studies are needed to demonstrate basis for psychotherapy interventions for breast cancer patients

(3) Psychotherapy for depression among advanced, incurable cancer patients: A systematic review and meta-analysis. (summary)

• 2017

• higher levels o f depression among advanced, incurable cancer patients

• preference among patients for non-pharmacological treatment such as psychotherapy over pharmacological treatment

• purpose: investigate effectiveness of psychotherapy in this pt pop via meta analysis of relevant RCTs

• 12 studies included

• conclusion: psychotherapy associated w/ moderate decrease in depression scores

• limitations: few studies focused on patients with clinically diagnosed depression; overall quality of studies was low; heterogeneity among studies high

• recommendations: more research needed to demonstrate evidence of psychotherapy treatment for advanced stage cancer patients; psychotherapy moderately more effective for amelioration of symptoms of depression among this population than control conditions