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Adapting meaning-centered psychotherapy for World Trade Center responders

Published online by Cambridge University Press:  02 March 2020

Melissa Masterson-Duva*
Affiliation:
New York University School of Medicine, World Trade Center Health Program Clinical Center of Excellence, New York, NY Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Peter Haugen
Affiliation:
New York University School of Medicine, World Trade Center Health Program Clinical Center of Excellence, New York, NY
Aditi Werth
Affiliation:
New York University School of Medicine, World Trade Center Health Program Clinical Center of Excellence, New York, NY
Alyce Foster
Affiliation:
New York University School of Medicine, World Trade Center Health Program Clinical Center of Excellence, New York, NY
Emily Chassman
Affiliation:
New York University School of Medicine, World Trade Center Health Program Clinical Center of Excellence, New York, NY
Kailey Roberts
Affiliation:
Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Jonathan DePierro
Affiliation:
Mt. Sinai World Trade Center Health Program Clinical Center of Excellence, New York, NY
Massielle Morales-Miller
Affiliation:
Mt. Sinai World Trade Center Health Program Clinical Center of Excellence, New York, NY
Sandra Lowe
Affiliation:
Mt. Sinai World Trade Center Health Program Clinical Center of Excellence, New York, NY
Hayley Pessin
Affiliation:
Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Wendy Lichtenthal
Affiliation:
Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
William Breitbart
Affiliation:
Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
*
Author for correspondence: Melissa Masterson-Duva, New York University School of Medicine, World Trade Center Health Program Clinical Center of Excellence, New York, NY, USA. E-mail: melissa.duva@nyulangone.org

Abstract

Objective

To date, nearly 10,000 World Trade Center (WTC) responders have been diagnosed with at least one type of WTC-related cancer, and over 70 types of cancer have been related to WTC occupational exposure. Due to the observed latency period for malignancies, the WTC Health Program anticipates increases in rates of new cancer diagnoses. Given the growing number of cancer diagnoses in this population, there is an urgent need to develop a novel intervention to address the psychosocial needs of WTC responders with cancer. Meaning-centered psychotherapy (MCP) is a structured psychotherapeutic intervention originally developed to help patients with advanced cancer find and sustain meaning in life despite illness-related limitations. Existential distress and loss of meaning are critical and understudied elements of psychological health that have been widely overlooked among WTC responders with cancer.

Method

We have adapted MCP for WTC responders (MCP-WTC) for the treatment of WTC responders who have been diagnosed with WTC-certified cancers. MCP-WTC aims to target the complex crisis in meaning faced by those responders who responded to the 9/11 attacks and subsequently were diagnosed with cancer as a result of their service.

Results

We describe the adaptation of MCP-WTC and the application of this intervention to meet the unique needs of those exposed to the terrorist attacks of September 11, 2001 (9/11), participated in the rescue, recovery, and clean-up effort at Ground Zero, and were diagnosed with WTC-related cancer. We highlight the novel aspects of this intervention which have been designed to facilitate meaning-making in the context of the patient's response to 9/11 and subsequent diagnosis of cancer.

Significance of results

This work provides a rationale for MCP-WTC and the potential for this intervention to improve the quality of life of WTC responders and help these patients navigate life after 9/11 and cancer.

Type
Original Article
Copyright
Copyright © Cambridge University Press 2020

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Footnotes

*

This article has been updated since its original publication. See doi: 10.1017/S147895152000067X

References

Abbey, G, Thompson, SB, Hickish, T, et al. (2015) A meta-analysis of prevalence rates and moderating factors for cancer-related post-traumatic stress disorder. Psycho-Oncology 24(4), 371381.10.1002/pon.3654CrossRefGoogle ScholarPubMed
Applebaum, AJ, Kulikowski, JR and Breitbart, W (2015) Meaning-centered psychotherapy for cancer caregivers (MCP-C): Rationale and overview. Palliative & Supportive Care 13(6), 16311641.CrossRefGoogle ScholarPubMed
Bills, C, Levy, N, Sharma, V, et al. (2008) Mental health of workers and volunteers responding to events of 9/11: Review of the literature. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine 75(2), 115127.10.1002/msj.20026CrossRefGoogle ScholarPubMed
Boffetta, P, Zeig-Owens, R, Wallenstein, S, et al. (2016) Cancer in World Trade Center responders: Findings from multiple cohorts and options for future study. American Journal of Industrial Medicine 59(2), 96105.10.1002/ajim.22555CrossRefGoogle ScholarPubMed
Breitbart, W and Poppito, S (2014a) Individual meaning-centered psychotherapy for patients with advanced cancer. New York, NY: Oxford University Press.CrossRefGoogle Scholar
Breitbart, W and Poppito, SR (2014b) Meaning-centered group psychotherapy for patients with advanced cancer: A treatment manual. New York, NY: Oxford University Press.Google Scholar
Breitbart, W, Rosenfeld, B, Gibson, C, et al. (2010) Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psycho-Oncology 19, 2128.CrossRefGoogle ScholarPubMed
Breitbart, W, Poppito, S, Rosenfeld, B, et al. (2012) Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Journal of Clinical Oncology 30, 13041309.CrossRefGoogle ScholarPubMed
Breitbart, W, Rosenfeld, B, Pessin, H, et al. (2015) Meaning-centered group psychotherapy: An effective intervention for reducing despair in patients with advanced cancer. Journal of Clinical Oncology 33, 749754.CrossRefGoogle Scholar
Breitbart, W, Pessin, H, Rosenfeld, B, et al. (2018) Individual meaning-centered psychotherapy for the treatment of psychological and existential distress: A randomized controlled trial in patients with advanced cancer. Cancer 124(15), 32313239.CrossRefGoogle ScholarPubMed
Crane, MA, Levy-Carrick, NC, Crowley, L, et al. (2014) The response to September 11: A disaster case study. Annals of Global Health 80(4), 320331.10.1016/j.aogh.2014.08.215CrossRefGoogle ScholarPubMed
Difede, J, Malta, LS, Best, S, et al. (2007) A randomized controlled clinical treatment trial for World Trade Center attack-related PTSD in disaster workers. The Journal of Nervous and Mental Disease 195, 861865.CrossRefGoogle ScholarPubMed
Dowling, FG, Moynihan, G, Genet, B, et al. (2006) A peer-based assistance program for officers with the New York City Police Department: Report of the effects of Sept. 11, 2001. The American Journal of Psychiatry 163(1), 151153.CrossRefGoogle ScholarPubMed
Fillion, L, Duval, SP, Dumont, S, et al. (2009) Impact of a meaning-centered intervention on job satisfaction and on quality of life among palliative care nurses. Psycho-Oncology 18, 13001310.CrossRefGoogle ScholarPubMed
Frankl, VE (1963/1984) Man's search for meaning. New York, NY: Washington Square Press.Google Scholar
Gonzalez, A, Mackin, D and Mahaffey, B (2018). A randomized controlled trial of the disaster worker resiliency training program. In: International Journal of Behavioral Medicine, Vol. 25. New York, NY, USA: Springer, pp. S134–S134.Google Scholar
Green, BL, Krupnick, JL, Rowland, JH, et al. (2000) Trauma history as a predictor of psychologic symptoms in women with breast cancer. Journal of Clinical Oncology 18(5), 10841084.10.1200/JCO.2000.18.5.1084CrossRefGoogle ScholarPubMed
Haugen, PT, Werth, AS, Foster, AL, et al. (2016) The role of theory-specific techniques and therapeutic alliance in promoting positive outcomes: Integrative psychotherapy in World Trade Center responders. The Journal of Nervous and Mental Disease 204, 955959.CrossRefGoogle ScholarPubMed
Haugen, PT, McCrillis, AM, Smid, GE, et al. (2017) Mental health stigma and barriers to mental health care for first responders: A systematic review and meta-analysis. Journal of Psychiatric Research 94, 218229.CrossRefGoogle ScholarPubMed
Jayasinghe, N, Spielman, L, Cancellare, D, et al. (2005) Predictors of treatment utilization in world trade center attack disaster workers: Role of race/ethnicity and symptom severity. International Journal of Emergency Mental Health 7(2), 91.Google Scholar
Kuan, P, Mi, Z, Georgopoulos, P, et al. (2019) Enhanced exposure assessment and genome-wide DNA methylation in World Trade Center disaster responders. European Journal of Cancer Prevention 28, 225233.10.1097/CEJ.0000000000000460CrossRefGoogle ScholarPubMed
Landrigan, P, Lioy, P, Thurston, G, et al. (2004) Health and environmental consequences of the World Trade Center disaster. Environmental Health Perspectives 112, 731739.10.1289/ehp.6702CrossRefGoogle ScholarPubMed
Lanza, A, Roysircar, G and Rodgers, S (2018) First responder mental healthcare: Evidence-based prevention, postvention, and treatment. Professional Psychology: Research and Practice 49, 193204.CrossRefGoogle Scholar
Li, J, Cone, J, Kahn, A, et al. (2012) Association between World Trade Center exposure and excess cancer risk. JAMA 308, 24792488.CrossRefGoogle ScholarPubMed
Lichtenthal, WG, Lacey, S, Roberts, KA, et al. (2017) Meaning-centered grief therapy. In Breitbart, W. (Ed.), Meaning-Centered Psychotherapy in the Cancer Setting: Finding Meaning and Hope (pp. 8899). New York: Oxford University Press.Google Scholar
Litz, BT, Engel, CC, Bryant, RA, et al. (2007) A randomized, controlled proof-of-concept trial of an Internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder. The American Journal of Psychiatry 164(11), 16761684.10.1176/appi.ajp.2007.06122057CrossRefGoogle ScholarPubMed
Marmar, CR, McCaslin, SE, Metzler, TJ, et al. (2006) Predictors of posttraumatic stress in police and other first responders. Annals of the New York Academy of Sciences 1071, 118.CrossRefGoogle ScholarPubMed
McCaslin, SE, Rogers, CE, Metzler, TJ, et al. (2006) The impact of personal threat on police officers’ responses to critical incident stressors. The Journal of Nervous and Mental Disease 194(8), 591597.CrossRefGoogle ScholarPubMed
Neria, Y, Digrande, L and Adams, BG (2011) Posttraumatic stress disorder following the September 11, 2001, terrorist attacks: A review of the literature among highly exposed populations. American Psychologist 66(6), 429446.10.1037/a0024791CrossRefGoogle ScholarPubMed
Nietzsche, FW (1984) Human, all too human: A book for free spirits. Lincoln: University of Nebraska Press.Google Scholar
O'Hara, AF, Violanti, JM, Levenson, RL Jr, et al. (2013) National police suicide estimates: Web surveillance study III. International Journal of Emergency Mental Health and Human Resilience.Google ScholarPubMed
Park, CL (2010) Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful like events. Psychological Bulletin 136, 257301.CrossRefGoogle Scholar
Peñalba, V, McGuire, H and Leite, JR (2008) Psychosocial interventions for prevention of psychological disorders in law enforcement officers. Cochrane Database of Systematic Reviews 3.10.1002/14651858.CD005601.pub2CrossRefGoogle Scholar
Perrin, MA, Digrande, L, Wheeler, K, et al. (2007) Differences in PTSD prevalence and associated risk factors among World Trade Center disaster rescue and recovery workers. The American Journal of Psychiatry 164(9), 13851394.CrossRefGoogle ScholarPubMed
Platner, J (2002) Industrial hygiene at the World Trade Center disaster. Applied Occupational and Environmental Hygiene 17, 8485.10.1080/104732202317201302CrossRefGoogle ScholarPubMed
Rosenfeld, B, Saracino, R, Tobias, K, et al. (2017) Adapting meaning-centered psychotherapy for the palliative care setting: Results of a pilot study. Palliative Medicine 31(2), 140146.10.1177/0269216316651570CrossRefGoogle ScholarPubMed
Rosenfeld, B, Cham, H, Pessin, H, et al. (2018) Why is meaning-centered group psychotherapy (MCGP) effective? Enhanced sense of meaning as the mechanism of change for advanced cancer patients. Psycho-Oncology 27(2), 654660.CrossRefGoogle ScholarPubMed
Schnyder, U, Ehlers, A, Elbert, T, et al. (2015) Psychotherapies for PTSD: what do they have in common? European Journal of Psychotraumatology 6(1), 281286.CrossRefGoogle ScholarPubMed
Solan, S, Wallenstein, S, Shapiro, M, et al. (2013) Cancer incidence in World Trade Center rescue and recovery workers, 2001–2008. Environmental Health Perspectives 121(6), 699704.CrossRefGoogle ScholarPubMed
Spek, NVD, Vos, J, Uden-Kraan, CFV, et al. (2017) Efficacy of meaning-centered group psychotherapy for cancer survivors: A randomized controlled trial. Psychological Medicine 47(11), 19902001.10.1017/S0033291717000447CrossRefGoogle ScholarPubMed
Stellman, JM, Smith, RP, Katz, CL, et al. (2008) Enduring mental health morbidity and social function impairment in World Trade Center rescue, recovery, and cleanup workers: The psychological dimension of an environmental health disaster. Environmental Health Perspectives 116(9), 12481253.CrossRefGoogle ScholarPubMed
Swartzman, S, Booth, JN, Munro, A, et al. (2017) Posttraumatic stress disorder after cancer diagnosis in adults: A meta-analysis. Depression and Anxiety 34(4), 327339.CrossRefGoogle ScholarPubMed
van der Spek, N, Vos, J, van Uden-Krann, CF, et al. (2017) Efficacy of meaning-centered group psychotherapy for cancer survivors: a randomized controlled trial. Psychological Medicine 47, 19902001.CrossRefGoogle ScholarPubMed
Wang, Z, Inslicht, SS, Metzler, TJ, et al. (2010) A prospective study of predictors of depression symptoms in police. Psychiatry Research 175(3), 211216.CrossRefGoogle ScholarPubMed
Woody, RH (2005) The Police culture: Research implications for psychological services. Professional Psychology: Research and Practice 36, 525529.10.1037/0735-7028.36.5.525CrossRefGoogle Scholar
World Trade Center Health Program (2019). https://www.cdc.gov/wtc/ataglance.html.Google Scholar
Zeig-Owens, R, Webber, MP, Hall, CB, et al. (2011) Early assessment of cancer outcomes in New York City firefighters after the 9/11 attacks: An observational cohort study. The Lancet 378(9794), 898905.CrossRefGoogle Scholar