title: A stepped care stress management intervention on cancer-related traumatic stress symptoms among breast cancer patients—a randomized study in group vs. individual setting.
abstract: OBJECTIVE
  To evaluate the mode of delivery of a stress management intervention, in a group or individual setting, on self-reported cancer-related traumatic stress symptoms. A secondary aim was to evaluate a stepped care approach.
  
  
  METHODS
  All study participants (n = 425), who were female, newly diagnosed with breast cancer and receiving standard oncological care were offered Step I of the stepped care approach, a stress management education (SME). Thereafter, they were screened for cancer-related traumatic stress symptoms, and, if present (n = 304), were invited to join Step II, a more intense intervention, derived from cognitive behavioral therapy, to which they were randomized to either a group (n = 77) or individual (n = 78) setting. To assess cancer-related traumatic stress symptoms, participants completed the Impact of Event Scale and the Hospital Anxiety and Depression Scale at the time of inclusion, three-months post-inclusion and approximately 12-months post-inclusion.
  
  
  RESULTS
  The SME did not significantly decrease any of the cancer-related traumatic stress symptoms. No statistically significant differences were found between the group and the individual setting interventions. However, only 54% of the participants attended the group setting compared to 91% for the individual setting.
  
  
  CONCLUSIONS
  The mode of delivery had no effect on the cancer-related traumatic stress symptoms; however, the individual setting was preferred. In future studies, a preference-based RCT design will be recommended for evaluating the different treatment effects.
authors: Department of Public Health and Caring Sciences, Uppsala University, Sweden.
authors: Ritva
authors: R
authors: Rissanen
authors: Department of Public Health and Caring Sciences, Uppsala University, Sweden.|Department of Global Public Health and Primary Care, University of Bergen, Norway.
authors: Karin
authors: K
authors: Nordin
authors: Department of Oncology, University of Örebro, Sweden.
authors: Johan
authors: J
authors: Ahlgren
authors: Department of Public Health and Caring Sciences, Uppsala University, Sweden.
authors: Cecilia
authors: C
authors: Arving
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology / Q000628:therapy; D001943:Breast Neoplasms / Q000523:psychology*; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008016:Life Change Events; D008875:Middle Aged; D057240:Patient Preference; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D011615:Psychotherapy, Group; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology* / Q000628:therapy*; D013315:Stress, Psychological / Q000209:etiology* / Q000628:therapy*; D013548:Sweden; D016896:Treatment Outcome