Skip to main content Accessibility help
×
Home

Randomized clinical trial on cognitive therapy for depression in women with metastatic breast cancer: Psychological and immunological effects

  • JOSÉE SAVARD (a1) (a2), SÉBASTIEN SIMARD (a1) (a2), ISABELLE GIGUÈRE (a1), HANS IVERS (a1) (a2), CHARLES M. MORIN (a2), ELIZABETH MAUNSELL (a3) (a4), PIERRE GAGNON (a5) (a6), JEAN ROBERT (a4) and DANIÈLE MARCEAU (a7)...

Abstract

Objective: Depression is particularly prevalent in patients with advanced cancer. Cognitive therapy (CT) is an empirically supported treatment for depression in the general population. However, efficacy remains to be demonstrated in patients with advanced cancer. A prior controlled trial of CT in a group format showed improvements in depression, mood disturbance, and self-esteem; however, these effects were not maintained over time. Studies examining the efficacy of individual format CT interventions that may ensure more long-term maintenance of benefits are necessary. This study assessed the efficacy of CT for depression administered individually in women with metastatic breast cancer and its effect on immune function.

Method: Forty-five women were randomly assigned to either individual CT or to a waiting-list control (WLC) condition. CT was composed of eight weekly sessions of CT and three booster sessions administered at 3-week intervals following the end of treatment.

Results: Patients treated with CT had significantly lower scores on the Hamilton Depression Rating Scale at posttreatment compared to untreated patients. Pooled data from both groups indicated significant reductions of depressive symptoms from pre- to posttreatment, as well as reduction of associated symptoms including anxiety, fatigue, and insomnia symptoms. These effects were well sustained at the 3- and 6-month follow-up evaluations. CT for depression did not appear to have a significant impact on immune functioning.

Significance of results: Findings of this study support the efficacy of CT for depression in this population and suggest that the administration of individual and booster sessions after treatment termination may be instrumental in sustaining the treatment effects over time.

Copyright

Corresponding author

Corresponding author: Josée Savard, Ph.D., Laval University Cancer Research Center, 11 Côte du Palais, Québec, Québec, G1R 2J6, Canada. E-mail: josee.savard@psy.ulaval.ca

References

Hide All

REFERENCES

Aaronson, N.K., Ahmedzai, S., & Bergman, B. (1993). The EORTC QLQ-C30: A quality of life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85, 365376.
American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association.
Andersen, B.L., Farrar, W.B., Golden-Kreutz, D.M., et al. (2004). Psychological, behavioral, and immune changes after a psychological intervention: A clinical trial. Journal of Clinical Oncology, 22, 35703580.
Antoni, M.H., Lehman, J.M., Kilbourn, K.M., Boyers, A.E., Culver, J.L., Alferi, S.M., et al. (2001). Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, 20(1), 2032.
Bagby, R.M., Ryder, A.G., Schuller, D.R., et al. (2004). The Hamilton Depression Rating Scale: Has the gold standard become a lead weight? American Journal of Psychiatry, 161, 21632177.
Bastien, C.H., Vallières, A., & Morin, C.M. (2001). Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Medicine, 2, 297307.
Beck, A.T., Kovacs, M., & Weissman, A. (1979a). Assessment of suicidal intention: The Scale for Suicide Ideation. Journal of Consulting and Clinical Psychology, 47, 343352.
Beck, A.T., Rush, A.J., Shaw, B.F., et al. (1979b). Cognitive Therapy of Depression. New York: The Guilford Press.
Beck, A.T., Ward, C.E., Mendelson, M., et al. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561571.
Bird, K.D. (2002). Confidence intervals for effect sizes in analysis of variance. Educational and Psychological Measurement, 62, 197226.
Blackburn, I.M., Eunson, K.M., & Bishop, S. (1986). A two-year naturalistic follow-up of depressed patients treated with cognitive therapy, pharmacotherapy and combination of both. Journal of Affective Disorders, 10, 6775.
Bourque, P. & Beaudette, D. (1982). Étude psychométrique du questionnaire de dépression de Beck auprès d'un échantillon d'étudiants universitaires francophones. Revue Canadienne des Sciences du Comportement, 14, 211218.
Brugha, T., Bebbington, P., Tennant, C., et al. (1985). The List of Threatening Experiences: A subset of 12 life event categories with considerable long-term contextual threat. Psychological Medicine, 15, 189194.
Chang, L., Gusewitch, G.A., Chritton, D.B.W., et al. (1993). Rapid flow cytometric assay for the assessment of natural killer cell activity. Journal of Immunological Methods, 166, 4554.
Cohen, S. & Herbert, T.B. (1996). Health psychology: Psychological factors and physical disease from the perspective of human psychoneuroimmunology. Annual Review of Psychology, 47, 113142.
Cunningham, A.J., Edmonds, C.V.I., Jenkins, G.P., et al. (1998). A randomized controlled trial of the effects of group psychological therapy on survival in women with metastatic breast cancer. Psycho-Oncology, 7, 508517.
De Groote, D., Zangerle, P.F., Gevaert, Y., et al. (1992). Direct stimulation of cytokines (IL-1-B, TNF-a, IL-2, IFN-y and GM-CSF) in whole blood: Comparison with isolated PBMC stimulation. Cytokine, 4, 239248.
DeRubeis, R.J. & Crits-Christoph, P. (1998). Empirically supported individual and group psychological treatments for adult mental disorders. Journal of Consulting and Clinical Psychology, 66, 3752.
DeRubeis, R.J., Hollon, S.D., Amsterdam, J.D., et al. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62, 409416.
Edelman, S., Bell, D.R., & Kidman, A.D. (1999a). A group cognitive behaviour therapy programme with metastatic breast cancer patients. Psycho-Oncology, 8, 295305.
Edelman, S., Lemon, J., Bell, D.R., et al. (1999b). Effects of group CBT on the survival time of patients with metastatic breast cancer. Psycho-Oncology, 8, 474481.
Edgar, L., Rosberger, Z., & Nowlis, D. (1992). Coping with cancer during the first year after diagnosis. Cancer, 69, 817828.
Edwards, B.C., Lambert, M.J., Moran, P.W., et al. (1984). A meta-analytic comparison of the Beck Depression Inventory and the Hamilton Rating Scale for Depression as measure of treatment outcome. British Journal of Clinical Psychology, 23, 9399.
Evans, M.D., Hollon, S.D., DeRubeis, R.J., et al. (1992). Differential relapse following cognitive therapy and pharmacotherapy for depression. Archives of General Psychiatry, 49, 802808.
Fava, G.A., Grandi, S., Zielezny, M., et al. (1994). Cognitive behavioral treatment of residual symptoms in primary major depressive disorder. American Journal of Psychiatry, 151, 12951299.
Fawzy, F.I., Cousins, N., Fawzy, N.W., Kemeny, M.E., Elashoff, R., & Morton, D. (1990). A structured psychiatric intervention for cancer patients. I Changes over time in methods of coping and affective disturbance. Archives of General Psychiatry, 47, 720725.
Fillion, L., Gelinas, C., Simard, S., et al. (2003). Validation evidence for the French Canadian adaptation of the Multidimensional Fatigue Inventory as a measure of cancer-related fatigue. Cancer Nursing, 26, 143154.
Fillion, L., Kohn, P., Gagnon, P., et al. (2001). The Inventory of Recent Life Experiences for Cancer Patients (IRLE-C): A decontaminated measure of cancer-based hassles. Psychology and Health, 16, 443459.
First, M.B., Spitzer, R.L., Gibbon, M., et al. (1996). Structured Clinical Interview for DSM-IV Axis I Disorders–Patient Edition (SCID-I/P, Version 2.0). New York: Biometrics Research Department, New York State Psychiatric Institute.
Frigon, J.-Y. & Laurencelle, L. (1993). Analysis of covariance: A proposed algorithm. Educational and Psychological Measurement, 53, 118.
Garssen, B. & Goodkin, K. (1999). On the role of immunological factors as mediators between psychosocial factors and cancer progression. Psychiatry Research, 85, 5161.
Goodwin, P., Leszcz, M., Ennis, M., et al. (2001). The effect of group psychosocial support on survival in metastatic breast cancer. New England Journal of Medicine, 345, 17191726.
Goodwin, P.J. (2004). Support groups in breast cancer: When a negative result is positive. Journal of Clinical Oncology, 22, 42444246.
Greer, S., Moorey, S., Baruch, J.D.R., Watson, M., Robertson, B.M., Mason, A., et al. (1992). Adjuvant psychological therapy for patients with cancer: A prospective randomised trial. British Medical Journal, 304, 675680.
Gruber, B.L. (1993). Immunological responses of breast cancer patients to behavioral interventions. Biofeedback and Self-Regulation, 18, 222.
Hamilton, M.A. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5661.
Herbert, T.B. & Cohen, S. (1993). Depression and immunity: A meta-analytic review. Psychological Bulletin, 113, 472486.
Hollon, S.D., DeRubeis, R.J., Evans, M.D., et al. (1992). Cognitive therapy and pharmacotherapy for depression: Singly and in combination. Archives of General Psychiatry, 49, 774781.
Hollon, S.D., DeRubeis, R.J., Shelton, R.C., et al. (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of General Psychiatry, 62, 417422.
Hotopf, M., Chidgey, J., Addington-Hall, J., et al. (2002). Depression in advanced disease: A systematic review. Part 1. Prevalence and case finding. Palliative Medicine, 16, 8197.
Irwin, M. (1999). Immune correlates of depression. Advances in Experimental Medicine and Biology, 461, 124.
Jarrett, R.B., Basco, M.R., Risser, R., et al. (1998). Is there a role for continuation phase cognitive therapy for depressed outpatients? Journal of Consulting and Clinical Psychology, 66, 10361040.
Keselman, H.J., Algina, J., & Kowalchuk, R.K. (2001). The analysis of repeated measures designs: A review. British Journal of Mathematical and Statistical Psychology, 54, 120.
Kirchner, H., Kleinicke, C., & Digel, W. (1982). A whole-blood technique for testing production of human interferon by leukocytes. Journal of Immunological Methods, 48, 213219.
Kline, R.B. (2004). Beyond Significance Testing: Reforming Data Analysis Methods in Behavioral Research. Washington, DC: American Psychological Association.
Kovacs, M., Rush, A., Beck, A.T., et al. (1981). Depressed outpatients treated with cognitive therapy or pharmacotherapy: A one-year follow-up. Archives of General Psychiatry, 38, 3339.
Kroesen, B.-J., Mesander, G., ter Haar, J.G., et al. (1992). Direct visualisation and quantification of cellular cytotoxicity using two colour fluorescence. Journal of Immunological Methods, 156, 4754.
Lambert, M.J., Hatch, D.R., Kingston, M.D., et al. (1986). Zung, Beck, and Hamilton Rating Scales as measures of treatment outcome: A meta-analytic comparison. Journal of Consulting and Clinical Psychology, 54, 5459.
Lambert, M.J., Masters, K.S., & Astle, D. (1988). An effect-size comparison of the Beck, Zung, and Hamilton rating scales for depression: A three-week and twelve-week analysis. Psychological Reports, 63, 467470.
Larson, M.R., Duberstein, P.R., Talbot, N.L., et al. (2000). A presurgical psychosocial intervention for breast cancer patients: Psychological distress and the immune response. Journal of Psychosomatic Research, 48, 187194.
Lévesque, M., Savard, J., Simard, S., et al. (2004). Efficacy of cognitive therapy for depression among women with metastatic cancer: A single-case experimental study. Journal of Behavior Therapy and Experimental Psychiatry, 35, 287305.
Marchioro, G., Azzarello, G., Checchin, F., Perale, M., Segati, R., Sampognaro, E., et al. (1996). The impact of a psychological intervention on quality of life in non-metastatic breast cancer. European Journal of Cancer, 32A(9), 16121615.
McGregor, B.A., Antoni, M.H., Boyers, A., et al. (2004). Cognitive-behavioral stress management increases benefit finding and immune function among women with early-stage breast cancer. Journal of Psychosomatic Research, 56, 18.
McLachlan, S.-A., Devins, G.M., & Goodwin, P.J. (1998). Validation of the European Organization for Research and Treatment of Cancer quality of life questionnaire (QLQ-C30) as a measure of psychosocial function in breast cancer patients. European Journal of Cancer, 34, 510517.
Moorey, S., Greer, S., Bliss, J., & Law, M. (1998). A comparison of adjuvant psychological therapy and supportive counselling in patients with cancer. PsychoOncology, 7, 218228.
Morin, C.M. (1993). Insomnia: Psychological Assessment and Management. New York: The Guilford Press.
Murphy, G.E., Simons, A.D., Wetzel, R.D., et al. (1984). Cognitive therapy and pharmacotherapy: Singly and together in the treatment of depression. Archives of General Psychiatry, 41, 3341.
Osoba, D., Aaronson, N., Zee, B., et al. (1997). Modification of the EORTC QLQ-C30 (version 2.0) based on content validity and reliability testing in large samples of patients with cancer. Quality of Life Research, 6, 103108.
Papadopoulos, N.G., Dedoussis, G.V.Z., Spanakos, G., et al. (1994). An improved fluorescence assay for the determination of lymphocyte-mediated cytotoxicity using flow cytometry. Journal of Immunological Methods, 177, 101111.
Reiche, E.M., Nunes, S.O., & Morimoto, H.K. (2004). Stress, depression, the immune system, and cancer. Lancet Oncology, 5, 617625.
Robinson, J.P. (1993). Handbook of Flow Cytometry Method. New York: Wiley-Liss.
Rush, A.J., Hollon, S.D., Beck, A.T., et al. (1977). Comparative efficacy of cognitive therapy and imipramine in the treatment of depressed outpatients. Cognitive Therapy & Research, 1, 1737.
SAS Institute. (2001). SAS/STAT User's guide, version 8: Volume 1, 2 & 3. Cary, NC: SAS Institute.
Savard, J., Laberge, B., Gauthier, J.G., et al. (1998). Evaluating anxiety and depression in HIV-infected patients. Journal of Personality Assessment, 71, 349367.
Savard, J., Laberge, B., Gauthier, J.G., et al. (1999). Screening clinical depression in HIV-seropositive patients using the Hospital Anxiety and Depression Scale. AIDS and Behavior, 3, 167175.
Savard, J., Laroche, L., Simard, S., et al. (2003). Chronic insomnia and immune functioning. Psychosomatic Medicine, 65, 211221.
Savard, M.H., Savard, J., Simard, S., et al. (2005). Empirical validation of the Insomnia Severity Index in cancer patients. Psycho-Oncology, 14, 429441.
Sayer, N.A., Sackeim, H.A., Moeller, J.R., et al. (1993). The relations between observer-rating and self-report of depressive symptomatology. Psychological Assessment, 5, 350360.
Schedlowski, M., Tewes, U., & Schmoll, H.-J. (1994). The effects of psychological intervention on cortisol levels and leukocyte numbers in the peripheral blood of breast cancer patients. In The Psychoimmunology of Cancer: Mind and Body in the Fight for Survival? Lewis, C.E., O'Sullivan, C., & Barraclough, J. (eds.), pp. 336348. Oxford: Oxford University Press.
Simons, A.D., Murphy, G.E., Levine, J.L., et al. (1986). Cognitive therapy and pharmacotherapy for depression. Archives of General Psychiatry, 43, 4348.
Smets, E.M.A., Garssen, B., Bonke, B., et al. (1995). The Multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. Journal of Psychosomatic Research, 39, 315325.
Smith, S. & Trinder, J. (2001). Detecting insomnia: Comparison of four self-report measures of sleep in a young adult population. Journal of Sleep Research, 10, 229235.
Spiegel, D., Bloom, J.R., Kraemer, H.C., et al. (1989). Effect of psychosocial treatment on survival of patients with metastatic breast cancer. The Lancet, 2, 888891.
Sprangers, M.A.G., Groenvold, M., Arraras, J.I., et al. (1996). The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: First results from a three-country field study. Journal of Clinical Oncology, 14, 27562768.
Tabachnik, B.G. & Fidell, L.S. (2001). Using Multivariate Statistics (4th ed.). New York: Harper Collins Publishers.
Watson, M., Fenlon, D., McVey, G., & Fernandez-Marcos, M. (1996). A support group for breast cancer patients: Development of a cognitive-behavioral approach. Behavioural and Cognitive Psychotherapy, 24, 7381.
Weisse, C.S. (1992). Depression and immunocompetence: A review of the literature. Psychological Bulletin, 111, 475489.
Williams, J.B.W. (1988). A structured interview guide for the Hamilton Depression Rating Scale. Archives of General Psychiatry, 45, 742747.
Wilson, K.G., Chochinov, H.M., De Faye, B.J., et al. (2000). Diagnosis and management of depression in palliative care. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 2549. Oxford: Oxford University Press.
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361370.

Keywords

Randomized clinical trial on cognitive therapy for depression in women with metastatic breast cancer: Psychological and immunological effects

  • JOSÉE SAVARD (a1) (a2), SÉBASTIEN SIMARD (a1) (a2), ISABELLE GIGUÈRE (a1), HANS IVERS (a1) (a2), CHARLES M. MORIN (a2), ELIZABETH MAUNSELL (a3) (a4), PIERRE GAGNON (a5) (a6), JEAN ROBERT (a4) and DANIÈLE MARCEAU (a7)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed