DOI: 10.1097/01.COT.0000400075.66050.48
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Issn Print: 0276-2234
Publication Date: 2011/07/10
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Excerpt
As the researchers, led by Brittany Brothers, PhD, Program Director of Ohio State University Comprehensive Cancer Center's LIVESTRONG Survivorship Center of Excellence, described in the study reported in the Journal of Consulting and Clinical Psychology (2011;79:253-260), the intervention was tailored specifically to treat depression, reduce stress, and help patients develop copying strategies.
Thirty-six patients with current or prior gynecologic or breast cancers and depression were offered up to 20 weekly individual psychotherapeutic sessions. At the final evaluation, patients whose symptoms had not remitted were referred for other treatment.
There was also significant reduction in fatigue and improved mental health quality of life. The fact that there was no improvement in pain relief or physical health quality of life, however, was more evidence that the improvements were likely due to the intervention and not to some physical change, the authors said.
A treatment manual and patient guidebook provided the framework for the intervention. “This enabled us to conduct phone sessions with the patients when they were not well, allowing them to continue to be active in treatment, even if they couldn't physically come to our office,” Dr. Brothers, Program Director of Ohio State's LIVESTRONG Survivorship Center of Excellence, said in an interview.
Each session, she explained, began with a relaxation exercise that “provided a very positive, calming experience, and helped patients to focus on developing coping strategies.” Other approaches taught patients more about their disease and how to respond to the crisis of having cancer. Patients learned to manage treatment side effects, communicate their needs effectively, cope, and solve problems. They identified activities that had previously brought them pleasure, and found ways to reincorporate them into their lives.
Three cognitive behavioral therapy (CBT) concepts were also important, she continued:
“The treatment is very ‘homework'-oriented, putting skills into practice,” Dr. Brothers said. “During sessions, we would discuss which techniques were helpful, and which were not—and what the patient would do to apply the strategies that we were teaching.”
Another coauthor of the study, Barbara L. Andersen, PhD, Professor of Psychology and Director of the LIVESTRONG Center, noted that although major depression is highly prevalent in cancer patients, affecting as many as a quarter to a third of newly diagnosed patients, it often goes undetected and untreated, while at the same time being very debilitating, interfering with daily activities and affecting adherence to treatment.
“There's low motivation in the depressed population,” Dr. Andersen said. “Patients spend a lot of time alone, and withdraw from everything.”
People with depression may also experience social anxiety, and may fail to maintain contacts. Part of the therapeutic process is getting patients to evaluate their social network and ask for support.
Dr. Brothers described an exercise in which patients identified potential sources of support. They were asked to draw a diagram with themselves at the center, surrounded by concentric circles in which they placed family and friends in relation to how close they considered them to be.
“We urge patients to ask for support, and encourage them to match their request to what the other person is good at providing,” she said. “We differentiate between “task support” and “emotional support.” By looking at the chart, patients could clearly see who would be most appropriate to ask to mow the lawn—task support—and who could provide a shoulder to lean on—emotional support.”
Over time, she added, patients realize that their social network is actually broader than they had thought.
