title: The effects of psychotherapy on psychological well-being and diurnal cortisol patterns in breast cancer survivors.
abstract: BACKGROUND
  Neuroendocrine dysregulation influenced by psychosocial stress is related to breast cancer recurrence. Very few studies examine the impacts of psychotherapy on diurnal cortisol patterns among breast cancer survivors.
  
  
  METHODS
  Forty-eight breast cancer patients who completed active cancer treatment were randomly assigned to receive either 8 weekly body-mind-spirit (BMS) group therapy sessions or 1 educational (EDU) session. Self-report measures included the Beck Depression Inventory-II (BDI-II), and the Meaning in Life questionnaire (MLQ) including two subscales: MLQ-Presence and MLQ-Search. Salivary cortisol levels were collected by the subjects in their homes at the time of awakening, 30 and 45 min after awakening, and at 12.00, 17.00, and 21.00 h. Measurement time points include baseline, the 2nd month (completion of BMS therapy), the 5th month, and the 8th month.
  
  
  RESULTS
  There were no significant differences in BDI-II scores (p>0.05) and MLQ-Presence scores (p >0.05) between BMS and EDU groups at baseline or across the three follow-ups. Nevertheless, greater MLQ-Search scores were found in the BMS group compared to the EDU group during the 5th month of follow-up (p <0.01). The higher level of cortisol at 21.00 h (p < 0.01) and a flatter diurnal cortisol pattern were more likely to occur in EDU than in BMS participants (p < 0.05) at the 8th month of follow-up.
  
  
  CONCLUSIONS
  BMS group therapy likely contributed to enhancing an active search for meaning in life toward more opportunities for personal growth and to maintaining stable cortisol responses to everyday life stress for breast cancer survivors.
authors.affiliation: Department of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan, ROC.
authors.forename: Fei-Hsiu
authors.initials: FH
authors.lastname: Hsiao
authors.forename: Guey-Mei
authors.initials: GM
authors.lastname: Jow
authors.forename: Wen-Hung
authors.initials: WH
authors.lastname: Kuo
authors.forename: King-Jen
authors.initials: KJ
authors.lastname: Chang
authors.forename: Yu-Fen
authors.initials: YF
authors.lastname: Liu
authors.forename: Rainbow T H
authors.initials: RT
authors.lastname: Ho
authors.forename: Siu-Man
authors.initials: SM
authors.lastname: Ng
authors.forename: Cecilia L W
authors.initials: CL
authors.lastname: Chan
authors.forename: Yu-Ming
authors.initials: YM
authors.lastname: Lai
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Chen
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001943:Breast Neoplasms / Q000378:metabolism / Q000523:psychology* / Q000628:therapy; D002940:Circadian Rhythm / Q000502:physiology*; D003863:Depression / Q000628:therapy; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism*; D008875:Middle Aged; D026441:Mind-Body Therapies; D010353:Patient Education as Topic; D011569:Psychiatric Status Rating Scales; D011614:Psychotherapy, Brief / Q000379:methods*; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000378:metabolism / Q000628:therapy; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006854:Hydrocortisone