Cognitive-behavioural stress management enhances adjustment in women with breast cancer
Cognitive-behavioural stress management enhances adjustment in women with breast cancer
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DOI：
10.1111/bjhp.12009
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发表时间：
2013-09-01
影响因子：
7.9
通讯作者：
Kerin, Michael
中科院分区：
文献类型：
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作者：
Groarke, AnnMarie;Curtis, Ruth;Kerin, Michael
目的这项随机对照试验探讨了比正常情况更简短的认知行为 (CBT) 压力管理干预是否可以减轻乳腺癌女性的压力和痛苦并增强获益。它还旨在确定最有可能从干预中受益的女性的特征。设计和方法进行了一项随机对照试验来评估心理干预的功效。 4 个月前接受过乳腺癌手术的女性 (N=355)，其中大多数目前正在接受辅助治疗，完成了评估整体和癌症特异性压力、抑郁、焦虑、乐观和获益的调查问卷。他们被随机分配到为期 5 周的小组认知行为压力管理 (CBSM) 计划加标准护理或仅标准护理。在干预后和 12 个月后进行重新评估。结果方差分析显示，与对照组相比，接受干预的患者总体压力和焦虑显着降低，获益发现增加。然而，这些差异并没有维持在 12 个月。干预的效果受到压力的调节，因此基线时整体压力较高的女性的压力和焦虑程度均显着降低。 结论 CBSM 干预比正常情况更短（5 周与 9-20 周），对乳腺癌女性的调整具有有益作用，对于整体压力增加的女性尤其有效。在此基础上进行筛查可能有助于最佳且具有成本效益的心理治疗。贡献声明关于这个主题已知什么？多种心理干预措施已被用来增强乳腺癌女性的适应能力。认知行为疗法已被认为是最有希望的干预措施，并已证明可以短期降低焦虑抑郁和生活质量。纵向研究的结果好坏参半，因此需要更多的研究来评估效果的持久性。以前在辅助治疗阶段对乳腺癌女性进行的 CBT 干预时间为 9 至 20 周，这既费时又费资源。这项研究增加了哪些内容？这是一项纵向随机对照试验，在辅助治疗阶段引入 CBT 干预，其实施时间比之前的干预更短。较短的干预确实增强了干预后的调整，但差异在 12 个月时并未持续。在这项研究中，评估了积极和消极的调整，只有另外两项 CBT 干预研究包含了积极的结果。在这项研究中，与 CBSM 干预措施的其他关键研究一样，通过不同的方法招募和选择来自诊所的连续患者。这是唯一一项评估初始整体压力作为 CBT 干预效果调节因素的研究，初始整体压力较高的女性在干预中表现更好。衡量这一点的量表可能是一个有用的筛查工具，可以识别需要心理干预的女性，从而有助于提供更具成本效益的医疗保健。
ObjectiveThis randomized controlled trial examines whether a briefer cognitive-behavioural (CBT) stress management intervention than the norm can reduce stress and distress and enhance benefit finding in women with breast cancer. It further aims to identify characteristics of those women most likely to benefit from the intervention.Design and methodA randomized controlled trial was conducted to assess the efficacy of a psychological intervention. Women (N=355) who had undergone surgery for breast cancer 4months earlier, the majority of whom were currently undergoing adjuvant therapy, completed questionnaires assessing global and cancer-specific stress, depression, anxiety, optimism and benefit finding. They were randomly assigned to a 5-week group cognitive-behavioural stress management (CBSM) programme plus standard care or standard care only. Reassessment occurred post-intervention and 12months later.ResultsAnalyses of variance revealed that patients who received the intervention showed significant lowering of global stress and anxiety and increased benefit finding compared to controls. These differences, however, were not maintained at 12months. Effects of the intervention were moderated by stress such that women with high global stress at baseline showed greater reduction in both stress and anxiety.ConclusionsA CBSM intervention, which was briefer than the norm (5weeks vs. 9-20weeks), had beneficial effects on adjustment for women with breast cancer and was particularly effective for those with increased global stress. Screening on this basis may facilitate optimal and cost-effective psychological treatment.Statement of contributionWhat is already known on this subject? Diverse psychological interventions have been utilized to enhance adjustment in women with breast cancer. Cognitive-behavioural therapy has been identified as the most promising intervention and has demonstrated short-term reductions in anxiety depression and quality of life. The findings from longitudinal studies are mixed, so more studies are needed which assess the durability of effects. Previous CBT interventions with women with breast cancer during the adjuvant treatment phase have ranged from 9 to 20weeks which is both time and resource intensive.What does this study add? This is a longitudinal randomized control trial with introduction of a CBT intervention conducted over a shorter period than previous interventions in the adjuvant treatment phase. The shorter intervention did enhance adjustment post-intervention, but differences were not sustained at 12months. In this study, positive and negative adjustments are assessed, and only two other CBT intervention studies have included positive outcomes. In this study, consecutive patients from a clinic are recruited versus selection through diverse methods as in other key studies of CBSM interventions. This is the only study to assess initial global stress as a moderator of the effects of a CBT intervention and women with high initial global stress did better in the intervention. A scale measuring this could be a useful screening tool to identify women in need of psychological intervention, thereby contributing to more cost-effective health care.