Psychotherapies in psycho-oncology. An exciting new challenge

A Palliative Care Intervention in Forgiveness Therapy for Elderly Terminally Ill Cancer Patients

Palliative care is now considered an essential part of end-of-life care, yet little research examines the efficacy of interventions addressing the psychological treatment of dying patients. Forgiveness therapy has been shown to be effective in improving psychological well-being and may provide a valuable addition to a terminal cancer patient's overall treatment plan. This study experimentally tested the effectiveness of a four-week forgiveness therapy in improving the quality of life of elderly terminally ill cancer patients. Participants (n=20) were randomly assigned to a forgiveness therapy group or to a wait-list control group, which received forgiveness therapy in the second four-week period. All participants completed instruments measuring forgiveness, hope, quality of life, and anger at pre-test, post-test 1, and post-test 2. The forgiveness therapy group showed greater improvement than the control group, with one-tailed t-tests, on all measures. After receiving forgiveness therapy, participants in both forgiveness treatment conditions demonstrated significant improvements on all measures. The aggregated effect size was large. The four-week forgiveness therapy demonstrated psychological benefits for elderly terminally ill cancer patients and thus may be an appropriate addition to the treatment plan for terminal cancer patients.

Managing depression in physical illness

Depressive disorders are more common in patients with physical illness than in those without, with up to one-third of medical in-patients reporting mild to moderate symptoms of depression (Rodin & Voshart, 1986). Some medical conditions have a stronger association with psychiatric illness than others, for example the prevalence rates of depressive illness in patients with diabetes, cardiac or neurological disease is about 25%, but not much more than the general population in those with hypertension. Medical in-patients are more likely to have depression than are out-patients. There are a number of potential factors that may contribute to this increased risk of depression in people with physical illness, as outlined in Box 1.

The Life Tape Project: Increasing Family Social Support and Symbolic Immortality with a Brief Existential Intervention for Cancer Patients and Their Families

Cancer poses a powerful threat to the emotional equilibrium of patients and their families. A key role of the family and medical team is to provide a supportive environment as the patient confronts the reality of death. Few interventions have been developed to help families support patients in dealing with fears of death and dying. We present one such approach, the Life Tape Project (LTP), that helps bring families closer together, increases communication, and acts as an existential intervention leading to greater sense of legacy, meaning, self-awareness, identity, and connection. Additionally, the results of a pilot study exploring the benefits of the LTP are presented, and we describe symbolic immortality, an aspect of existential coping, to illuminate how existential and social support factors can work together to benefit patients and their families.

Perceived Benefits and Psychosocial Outcomes of a Brief Existential Family Intervention for Cancer Patients/Survivors

This study assessed a range of benefits from participation in a brief existential intervention consisting of a semi-structured videotaped interview with cancer patients and their families designed to illuminate a life legacy for the family (the Life Tape Project [LTP]). Results indicated the majority reported intervention-specific benefits, especially in the areas of symbolic immortality (passing on personal values and philosophy), self-reflection and growth, and improved family cohesion and communication. Participants, particularly those who had perceived their cancer as a threat of death, serious injury, or threat to their physical integrity, and responded with intense fear or helplessness, also reported more general reductions in mood disturbance, improvements in aspects of well-being (including overall quality of life), satisfaction with the understanding they received, and enhanced cancer-related posttraumatic growth. In short, the LTP is a brief, inexpensive, existential intervention that can yield broad positive psychosocial changes for a majority of participants.

Diagnosticando e tratando depressão no paciente com doença clínica

Diagnosticar depressão em um doente clínico é uma tarefa difícil por vários motivos. Muito embora tristeza e humor depressivo possam indicar síndrome depressiva subjacente, eles também podem fazer parte da adaptação normal a uma doença que ameace a vida. Os sintomas somáticos e vegetativos incluídos nos critérios diagnósticos das classificações atuais não são específicos e podem de fato ser atribuíveis à hospitalização, aos tratamentos ou à própria doença clínica. Tratar a depressão no paciente clínico é também difícil devido à preocupação com a interação de drogas, assim como questões de eficácia e segurança nesse grupo. Nesta conferência clínica os autores discutem questões como que diagnósticos podem ser feitos em pacientes clínicos com sintomas depressivos; prevalência de depressão em diferentes ambientes; mecanismos de co-morbidade (fatores fisiológicos e comportamentais) que relacionam a depressão às doenças clínicas e o manuseio da depressão nesse grupo.

An investigation of inpatient referrals to a clinical psychologist in a hospice

A clinical psychologist, in a new post in a hospice, developed an assessment, therapeutic and consultation role. A retrospective, diary-based audit was made of the inpatients referred during the first 2 years, allowing an examination of referral practices and changes over time as the psychologist's role developed. During the 2 years 11% of the hospice inpatients were referred, consistent with previous published work in this area. Referrals increased from 10% in year 1 to 12% in year 2. Referrals were not skewed in terms of patient gender or diagnosis but younger patients were referred more. Comparison with other studies suggests the psychologist's gender may influence referral rates of woman patients. Referrals for depression and anxiety increased in year 2 but decreased for pain. The number of patients seen with marital/family stresses also increased with time. Such patients required the most psychological input. Patients with problems of alcohol misuse or dementia were particularly challenging for the hospice team and specific training was developed. The psychologist's role is discussed in the light of these findings, particularly in enhancing the multidisciplinary team's holistic approach to the patient and their family, by emphasizing the patient's experience and the collaborative basis of care.

The link between response styles and major depression and anxiety disorders after child-loss

Although several studies have indicated that persons with a high ruminative coping style experience higher depression after the loss of a loved one, the relationship between ruminative coping and the occurrence of clinical depression and anxiety disorders after a loss has not been thoroughly investigated. This study investigated the relationship between response styles (ruminative coping v distractive coping) and the onset of major depression and anxiety disorders in a sample of parents who had experienced sudden child-loss (N = 106). The incidence of major depression after the loss of a child was very high (69%). After controlling for demographic variables and psychiatric history, ruminative coping was significantly associated with the onset of major depression, as defined by DSM-IV, but not with the onset of anxiety disorders. Thus ruminative coping after the loss of a child appears to be a risk factor specifically for major depression.

The psychological impact of cancer on patients' partners and other key relatives: a review

Partners and other family members are key supports for cancer patients. Most cope well with the caregiving role, but an important minority become highly distressed or develop an affective disorder. Female carers and those with a history of psychiatric morbidity are more vulnerable, as are those who take a more negative view of the patient's illness and its impact on their lives. Carers are likely to become more distressed and develop psychiatric morbidity as the illness advances and treatment is palliative. Carers are also more at risk when they lack a support network of their own and when there are relationship difficulties with the patient. The review discusses why, given this evidence, carers fail to take advantage of interventions designed to help them and those who participate derive only limited psychological benefits.

Age-specific norms and determinants of anxiety and depression in 731 women with breast cancer recruited through a population-based cancer registry

The aim of this study was to determine population norms and determinants of anxiety and depression in a population-based sample of 731 women with breast cancer (aged 23-60 years) with the Hospital Anxiety and Depression scale (HADS). The prevalence of 'probable' psychological morbidity due to anxiety was 23% and due to depression was 3%. When the women identified as 'possible' cases were included, the respective proportions were 45 and 12%. Higher anxiety was present in younger, less educated women not born in Australia. There was no clear pattern of risk factors for depression. These population-based findings highlight the need for clinicians to be aware that age, education and country of birth may identify a particularly vulnerable subgroup. While brief scales such as the HADS are limited in their ability to accurately predict a clinical diagnosis, high scores identify those who may warrant referral for clinical evaluation.