Narrative Therapy to Prevent Illness-Related Stress Disorder

Effects of Narrative Exposure Therapy for Treating Depressive and Anxious Disorders: A Systematic Review and Meta-Analysis

OBJECTIVE

Narrative exposure therapy (NET) has been used in various contexts for the treatment of the effects of trauma, with promising results in clinical trials. However, its effects on anxiety and depression are still unclear. The present study is a systematic review and meta-analysis of the effects of NET on depression and anxiety.

METHODS

The Embase, Cumulative Index of Nursing and Allied Health Literature, PubMed, Web of Science core collection, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Database, and Wangfang databases were searched from the earliest records to March 2023. Two researchers independently screened the literature, extracted data, evaluated the risk of bias, and cross-checked the data. Meta-analysis was performed using the program RevMan 5.3.

RESULTS

Eleven randomized controlled trials with a total of 754 participants were included in the study. The results showed that NET reduced both the depression (standard mean difference [SMD]=-0.51, 95% confidence interval [CI] -0.73--0.29, p<0.00001) and anxiety (SMD=-0.65, 95% CI -1.13--0.18, p=0.007) scores of the patients. Furthermore, NET was found to alleviate negative emotions associated with guilt (mean difference [MD]=-3.60, 95% CI -5.52--1.68, p=0.0005) and negative change (MD=-5.80, 95% CI -9.76--1.83, p=0.004).

CONCLUSION

This analysis showed that NET can alleviate depression and anxiety. It may thus be used in clinical settings to alleviate patients' negative feelings and aid their overall recovery.

Optimizing Rural People's Access to Relevant Cancer Education and Support Using Peer-Led YouTube Films

Rural cancer patients have inferior cancer outcomes and unique unmet information needs. This paper explores the value of rural people affected by cancer delivering cancer-related education and support to their peers via 3-5 min online YouTube films. In part 1, 14 rural Australians affected by cancer (10 survivors, 4 carers), 50% (7/14) female, 55-79 years, "storytellers", were purposively invited to be filmed sharing their cancer-related experience and advice for others facing similar challenges. They then reflected on their storytelling experience during semi-structured interviews with an independent researcher. In part 2, 11 rural South Australians affected by cancer (8 survivors, 3 carers), 82% (9/11) female, 32-75 years, "viewers", who had watched at least three of the videos, were interviewed. When data saturation was reached, thematic analysis was employed. Storytellers were found to be highly satisfied with the film-making process and product. They valued rapport building prior to filming and the opportunity to help others. They also found storytelling cathartic and the films useful in communicating their cancer experience to family and friends. Rural viewers appreciated the honesty, authenticity, relatability and believability of the storytellers, the practical advice on rural-specific psychosocial issues, acknowledgment of the impact of isolation and the opportunity to understand others' cancer experiences. The film's short duration and professional film-making added appeal. Inclusion of younger storytellers and methods of delivery other than YouTube were suggested. This study highlights the value of this approach for storytellers and viewers. It may be particularly beneficial for isolated rural cancer survivors who feel that their unique challenges are not adequately addressed by mainstream cancer education resources However, further quantitative research to test acceptability and impact in representative rural samples is required.

Narrative therapy to relieve stigma in oral cancer patients: A randomized controlled trial

AIMS AND OBJECTIVES

This study aimed to evaluate the efficacy of narrative therapy in relieving stigma in oral cancer patients who underwent major surgical treatment.

BACKGROUND

Health-related stigma compromises mental health and life quality in people with physical or mental abnormalities. Narrative therapy has been implemented to overcome stigma among populations in a diversity of disease states. However, the effectiveness of narrative therapy in relieving stigma among patients with oral cancer is not known.

DESIGN

This study was a randomized controlled trial, in which 100 oral cancer patients were selected and randomly assigned to the 'narrative therapy' group, who received narrative therapy treatment in addition to standard care, and the 'control' group, who was provided standard care only.

METHODS

This research combined measurement of several questionnaires to evaluate stigma. Analysis of variance and paired t tests were employed for data analysis.

RESULTS

Findings in this study demonstrated that narrative therapy treatment effectively relieved oral cancer patients' sense of shame, reducing overall stigma and significantly improving self-esteem and social relationships.

CONCLUSIONS

Narrative therapy was demonstrated to be a promising therapeutic intervention for stigma relief in oral cancer patients.

SUMMARY STATEMENT

What is already known about this topic? Stigma is common among oral cancer patients, especially those who undergo major surgical resection. Psychological intervention is highly recommended in addition to postsurgical care. Narrative therapy might help relieve stigma among oral cancer patients. What this paper adds? Conventional postsurgical care did not improve oral cancer patients' psychological situation. A 7-week intervention of narrative therapy treatment significantly reduced stigma and enhanced sense of self-worth and social support among oral cancer patients. The implications of this paper: Narrative therapy can be clinically accepted as a therapeutic approach to assist oral cancer patients with stigma after major surgery. Tailored approaches, including patient-customized methods, should be encouraged in conducting narrative therapy.

Psychological support for patients with cancer: evidence review and suggestions for future directions

PURPOSE OF REVIEW

Psychological distress and mental health comorbidity are common in cancer. Various therapeutic frameworks have been used for interventions to improve psychological wellbeing and quality of life in cancer patients with mixed results. This article reviews contributions to that literature published since January 2017.

RECENT FINDINGS

The majority of new psychological intervention research in cancer has used cognitive behavioural therapy (CBT) or mindfulness-based interventions. CBT has been considered a gold-standard intervention and recent evidence justifies continuation of this. Recent reviews call into question the validity of evidence for mindfulness-based interventions. A smaller number of trials using acceptance and commitment therapy, meta-cognitive therapy, dignity therapy and coaching have emerged, and whereas findings are promising, additional fully powered trials are required. Weaker evidence exists for counselling, support-based and narrative therapy interventions.

SUMMARY

Efficacious, timely and acceptable psychological interventions are a necessary component of comprehensive cancer care. There is some way to go before the evidence conclusively points towards which interventions work for which cancer groups and for which specific outcomes. Methodological limitations must be addressed in future trials; at the forefront remains the need for fully powered, head-to-head comparison trials.

Post-traumatic stress disorder and cancer

Being diagnosed with and treated for cancer is highly stressful and potentially traumatic. An extensive literature has evaluated the prevalence, predictors, and correlates of cancer-related post-traumatic stress disorder (PTSD) symptoms and diagnoses. In this qualitative review of cancer-related PTSD literature, we highlight conceptual, methodological, and diagnostic issues, and identify clinical implications and areas for future research. Cancer-related PTSD has been documented in a minority of patients with cancer and their family members, is positively associated with other indices of distress and reduced quality of life, and has several correlates and risk factors (eg, prior trauma history, pre-existing psychiatric conditions, poor social support). The literature on treatment of cancer-related PTSD is sparse. Existing literature on cancer-related PTSD has used DSM-IV-TR diagnostic criteria; the revised DSM-5 PTSD criteria have important implications for the assessment of cancer-related distress. Application of PTSD diagnosis to patients with cancer has been critiqued on conceptual and methodological grounds, and important differential diagnosis considerations should be taken into account. Psychosocial assessment of patients with cancer should include careful evaluation of pre-cancer diagnosis trauma and psychiatric history, and diagnostic interviewing should consider concurrent conditions (eg, adjustment disorder). Treatment of cancer-related PTSD should be approached with caution and be informed by existing evidence-based approaches for traumatic stress.

Living with a pituitary tumour: a narrative analysis

This study aimed to synthesise the illness narratives of individuals living with a pituitary tumour. Eight adults with a pituitary tumour were recruited from an endocrinology service in the north-west of England. A narrative methodology was adopted which investigated elements of the individual narratives such as metaphor and structure but which also aimed to produce a joint account of experience in this particular illness context by extracting themes across the stories; these are presented as part of a chronological narrative. However, the resulting group story was also analysed in terms of different types of narrative plots. The group narrative started from the recognition of symptoms and then diagnosis though treatment to post-treatment and future plans. In terms of narrative plots, one notable element of the joint narrative was the flow between the culturally dominant restitution narrative, where participants focused on treatment and recovery and the chaos narrative when recovery did not seem possible. The findings contain many elements consistent with previous research; however, the use of a celebrity figure to communicate about the illness experience and a perception that objects or individuals should not be taken at face value emerged as more novel findings.

Theoretical and practical outline of the Copenhagen PACT narrative-based exercise counselling manual to promote physical activity in post-therapy cancer survivors

BACKGROUND

Sedentary behaviour and reduced exercise capacity are potential persisting effects of anti-cancer therapy that may predispose to serious health conditions. It is well-established that physical exercise may prevent some of these problems. However, the extent to which cancer survivors are able to adopt long-term physical activity habits depends largely on their motivation.

AIM

This theoretical paper aims to outline how researchers and practitioners can draw from Antonovsky's salutogenetic theory and White & Epston's Narrative Therapy to develop and implement intervention efforts centered on promotion of long-term physical activity behaviour, while at the same time increasing the individual cancer survivor's sense of meaning and personal health resources.

MATERIAL AND METHODS

The Copenhagen PACT (Physical Activity after Cancer Treatment) Study targeting adoption and maintenance of regular physical activity in post-therapy cancer survivors is briefly presented including a brief review of the theoretical rationale behind the psychological component of the intervention, i.e. a narrative-based exercise counselling programme. Subsequently, particular attention is given to the core principles, different components and structure of the counselling manual including sample questions and examples of written documents that have emanated from the individual counselling sessions.

DISCUSSION

The discussion includes consideration of some methodological challenges that arise when attempting to evaluate narrative-based interventions in the context of physical activity promotion in cancer rehabilitation and survivorship care.

The effectiveness of narrative therapy with young people with autism

PROBLEM

The aim of this pilot study was to be the first step toward empirically determining whether narrative therapy is effective in helping young people with autism who present with emotional and behavioral problems. Autism is increasingly being recognized in young people with average and above intelligence. Because of the nature of autism, these young people have difficulty navigating the challenges of school and adolescence. Narrative therapy can help them with their current difficulties and also help them develop skills to address future challenges. Narrative therapy involves working with a person to examine and edit the stories the person tells himself or herself about the world. It is designed to promote social adaptation while working on specific problems of living.

METHOD

This pilot intervention study used a convenience sample of 10 young people with autism (10-16 years) to evaluate the effectiveness of five 1 hr sessions of narrative therapy conducted over 10 weeks. The study used the parent-rated Strengths and Difficulties Questionnaire (SDQ) as the primary outcome measure. Secondary outcome measures were the Kessler-10 Scale of Psychological Distress (K-10), the Beck Hopelessness Scale, and a stress biomarker, the salivary cortisol to dehydroepiandrosterone (DHEA) ratio.

FINDINGS

Significant improvement in psychological distress identified through the K-10 was demonstrated. Significant improvement was identified on the Emotional Symptoms Scale of the SDQ. The cortisol:DHEA ratio was responsive and a power analysis indicated that further study is indicated with a larger sample.

CONCLUSION

Narrative therapy has merit as an intervention with young people with autism. Further research is indicated.