title: Cognitive behaviour therapy for menopausal symptoms following breast cancer treatment: Who benefits and how does it work?
abstract: OBJECTIVE
  Cognitive behaviour therapy (CBT) has been found to reduce the impact of menopausal symptoms, hot flushes and night sweats. This study investigates the moderators and mediators of CBT for women who had problematic menopausal symptoms following breast cancer treatment.
  
  
  METHODS
  Analysis of 96 patients with breast cancer induced menopausal symptoms recruited to the MENOS1 trial; 47 were randomly assigned to Group CBT and 49 to usual care. Questionnaires were completed at baseline, 9 and 26 weeks post randomisation. Potential moderators and mediators, including sociodemographic, clinical and psychological factors, of the treatment effect on the primary outcome were examined.
  
  
  METHODS
  Hot Flush Problem Rating.
  
  
  RESULTS
  CBT was effective at reducing problem rating at 9 weeks regardless of age, BMI, time since breast cancer diagnosis, menopausal status at time of diagnosis, or type of cancer treatment (radiotherapy or chemotherapy or endocrine treatment). The treatment effect was significantly greater in women not receiving chemotherapy, those with higher levels of psychological distress at baseline and for non-white women. Beliefs about control/coping with hot flushes were the main mediators of improvement in problem rating following CBT. Beliefs about hot flushes in a social context, depressed mood and sleep problems were also identified as mediators.
  
  
  CONCLUSIONS
  These findings suggest that CBT is widely applicable for breast cancer patients who are experiencing treatment related menopausal symptoms, and that CBT works mainly by changing beliefs and improving mood and sleep.
authors.affiliation: Institute of Psychiatry, King's College London, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Chilcot
authors.affiliation: Institute of Psychiatry, King's College London, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Norton
authors.affiliation: Institute of Psychiatry, King's College London, UK. Electronic address: myra.hunter@kcl.ac.uk.
authors.forename: Myra S
authors.initials: MS
authors.lastname: Hunter
mesh_terms: D001943:Breast Neoplasms / Q000628:therapy; D015928:Cognitive Behavioral Therapy; D003469:Culture; D003863:Depression / Q000150:complications; D005006:Ethnicity; D005260:Female; D019584:Hot Flashes / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008593:Menopause / Q000523:psychology*; D008875:Middle Aged; D020377:Self Efficacy; D012893:Sleep Wake Disorders / Q000150:complications; D012931:Social Environment; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D013546:Sweating
keywords: CBT; Cognitive behaviour therapy; Hot flushes; Mediator; Menopause; Moderator