Persistent effects of a structured psychiatric intervention on breast cancer patients' emotions

Effects of short-term existential group therapy for breast Cancer patients

Objectives

Cancer patients who suffer from existential difficulties, including fear of death, isolation, or loss of human relationships, try to accept these fears by exploring the meaning of their life. In particular, early psychological intervention for patients prevents them from psychosocial maladjustment afterwards. Therefore, we have developed the Short-term Existential Group Therapy Program (Short-term EGP) for cancer patients, focusing on relief of existential or spiritual suffering and/or pain. This study aims to statistically evaluate the effects of this program on breast cancer patients within the first year after cancer diagnosis.

Methods

Thirty-one patients completed our research program. A ninety-minute therapeutic group session was held once a week for 5 weeks. We performed the above assessments three times: just before and after the intervention, as well as a month after the end of intervention. Outcome assessment included measures of spiritual well-being (SELT-M), Mental Adjustment to Cancer (MAC) and Profile of Mood States (POMS).

Results

The SELT-M “Overall QOL” scores were significantly increased after intervention, and these scores were maintained a month after intervention, particularly in those with high MAC “Hopelessness” scores. Subscales of the SELT-M scores were significantly increased after intervention, and these scores were maintained up to a month after intervention.

Conclusion

Short-term EGP intervention could be effective in helping patients relieve their existential distress. Some of the treatment effects were maintained a month after the end of the intervention. In addition, Short-term EGP could be particularly effective for those patients who feel hopelessness after cancer diagnosis.

Trial registration

Retrospectively registered. University Hospital Medical Information Network (UMIN CTR) UMIN000040651. Registered June 4, 2020.

The modifying effects of social support on psychological outcomes in patients with heart failure

OBJECTIVE

We examined the modifying effects of social support on depressive symptoms and health-related quality of life (QoL) in patients receiving coping skills training (CST).

METHOD

We considered the modifying effects of social support in the Coping Effectively with Heart Failure clinical trial, which randomized 179 heart failure (HF) patients to either 4 months of CST or usual care enhanced by HF education (HFE). CST involved training in specific coping techniques, whereas HFE involved education about HF self-management. Social support was assessed by the Enhancing Recovery in Coronary Heart Disease (ENRICHD) Social Support Inventory, QoL was assessed with the Kansas City Cardiomyopathy Questionnaire (KCCQ), and depression was assessed with the Beck Depression Inventory-II (BDI-II).

RESULTS

Linear regression models revealed a significant Intervention Group × Baseline Social Support interaction for change in KCCQ total scores (p = .006) and BDI-II scores (p < .001). Participants with low social support assigned to the CST intervention showed large improvements in KCCQ scores (M = 11.2, 95% CI [5.7, 16.8]), whereas low-social-support patients assigned to the HFE controls showed no significant change (M = -0.8, 95% CI [-7.2, 5.6]). Similarly, BDI-II scores in participants with low social support in the CST group showed large reductions (M = -8.7, 95% CI [-11.3, -6.1]) compared with low-social-support HFE participants (M = -3.0, 95% CI [-6.0, -0.1]).

CONCLUSIONS

HF patients with low social support benefit substantially from telephone-based CST interventions. Targeting HF patients with low social support for behavioral interventions could prove to be a cost-effective strategy for improving QoL and reducing depression. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A Systematic Review of Psychological and Pharmacological Treatments for Adjustment Disorder in Adults

Adjustment disorder is a common psychiatric disorder, yet knowledge of the efficacious treatments for adjustment disorder is limited. In this systematic review, we aimed to examine psychological and pharmacological interventions that target adjustment disorder in adults to determine which interventions have the best evidence for improving adjustment disorder symptoms. We performed database searches for literature published between January 1980 and September 2016 and identified studies that included both a sample majority of individuals diagnosed with adjustment disorder and findings on adjustment disorder symptom outcomes. There were 29 studies that met the inclusion criteria for qualitative synthesis; the majority of studies (59%) investigated psychological therapies rather than pharmacological treatments (35%). The range of psychological therapies tested was diverse, with the majority containing cognitive behavioral therapy (CBT) components (53%), followed by three studies that were psychodynamic-related, three studies that were behavioral therapy-based, and two studies that involved relaxation techniques. We rated individual studies using a modified National Health and Medical Research Council quality and bias checklist and then used the Grading of Recommendations Assessment, Development and Evaluation (GRADE; Grade Working Group, 2004) system to rate the overall quality of the evidence. Despite several randomized controlled trials, the quality of the evidence for positive effects of all psychological and pharmacological treatments on symptoms of adjustment disorder was ranked as low to very low. Future high-quality research in the treatment of adjustment disorder has the potential to make a significant difference to individuals who struggle to recover after stressful events.

The Effectiveness of Support Groups in Asian Breast Cancer Patients: An Integrative Review

Cancer support group has been studied as an intervention to improve patient psychosocial well-being. The effectiveness of support groups among Asian breast cancer (BC) patients has been unclear and received limited attention to the evidence of its effectiveness. The social-cognitive processing theory underlies the principles of support groups and advocates that a positive, supportive social environment can improve cognitive processing. The purpose of this paper is to present an integrative review of research evidence on the effectiveness of cancer support groups with Asian BC patients. Empirical studies related to support group among Asian and Asian American BC patients published between 1982 and April 2014 are reviewed. There are 15 studies selected (12 from the Asian-Pacific region and 3 from Western countries). The review includes 1 qualitative study, 3 descriptive studies, 1 mixed method design, and 10 experimental or quasi-experimental studies. The support group intervention activities include psycho-educational program such as health education, problem-solving, and stress management. These studies support the effectiveness of support group in alleviating psychological distress and supporting quality of life of Asian BC women. Overall, there is limited research on the use and effectiveness of support groups with Asians cancer patients in Asia and in Western countries. Without accounting for Asian immigrants overseas, the Asian population is expected to grow from 4.3 to 5.3 billion by 2050. As cancer patients become more diverse due to global emigration, more rigorous studies examining the effectiveness of psychosocial intervention among transcultural cancer patients are needed.

Group Interventions for Patients with Cancer and HIV Disease: Part III. Moderating Variables and Mechanisms of Action

Growing evidence supports the value of group interventions for individuals who are at risk for or have developed cancer or HIV disease. However, information is more limited concerning how these services can be delivered in an optimal manner, and what processes contribute to their benefits. Parts I and II of this review examined the efficacy of different interventions for individuals at different phases of illness, ranging from primary prevention to late-stage disease, in both psychosocial and biological domains. The current paper examines some of the factors other than phase of illness that might influence group treatment effects (e.g., intervention parameters, participant characteristics), and explores mechanisms of action.

Treatment effect modifiers for the patient education programme for Parkinson's disease

AIM

A recent randomised controlled trial showed significant benefits for Parkinson's disease (PD) caregivers' psychosocial problems and need for help and a trend towards significant improvement of patients' quality of life after participation in the Patient Education Programme for Parkinson's disease (PEPP). Large variations in change scores were found, indicating variation in benefit. The aim of this study was to search for treatment effect modifiers.

METHODS

Outcome measures were patients' quality of life [Parkinson's Disease Questionnaire (PDQ)-39] and caregivers' psychosocial burden [Belastungsfragebogen Parkinson Angehörigen kurzversion (BELA-A-k)]. Candidate treatment effect modifiers were participants' characteristics and baseline scores on psychological questionnaires (BELA-P/A-k, PDQ-39, EQ-5D, Self-rating Depression Scale) and patients' neuropsychological test scores (Mini Mental State Examination, National Adult Reading Test, Dutch version, Word Test, Behavioural Assessment of the Dysexecutive Syndrome rule shift, Trail Making Test, Stroop). Secondary analyses of data from a randomised controlled trial with 64 patients and 46 caregivers were performed using regression analyses with treatment group interaction terms.

RESULTS

No significant modifiers were found for the patients. In the caregiver group, a higher MMSE score of the patient at baseline was found to be a significant predictor of a lower BELA-A-k Bothered by score post-intervention of the caregiver.

CONCLUSIONS

A potential predictor of treatment benefit was found for caregivers of PD patients with better cognitive functioning. This study did not find treatment effect modifiers for PD patients: demographics, disease stage and time of diagnosis, cognitive functioning, level of baseline psychosocial burden, participating with or without a caregiver, and caregiver changes did not influence treatment outcome. The PEPP seems suitable for the majority of patients.

Evaluation of the effectiveness of a group intervention approach for nurses exposed to violent speech or violence caused by patients: a randomized controlled trial

The purpose of this study was to evaluate the effectiveness of a group intervention approach aimed at improving the mental health of psychiatric nurses exposed to violent speech/violence. Sixty-two nurses having experienced serious episodes of violent speech/violence were enrolled in this study. A group intervention approach was used in the intervention group. For both the intervention and the control groups, evaluations were conducted at three time points. Evaluations were conducted using the Impact of Event Scale-Revised (IES-R) and Profile of Mood States (POMS). The results showed that changes in the flashback, hyper-arousal, avoidance behavior, and total scores on the IES-R and anxiety and depression scores on the POMS differed significantly between the two groups. These results suggest that a group intervention approach can lessen the psychological burden of nurses exposed to violence and reduce their mental stress.

Pre-intervention distress moderates the efficacy of psychosocial treatment for cancer patients: a meta-analysis

This meta-analysis examined whether effects of psychosocial interventions on psychological distress in cancer patients are conditional upon pre-intervention distress levels. Published articles and unpublished dissertations between 1980 and 2005 were searched for interventions reporting the Hospital Anxiety and Depression Scale (HADS) or the Spielberger State-Trait Anxiety Inventory (STAI). Multilevel mixed-effects modeling was used to meta-analyze effect-sizes separately for the HADS (27 trials, 2,424 patients) and STAI (34 trials, 2,029 patients). Pre-intervention distress significantly moderated intervention effects, explaining up to 50% of the between-study effect-size variance: effects on anxiety and depression were generally negligible when pre-intervention distress was low and pronounced when it was high. These results could not be explained by differences in intervention type, setting, dose, and whether intervention was targeted at distressed patients. Psychosocial interventions may be most beneficial for cancer patients with elevated distress. Future research should identify which treatment components are most effective for these patients to facilitate optimal treatment tailoring and cost-effective health care.

A feasibility study of psychosocial group intervention for breast cancer patients with first recurrence

GOALS OF WORK

The effects of psychosocial group interventions on improving quality of life (QOL) for patients with recurrent breast cancer are not well known. The objective of this study was to assess the feasibility of a psychosocial group intervention in Japanese women with first recurrence of breast cancer.

PATIENTS AND METHOD

The subjects were consecutively selected from among patients who were diagnosed with a first recurrence of breast cancer. We conducted a 6-week psychosocial group intervention. QOL was assessed using the Profile of Mood States (POMS), the Impact of Event Scale-Revised, the Mental Adjustment to Cancer (MAC) scale, and the European Organization for Research and the Treatment of Cancer (EORTC) Quality of Life Questionnaire-Cancer 30/Breast module 23 (QLQ-C30/Br23) at baseline then immediately and 3 and 6 months after completion of the intervention.

RESULTS

Among 58 eligible patients, written consent was obtained from 28 (48%), and the final evaluation was conducted on 19 subjects. The repeated measured analysis of variance (ANOVA) revealed a significant change in tension-anxiety, depression-dejection, anger-hostility and total mood disturbance on the POMS, helplessness/hopelessness on the MAC scale, and body image and future perspective on the QLQ-C30/Br23. Dunnett's test revealed a significant difference in these scores between baseline and 3 months after the intervention but no difference between baseline and 6 months after the intervention.

CONCLUSION

These results suggested the possibility of a short-term effectiveness of the intervention; however the results were inconclusive because of selected small samples.

Structured intervention in family caregivers of the demented elderly and changes in their immune function

The aim of the present study was to investigate the effects of a group structured intervention on the mental and physical discomfort and immune function of 20 family caregivers. A structured intervention for caregivers consists of five sessions, each of which lasts 90 min. This was a modified version of the program that had been originally developed for cancer patients. All the family caregivers were female and ranged in age from 47 to 66 years (mean: 54.7 +/- 4.4). The period of care at home ranged from 1 to 12 years (mean: 5.8 +/- 2.7). Concerning the original diseases of the care-receivers, 10 had vascular dementia and eight had Alzheimer's disease. Nine out of 20 caregivers had no care support, and seven utilized no public resources such as day-care centers. Only five caregivers felt that they were healthy. Two psychometries, that is, Profile of Mood States (POMS) and General Health Questionnaire-30 (GHQ-30) were administered and blood samples were drawn before and after intervention. Comparison of results showed that there was significant improvement (P < 0.05) in the scores of depression, anger-hostility, fatigue and confusion in the POMS, and physical symptoms, anxiety-mood disorder, suicidality-depression in the GHQ-30. Also, there was significant (P = 0.0325) augmentation of natural-killer cell activity. The present study suggests that this kind of intervention was effective for relieving emotional and physical discomfort, and also for improving immune function.

Effect of psychiatric group intervention on natural-killer cell activity and pregnancy rate

We investigated the effects of psychiatric group intervention on the emotions, natural-killer (NK) cell activity and pregnancy rate in Japanese infertile women by a randomized study. Thirty-seven women completed a 5-session intervention program and were compared with 37 controls. Psychological discomfort and NK-cell activity (47.7% to 34.1%, P<.0001) significantly decreased after the intervention, whereas no significant changes were observed in controls. According to a 1-year follow-up of both groups, the pregnancy rate in the intervention group was significantly higher than that of controls (37.8% vs. 13.5%, P=.03). Psychological group intervention was therefore effective in Japanese infertile women.

Effects of a modified group intervention with early-stage breast cancer patients

The aim of this study was to investigate the clinical effectiveness of a psychiatric intervention program consisting of 5 weekly structured interventions and 3 additional group meetings every two months. Previous studies revealed that a 5 weekly structured intervention program was effective for alleviating psychological discomforts in Japanese breast cancer patients, and that the effectiveness persisted for 6 months for patients without lymph node metastasis or adjustment disorders. Since this 5-session intervention did not have persistent effects in patients with lymph node metastasis and/or adjustment disorders, 3 additional group meetings every two months were added after completion of the 5 weekly structured interventions. A total of 43 breast cancer patients completed the full program. The Profile of Mood States (POMS) scores were compared before, immediately after 5 sessions, immediately after the 3 additional interventions, and 6 months after all programs. As analyzed by POMS scores, the clinical effectiveness of a structured group intervention program persisted for 6 months for patients even with nodal metastases and/or adjustment disorders. These findings of the present study suggested that the 5 weekly intervention program was sufficient for patients without lymph node metastasis or adjustment disorders. In contrast, this intervention program alone was insufficient for patients with nodal metastases and/or adjustment disorders. For them, a new psychiatric intervention program consisting of 5 weekly structured interventions and 3 additional group meetings every two months were effective and sufficient.