Pilot Randomized Controlled Trial of Individual Meaning-Centered Psychotherapy for Patients With Advanced Cancer

Breitbart, William; Poppito, Shannon R.; Rosenfeld, Barry; Vickers, Andrew J.; Li, Yuelin; Abbey, Jennifer; Olden, Megan; Pessin, Hayley; Lichtenthal, Wendy G.; Sjoberg, Daniel D.; Cassileth, Barrie R.

doi:10.1200/jco.2011.36.2517

Cited by 324 publications

(370 citation statements)

References 25 publications

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“…Additionally, a study that examined gene transcriptional profiles found that eudaimonic well-being (an overarching umbrella term that includes purpose) was associated with enhanced expression of antiviral response genes and reduced expression of proinflammatory genes (31). Furthermore, and perhaps most importantly, purpose-along with other components of psychological well-being-have become the focus of multiple intervention studies designed to improve a person's life outlook (10,(32)(33)(34)(35). Therefore, it may provide a point of intervention for improving health outcomes.…”

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confidence: 99%

“…The technique is typically used after standard care (e.g., cognitive behavioral therapy and pharmacotherapy) and is known to help prevent relapse. Additionally, early randomized controlled trials have shown that a meaning-centered therapy, delivered either in a group or individual format, can help raise meaning and purpose in life among people with cancer (32,33). Finally, as people retire, several volunteering programs have emerged that help older adults transition into meaningful and socially engaging activities, likely enhancing their sense of purpose in life (e.g., Experience Corp, Retired and Senior Volunteer Program, Foster Grandparents) (52).…”

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Purpose in life and use of preventive health care services

Kim

Strecher

Ryff

2014

Proc. Natl. Acad. Sci. U.S.A.

244

204

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Purpose in life has been linked with better health (mental and physical) and health behaviors, but its link with patterns of health care use are understudied. We hypothesized that people with higher purpose would be more proactive in taking care of their health, as indicated by a higher likelihood of using preventive health care services. We also hypothesized that people with higher purpose would spend fewer nights in the hospital. Participants (n = 7,168) were drawn from the Health and Retirement Study, a nationally representative panel study of American adults over the age of 50, and tracked for 6 y. After adjusting for sociodemographic factors, each unit increase in purpose (on a six-point scale) was associated with a higher likelihood that people would obtain a cholesterol test [odds ratio (OR) = 1.18, 95% confidence interval (CI) = 1.08-1.29] or colonoscopy (OR = 1.06, 95% CI = 0.99-1.14). Furthermore, females were more likely to receive a mammogram/ X-ray (OR = 1.27, 95% CI = 1.16-1.39) or pap smear (OR = 1.16, 95% CI = 1.06-1.28), and males were more likely to receive a prostate examination (OR = 1.31, 95% CI = 1.18-1.45). Each unit increase in purpose was also associated with 17% fewer nights spent in the hospital (rate ratio = 0.83, 95% CI = 0.77-0.89). An increasing number of randomized controlled trials show that purpose in life can be raised. Therefore, with additional research, findings from this study may inform the development of new strategies that increase the use of preventive health care services, offset the burden of rising health care costs, and enhance the quality of life among people moving into the ranks of our aging society.purpose in life | meaning in life | well-being | health screening T hree factors converge to underscore the heightened importance of preventive health care services among United States adults. First, there is the rapidly aging population: by 2050, the number of United States adults over the age of 65 is estimated to double (1). Second, there is the rising cost of medical care: chronic illnesses and end-of-life issues that older adults face are expensive. The Congressional Budget office projects that spending on Medicare will nearly double as a share of gross domestic product (GDP), from 3.7% in 2012 to 7.3% by 2050 (2). Third, despite spending more on health care than any country in the world, United States adults generally have poorer health and lower life expectancies than those in other developed countries (3,4). This health disadvantage is not solely attributable to those who are poor and underprivileged, because even wealthy, educated Americans are in poorer health than their counterparts in comparable countries (3, 4).These troublesome realities could be offset by greater use of preventive health care services, which are known to enhance health and reduce health care costs. However, in 2007 the Brookings Institution estimated that only 4% of the $1.7 trillion spent on national health expenditures was for prevention (5). Older adults, in particular, use less prev...

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confidence: 99%

mentioning

confidence: 99%

Purpose in life and use of preventive health care services

Kim

Strecher

Ryff

2014

Proc. Natl. Acad. Sci. U.S.A.

244

204

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“…Meaning-centered psychotherapy, a brief (seven-session) intervention offered to critically ill patients that aims to increase a sense of meaning and decrease emotional distress [16], has been shown to benefit cancer patients [16,17]. We know of no comparable randomized studies of psychodynamic psychotherapy in the cancer setting.…”

Section: Manualized Therapy Versus Psychodynamic Therapy: a Case Studymentioning

confidence: 99%

When and Why Should Mental Health Professionals Offer Traditional Psychodynamic Therapy to Cancer Patients?

Yuppa

Meyer

2017

AMA Journal of Ethics

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Given the recent studies promoting time-limited manualized therapies in the oncology setting, clinicians may be reluctant to offer traditional psychodynamic therapy to cancer patients. However, there are no studies directly comparing psychodynamic therapy and other therapy modalities in this patient population and no data suggesting harm from psychodynamic approaches. Therefore, it is inappropriate to draw the conclusion that psychodynamic therapy is inferior to manualized therapy from existing evidence. Manualized treatment, such as cognitive behavioral therapy, is generally short term and therefore may reduce the practitioner's own anxiety stemming from exposure to patients facing grave disability and death. However, manualized treatment is not fully effective in specific clinical scenarios. We present a case reflecting these limitations and advocate for a flexible treatment approach incorporating elements of psychodynamic therapy. IntroductionThe field of psycho-oncology has moved away from psychodynamic psychotherapy toward discrete methods of measuring psychological distress and monitoring treatment response using self-report symptom assessment scales, as recommended by clinical practice guidelines [1]. Psychodynamic psychotherapy is understood to be based upon the principles of psychoanalysis and encourages patients to speak openly and freely without any agendas or "goals" on the part of the therapist. Treatment frequency ranges from one to three times per week and lasts for a few weeks to a few years. The method involves analyzing and interpreting conflicts and other psychic forces outside of the patient's awareness. It is the resolution of these conflicts that leads to symptom improvement [2]. By contrast, manualized therapies, such as cognitive behavioral therapy (CBT), involve the use of standardized treatment guidebooks that prescribe specific techniques to be applied and goals to be attained in a designated number of therapy sessions, measuring responses with validated symptom rating scales. CBT is a time-limited intervention (with weekly sessions lasting 45-60 minutes for approximately 8-12 weeks) that emphasizes the patient's ability to change his or her emotions by modulating thoughts and behaviors [3].

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“…Cada sesión aborda un tema específico: introducción al concepto del sentido (1), cáncer y sentido (2), historia del concepto de sentido (3)(4), fuentes del sentido (5-7), y cierre (8) (Cuadro 1).…”

Section: Descripción De La Intervenciónunclassified

“…Por ello, requieren de un modelo de intervención ajustado a sus necesidades. El modelo de psicoterapia desarrollado por William Breitbart (4) ha demostrado su eficacia en este grupo de pacientes con cáncer avanzado.…”

Section: Introductionunclassified

Psicoterapia centrada en el sentido: “vivir con sentido”. Estudio piloto

Moncayo

Breitbart

2014

Psicooncología

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ResumenIntroducción: Los pacientes con cáncer avanzado expresan sentimientos de desesperanza, deseo de adelantar la muerte, y niveles elevados de ansiedad y sintomatología depresiva asociada a la pérdida de sentido de vida.Objetivos: El principal objetivo de la Psicoterapia de Grupo Centrada en el Sentido (PGCS) es ayudar a los pacientes con cáncer a vivir con sentido, de una manera plena, manteniendo y ampliando el sentido de su vida, viviendo en paz y con un objetivo en la vida.Participantes y Método: Actualmente, estamos realizando el estudio piloto, como primer paso del proyecto de validación del Modelo de Psicoterapia Centrada en el Sentido. Hemos realizado dos de los tres grupos de pacientes con cáncer avanzado que corresponde al presente estudio piloto, y estamos realizando las trascripción de cada una de la sesiones de los grupos, para su posterior análisis cualitativo.Resultados: Los grupos de psicoterapia centrada en el sentido muestran una reducción de la sintomatología ansiosa y depresiva, desesperanza y deseo de adelantar la muerte en pacientes con cáncer avanzado, a la vez de aumentar el bienestar espiritual y la sensación de sentido.Palabras claves: Terapia centrada en el sentido, terapia de grupo, cáncer, psicoterapia. Results: The Meaning-Centered Group Psychotherapy show a reduction of anxiety and depression, hopelessness and wish to advance the death in patients with advanced cancer, at the same time to increase the spiritual welfare and the feeling of sense.

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Pilot Randomized Controlled Trial of Individual Meaning-Centered Psychotherapy for Patients With Advanced Cancer

Cited by 324 publications

References 25 publications

Purpose in life and use of preventive health care services

Purpose in life and use of preventive health care services

When and Why Should Mental Health Professionals Offer Traditional Psychodynamic Therapy to Cancer Patients?

Psicoterapia centrada en el sentido: “vivir con sentido”. Estudio piloto

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