Ambulante verhaltenstherapeutische Gruppentherapie zur Behandlung von Progredienzangst bei Krebspatienten

Abstract

Fear of progression (FoP) is an appropriate, rational response to the real threat of cancer and its treatments. However, patients experiencing elevated, dysfunctional levels of FoP often feel severely distressed and are in need of treatment. We previously conducted a (partly-)randomized controlled study with cancer patients undergoing in-patient rehabilitation and showed that a brief, four-session cognitive-behavioral group therapy significantly reduced dysfunctional FoP. In this report, we describe the adaption of the cognitive-behavioral group therapy program for use with cancer out-patients. This group therapy program was conducted in the psycho-oncological out-patient department of a large university hospital. It comprises 6 group sessions lasting 90 min each. Because of the larger number of sessions there is more room for the use of exposure-based techniques. Imaginal exposure is used to confront the patient's cancer-related fears and worries. Patients are asked to vividly recount their worries and to think of what would be the worst that can happen (worst-case scenario exercise). In addition, interventions that focus the patient's ressources are applied. The completion of 3 group therapies in the pilot phase supported the feasibility of the program. Pre-post evaluation (n=10) revealed a significant decline of FoP (Fear of Progression Questionnaire, FoP-Q) from M=12,0 (SD=2,0) to M=10,3 (SD=1,7), p=0.029. This represents a large effect (Cohen's d=0.9). Three out of 14 participants (21%) quit treatment after 2 sessions. In sum, the results and our experiences show that this out-patient group therapy program is feasible and probably effective. However, it also shows that some patients regard confronting their cancer-related fears and worries as too stressful. High ambivalence with regard to exposure seems to increase the risk for premature termination. Thus, cancer patients should be thoroughly educated before starting exposure-based treatment of dysfunctional FoP.

Association Between Daily Worry, Pathological Worry, and Fear of Progression in Patients With Cancer

“…Similar to the cognitive-behavioral approach for GAD, which focuses on the exposure of worry themes, patients with cancer are asked to vividly recount their worries and to work through a worst-case scenario (Dinkel and Herschbach, 2018). This approach has proven feasible and effective in reducing FoP of patients with cancer (Herschbach et al, 2010;Dinkel et al, 2012;Rudolph et al, 2018) and is supported by the independent association between our measures of daily worry, which focuses on the content of worrying thoughts.…”

Progredienzangst bei Krebspatienten

“…Die Exposition der Progredienzangst ist in den meisten der bekannten Ansätze kein explizites Element 14 . Im Unterschied dazu sieht der in der Arbeitsgruppe von Peter Herschbach in München entwickelte Ansatz eine Konfrontation der angstauslösenden Situationen in sensu vor 15 , 16 .…”