Cognitive-existential Group Research Articles

Mechanisms of change of a cognitive-existential group intervention for fear of cancer recurrence: mediation analyses of the FORT trial

Abstract Background: Meta-analyses have demonstrated that brief interventions can address fear of cancer recurrence (FCR), but their mechanisms of action are largely unknown. Our goal was to identify the mediators of treatment efficacy of the Fear Of Recurrence Therapy (FORT) intervention using data from a multisite randomized controlled trial targeting FCR. That randomized controlled trial compared a 6-week cognitive-existential group intervention with an active control group. Methods: Participants (n = 135) were women diagnosed with stage I-III breast or gynecological cancer who were assessed at 4 time points (pretherapy, post-therapy, 3-month, and 6-month follow-up). The primary outcome, changes in FCR at 6 months, was measured with the Fear of Cancer Recurrence Inventory. We examined 6 mediators based on our theoretical model of FCR: perceived risk of recurrence, uncertainty in illness, intolerance of uncertainty, positive beliefs about worrying, reassurance-seeking, and cognitive avoidance. Changes in the possible mediator variables were simultaneously investigated to predict changes in FCR using Generalized Structural Equation Models with robust variance estimation. Results: FORT predicted FCR at 6 months in univariate analyses (β = −8.93, P = .0001). In the model including the 6 possible mediators, changes in uncertainty in illness (β = −8.72, P < .0001) and cognitive avoidance (β = −8.36, P < .0001) mediated the relationship between treatment and changes in FCR. However, FORT still predicted changes in FCR at 6 months (β = −6.35, P = .02), suggesting partial mediation. Conclusions: We identified 2 mechanisms of action that can be incorporated in future interventions. However, other processes that underlie the efficacy of these interventions need to be uncovered.

Research advances in the fear of cancer recurrence in breast cancer patients

This article introduces the definition, research status, measurement tools and influencing factors of fear of cancer recurrence in breast cancer patients. Some measures, such as mindfulness decompression therapy, supportive expression therapy, cognitive behavioral therapy and cognitive-existential group intervention, were put forward in order to provide references for Chinese medical staff to study cancer recurrence fear of breast cancer patients. Key words: Review; Breast neoplasms; Fear of cancer recurrence

Efficiency of Cognitive-Existential Group Therapy on Life Expectancy and Depression of Elderly Residing in Nursing Home

Efficiency of Cognitive-Existential Group Therapy on Life Expectancy and Depression of Elderly Residing in Nursing Home

The Effectiveness of Cognitive-Existential Group Therapy on Reducing Existential Anxiety in the Elderly

The Effectiveness of Cognitive-Existential Group Therapy on Reducing Existential Anxiety in the Elderly

Erratum to: An exploratory study of the worst-case scenario exercise as an exposure treatment for fear of cancer recurrence

Purpose The worst-case scenario (WCS) exercise is part of a manualized cognitive-existential group intervention for fear of cancer recurrence (FCR). It requires cancer survivors to describe the scenario they most fear when they think about the possibility of their cancer returning and to re-read the scenario daily for 1 week as homework. The purpose of this study was to present this novel clinical treatment for FCR and to examine whether at-home repeated exposure to the WCS was related to pre- and post-therapy FCR levels.

An exploratory study of the worst-case scenario exercise as an exposure treatment for fear of cancer recurrence.

The worst-case scenario (WCS) exercise is part of a manualized cognitive-existential group intervention for fear of cancer recurrence (FCR). It requires cancer survivors to describe the scenario they most fear when they think about the possibility of their cancer returning and to re-read the scenario daily for 1week as homework. The purpose of this study was to present this novel clinical treatment for FCR and to examine whether at-home repeated exposure to the WCS was related to pre- and post-therapy FCR levels. Women with breast and gynaecological cancers who received care at The Ottawa Hospital Cancer Centre were recruited to participate in this follow-up study. Consenting participants provided copies of their WCS exercises. The WCS of ten female cancer survivors were collected to examine the homework portion of the exercise. Higher adherence to homework was significantly related to lower post-therapy FCR but not to pre-therapy scores. Baseline levels of FCR may not be a factor influencing inter-session homework adherence to the WCS, while exposure to the WCS resulting from adherence to the homework exercise may influence post-therapy FCR outcomes. These effects remain to be differentiated from the overall therapeutic effect of the 6-week cognitive-existential intervention for FCR, using a larger sample. This study presents preliminary evidence for an upcoming multi-centre trial in which the WCS exercise will be re-examined with larger sample sizes.

Protocol of a randomized controlled trial of the fear of recurrence therapy (FORT) intervention for women with breast or gynecological cancer.

BackgroundClinically significant levels of fear of cancer recurrence (FCR) affect up to 49 % of cancer survivors and are more prevalent among women. FCR is associated with psychological distress, lower quality of life, and increased use of medical resources. Despite its prevalence, FCR is poorly addressed in clinical care. To address this problem, we first developed, and pilot tested a 6-week, 2 h, Cognitive-existential group intervention therapy that targeted FCR in survivors of breast or gynecological cancer. Following the positive outcome of the pilot, we are now testing this approach in a randomized clinical trial (RCT).Goal and hypotheses: This multicenter, prospective RCT aims to test the efficacy of the intervention. The study hypotheses are that, compared to a control group, cancer survivors participating in the intervention (1) will have less FCR, (2) will show more favorable outcomes on the following measures: cancer-specific distress, quality of life, illness uncertainty, intolerance of uncertainty, perceived risk of cancer recurrence, and coping skills. We further postulate that the between-group differences will persist three and 6 months post-intervention.MethodsSixteen groups of seven to nine women are being allocated to the intervention or the control group. The control group receives a 6-week, 2 h, structurally equivalent support group. We are recruiting 144 cancer survivors from four hospital sites in three Canadian cities. The sample size was based on the moderate pre/post-test changes found in our pilot study and adjusted to the drop-out rates. Measurements: The primary outcome, FCR, is measured by the Fear of Cancer Recurrence Inventory. Secondary outcomes measured include cancer-specific distress, perceived risk of cancer recurrence, illness uncertainty, intolerance of uncertainty, coping, and quality of life. We use reliable and recognized valid scales. Participants are to complete the questionnaire package at four times: before the first group session (baseline), immediately after the sixth session, and 3 and 6 months post-intervention. Analysis: In the descriptive analysis, comparison of group equivalent baseline variables, identification of confounding/intermediate variables and univariate analysis are planned. Each participant’s trajectory is calculated using Generalized Estimating Equation models to determine the time and group effects, after considering the correlation structures of the groups. An intent-to-treat analysis approach may be adopted.DiscussionOur Fear of Recurrence Therapy (FORT) intervention has direct implications for clinical service development to improve the quality of life for patients with breast (BC) and gynecological cancer (GC). Based on our pilot data, we are confident that the FORT intervention can guide the development of effective psychosocial cancer survivorship interventions to reduce FCR and improve psychological functioning among women with BC or GC.Trial registrationDr. Christine Maheu registered the trial with ISRCTN registry (Registration number: ISRCTN83539618, date assigned 03/09/2014).

The Effectiveness of Cognitive-Existential Group Therapy on Increasing Hope and Decreasing Depression in Women-Treated With Haemodialysis.

Introduction:Hopefulness is one of the most significant predictors of adaptation in hemodialysis patients, and plays a vital role in the recovery process. In contrast to hopefulness, depression is a frequent psychological reaction of the hemodialysis treatment with many negative consequences. The current research was designed to examine the effect of cognitive-existential treatment on the level of hopefulness and depression in hemodialysis patients.Materials & Methods:This quasi-experimental research included 22 female patients suffering from chronic kidney failure disease undergoing hemodialysis treatment for at least 3 months. The patients were randomly assigned into two groups of experimental and control conditions. The experimental group received a combination of treatment including some elements of “existentialism” philosophy and a “cognitive” approach designed for the Iranian population. The treatment protocol lasted for 12 sessions of 90 minutes twice per week prior to the entry of the patient to the dialysis session. Miller’s hope scale and BDI-II-21 were employed to collect the data. Statistical analysis was performed on the data using analysis of covariance by SPSS: 16 software.Results:The result of the analysis indicated that there was a significant improvement in hopefulness level and decrease in depression of the patients in the experiment condition (P<0.01).Conclusion:The result of analysis showed that cognitive-existential treatment resulted in the increase of hopefulness and decrease level of depression in the hemodialysis patients suffering from chronic kidney failure.

Breast and ovarian cancer survivors' experience of participating in a cognitive-existential group intervention addressing fear of cancer recurrence

PurposeCurrently, very few clinical approaches are offered to cancer survivors dealing with fear of cancer recurrence (FCR). This paper provides an overview of cancer survivors' experience and satisfaction after taking part in a six-week, cognitive-existential (CE) group intervention that aimed to address FCR. MethodIn this qualitative descriptive study, 12 women with breast or ovarian cancer provided in-depth interviews of their experience in taking part in the CE group intervention. ResultsAnalysis of their accounts revealed struggles to face their fears. Yet, by embracing their group experience, the women learned how to confront their fears and gain emotional control. The women reported that the group work was highly valuable. ConclusionFrom the women's analysed accounts, the authors have proposed recommendations for changes to the group work process before moving the study to a full clinical trial. The study's findings also provide valuable insights to other cancer survivor groups who may also be experiencing FCR.

Addressing fear of cancer recurrence among women with cancer: a feasibility and preliminary outcome study.

Evidence suggests that fear of cancer recurrence (FCR) is one of the most frequently cited unmet needs among cancer survivors and is associated with psychological distress, stress-response symptoms, and lower quality of life, as well as increased use of health care resources. Despite these factors, few manualized interventions exist to address FCR among cancer survivors. To develop, manualize, and pilot test the feasibility and preliminary efficacy of a 6-week cognitive-existential (CE) group intervention designed to address FCR in women with breast or ovarian cancer. This study was a single-arm multi-site study with pre-, post-, and 3-month follow-up measurement occasions. A total of 56 breast or ovarian cancer survivors enrolled in the study; 44 completed the CE group intervention. Following the intervention, women experienced a reduction in the primary study outcome measure of FCR and secondary study outcome measures of cancer-specific distress and uncertainty. They also reported improvements in secondary study outcome measures of quality of life and coping. The effect sizes of the observed changes were for the most part in the medium to large effect range; furthermore, almost all changes were sustained at 3-month follow-up. This brief intervention appears feasible and has shown promising results in addressing FCR and related secondary outcomes of cancer-specific distress, uncertainty, quality of life, and coping; however, it should be further tested using a randomized controlled study design to more definitively assess its efficacy. FCR is a near-universal worry for cancer survivors that, when left unaddressed, tends to remain stable over time. This study has important implications for all cancer survivors as it is the first published intervention that provides preliminary evidence of its efficacy in decreasing fear of cancer recurrence.

Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis

Objective: To assess psychosocial morbidity in women with breast cancer and to compare the differential rates between women with early stage and advanced disease. Method: In this report, 303 women with early stage breast cancer, psychiatrically assessed at baseline (as part of a study of cognitive-existential group therapy during adjuvant chemotherapy), are compared with 200 women with advanced breast cancer (similarly assessed in a trial of supportive-expressive group therapy). A structured psychiatric interview plus self-report measures were used to assess psychiatric morbidity, quality of life and cognitive attitude to cancer. Results: The early stage patients, whose mean age was 46 years, were on average 3 months post-surgery and had an overall prevalence of DSM-IV psychiatric diagnosis of 45%. The metastatic patients, whose mean age was 51 years, were on average 63 months post-primary diagnosis and had an overall prevalence of DSM-IV diagnosis of 42%; the difference between the two rates was not statistically significant. Of women with early stage breast cancer, 36.7% had mood disorders, 9.6% suffering from major depression and 27.1% from minor depression. In the metastatic sample 31% had mood disorders, 6.5% having major depression and 24.5% with minor depression. Anxiety disorders were present in 8.6% of the early stage group and 6% of women with advanced disease. Fatigue, a past history of depression, and cognitive attitudes of helplessness, hopelessness or resignation were significantly associated with depression in both groups. The women from the metastatic sample were significantly less distressed by hair loss but more dissatisfied with body image, and had higher rates of lymphoedema and hot flushes than the early stage women. Conclusions: The rates of psychosocial distress are high, and similar, across patients with both early and advanced stage breast cancer, although the illness related causes of distress are different. These data present a challenge to clinical services to provide a comprehensive range of support services to ameliorate this distress.

Cognitive‐existential group psychotherapy for women with primary breast cancer: A randomised controlled trial

We conducted a randomised, controlled trial of cognitive-existential group therapy (CEGT) for women with early stage breast cancer receiving adjuvant chemotherapy with the aim of improving mood and mental attitude to cancer. Women were randomised to 20 sessions of weekly group therapy plus 3 relaxation classes or to a control arm receiving 3 relaxation classes. Assessments, independently done at baseline, 6 and 12 months, included a structured psychiatric interview and validated questionnaires covering mood, attitudes to cancer, family relationships, and satisfaction with therapy. Three hundred and three of 491 (62%) eligible patients participated over 3 years. Distress was high pre-intervention: 10% were diagnosed as suffering from major depression, 27% from minor depression and 9% from anxiety disorders. On an intention-to-treat analysis, there was a trend for those receiving group therapy (n=154) to have reduced anxiety (p=0.05, 2-sided) compared to controls (n=149). Women in group therapy also showed a trend towards improved family functioning compared to controls (p=0.07, 2-sided). The women in the groups reported greater satisfaction with their therapy (p<0.001, 2-sided), appreciating the support and citing better coping, self-growth and increased knowledge about cancer and its treatment. They valued the CEGT therapy. Overall effect size for the group intervention was small (d=0.25), with cancer recurrence having a deleterious effect in three of the 19 therapy groups. Psychologists as a discipline achieved a moderate mean effect size (d=0.52). CEGT is a useful adjuvant psychological therapy for women with early stage breast cancer. Interaction effects between group members and therapists are relevant to outcome. Group-as-a-whole effects are powerful, but the training and experience of the therapist is especially critical to an efficacious outcome.

Cognitive-existential group therapy for patients with primary breast cancer--techniques and themes.

We describe a model of cognitive-existential group therapy designed to be integrated over 6 months with regimens of adjuvant chemotherapy given as conventional medical treatment to breast cancer patients with stage 1 and 2 disease. Our broad therapy goals are for members to develop a supportive network, work through grief over losses, improve problem solving and develop cognitive strategies to maximise coping, enhance a sense of mastery over life and re-evaluate priorities for the future. Specific group themes include death anxiety, fear of recurrence, living with uncertainty, understanding treatment with chemotherapy, radiotherapy and hormone regimens, the collaborative doctor-patient relationship, body and self image, sexuality, relationships with partner, friends and family, surgical reconstruction, life style effects and future goals. Active coping skills are developed through teaching formal problem solving and cognitive restructuring of automatic negative thoughts. Technical aspects of the therapy are discussed.

Cognitive‐Existential Group Therapy for Patients with Primary Breast Cancer — Techniques and Themes

We describe a model of cognitive-existential group therapy designed to be integrated over 6 months with regimens of adjuvant chemotherapy given as conventional medical treatment to breast cancer patients with stage 1 and 2 disease. Our broad therapy goals are for members to develop a supportive network, work through grief over losses, improve problem solving and develop cognitive strategies to maximise coping, enhance a sense of mastery over life and re-evaluate priorities for the future. Specific group themes include death anxiety, fear of recurrence, living with uncertainty, understanding treatment with chemotherapy, radiotherapy and hormone regimens, the collaborative doctor-patient relationship, body and self image, sexuality, relationships with partner, friends and family, surgical reconstruction, life style effects and future goals. Active coping skills are developed through teaching formal problem solving and cognitive restructuring of automatic negative thoughts. Technical aspects of the therapy are discussed. © 1997 John Wiley & Sons, Ltd.