title: Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial.
abstract: BACKGROUND
  We conducted a randomised, controlled trial of cognitive-existential group therapy (CEGT) for women with early stage breast cancer receiving adjuvant chemotherapy with the aim of improving mood and mental attitude to cancer.
  
  
  METHODS
  Women were randomised to 20 sessions of weekly group therapy plus 3 relaxation classes or to a control arm receiving 3 relaxation classes. Assessments, independently done at baseline, 6 and 12 months, included a structured psychiatric interview and validated questionnaires covering mood, attitudes to cancer, family relationships, and satisfaction with therapy.
  
  
  RESULTS
  Three hundred and three of 491 (62%) eligible patients participated over 3 years. Distress was high pre-intervention: 10% were diagnosed as suffering from major depression, 27% from minor depression and 9% from anxiety disorders. On an intention-to-treat analysis, there was a trend for those receiving group therapy (n=154) to have reduced anxiety (p=0.05, 2-sided) compared to controls (n=149). Women in group therapy also showed a trend towards improved family functioning compared to controls (p=0.07, 2-sided). The women in the groups reported greater satisfaction with their therapy (p<0.001, 2-sided), appreciating the support and citing better coping, self-growth and increased knowledge about cancer and its treatment. They valued the CEGT therapy. Overall effect size for the group intervention was small (d=0.25), with cancer recurrence having a deleterious effect in three of the 19 therapy groups. Psychologists as a discipline achieved a moderate mean effect size (d=0.52).
  
  
  CONCLUSIONS
  CEGT is a useful adjuvant psychological therapy for women with early stage breast cancer. Interaction effects between group members and therapists are relevant to outcome. Group-as-a-whole effects are powerful, but the training and experience of the therapist is especially critical to an efficacious outcome.
authors.affiliation: Department of Psychiatry, University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia. dkissane@unimelb.edu.au
authors.forename: David W
authors.initials: DW
authors.lastname: Kissane
authors.forename: Sidney
authors.initials: S
authors.lastname: Bloch
authors.forename: Graeme C
authors.initials: GC
authors.lastname: Smith
authors.forename: Patricia
authors.initials: P
authors.lastname: Miach
authors.forename: David M
authors.initials: DM
authors.lastname: Clarke
authors.forename: Jillian
authors.initials: J
authors.lastname: Ikin
authors.forename: Anthony
authors.initials: A
authors.lastname: Love
authors.forename: Nadia
authors.initials: N
authors.lastname: Ranieri
authors.forename: Dean
authors.initials: D
authors.lastname: McKenzie
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000339:Affect; D000368:Aged; D001294:Attitude to Health; D001943:Breast Neoplasms / Q000188:drug therapy / Q000523:psychology* / Q000534:rehabilitation*; D017024:Chemotherapy, Adjuvant; D015928:Cognitive Behavioral Therapy; D005086:Existentialism; D005260:Female; D006801:Humans; D008875:Middle Aged; D017060:Patient Satisfaction; D011615:Psychotherapy, Group; D016896:Treatment Outcome