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Psychotherapy

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 non-metastatic 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).

Dietary Supplements: What Is Safe?

The ACS Operational Statement on Complementary and Alternative Methods of Cancer Management

Complementary and Alternative Methods and Cancer

Placebo Effect

Learning About New Ways to Treat Cancer

Learning About New Ways to Prevent Cancer

References

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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. 1982;49:1048-1055.

Marchioro G, Azzarello G, Checchin F, et al. 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 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