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Other common
name(s): therapy, counseling, psychological intervention,
psychotherapeutic treatment
Scientific/medical
name(s): none
Description
Psychotherapy covers a wide range of approaches designed to
help people change their ways of thinking, feeling, or behaving.
Overview
Research has shown that psychotherapy may improve a patient's
quality of life. It can help reduce anxiety and depression that
sometimes occur in people with cancer. It can also help people cope
with cancer and the changes in their lives. Psychotherapy has not,
however, been demonstrated to increase survival in people with cancer.
How is it promoted for use?
Psychotherapists believe that psychotherapy can help people,
including those with cancer, find the inner strength they need to
improve their coping skills, allowing them to more fully enjoy their
lives. Psychotherapy can be used to help people deal with the diagnosis
and treatment of cancer. It can also be useful in overcoming depression
and anxiety, which are common in people with cancer.
Psychotherapy is available in many forms. People may seek
individual therapy, where there is a one-on-one relationship with a
therapist. There are also therapists who work with couples or entire
families, in order to help those most affected by the cancer diagnosis.
Psychotherapy also may be practiced with groups, in which a number of
people meet together to discuss common experiences and issues and to
learn specific coping techniques. Unlike self-help groups,
psychotherapy groups are offered and managed by a professional
therapist.
What does it involve?
There are many different kinds of therapy, from long-term
analysis to brief problem-oriented treatment. Therapy may include
looking at emotional experiences, working with coping styles, doing
homework assignments, and more.
People can get referrals to therapists by asking members of
their health care team or by contacting professional organizations for
names of psychotherapists who specialize in the area. Oncology units of
hospitals sometimes have departments that include therapists.
Most individual psychotherapy is held in the therapist's
office. In some situations, it may be done in the hospital or the
patient's home. Sessions typically last 45 to 50 minutes. The number of
meetings is decided by the client and therapist. Most meet weekly for a
short time, depending on the problem and the client's response to
therapy.
There are a wide range of psychotherapy approaches and
techniques. These are some examples:
Behavioral therapy (behavior modification)
This therapy focuses on replacing problematic behavior
patterns (such as obsessive-compulsive behavior) with more healthy
responses. A behavioral therapist may use techniques such as
biofeedback and muscle relaxation. This kind of therapy deals only with
the symptoms of a problem.
Client-centered therapy
This form of therapy focuses on the feelings and current
experiences of the individual. The therapist encourages the patient to
direct the sessions while providing empathy and support. The goal is to
help patients help themselves. The length of this therapy varies.
Body-oriented therapy
This kind of therapy is based on the belief that emotions are
stored in the body and may be expressed in the form of physical tension
and restriction. Breathing techniques, movement, manual pressure, and
probing are used to help people release emotions that have built up in
the body.
Cognitive therapy, also called
cognitive-behavioral therapy
Cognitive therapy is directed at changing thoughts and
behaviors by addressing the repeated, faulty, negative thoughts that
affect behavior. Cognitive therapists help people learn to reprogram
harmful internal messages and create positive self-talk, or internal
dialogue. This kind of therapy often includes homework assignments for
the patient such as disputing disturbing thoughts, trying different
responses to criticism, or making a list of things he or she likes
about himself or herself. It also includes different forms of
behavioral therapy.
Family/couples therapy
Family therapy focuses on relationship patterns. All family
members may be involved in therapy sessions. A therapist involved in
this type of therapy acts as a facilitator to help the family or couple
communicate their feelings more effectively. Although usually
short-term, this therapy can last longer depending on the needs of the
individuals.
Group therapy
Group therapy varies widely in size and format, as well as in
length. Some groups are small and meet weekly without a scheduled
agenda. Others may meet monthly and offer information, teach coping
skills, help reduce anxiety, and provide a place to share common
concerns and emotional support.
Psychodynamic therapy
Similar to traditional psychoanalysis, the goal of this form
of therapy is to change lifelong personality patterns by uncovering the
connections between current emotional reactions and early childhood
experiences. This form of therapy is long-term (lasting several years)
and focuses on the underlying causes of a problem.
Whatever approach is used, when a person has a serious
physical illness such as cancer, the therapy is likely to focus on the
emotional stress resulting from the illness. It will also focus on any
depression or anxiety and explore past or present issues that may
affect the person's adjustment to the illness. The therapist may ask
about the person's previous experiences with loss in general and loss
related to the current illness.
What is the history behind it?
The influence of personality characteristics on health has
been examined for many years. Research conducted by Lawrence LeShan,
PhD, during the early 1950s on the relationship between personality
characteristics and cancer found that many patients experienced a loss
of hope in finding true meaning in their lives well before their cancer
diagnoses. Dr. LeShan developed a specific approach to psychotherapy
designed to treat people living with cancer. This approach focuses on
helping patients use their own inner self-healing abilities to live
more fulfilled, enjoyable, and personally meaningful lives.
Over the past twenty years, several books on the role of
emotions and behavior in recovery from serious illness have become
popular. Books by Norman Cousins, Bernie Siegel, MD, and Carl Simonton,
MD, have focused on developing effective coping strategies to manage
the feelings of hopelessness, passivity, and depression that can occur
with life-threatening illness. Psychological and behavioral methods are
now becoming a regular part of cancer treatment.
Psychotherapy is practiced by licensed mental health
professionals, including psychologists, psychiatrists, social workers,
nurses, counselors, and marriage and family therapists. Specialized
training and experience in the issues involved in treating people with
cancer is necessary, and some professionals specifically work as
psycho-oncologists.
What is the evidence?
Research has consistently shown that psychotherapy can be
beneficial to people with cancer in a variety of ways. A psychologist
at the University of California School of Medicine in Los Angeles
reported in 1999 that behavioral therapy is most useful in managing
anxiety related to specific treatment concerns, such as phobic
reactions to needles, fears related to surgery or chemotherapy, and
claustrophobic feelings during magnetic resonance imaging (MRIs). A
1996 study reported weekly individual cognitive therapy and bimonthly
family counseling improved both depression and quality of life of women
with nonmetastatic breast cancer. Research has generally shown that
psychotherapy can help reduce anxiety and depression in people with
cancer, help them make better use of their time, and help them return
to work. Psychotherapy can also help people learn to communicate better
with their doctors and adhere to medical treatment.
A 2006 study of nearly two hundred women with early-stage
breast cancer showed that a ten-week cognitive behavioral therapy group
course helped the women reduce social disruption and improve their
outlook, sense of well-being, and ability to relax, even up to one year
after the therapy. A similar effect was shown in a 2006 study of men
who had been treated for early-stage prostate cancer with surgery or
radiation. The group of men who had the ten-week cognitive behavioral
therapy stress management course had better quality of life afterward
than those who did not.
The National Comprehensive Cancer Network (NCCN), a group of
twenty-one expert cancer treatment centers in the United States, now
recommends that all patients with cancer be evaluated for emotional
distress. People who are found to have higher distress levels during
cancer treatment are referred for counseling or therapy. Psychotherapy
has become a standard complementary measure to improve quality of life
for people with cancer.
Research has not shown, however, that psychotherapy can
prolong the life of cancer patients. Few controlled studies of this
nature have been conducted. In 1982, researchers studied 120 end-stage
male cancer patients. About half were randomly assigned to a control
group and the other half received individual counseling. Whereas those
receiving psychotherapy showed improvement on quality of life measures,
no difference was found between groups in survival rate after one year.
A 1989 study from Stanford University reported a substantial survival
benefit among women with metastatic breast cancer who received
psychotherapy. However, a later study from the same researcher reported
improved quality of life but no difference in survival.
A 2004 analysis pooled the results of several well-designed
studies of cancer patients receiving psychotherapy. With more than a
thousand patients in the final analysis, no effect was found on
survival.
Are there any possible problems or
complications?
Psychotherapists vary in the amount of their training and
experience in dealing with issues that are important for people with
cancer. Difficult personal issues that arise from psychotherapy can
also be emotionally upsetting or uncomfortable. Most physicians now
view psychotherapy as complementary to standard medical treatment for
cancer. Relying on this type of treatment alone and avoiding or
delaying conventional medical care for cancer may have serious health
consequences.
Additional Resources
More information from your American Cancer
Society
The following information on complementary and alternative
therapies may also be helpful to you. These materials may be found on
our Web site (www.cancer.org)
or ordered from our toll-free number (1-800-ACS-2345).
References
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improves quality of life after treatment for breast cancer. J Consult Clin Psychol.
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Cassileth BR. The aim of psychotherapeutic intervention in
cancer patients. Support
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Chow E, Tsao MN, Harth T. Does psychosocial intervention
improve survival in cancer? A meta-analysis. Palliat Med.
2004;18:25-31.
Fox BH. The role of psychological factors in cancer incidence
and prognosis. Oncology
(Williston Park). 1995;9:245-253.
Linn MW, Linn BS, Harris R. Effects of counseling for late
stage cancer patients. Cancer.
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Marchioro G, Azzarello G, Checchin F, Perale M, Segati R,
Sampognaro E, Rosetti F, Franchin A, Pappagallo GL, Vinante O. The
impact of a psychological intervention on quality of life in
non-metastatic breast cancer.
Eur J Cancer. 1996;32A:1612-1615.
NCCN clinical practice guidelines in oncology: distress
management. National Comprehensive Cancer Network Web site. Accessed at
http://www.nccn.org/professionals/physician_gls/PDF/distress.pdf on
March 23, 2007.
Penedo FJ, Molton I, Dahn JR, et al. A randomized clinical
trial of group-based cognitive-behavioral stress management in
localized prostate cancer: development of stress management skills
improves quality of life and benefit finding. Ann Behav Med.
2006;31:261-270.
Sourkes BM, Massie MJ, Holland JC. Psychotherapeutic issues.
In: Holland JC, Breitbart, eds. Psycho-Oncology.
New York, NY: Oxford University Press; 1998.
Spiegel D. Essentials of psychotherapeutic intervention for
cancer patients. Support
Care Cancer. 1995;3:252-256.
Spiegel D, Butler LD, Giese-Davis J, et al. Effects of
supportive-expressive group therapy on survival of patients with
metastatic breast cancer: a randomized prospective trial. Cancer.
2007;110:1130-1138.
Wellisch DK. Treating cancer patients: a growing area for
psychologists. The
National Psychologist. May/June;1999:26-27.
Note:
This
information may not cover all possible claims, uses, actions,
precautions, side effects or interactions. It is not intended as
medical advice, and should not be relied upon as a substitute for
consultation with your doctor, who is familiar with your medical
situation.
Last Medical Review: 11/01/2008
Last Revised: 11/01/2008
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