Effects of group therapy for people with cancer tokyo

 One of the earliest randomized studies to show a positive outcome of improved mood, “Group support for patients with metastatic cancer... [Epub ahead of print]  Results of this s

Effects of Group Therapy for people with Cancer

Patricia Fobair, LCSW, MPH

Supportive Care Program,

Stanford University Hospital,

Cancer Program

Overview of Effects of Groups

 Positive effects—improves mood and

knowledge; lowers stress, anxiety,

depression, less vomiting and

pain- Neutral effects -less needy patients

experience less of

benefit- Negative effects -a small percentage of patients find groups not helpful-

Effectiveness studies

 Meta-analysis of 116 studies found positive

benefits for adults with cancer: less anxiety,

depression, nausea; better mood and patient knowledge Devine, E C., & Westlake, S K (1995)

Oncology Nursing Forum, 22, , 1369-1381

 One of the earliest randomized studies to

show a positive outcome of improved mood,

“Group support for patients with metastatic

cancer Spiegel, D., Bloom, J R., & Yalom, I (1981) Arch Gen

Psychiatry, 38(5), 527-533 .

Recent studies of effectiveness

 Psychosocial interventions as part of breast

cancer rehabilitation programs? Results from a systematic review Fors EA , Bertheussen GF , Thune I ,

Juvet LK, Elvsaas IK, Oldervoll L, Anker G, Falkmer U, Lundgren

S, Leivseth G Psychooncology 2010 Sep 6 [Epub

ahead of print]

 Results of this study: In 4 out of 7 studies of cognitive behavioral therapy, the Quality of life improved when patients were provided group therapy immediately

after primary breast cancer treatment.

Group Support found helpful

 In the San Francisco Bay area, Levine and her group (2005) assigned 181 breast cancer

patients to support group or to

 Levine, E G., Eckhardt, J., & Targ, E (2005) Change in

post-traumatic stress symptoms following psychosocial treatment for

breast cancer Psycho-Oncology, 14(8), 618-635

Three controlled studies from Japan

In a study by Fukui, Kugaya, Okamura et al (2000)

 -50 breast cancer patients were randomized into a 6

week structured, (25) group intervention or (25) control The class topics included health education, coping skills training, stress management and

psychological support

 Fukui et al (2000) found that the patients in the

experimental group had significantly lower scores than controls for total mood disturbance, along with a higher score of vigor

- Cancer, 89(5), 1026-1036

Three controlled studies from Japan

2 Fukui, Koike, Ooba, & Uchitomi (2003) In a

secondary analysis Fukui et al looked at

loneliness, number of confidants, and

satisfaction with confidants and mutual

support The experimental group had

significantly lower loneliness scores than the control patients, and significantly higher scores for the number of confidants, as well as

greater satisfaction with confidants, and with mutual support over the six-month study

period Oncology Nursing Forum, 30(5),

823-830.

Three controlled studies from Japan

3 Maeda, Kurihara, Morishima, & Munakata (2008) studied the

effectiveness of psychological intervention on personality change, enhancing perceived emotional support, adaptive coping and psychological well-being of 28 primary breast cancer patients (14 experimental, 14 control group).

The intervention consisted of 3 sessions that included providing

medical and psychological information and counseling using structured association techniques; 3-4 days after surgery, 3 months later post intervention and 6 months follow-up.

Intervention seemed to enhance the short-term personality

change, adaptive coping, and psychological well-being of experimental patients More studies are needed to confirm

Cancer Nursing, 31(4), E27-35.

Groups at Stanford University

Stanford study finds improvement

 Classen, C., Butler, L D., Koopman, C., Miller, E.,

DiMiceli, S., Giese-Davis, J., et al (2001) expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical

Supportive-intervention trial Arch Gen Psychiatry, 58(5), 494-501.

 125 breast cancer patients with metastatic disease

were studied 64 intervention group with a 1 year

group intervention, versus 61 controls

 Group members showed a decline in IES trauma

(stress)

Benefits of psychosocial oncology

care: Improved quality of life

 “Interventions to treat distress and improve quality of life in cancer patients are widely available, effective, and standardized.”

 “Given the bulk of literature available detailing the

efficacy of various types of interventions for patients at all points of the illness trajectory,

 It would seem ill considered not to provide these

services to cancer patients.”

Carlson, L E., & Bultz, B D (2003) Health and Quality of Life Outcomes, 1(8), 1-8

Neutral Effects

 The patients who benefit most from

groups tend to be those who are most

distressed

 Vos et al 2004, 2007, found that when comparing patients without high distress in support groups, versus patients held in control, that well-adjusted women diagnosed with breast cancer did not specifically benefit from group interventions.

 Vos, P J., Garssen, B., Visser, A P., Duivenvoorden, H J., & de Haes,

H C (2004) Psychotherapy Psychosomatics, 73(5), 276-285

 Vos, P J., Visser, A P., Garssen, B., Duivenvoorden, H J., & de Haes,

H C (2007) J Psychosocial Oncol, 25(4), 37-60

 Goodwin, P J., Leszcz, M., Ennis, M., Koopmans, J., Vincent, L.,

Guther, H., et al (2001) The effect of group psychosocial support on

survival in metastatic breast cancer N Engl J Med, 345(24), 1719-1726.

 Boesen, E H., Ross, L., Frederiksen, K., Thomsen, B L., Dahlstrom, K., Schmidt, G., et al (2005) Psycho educational Intervention for patients

with cutaneous malignant melanoma: a replication study Journal of

Clinical Oncology, 23(6), 1270-1277

Example of distressed patient

Distressed patient

Who participates in Groups

Support group members tend to

be- Female; Younger; More educated; Without a partner,

 Comfortable in using formal support,

 Held more positive beliefs about group benefits,

 Felt ‘others’ were supportive of groups,’

 Perceived less difficulty in joining a group,

 Felt more distressed & anxious about having cancer,

 Lack of support from a ‘special person,’

 Used active coping techniques, such as planning, and reframing problems.

Grande, G E., Myers, L B., & Sutton, S R (2006) How do patients who participate in cancer support groups differ from those who do not?

Psycho-Oncology, 15(4), 321-334

Can group be harmful?

“Negative group experiences can result from any interaction,”

Galinsky, M J., & Schopler, J H (1984) Social Work in Health

Care, 20, 77-95.

 Open communication can feel scary, and threatening;

 Feeling pressure to conform or stress about group obligations;

 Group experiences may leave members feeling overwhelmed, less adequate;

 Lack of group direction makes group members uneasy;

 Feeling bothered by disruptive or controlling members;

 Fears of seeming ‘stupid,’ bothers many group members;

 “Is this group for me?” may mean, “I don’t feel understood, here.”

Coping with problems in group

 Group Leader tasks include the need to reinforce a positive image of

each group member

 Fears of ‘feeling stupid,’ can be lowered by the leader’s positive regard for each person’s worry and question

 Help each group member locate a ‘similar other,’ within the group

 Difficult group members can be helped when group leaders address the underlying fear, anger, or sadness that isn’t being disclosed directly “It feels to me (leader says), that something may be bothering you How have things been for you, this week?

 The attacking group member may be projecting the most disliked aspect

of himself or herself to the group member in the room

 By redirecting the attention back to the attacker’s feelings at the moment, the group leader shows the group that they are safe to explore their own feelings.

In

Summary  Group interventions have been found effective in improving patient

mood, fatigue, and social support, in many studies

 Patients with the highest percentage of emotional distress are likely to appreciate what groups offer them, while patients feeling less distressed

by a cancer diagnosis or treatment may benefit less

 Patients can be harmed in support groups, when insensitive comments made are a reflection of the ‘sayers,’ problems

 Leaders can learn to manage difficult moments in groups by: 1) enquiring into the feelings of the aggressor, “What’s coming up for you, today?”

 When feelings have been identified and expressed, the group leader can reframe the attack as a worry or an unexamined turf issue that reflects a difference in priorities “How did the rest of you hear experience this?”

 Group leader defuses the tension by helping both sides express their

feelings and by reframing the problem as a semantic misunderstanding

or priority difference “People are never the problem, people have

problems.” Watts, R (1998) Tulsa, Oklahoma: Honor Books.

We end with a picture of a

successful group, 2003-2009