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

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 to supportive group psychotherapy (SGP) and care as usual (CAU). Methods 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). Primary outcome measure was Personal Meaning Profile (total score PMP). Secondary outcome measures were subscales of the PMP, psychological well-being (SPWB), posttraumatic growth (PTGI), mental adjustment to cancer (MAC), optimism (LOT-R), hopelessness (BHS), psychological distress (anxiety and depression, HADS), and quality of life (EORTC QLQ-C30). Outcome measures were assessed before randomization, post-intervention, after three and six months 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 to 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), helpless/hopeless (d=−0.87) (3 months FU); distress (d=−0.6) and depression (d=−0.38) (6 months FU). Significantly stronger effects of MCGP-CS compared to 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.

Effects of psychosocial interventions on meaning and purpose in adults with cancer: A systematic review and meta‐analysis

“…Different types of meaning‐focused therapies (eg, meaning‐focused group psychotherapy, cognitive‐existential therapy, supportive‐expressive therapy, and mindfulness‐based stress reduction) may be differentially effective. Combination therapies that use mind‐body techniques along with a specific focus on meaning might usefully create synergies across these modalities . Moreover, different meaning‐based approaches may be more beneficial for some individuals than for others.…”

“…Our results suggest that psychosocial interventions can increase a sense of meaning and purpose in patients with cancer and survivors, especially if they are explicitly designed to do so and focus on enhancing patients' sense of meaning and purpose. 26,92 These interventions are generating growing interest, [18][19][20][21][23][24][25] and thus, we anticipate that development and testing of meaningrelated interventions will increase fairly rapidly. Because meaning and purpose have been conceptualized in different ways and encompass multiple distinct dimensions, 4 it will be important for future studies to consider carefully and delineate more clearly what aspects of meaning the intervention is intended to target and to differentiate these endpoints from related concepts (such as spirituality or general well-being).…”

“…Combination therapies that use mind-body techniques along with a specific focus on meaning might usefully create synergies across these modalities. 24,90,91 Moreover, different meaning-based approaches may be more beneficial for some individuals than for others. For example, patients in active treatment may have different existential concerns than those transitioning to longer term survivorship or palliative care.…”

“…Of these, 485 did not meet the inclusion criteria; 29 did and were included in the analyses. 18,21,24,47,48,50,…”

“…[15][16][17] A recent wave of interventions for patients with cancer has been specifically designed to address existential/ spiritual concerns or questions of personal meaning. [18][19][20][21][22][23][24][25][26] Psychosocial interventions designed to influence a wide array of psychological and even physical health outcomes might also affect meaning-related endpoints, even if these are not their singular or primary emphasis (eg, coping skills, health education, or creative arts programs). A large and growing research base has evaluated psychosocial interventions for patients with various malignancies, and many of these trials have included outcomes concerning meaning or purpose.…”