Hostname: page-component-8448b6f56d-wq2xx Total loading time: 0 Render date: 2024-04-24T03:20:03.470Z Has data issue: false hasContentIssue false
  • English
  • Français

Efficacy of meaning-centered group psychotherapy for cancer survivors: a randomized controlled trial

Published online by Cambridge University Press:  04 April 2017

N. van der Spek ,
J. Vos ,
C. F. van Uden-Kraan ,
W. Breitbart ,
P. Cuijpers ,
K. Holtmaat ,
B. I. Witte ,
R. A. E. M. Tollenaar  and
I. M. Verdonck-de Leeuw
N. van der Spek
Affiliation:
Department of Clinical Psychology, VU University, Amsterdam, the Netherlands IDC Center for Psychological Care for Cancer Patients, OLVG Hospital, Amsterdam, the Netherlands
J. Vos
Affiliation:
Department of Psychology, University of Roehampton, London, UK
C. F. van Uden-Kraan
Affiliation:
Department of Clinical Psychology, VU University, Amsterdam, the Netherlands
W. Breitbart
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
P. Cuijpers
Affiliation:
Department of Clinical Psychology, VU University, Amsterdam, the Netherlands
K. Holtmaat
Affiliation:
Department of Clinical Psychology, VU University, Amsterdam, the Netherlands
B. I. Witte
Affiliation:
Epidemiology & Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
R. A. E. M. Tollenaar
Affiliation:
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
I. M. Verdonck-de Leeuw*
Affiliation:
Department of Clinical Psychology, VU University, Amsterdam, the Netherlands VU University Medical Center, Department of Otolaryngology – Head & Neck Surgery, Amsterdam, the Netherlands
*
*Address for correspondence: I. M. Verdonck-de Leeuw, Department of Clinical Psychology, VU University, Amsterdam, the NetherlandsBoechorststraat 1, room 2E-21, 1081 BT, Amsterdam, the Netherlands. (Email: im.verdonck@vu.nl)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The aim of this study was to assess the efficacy of meaning-centered group psychotherapy for cancer survivors (MCGP-CS) to improve personal meaning, compared with supportive group psychotherapy (SGP) and care as usual (CAU).

Method

A total of 170 cancer survivors were randomly assigned to one of the three study arms: MCGP-CS (n = 57); SGP (n = 56); CAU (n = 57). The primary outcome measure was the Personal Meaning Profile (PMP; total score). Secondary outcome measures were subscales of the PMP, psychological well-being (Scales of Psychological Well-being; SPWB), post-traumatic growth (Posttraumatic Growth Inventory), Mental Adjustment to Cancer (MAC), optimism (Life Orientation Test-Revised), hopelessness (Beck's Hopelessness Scale), psychological distress (anxiety and depression, Hospital Anxiety and Depression Scale; HADS) and quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire; EORTC QLQ-C30). Outcome measures were assessed before randomization, post-intervention, and after 3 and 6 months of follow-up (FU).

Results

Linear mixed model analyses (intention-to-treat) showed significant differences between MCGP-CS, SGP and CAU on the total PMP score, and on (sub)scales of the PMP, SPWB, MAC and HADS. Post-hoc analyses showed significantly stronger treatment effects of MCGP-CS compared with CAU on personal meaning (d = 0.81), goal-orientedness (d = 1.07), positive relations (d = 0.59), purpose in life (d = 0.69); fighting spirit (d = 0.61) (post-intervention) and helpless/hopeless (d = −0.87) (3 months FU); and distress (d = −0.6) and depression (d = −0.38) (6 months FU). Significantly stronger effects of MCGP-CS compared with SGP were found on personal growth (d = 0.57) (3 months FU) and environmental mastery (d = 0.66) (6 months FU).

Conclusions

MCGP-CS is an effective intervention for cancer survivors to improve personal meaning, psychological well-being and mental adjustment to cancer in the short term, and to reduce psychological distress in the long run.

Keywords

Group psychotherapycancer survivorsmeaningRCTpsychological well-being
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 11 , August 2017 , pp. 1990 - 2001
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Breitbart, W, Rosenfeld, B, Pessin, H, Applebaum, A, Kulikowski, J, Lichtenthal, WG (2015). Meaning-centered group psychotherapy: an effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology 33, 749–754.CrossRefGoogle ScholarPubMed
Breitbart, WS (2002). Spirituality and meaning in supportive care: spirituality and meaning-centered group psychotherapy interventions in advanced cancer. Supportive Care in Cancer 10, 272–280.CrossRefGoogle ScholarPubMed
Breitbart, WS, Poppito, SR (2014). Meaning-Centered Group Psychotherapy for Patients with Advanced Cancer: A Treatment Manual. Oxford University Press: New York.Google Scholar
Chochinov, HM, Kristjanson, LJ, Breitbart, W, McClement, S, Hack, TF, Hassard, T, Harlos, M (2011). Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomised controlled trial. Lancet Oncology 12, 753–762.CrossRefGoogle ScholarPubMed
Cohen, J (1977). Statistical Power Analysis for the Behavioral Sciences. Routledge: London.Google Scholar
Fayers, P, Bottomley, A (2002). A Quality of Life Research within the EORTC -EORTC QLQ-C30. Eur J Cancer 38, 125–133.CrossRefGoogle ScholarPubMed
Frankl, V (1986). The Doctor and the Soul. From Psychotherapy to Logotherapy: London.Google Scholar
Frankl, V (1998). Man's Search for Meaning: An Introduction to Logotherapy. British paper back edition: Ranom House, London.Google Scholar
Gelman, A, Hill, J, Yajima, M (2012). Why we (usually) don't have to worry about multiple comparisons. Journal of Research on Educational Effectiveness 5, 189–211.CrossRefGoogle Scholar
Hoffman, KE, McCarthy, EP, Recklitis, CJ, Ng, AK (2009). Psychological distress in long-term survivors of adult-onset cancer results from a national survey. Archives of Internal Medicine 14, 1274–1281.CrossRefGoogle Scholar
Jaarsma, TA, Pool, G (2003). Posttraumatic Growth Inventory: Dutch Version. Noordelijk Centrum Voor Gezondheidsvraagstukken: Groningen.Google Scholar
Jaarsma, TA, Pool, G, Ranchor, AV, Sanderman, R (2007). The concept and measurement of meaning in life in Dutch cancer patients. Psycho-Oncology 16, 241–248.CrossRefGoogle ScholarPubMed
Kissane, DW, Bloch, S, Smith, GC, Miach, P, Clarke, DM, Ikin, J, Love, A, Ranieri, N, McKenzie, D (2003). Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. Psycho-Oncology 12, 532–546.CrossRefGoogle ScholarPubMed
Lee, V (2008). The existential plight of cancer: meaning making as a concrete approach to the intangible search for meaning. Supportive Care in Cancer 16, 779–785.CrossRefGoogle Scholar
Lee, V, Cohen, SR, Edgar, L, Laizner, AM, Gagnon, AJ (2006). Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Social Science and Medicine 62, 3133–3145.CrossRefGoogle ScholarPubMed
LeMay, K, Wilson, KG (2008). Treatment of existential distress in life threatening illness: a review of manualized interventions. Clinical Psychological Review 28, 472–493.CrossRefGoogle ScholarPubMed
Lethborg, C, Aranda, S, Cox, S, Kissane, D (2007). To what extent does meaning mediate adaptation to cancer? The relationship between physical suffering, meaning in life, and connection to others in adjustment to cancer. Palliative Supportive Care 5, 377–388.CrossRefGoogle ScholarPubMed
Leykin, Y, DeRubeis, RJ (2009). Allegiance in psychotherapy outcome research: separating association from bias. Clinical Psychological Science and Practice 16, 54–65.CrossRefGoogle Scholar
McClain, CS, Rosenfeld, B, Breitbart, W (2003). Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet 361, 1603–1607.CrossRefGoogle ScholarPubMed
Miller, KD, Siegel, RL, Lin, CC, Mariotto, AB, Kramer, JL, Rowland, JH, Stein, KD, Alteri, R, Jemal, A (2016). Cancer treatment and survivorship statistics, 2016. CA: A Cancer Journal for Clinicians 66, 271–289.Google Scholar
Park, CL (2010). Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin 136, 257–301.CrossRefGoogle ScholarPubMed
Park, CL, Edomondson, D, Fenster, JR, Blank, TO (2008). Meaning making and psychological adjustment following cancer: the mediating roles of growth, life meaning, and restored just-world beliefs. Journal of Consulting and Clinical Psychology 76, 863–875.CrossRefGoogle ScholarPubMed
Payne, DK, Vroom, P, Phil, M (2009). Supportive Group Psychotherapy: A Group Intervention for Cancer Patients. Memorial Sloan-Kettering Cancer Center: New York.Google Scholar
Santin, O, Murray, L, Prue, G, Gavin, A, Gormley, G, Donnelly, M (2015). Self-reported psychosocial needs and health-related quality of life of colorectal cancer survivors. European Journal of Oncology Nursing 19, 336–342.CrossRefGoogle ScholarPubMed
Spiegel, D, Spira, J (1991). Supportive-Expressive Group Therapy: A Treatment Manual of Psychosocial Intervention for Women with Recurrent Breast Cancer. Stanford University School of Medicine: Stanford, CA.Google Scholar
Spinhoven, P (1997). A validation study of the Hospital Anxiety and Depression Scale (HADS) in different groups of Dutch subjects. Psychological Medicine 27, 363–370.CrossRefGoogle ScholarPubMed
ten Klooster, PM, Weekers, AM, Eggelmeijers, F, Van Woerkom, JM, Drossaert, CHC, Taal, E, Baneke, JJ, Rasker, JJ (2010). Optimisme En/of Pessimisme: Factorstructuur van de Nederlandse Life Orientation Test-Revised. Psychologie En Gezondheid 38, 89–100.CrossRefGoogle Scholar
Thewes, B, Butow, P, Girgis, A, Pendlebury, S (2004). The psychosocial needs of breast cancer survivors; a qualitative study of the shared and unique needs of younger versus older survivors. Psycho-Oncology 13, 177–189.CrossRefGoogle ScholarPubMed
Tomich, PL, Helgeson, VS (2002). Five years later: a cross-sectional comparison of breast cancer survivors with healthy women. Psycho-Oncology 11, 154–169.CrossRefGoogle Scholar
van der Spek, N, van Uden-Kraan, CF, Vos, J, Breitbart, W, Tollenaar, RAEM, van Asperen, CJ, Cuijpers, P, Verdonck-de Leeuw, IM (2014 a). Meaning-centered group psychotherapy in cancer survivors: a feasibility study. Psycho-Oncology 23, 827–831.CrossRefGoogle ScholarPubMed
van der Spek, N, Vos, J, van Uden-Kraan, CF, Breitbart, W, Cuijpers, P, Knipscheer-Kuipers, K, Willemsen, V, Tollenaar, RAEM, van Asperen, CJ, Verdonck-de Leeuw, IM (2014 b). Effectiveness and cost-effectiveness of meaning-centered group psychotherapy in cancer survivors: protocol of a randomized controlled trial. BMC Psychiatry 14, 22.CrossRefGoogle ScholarPubMed
van der Spek, N, Vos, J, van Uden-Kraan, CF, Breitbart, W, Tollenaar, RAEM, Cuijpers, P, Verdonck-de Leeuw, IM (2013). Meaning making in cancer survivors: a focus group study. PLOS ONE 8, e76089.CrossRefGoogle ScholarPubMed
van Dierendonck, D (2004). The construct validity of Ryff's scales of psychological well-being and its extension with spiritual well-being. Personality and Individual Differences 36, 629–643.CrossRefGoogle Scholar
Watson, M, Greer, S, Young, J, Inayat, Q, Burgess, C, Robertson, B (1988). Development of a questionnaire measure of adjustment to cancer: the MAC scale. Psychological Medicine 18, 203–209.CrossRefGoogle ScholarPubMed
Wong, PTP (editor) (2010). The Human Quest for Meaning. Theories, Research, and Applications, 2nd edn. Routledge, Taylor & Francis Group: New York.Google Scholar
Yalom, ID (1980). Existential Psychotherapy. Basic Books: New York.Google Scholar
Yalom, ID, Greaves, C (1977). Group therapy with the terminally ill. American Journal of Psychiatry 134, 396–400.Google ScholarPubMed
Young, MA, Halper, IS, Clark, DC, Scheftner, W, Fawcett, J (1992). An item-response theory evaluation of the Beck Hopelessness Scale. Cognitive Therapy and Research 16, 579–587.CrossRefGoogle Scholar
Zika, S, Chamberlain, K (1992). On the relation between meaning in life and psychological well-being. British Journal of Psychology 83, 133–145.CrossRefGoogle ScholarPubMed
Zoellner, T, Rabe, S, Karl, A, Maercker, A (2011). Post-traumatic growth as outcome of a cognitive–behavioural therapy trial for motor vehicle accident survivors with PTSD. Psychology and Psychotherapy 84, 201–213.CrossRefGoogle ScholarPubMed