Existential Interventions Research Articles

Psychosocial intervention in palliative care: What do psychologists need to know.

Emotional and existential suffering is prevalent in advanced diseases and psychologists have valuable skills to support people in this time of life. Yet, psychologists are rarely integrated in palliative care and relevant training is sparse. Being integrated in other areas of health, it is likely that we will be supporting these patients, whether integrated in a specialized team or not. This article is meant to serve psychologists, already skilled in the art and science of psychosocial intervention, who may find themselves supporting patients with advanced disease. Relevant history of palliative care is provided to elucidate palliative philosophy and approach. Evidence-based existential interventions will be reviewed. Integration of psychological models and both palliative theory and practice is provided to support palliative-appropriate case conceptualizations. Finally, case examples are provided throughout to help readers reconcile their existing practice in this domain of care.

The Scrooge Group Therapy: A Meaning-Centered Group Therapy for Outpatients Following CBT

Perceiving one’s own life as meaningful is associated with mental health and well-being. Yet, psychotherapeutic interventions to enhance the experience of meaning have not been sufficiently evaluated in the context of cognitive behavioral therapy (CBT). The aim of this study was to pilot a group therapy to increase meaning and to evaluate its feasibility and effectiveness. A small ( N = 8) study was conducted with patients after or near the end of their CBT treatment. The intervention was evaluated with a mixed-methods design that utilized qualitative interviews as well as quantitative questionnaires (Satisfaction with Life Scale, Well-being Scale) at pre- and post-treatment as well as after 8-week follow-up. Additional measures (Depression Anxiety Stress Scale, Positive Mental Health Scale, and the existential subscale of the McGill Quality of Life Scale) were administered after each session. Findings indicate that the group therapy was feasible and effective. Participants benefited from the therapy to a moderate to high extent, both in terms of symptom reduction and in terms of an improvement in general psychological well-being. Participants reported positive emotional and behavioral changes. Based on our findings, we conclude that existential interventions are meaningful extensions to CBT.

Spiritual Interventions Delivered by Nurses to Address Patients' Needs in Hospitals or Long-Term Care Facilities: A Systematic Review.

Introduction: Despite increasing evidence of the benefits of spiritual care and nurses' efforts to incorporate spiritual interventions into palliative care and clinical practice, the role of spirituality is not well understood and implemented. There are divergent meanings and practices within and across countries. Understanding the delivery of spiritual interventions may lead to improved patient outcomes. Aim: We conducted a systematic review to characterize spiritual interventions delivered by nurses and targeted outcomes for patients in hospitals or assisted long-term care facilities. Methodology: The systematic review was developed following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, and a quality assessment was performed. Our protocol was registered on PROSPERO (Registration No. CRD42020197325). The CINAHL, Embase, PsycINFO, and PubMed databases were searched from inception to June 2020. Results: We screened a total of 1005 abstracts and identified 16 experimental and quasi-experimental studies of spiritual interventions delivered by nurses to individuals receiving palliative care or targeted at chronic conditions, such as advanced cancer diseases. Ten studies examined existential interventions (e.g., spiritual history, spiritual pain assessment, touch, and psychospiritual interventions), two examined religious interventions (e.g., prayer), and four investigated mixed interventions (e.g., active listening, presence, and connectedness with the sacred, nature, and art). Patient outcomes associated with the delivery of spiritual interventions included spiritual well-being, anxiety, and depression. Conclusion: Spiritual interventions varied with the organizational culture of institutions, patients' beliefs, and target outcomes. Studies showed that spiritual interventions are associated with improved psychological and spiritual patient outcomes. The studies' different methodological approaches and the lack of detail made it challenging to compare, replicate, and validate the applicability and circumstances under which the interventions are effective. Further studies utilizing rigorous methods with operationalized definitions of spiritual nursing care are recommended.

The Present State of Existential Interventions Within Palliative Care.

Existential psychotherapy is rooted in the European tradition of existential philosophy. Existential philosophers include Husserl and Heidegger, who were German, and Camus, Sartre, de Beauvoir, and Merleau-Ponty, who were French. Their works contain existentially ultimate themes such as death, freedom, meaninglessness, and isolation. Based on their knowledge of existential philosophy, Binswanger, Frankl, and Boss developed the earlier existential psychotherapies such as Dasein-analysis and Logotherapy, while May, Laing, Yalom, May, and Wong started later existential psychotherapies in the British and American culture. Focusing on patients with advanced cancer and/or terminal care, we found nine types of existential psychotherapies which were investigated using randomized controlled trials (RCTs): Meaning-Centered Group Psychotherapy (MCGP), Individual Meaning-Centered Psychotherapy (IMCP), Meaning-Making intervention (MMi), Meaning of Life Intervention, Managing Cancer and Living Meaningfully (CALM), Hope Intervention, Cognitive and Existential Intervention, Dignity Therapy, and Life-Review Interviews, from 19 relevant RCTs. All deal with death, meaninglessness, isolation, and freedom. Particularly, MCGP, IMCP, MMi, Meaning of Life intervention, and CALM emphasize finding and/or making meaning in the individual's life. The effects on existential or spiritual well-being were confirmed in MCGP, IMCP, Meaning of Life intervention, and Life-Review intervention although the number of studies were very few. In the other interventions, there were heterogenous findings and again the number of studies was very small. Further studies are required to investigate the effects of existential psychotherapy on patients with advanced cancer.

Desarrollo de una intervención cognitiva-existencial para disminuir la fatiga por compasión en cuidadores formales

Palliative care aims to improve the quality of life of patients with chronic and advanced illnesses and their families. This requires a multidisciplinary approach from formal caregivers. Though caring for others could be rewarding and this satisfaction relates to higher work engagement and resiliency, formal caregivers of palliative care patients may develop compassion fatigue due to the nature of their work. This fatigue affects caregivers, their interpersonal relationships, and the quality of care they provide. Supporting formal caregivers and improving communication plays a vital role. Considering the efficacy of the existential interventions in other populations, and the lack of testing of these interventions on formal caregivers of palliative care teams, this article aims to describe the design and development of an eight-session cognitive-existential group-based psychoeducational intervention to reduce compassion fatigue and to promote self-care and satisfaction of formal caregivers of palliative care patients in a Latin American context. The intervention used Frankl’s Logotherapy and Ellis’ rational emotive therapy as the theoretical framework and included the necessities of formal caregivers in this specific setting. As a result, this article presents the theoretical development of the intervention and its structure, as well as the objectives and specific content of each session. Empirical research, reported elsewhere, has proven its long-term effectiveness in reducing the compassion fatigue of this population. This makes it a replicable intervention with promising results. Future studies need to continue its evaluation and include professionals in other settings outside palliative care.

O Suicídio na Perspectiva das Psicologias Humanista, Fenomenológica e Existencial: Revisão Sistemática e Metassíntese

Objetivamos analisar as producoes cientificas nacionais sobre o suicidio segundo as psicologias humanista, fenomenologica e existencial. Foi utilizado o metodo de revisao sistematica seguido de uma metassintese qualitativa dos achados. Computamos 18 artigos categorizados e analisados conforme titulo, autoria, base de dados, periodico, ano de publicacao, area de discussao, tipo de estudo, objetivos e resultados. Os resultados demonstram: proeminencia de producoes na Revista da Abordagem Gestaltica; concentracao de publicacoes no PePSIC; aglomeracao de producoes na ultima decada, em razao das politicas de prevencao ao suicidio; expressividade de producoes filiadas a UFRN; concentracao de estudos empiricos norteados pelo metodo fenomenologico e influenciados por Heidegger. Os achados foram sintetizados segundo: as relacoes entre psicopatologia e suicidio; os motivos e explicacoes sobre o suicidio; o pensamento fenomenologico-existencial acerca do suicidio; as praticas e intervencoes humanista, fenomenologica e existencial no tratamento. Concluimos que os estudos consideram as tradicionais perspectivas biomedicas de pensamento e manejo do suicidio, contudo tentam repensar isso com base em lentes clinicas mais subjetivas e compreensivas.

Existential interventions for adolescent suicidality: Practical interventions to target the root causes of adolescent distress

In this work we discuss common forms of treatment for suicidality and suicidality among adolescents. Vastly pervasive, crisis intervention-based treatment is found throughout nearly all suicidality treatments regardless of client age or intervention site. Crisis intervention-based approaches often overlook many crucial elements of suicidality in adolescents. We therefore explore elements of existential therapy and their potential merit in treatment for suicide among adolescents. These include existential angst and despair, meaninglessness and isolation. These elements are strong predictors of suicidal thoughts and behaviors in adolescents. While the common crisis-based treatment appropriately addresses immediate safety needs, it can neglect and even exacerbate the existential features that contribute to ongoing, long-term depression and suicidality. Finally, we present three principles of existential therapy with example interventions (theoretical) that can be flexibly applied in clinical settings with depressed and suicidal adolescents. An illustrative case study, which draws on our clinical experience, further details how this existential style might be applied in a typical clinical setting with a suicidal adolescent.

Attachment security and existential distress among patients with advanced cancer

BackgroundFelt security in close relationships may affect individual adaptation responses to existential threat in severe illness. We examined the contribution of attachment security to demoralization, a state of existential distress involving perceived pointlessness and meaninglessness in advanced cancer. MethodA mixed cross-sectional sample of 382 patients with advanced cancer (mean age 59, 60% female) was recruited from outpatient oncology clinics. Participants completed self-report measures of attachment security, demoralization, depression, and physical symptom burden. We used multiple linear regression to analyze the association between attachment security and demoralization, controlling for demographic factors and symptom burden and tested whether attachment security moderated the association of symptom burden with demoralization. Separate analyses compared the contribution of the dimensions of attachment anxiety and attachment avoidance. ResultsThe prevalence of clinically relevant demoralization was 35%. Demoralization was associated with lower attachment security (β = −0.54, 95%CI: −0.62 to 0.46). This effect was empirically stronger for attachment anxiety (β = 0.52, 95%CI: 0.44 to 0.60) compared to attachment avoidance (β = 0.36, 95%CI: 0.27 to 0.45). Attachment security also significantly moderated the association of physical symptom burden with demoralization, such that with less attachment security, there was a stronger association between symptom burden and demoralization. ConclusionAttachment security may protect from demoralization in advanced cancer. Its relative lack, particularly on the dimension of attachment anxiety, may limit adaptive capacities to deal with illness burden and to sustain morale and purpose in life. An understanding of individual differences in attachment needs can inform existential interventions for severely ill individuals.

Effects of existential interventions on spiritual, psychological, and physical well‐being in adult patients with cancer: Systematic review and meta‐analysis of randomized controlled trials

To synthesize the evidence of existential interventions in adult patients with cancer. Embase, MEDLINE, CENTRAL, CINAHL, PsycINFO, PSYNDEX, and the WHO ICTRP were searched up until 26 January 2018. Eligibility criteria for studies were (1) adult patients with cancer, (2) evaluation of existential interventions, (3) compared with active/non-active control, (4) assessing relevant spiritual, psychological, or physical outcomes, and (5) conducted as randomized controlled trials. Standardized mean differences (Hedges' g) were calculated, and meta-analyses were conducted using random effects models. Effects were aggregated within four time horizons (post-treatment; ≤3months; ≤6months; >6months). Heterogeneity was assessed by forest plots and I2 . Risk of bias was assessed using the Cochrane Risk of Bias Tool. This review has been registered with Prospero (CRD42016042895). A total of 3461 records were identified, of which 30 unique studies (3511 participants) were included in the review and 24 studies were included in meta-analyses. Existential interventions showed significant effects on existential well-being (g=0.52; CI[0.13; 0.91; k=10; I2 =85%) and quality of life (g=0.21; CI[0.01; 0.42]; k=17; I2 =75%) at post-treatment, on hope at post-treatment (g=0.43; CI[0.12; 0.74]; k=12; I2 =86%) and after 6months (g=0.25; CI[0.02; 0.48]; k=3; I2 =0%) and on self-efficacy at post-treatment (g=0.50; CI[0.09; 0.90]; k=2; I2 =0%). No significant effects were found on the remaining outcomes and time points. Significant moderator effects were found for professional background of therapists, intervention concept, number of sessions, and setting. This systematic review and meta-analysis provides evidence that adult patients with cancer across all stages and types benefit from existential interventions. Future research should strive towards a higher standardization in particular with respect to outcome assessments.

Existential distress and meaning-focused interventions in cancer survivorship.

Cancer can challenge fundamental assumptions about security, controllability and life priorities, which may lead to clinically relevant existential distress. We review recent studies on the prevalence of existential distress in cancer survivors, its distinctness from other distress concepts and interventions to address cancer-specific existential challenges. We further describe psychological mechanisms that may underlie change resulting from such interventions. One-third to one-half of cancer survivors experienced existential fears and concerns related to reduced control, identity and uncertainty about the future. Clinically relevant levels of demoralization (a state comprising loss of meaning and a sense of poor coping) were found in one in four to five cancer patients in mixed samples. Existential interventions have shown positive effects in facilitating personal meaning and promoting psychological adaptation. Existential distress can be understood as a distinct dimension of cancer-related distress requiring attention from healthcare professionals. Psychosocial interventions can facilitate dealing with existential challenges during and while transitioning to longer term survivorship. Such interventions can effectively support survivors to manage uncertainty, link cancer to their life story and engage in meaningful activity despite an uncertain and potentially foreshortened future.

P3.05-001 Psychological Intervention to Treat Distress and Suffering Experienced by People with Lung Cancer Nearing the End-Of-Life: Topic: Symptoms, Therapeutic Interventions

Despite advances in medical interventions, lung cancer continues to be associated with a poor prognosis with approximately 16% of people with lung cancer living five years post diagnosis. This poor prognosis can contribute to depression, anxiety, death anxiety and existential concerns and fears relating to meaning and purpose of life. There is a growing body of evidence indicating that behavioral and psycho-educational interventions are efficacious in treating depression and anxiety in lung cancer patients, however, little is known about how to psychologically treat suffering and distress nearer to the end-of-life. A comprehensive search using PsycINFO and Medline was undertaken to identify existential and meaning centered psychotherapies that were used towards the end-of-life with people with cancer. As the research in the area is in its infancy, all quantitative study designs and qualitative studies were included. Studies that focused on physical symptom management, dyads and bereavement interventions, measurement of psychological distress or existential concerns were excluded. The search yielded a total of 62 articles, of which only 34 examined the use of psychotherapies towards the end-of-life care of people with cancer. The majority of these studies were focused on women with breast cancer, used different outcome measures and included very few, if any, participants with lung cancer. These studies identified and described at least 14 novel psychotherapeutic interventions that could be used towards the end-of-life. These interventions included: Legacy Activities, Life Review Therapy, Meaning-Centered Group Psychotherapy, Individual Meaning-Centered Psychotherapy, Dignity Therapy, Forgiveness Therapy, Meaning-Making Psychotherapy, Outlook Psychotherapy, Supportive Group Interventions, The Healing Journey Intervention, Cognitive Existential Interventions, Re-creating Your Life Therapy, Mindfulness Interventions and Managing Cancer and Living Meaningfully. These interventions varied in the number of sessions and the level of training required to administer the interventions. Some of these interventions were manualized and others were less structured in their approach. Some of these interventions show potential in alleviating distress and suffering, improving life satisfaction, self-esteem and mood. There are only a small number of studies that evaluate the efficacy of psychotherapeutic interventions to be used with people with advanced cancer towards the end-of-life. Although results are promising it is difficult to conclude that one intervention is better than another. Further research is required to trial and adapts these interventions for use with people with lung cancer towards the end-of-life.

Existential therapies: a meta-analysis of their effects on psychological outcomes.

To review the evidence on the efficacy of different types of existential therapies: a family of psychological interventions that draw on themes from existential philosophy to help clients address such issues in their lives as meaning and death anxiety. Relevant electronic databases, journals, and reference lists were searched for eligible studies. Effects on meaning, psychopathology (anxiety and depression), self-efficacy, and physical well-being were extracted from each publication or obtained directly from its authors. All types of existential therapy for adult samples were included. Weighted pooled mean effects were calculated and analyses performed assuming fixed-effects model. Twenty-one eligible randomized controlled trials of existential therapy were found, from which 15 studies with unique data were included, comprising a total of 1,792 participants. Meaning therapies (n = 6 studies) showed large effects on positive meaning in life immediately postintervention (d = 0.65) and at follow-up (d = 0.57), and had moderate effects on psychopathology (d = 0.47) and self-efficacy (d = 0.48) at postintervention; they did not have significant effects on self-reported physical well-being (n = 1 study). Supportive-expressive therapy (n = 5) had small effects at posttreatment and follow-up on psychopathology (d = 0.20, 0.18, respectively); effects on self-efficacy and self-reported physical well-being were not significant (n = 1 and n = 4, respectively). Experiential-existential (n = 2) and cognitive-existential therapies (n = 1) had no significant effects. Despite the small number and low quality of studies, some existential therapies appear beneficial for certain populations. We found particular support for structured interventions incorporating psychoeducation, exercises, and discussing meaning in life directly and positively with physically ill patients. It is important to study more precisely which existential intervention works the best for which individual client.

A cognitive-existential intervention to improve existential and global quality of life in cancer patients: A pilot study.

We developed a specific cognitive-existential intervention to improve existential distress in nonmetastatic cancer patients. The present study reports the feasibility of implementing and evaluating this intervention, which involved 12 weekly sessions in both individual and group formats, and explores the efficacy of the intervention on existential and global quality of life (QoL) measures. Some 33 nonmetastatic cancer patients were randomized between the group intervention, the individual intervention, and the usual condition of care. Evaluation of the intervention on the existential and global QoL of patients was performed using the existential well-being subscale and the global scale of the McGill Quality of Life (MQoL) Questionnaire. All participants agreed that their participation in the program helped them deal with their illness and their personal life. Some 88.9% of participants agreed that this program should be proposed for all cancer patients, and 94.5% agreed that this intervention helped them to reflect on the meaning of their life. At post-intervention, both existential and psychological QoL improved in the group intervention versus usual care (p = 0.086 and 0.077, respectively). At the three-month follow-up, global and psychological QoL improved in the individual intervention versus usual care (p = 0.056 and 0.047, respectively). This pilot study confirms the relevance of the intervention and the feasibility of the recruitment and randomization processes. The data strongly suggest a potential efficacy of the intervention for existential and global quality of life, which will have to be confirmed in a larger study.

Alienation and Psychological Wellbeing: Moderation by Resilience

This study adopted the radical perspective of perceived alienation in interpersonal, political and socio-economic domains of life and examined their relationships to psychological wellbeing. The moderator role of resilience on the relationship of the three facets of alienation and psychological wellbeing was also investigated. Psychological wellbeing was conceptualized as self-report of psychological distress. Participants were 337 undergraduate students (164 males, 173 females; Mage = 23.42, SD = 3.70) who are indigenous young adults of the oil-rich Niger Delta region of Nigeria. Pearson’s correlations and multiple regression analysis were used to analyse the data. Results showed that interpersonal alienation, political alienation and socio-economic alienation were positively associated with psychological distress while resilience was negatively related to psychological distress. Psychological distress was also predicted by alienation and resilience. Resilience neither moderated the relationship of interpersonal alienation and psychological distress nor political alienation and psychological distress but the relationship between socio-economic alienation and psychological distress was moderated by resilience. It was concluded that initiation of resilience building programmes as a form of cognitive-behavioural and existential interventions may buffer the negative relationship of alienation to psychological distress.

What to Do When there is Nothing to Do: The psychotherapeutic value of Meaning Therapy in the treatment of late life depression

Psychotherapeutic treatment with the goal of cure, of course, is the standard within the healing professions but when we are dealing with late life depression where there is no hope for longevity, the agenda necessarily must shift from cure to care, from treatment with the goal of renewed healthy living to a focus upon the palliative aspects of a limited prognosis. Here, then, the clinician is faced with the challenge of existential intervention with an emphasis upon the “moment” rather than the future. The encroachment of ennui upon the elderly, particularly and especially those who have been actively engaged in a full life of service such as the clergy, physicians, teachers, and attorneys, can be a traumatic and debilitating experience.When hope for the future is not being sought but rather an effective and celebrative address to the existential realities confronting the elderly patient who is facing decline and death, the quest for those “happy moments” conjured in the patient’s memory constitute a promising field of treatment.Geriatric logotherapy is uniquely constructed to do just that.

Perceived Benefits and Psychosocial Outcomes of a Brief Existential Family Intervention for Cancer Patients/Survivors

This study assessed a range of benefits from participation in a brief existential intervention consisting of a semi-structured videotaped interview with cancer patients and their families designed to illuminate a life legacy for the family (the Life Tape Project [LTP]). Results indicated the majority reported intervention-specific benefits, especially in the areas of symbolic immortality (passing on personal values and philosophy), self-reflection and growth, and improved family cohesion and communication. Participants, particularly those who had perceived their cancer as a threat of death, serious injury, or threat to their physical integrity, and responded with intense fear or helplessness, also reported more general reductions in mood disturbance, improvements in aspects of well-being (including overall quality of life), satisfaction with the understanding they received, and enhanced cancer-related posttraumatic growth. In short, the LTP is a brief, inexpensive, existential intervention that can yield broad positive psychosocial changes for a majority of participants.

Hawaii: Culture Shock, the Invisible MMPI, and Clinical Vignettes

A review of past and present psychological applications in tropical Hawaii in vignette format, including the appearance and disappearance of the MMPI as a section instrument, case histories of a parricide and his brother, senile pseudo-psychosis and an existential intervention, a forbidden island of culture suppression, and a 30-year follow-up of seasonal psychosis.

Impact of a meaning‐centered intervention on job satisfaction and on quality of life among palliative care nurses

Palliative care (PC) nurses experience several recurrent organizational, professional, and individual challenges. To address existential and emotional demands, the meaning-centered intervention was recently developed. The intervention applied didactic and process-oriented strategies, including guided reflections, experiential exercises, and education based on themes of Viktor Frankl's logotherapy. The objective of this study was to test its efficiency to improve job satisfaction and quality of life in PC nurses from three regional districts in Quebec Province, Canada. A randomized waiting-list group design was conducted, intervention group (n=56) versus waiting-list group (n=53). Job satisfaction, perception of benefits of working in PC, and spiritual and emotional quality of life were measured at pre-, posttest, and 3-month follow-up. The PC nurses in the experimental group reported more perceived benefits of working in PC after the intervention and at follow-up. Spiritual and emotional quality of life remained, however, unaffected by the intervention. To explain null findings, theoretical and methodological challenges, related to existential interventions, such as choice of outcomes, and selection bias (participants recruited were healthy workers) are discussed. Future directions and strategies to deal with those issues are proposed.

Existential concerns among patients with cancer and interventions to meet them: an integrative literature review

An integrative literature review was undertaken to explore existential concerns among patients with cancer with respect to components, related concepts and targets of interventions. Comprehensive searches in MEDLINE, CINAHL, PsychINFO, Social Citation Index, SweMed+, Eurethics, NLM Gateway, Faculty of 1000 Medicine, Cochrane Library, EMBACE were undertaken. Each paper was read and classified according to design as descriptive qualitative, descriptive quantitative or interventional. Main themes, interventions and outcomes were identified. The searches yielded a total of 162 articles, of which 109 met inclusion criteria. Existential components from the qualitative studies were divided into two main themes: struggle to maintain self-identity and threats to self-identity. Quantitative studies mainly concerned relationships between existential concerns and other concepts. Interventions and assessed outcomes were consistent with components and relationships found in the descriptive studies. Relationships concerned physical and psychological domains; however, few interventions were evaluated against physical outcomes. No interventions applicable to everyday health-care practice were found. Interventions targeted and evaluated concepts related to existential concerns found in the descriptive studies. Gaps in research on existential concerns in patients with cancer include the need to clarify the concept; how patients' existential well-being may best be supported by health-care professionals in everyday practice; effects of existential interventions on physical symptoms; and stability of results of interventions.

The Life Tape Project: Increasing Family Social Support and Symbolic Immortality with a Brief Existential Intervention for Cancer Patients and Their Families

Cancer poses a powerful threat to the emotional equilibrium of patients and their families. A key role of the family and medical team is to provide a supportive environment as the patient confronts the reality of death. Few interventions have been developed to help families support patients in dealing with fears of death and dying. We present one such approach, the Life Tape Project (LTP), that helps bring families closer together, increases communication, and acts as an existential intervention leading to greater sense of legacy, meaning, self-awareness, identity, and connection. Additionally, the results of a pilot study exploring the benefits of the LTP are presented, and we describe symbolic immortality, an aspect of existential coping, to illuminate how existential and social support factors can work together to benefit patients and their families.