Group support for patients with metastatic cancer. A randomized outcome study.
01 May 1981-Archives of General Psychiatry (American Medical Association)-Vol. 38, Iss: 5, pp 527-533
TL;DR: Objective evidence is provided that a supportive group intervention for patients with metastatic cancer results in psychological benefit and mechanisms underlying the effectiveness of this group intervention are explored.
Abstract: • The effects of weekly supportive group meetings for women with metastatic carcinoma of the breast were systematically evaluated in a one-year, randomized, prospective outcome study. The groups focused on the problems of terminal illness, including improving relationships with family, friends, and physicians and living as fully as possible in the face of death. We hypothesized that this intervention would lead to improved mood, coping strategies, and self-esteem among those in the treatment group. Eighty-six patients were tested at four-month intervals. The treatment group had significantly lower mooddisturbance scores on the Profile of Mood States scale, had fewer maladaptive coping responses, and were less phobic than the control group. This study provides objective evidence that a supportive group intervention for patients with metastatic cancer results in psychological benefit. Mechanisms underlying the effectiveness of this group intervention are explored.
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TL;DR: Common mind-body modalities (meditation/mindfulness-based stress reduction, relaxation therapy, cognitive-behavioral therapy, hypnosis, biofeedback, music therapy, art therapy, support groups, and aromatherapy) are acquainted and important evidence in support of or against their clinical application is examined.
Abstract: The idea that thoughts and emotions influence health outcomes is an ancient concept that was initially abandoned by Western medicine researchers. Today, researchers are showing a renewed interest in the interactions of the mind and body and the role these interactions play in disease formation and recovery. Complementary and alternative interventions, such as mind-body therapies, are increasingly being used by cancer survivors for disease prevention, immune system enhancement, and symptom control. Traditional training has not been structured to provide advanced practitioners with an in-depth knowledge of the clinical applications of mind-body therapies. The aim of this article is to acquaint the reader with common mind-body modalities (meditation/mindfulness-based stress reduction, relaxation therapy, cognitive-behavioral therapy, hypnosis, biofeedback, music therapy, art therapy, support groups, and aromatherapy) and to examine important evidence in support of or against their clinical application.
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TL;DR: Although this age group is often thought to be nonresponsive to psychotherapeutic intervention, it appears that group psychotherapy is a valuable modality in addressing the common clinical picture of social isolation, depression, and demoralization.
Abstract: The group psychotherapy of a population of cognitively intact men, aged 70–95 years, resident in a home for the aged is described. Although this age group is often thought to be nonresponsive to psychotherapeutic intervention, it appears that group psychotherapy is a valuable modality in addressing the common clinical picture of social isolation, depression, and demoralization. The paper describes certain technical modifications in the conduct of the group by the leader—high activity and support, therapeutic transparency, translation, and integration—that facilitate this process. Psychodynamic aspects of aging and of living in an institution are also elaborated, with particular reference to the role of the life review, current theories of narcissism, and the consequences of the men's efforts to maintain their self-esteem and sense of self in the face of recurrent narcissistic injuries and losses.
19 citations
TL;DR: This study’s findings prompted a testable linear conceptual model of co-factors and their importance for providing effective psychiatric care for end-stage cancer patients’ psychiatric conditions, and an impassioned plea for accelerated study and better care.
Abstract: Rates of psychiatric conditions common to end-stage cancer patients (delirium, depression, anxiety disorders) remain unchanged. However, patient numbers have increased as the population has aged; indeed, cancer is a chief cause of mortality and morbidity in older populations. Effectiveness of psychiatric interventions and research to evaluate, inform, and improve interventions is critical to these patients’ care. This article’s intent is to report results from a recent review study on the effectiveness of interventions for psychiatric conditions common to end-stage cancer patients; the review study assessed the state of research regarding treatment effectiveness. Unlike previous review studies, this one included non-traditional/alternative therapies and spirituality interventions that have undergone scientific inquiry. A five-phase systematic strategy and a theoretic grounded iterative methodology were used to identify studies for inclusion and to craft an integrated, synthesized, comprehensive, and reasonably current end-product. Psychiatric medication therapies undoubtedly are the most powerful treatments. Among them, the most effective (i.e., “best practices benchmarks”) are: (1) for delirium, typical antipsychotics—though there is no difference between typical vs. atypical and other antipsychotics, except for different side-effect profiles, (2) for depression, if patient life expectancy is ≥4–6 weeks, then a selective serotonin reuptake inhibitor (SSRI), and if < 3 weeks, then psychostimulants or ketamine, and these generally are useful anytime in the cancer disease course, and (3) for anxiety disorders, bio-diazepams (BDZs) are most used and most effective. A universal consensus suggests that psychosocial (i.e., talk) therapy and spirituality interventions fortify the therapeutic alliance and psychiatric medication protocols. However, trial studies have had mixed results regarding effectiveness in reducing psychiatric symptoms, even for touted psychotherapies. This study’s findings prompted a testable linear conceptual model of co-factors and their importance for providing effective psychiatric care for end-stage cancer patients. The complicated and tricky part is negotiating patients’ diagnoses while articulating internal intricacies within and between each of the model’s co-factors. There is a relative absence of scientifically derived information and need for more large-scale, diverse scientific inquiry. Thus, this article is an impassioned plea for accelerated study and better care for end-stage cancer patients’ psychiatric conditions.
19 citations
TL;DR: In this article, a survey of 289 people from a variety of professions involved in counseling cancer patients and their families within the United Kingdom obtained a response rate of 82% and the primary findings discussed in this paper cover a range of issues, including the working conditions and responsibilities of the counsellors, what professional qualifications they possess, the extent and availability of supervision and support, as well as the types of counselling intervention employed.
Abstract: A national survey of 289 people from a variety of professions (nurses, social workers, clinical psychologists, psychiatrists, etc) involved in counselling cancer patients and their families within the United Kingdom obtained a response rate of 82%. The primary findings discussed in this paper cover a range of issues, including the working conditions and responsibilities of the counsellors, what professional qualifications they possess, the extent and availability of supervision and support, as well as the types of counselling intervention employed. Particularly disturbing was the fact that only 25% of our sample had any recognised formal counselling qualification and that 75% did not belong to any professional counselling organisation. In view of the wide diversity of qualifications, salary scales, responsibilities and working conditions and practices amongst the respondents, we propose that the National Health Service (NHS) should establish clearer guidelines as to the minimum acceptable qualifi...
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TL;DR: The purpose of this study was to understand the lived experience of music therapy for women with breast cancer; the author was both clinician/researcher and qualitative literature on group phenomenology and focus groups.
Abstract: Women living with breast cancer are faced with numerous challenges that have the potential to challenge their coping resources. However, positive benefits have been attributed to participation in psychosocial therapy groups. Music interventions used therapeutically within the context of music therapy demonstrate numerous positive benefits. Yet, little is written about the use of group music therapy for women with different stages of breast cancer. Moreover, there is a gap in understanding of the lived experience of women with breast cancer within a group context, for which data from descriptive phenomenology methods would fill. The purpose of this study was to understand the lived experience of music therapy for women with breast cancer; the author was both clinician/researcher. Four groups of women who were outpatients received six weekly music therapy sessions that incorporated various music therapy methods. Eighteen women at different stages of the disease spectrum took part in the study. The q...
19 citations
References
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TL;DR: In this paper, the effects of reward or reinforcement on preceding behavior depend in part on whether the person perceives the reward as contingent on his own behavior or independent of it, and individuals may also differ in generalized expectancies for internal versus external control of reinforcement.
Abstract: The effects of reward or reinforcement on preceding behavior depend in part on whether the person perceives the reward as contingent on his own behavior or independent of it. Acquisition and performance differ in situations perceived as determined by skill versus chance. Persons may also differ in generalized expectancies for internal versus external control of reinforcement. This report summarizes several experiments which define group differences in behavior when Ss perceive reinforcement as contingent on their behavior versus chance or experimenter control. The report also describes the development of tests of individual differences in a generalized belief in internal-external control and provides reliability, discriminant validity and normative data for 1 test, along with a description of the results of several studies of construct validity.
21,451 citations
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01 Jan 1969
TL;DR: In this article, the implications of terminal illness for patients and for those involved in their care were discussed, and patients invited to talk about their experience found great relief in expressing their fear and anger and were able to move towards a state of acceptance and peace.
Abstract: Although most areas of human experience are nowadays discussed freely and openly, the subject of death is still surrounded by conventional attitudes and reticence that offer only fragile comfort because they evade the real issues. The dying may thus be denied the opportunity of sharing their feelings and discussing their needs with family, friends, or hospital staff. Although receiving devoted medical care, a dying patient is often socially isolated and avoided, since professional staff and students can find contact painful and embarrasing.
Aware of the strains imposed on all sides by this situation, Dr Kubler-Ross established a seminar at the University of Chicago to consider the implications of terminal illness for patients and for those involved in their care. Patients invited to talk about their experience often found great relief in expressing their fear and anger and were able to move towards a state of acceptance and peace. The seminar, initially composed of students of medicine, sociology, psychology, and theology, but later joined by hospital staff and relatives of patients, enabled many members to come to terms with their own feelings and to respond constructi to what the patients had to teach them.
5,220 citations
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TL;DR: A study of 800 outpatient visits to Children's Hospital of Los Angeles as discussed by the authors explored the effect of verbal interaction between doctor and patient on patient satisfaction and follow-through on follow-up.
Abstract: Study of 800 outpatient visits to Childrens Hospital of Los Angeles to explore the effect of the verbal interaction between doctor and patient on patient satisfaction and follow-through on...
947 citations