Meaning centered therapy
In the past, when a patient was diagnosed with cancer, this often meant a short remaining time to live. Nowadays, patients live with cancer for a longer time. This implies a shift in the requested psychological help from palliative/terminal care towards help with finding meaningful ways to continue their lives, despite physical limitations and uncertainties.
Literature shows that meaning-making is important for cancer patients: 1.meaning-focused coping is at the core of adequate adjustment to cancer; 2.despite a lack of psychopathology, up to 70% of cancer-patients have questions and needs regarding meaning-making; 3.up to 70% of the patients wish to be helped with meaning-making; 4.cancer patients who experience their life as meaningful are better adjusted, have better quality of life and psychological functioning.
Most psychological interventions focus at teaching adequate coping styles and preventing/treating psychiatric symptoms, and not at living with cancer. There are few evidence based interventions to help patients living meaningfully with cancer. Breitbart et al developed an 8-session meaning-centered group psychotherapy for cancer patients in New York, based on Frankl’s logotherapy. The therapy is directed at stimulating the patients’ search for meaning, through creativity, experience, attitude and legacy, and consists of didactics, discussion and experiential exercises.
Breitbart found large improvement in meaning-making and psychological functioning (d=.8). These effects were larger than non-meaning centered psychological interventions. These effects were also larger than other existential therapies, possibly because the latter were often relatively unstructured/non-directive. The effects of Breitbart’s therapy could be explained by its: 1.direct focus at meaning-focused coping and goal reengagement, with many sources of meaning; 2.structured/manualized approach; 3.actively stimulating and deepening experiences; 4.practical; 5.providing explanations; 6.unconditional positive regard.
Purpose of project
We developed and evaluated the effectiveness of an 8-session meaning-centered group psychotherapy for Dutch cancer patients, on the basis of Breitbart’s intervention, entitled ‘Group Training Living Meaningfully with Cancer’.
Purpose of therapy
The therapy purpose is to help cancer patients to find their own ways to satisfactorily design and live their lives meaningfully within the context of physical limitations and uncertainty of having cancer. Specific purposes are: search for meaning (e.g. reordering/evaluating old meanings, search for new meanings, overcoming practical limitations); concrete goal-reengagement in daily life; learning to distinguish between what can and what cannot be changed; integration of cancer in life history; emotional expression; social support; improved psychological functioning.
Plan of investigation
Before start of the study, 2 focus groups with 6-10 cancer-patients were performed, and approval by the medical-ethical committee was obtained. The project consisted of 4 phases: 1.translation/adaptation of therapy, training of therapists, in discussion with experts; 2.pilot study in 2 groups of 6-8 patients; 3.randomized controlled trial in 180 patients (60 intervention-condition, 60 social-support-group-condition, 60 care-as-usual-condition); 4.analyses and generalization phase. Participants are at least 1 year after cancer treatment with curative intent in Leiden University Medical Center, Alrijen Hospital, Amstelland Hospital or OLVG Hospital and are able to follow all therapy sessions.
Outcome measures included valid, reliable outcome measures of meaning-making and psychological functioning (eg. personal meaning profile, Ryff’s well-being, session-rating-scale). To assess possible determinants of efficacy of the intervention, sociodemography, comorbidity, cancer, treatment, and coping styles will be included. Questionnaires will be filled-in before first and after last session, and 3, 6, 12 and 24 months later. 60 patients are needed in each group at baseline, assuming an effect size of 0.80, compensation for 30% loss to follow-up, 80% power and 5% p-value.
Possible results and relevance
An evidence-based, manualized intervention will be developed to help patients living meaningfully with cancer despite possible physical limitations and uncertainty. The intervention is expected to meet their meaning-related needs more explicitly than other therapies. More insight will be obtained in determinants of therapy success. A practical therapy manual and therapist training protocol will be developed and made available for implementation in other centers for oncological/psychosocial care.
VUmc and KWF/Alpe d’HuZes (2011-2015).
Prof I.M. Verdonck-de Leeuw, PhD, Psychologist, Speech & Language Therapist, Linguïst, dpt. of Clinical Psychology, VU Faculty of Psychology and Education, Amsterdam.
For questions, please contact prof dr IM Verdonck-de Leeuw, via [email protected]