News & Perspectives

Supportive Group Therapy Eases the Trauma of Advanced Breast Cancer
What the Study Showed

It's little surprise that many postsurgical women receiving the news that their breast cancer has metastasized (spread to other parts of the body) develop major anxiety, depression, and symptoms of post-traumatic stress disorder, such as avoidance. Investigators at Stanford University School of Medicine in California have found that these patients end up suffering much less distress and trauma when they participate in a year or more of group therapy and engage in open and unstructured discussion of existential issues, such the meaning of life, isolation, and freedom.

The results were published in the Archives of General Psychiatry in 2001.

How It Was Done

The investigators recruited 125 women with metastatic breast cancer and then randomized 61 of them to receive education materials only (the control group) and 64 to get specialized therapy in groups of 3 to 15 people. The sessions continued for at least 12 months and were facilitated by two therapists. The 90-minute unstructured weekly meetings were designed to get participants to openly express and confront their problems, strengthen their relationships with others, and find greater meaning in their lives.

The group facilitators encouraged various discussion themes such as fear of death and dying, setting of life priorities, communicating effectively with family members, friends and doctors, and contending with changes in body and self-image. Each session ended with an exercise in self-hypnosis designed to aid in managing stress and handling pain.

Educational materials provided to the control and treatment groups included pamphlets, videos, and audio tapes on a range of subjects from emotional coping to pain management.

Beginning and interim (every four months) data were ultimately collected from 102 participants for a 12-month period as well as every six months thereafter, until death. Mood states were considered (anxiety, depression, confusion, hostility, fatigue, vigor) as were symptoms of trauma such as avoidance and intrusion.

In the end, patients receiving the intensive, long-term support in the treatment group registered less distress and trauma than did those in the control group.

Why It's Important

A diagnosis of advanced (metastasized) breast cancer is extremely stressful, leading many women to withdraw from others and avoid the profound implications of the disease on their lives. In fact, the adjustment to metastatic disease is more difficult for many women than the initial adjustment to a breast cancer diagnosis.

A considerable body of research has found that support groups can really help in extending survival time and adjusting to the news that breast cancer has metastasized. Most group interventions so far, however, have been relatively brief and highly structured, with a set agenda that hones in quickly on coping strategies, stress management, and education about the disease.

The present study found that longer-term, more open-ended, and a relatively intensive format of group therapy--formally known as supportive-expressive group therapy--is more helpful in dealing with trauma symptoms and ultimately mood issues such as depression, anger, and tension.

In the study's treatment group, existential concerns aroused by the diagnosis of a terminal illness--questions about meaning, freedom, isolation, and death--were opened up for discussion. The facilitators aimed to create a closeness among group members that could help to counter feelings of isolation.

The strategy worked, and group members formed close-knit groups. They provided each other with role models for coping and managing the disease, in part by contending with the death of various members along the way. The benefits on mood and trauma symptoms were particularly profound in the assessment made just before the participant died from the cancer.

The study authors note that future research should look into such questions as to whether supportive-expressive group therapy improves adherence to treatment regimens and whether patients in this type of therapy live longer.

Classen C, Butler LD, Koopman C, et al. Supportive-expressive group therapy and distress in patients with metastatic breast cancer: a randomized clinical intervention trial. Arch Gen Psychiatry 2001;58(5):494-501.

Date Published: 08/30/2003
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