Effect of supportive-expressive therapy on fear of progression and resilience in lymphoma patients / 中国实用护理杂志

Objective:To explore the effect of supportive-expressive therapy (SET) on fear of progression and resilience in lymphoma patients, to provide reference for clinical nursing care.Methods:A total of 86 patients with lymphoma treated in the First Affiliated Hospital of Nanjing Medical University from February 2019 to September 2020 were divided into experimental group and control group according to random number table method, with 43 cases in each group. The control group was given conventional nursing, while the experimental group was applied with 6 times SET. Before and after intervention, the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) and Connor Davidson Resilience Scale (CD-RISC) was evaluated between two groups.Results:Finally, 40 cases were included in the experimental group and 42 cases in the control group. There was no significant difference between each dimension and total score of the two groups before intervention ( P>0.05). After intervention, scores of physiological health dimension, social and family dimension, and total FoP-Q-SF were (14.90 ± 3.96) points, (15.03 ± 4.29) points and (29.93 ± 5.65) points in the experimental group, significantly lower than those in the control group (17.71 ± 3.38) points, (17.29 ± 4.03) points and (35.00 ± 5.57) points ( t=3.47, 2.46, 4.10, all P<0.05); scores of tenacity, strength, optimism dimension and total CD-RISC were (28.08 ± 4.47) points, (21.30 ± 5.58) points, (10.65 ± 2.97) points and (60.03 ± 8.42) points in the experimental group, significantly higher than those in the control group (24.31 ± 4.11) points, (17.98 ± 4.13) points, (9.26 ± 2.47) points and (51.55 ± 5.86) points, the differences were statistically significant ( t values were 2.30-5.27, all P<0.05). Conclusions:SET can effectively alleviate the degree of fear of progression and promote resilience of lymphoma patients.

The Effectiveness of Psychological Treatments in Women with Breast Cancer: A Systematic Review and Meta-Analysis.

Breast cancer is the most prevalent oncological disease among women, and it represents the second oncological cause of death. Many studies have considered the quality of life in people with breast cancer because this condition has high comorbidity with mental distress, anxiety, affective disorders and depression. Psychological interventions can reduce the stressful consequences of both the diagnosis and the medical treatments of breast cancer. However, different methods (e.g., group or individual therapy) and focus (e.g., improving personal skills or increasing emotional well-being) do not help to identify which type of psychological therapy can be more effective in improving quality of life in patients with breast cancer. This study was aimed to systematically review and compare, by means of a meta-analysis, the efficacy of cognitive behavioural, supportive-expressive or psycho-educational treatments in women with breast cancer, focusing on anxiety, depression, mood and quality of life as outcomes. The PRISMA statement was adopted. MEDLINE, PsycINFO, PUBMED and PsycArticles databases were used, and reference lists were examined for additional publications. In the selection of the articles were included studies considering women between 18 and 65 years who were diagnosed with breast cancer at any stage and under any treatment, and who underwent psychological group interventions. At the end of the systematic review, 45 studies met all inclusion criteria and were analysed in the meta-analysis. The overall effect size was medium, especially considering cognitive behavioural therapy and psycho-educational treatments. However, the studies are characterised by high methodological heterogeneity. Despite some limitations, this review and meta-analysis partially confirm the efficiency of cognitive-behavioural and psycho-educational therapies in the improvement of well-being in women with breast cancer.

The process of change in psychotherapy with a pregnant patient following perinatal losses: An analysis of a case study.

AIM: Despite research suggesting increased anxiety and depressive symptoms after a perinatal loss and during future pregnancies, little knowledge exists to guide clinicians treating pregnant women after perinatal loss. This case study explores processes that facilitated therapeutic change for a pregnant patient with major depressive disorder (MDD) and posttraumatic stress disorder after perinatal losses. METHOD: The study integrated quantitative and narrative analyses in a single case derived from the pilot phase of a randomized controlled trial on supportive-expressive therapy for MDD. RESULTS: The quantitative and narrative analyses suggest that an improvement in maladaptive interpersonal patterns toward the therapist, in the form of attachment avoidance, made it possible to form a strong alliance, which in turn led to a successful outcome. CONCLUSIONS: The findings highlight the importance of improving maladaptive interpersonal patterns as a prerequisite to enable patients after pregnancy losses to develop and maintain a corrective therapeutic experience.

Psychodynamic Online Treatment Following Supportive Expressive Therapy (SET):Therapeutic Rationale, Interventions and Treatment Process.

OBJECTIVES: The feasibility of psychodynamic online treatments has remained an issue of debate. The paper presents rationale and technique of a psychodynamic online intervention discussing therapeutic process and alliance based on two case examples from an RCT. METHODS: A weekly writing task is followed by individual feedback from the online therapist. Treatment focuses on a 'Core Conflict Relationship Theme' based on relationship episodes according to the wish of the patient, reactions of the others and reactions of the self. Maladaptive interpersonal interactions are worked through by supportive and expressive therapeutic interventions. RESULTS: Case reports from our study illustrate a productive therapeutic process without immediate personal contact or nonverbal communication. CONCLUSIONS: Emotional reactions and felt concern of the online therapist promote engagement in patients. Online therapists need to detect alliance ruptures based on text messages and remedy them. We discuss psychodynamic online treatments as adjuncts to face to face psychotherapy.

Brief supportive-expressive group therapy for partners of men with early stage prostate cancer: lessons learned from a negative randomized controlled trial.

PURPOSE: The purpose of this paper is to report the results of a negative randomized controlled trial, which piloted brief supportive-expressive therapy (SET) for partners of men with prostate cancer, and to discuss lessons learned for future clinical trials. METHODS: Partners of men with newly diagnosed, non-metastatic prostate cancer were randomized to SET (n = 45) or usual care (n = 32). SET involved six weekly group sessions emphasizing emotional expression, social support, and finding meaning in the cancer experience. Measures of mood disturbance, marital satisfaction, and social support were administered to both partners and patients at baseline, post-program, and at 3- and 6-month follow-up. RESULTS: There were no significant differences between SET and the control group for either patients or their wives on any outcome. Regardless of group membership, partners reported improvements in total mood disturbance (p = .011), tension (p < .001), anger (p = .041), confusion (p < .001), state anxiety (p = .001), and emotional support (p = .037), and patients reported improvements in tension (p = .003), emotional support (p = .047), positive interaction support (p = .004), and overall social support (p = .026). CONCLUSIONS: Compared to the natural course of recovery, SET did not improve psychosocial outcomes for either men with prostate cancer or their wives. Methodological challenges experienced in implementing this trial yield valuable lessons for future research, including designing interventions relevant to unique problems faced by specific groups, being closely guided by previous research, and the potential utility of screening for distress as an inclusion criteria in intervention trials.

Randomized controlled trial of supportive-expressive group therapy and body-mind-spirit intervention for Chinese non-metastatic breast cancer patients.

PURPOSE: This study aimed to evaluate the efficacy of supportive-expressive group (SEG) therapy and body-mind-spirit (BMS) intervention on emotional suppression and psychological distress in Chinese breast cancer patients. METHODS: This three-arm randomized controlled trial assigned 157 non-metastatic breast cancer patients to BMS, SEG, or social support control group. SEG focused on emotional expression and group support, whereas BMS emphasized relaxation and self-care. All groups received 2-h weekly sessions for 8 weeks. The participants completed measurements on emotional suppression, perceived stress, anxiety, and depression at baseline and three follow-up assessments in 1 year. RESULTS: Using latent growth modeling, overall group difference was found for emotional suppression (χ 2(2) = 8.88, p = 0.012), marginally for perceived stress (χ 2(2) = 5.70, p = 0.058), but not for anxiety and depression (χ 2(2) = 0.19-0.94, p > 0.05). Post-hoc analyses revealed a significant and moderate reduction (Cohen d = 0.55, p = 0.007) in emotional suppression in SEG compared to control group, whereas BMS resulted in a marginally significant and moderate fall (d = 0.46, p = 0.024) in perceived stress. Neither SEG nor BMS significantly improved anxiety and depression (d < 0.20, p > 0.05). CONCLUSIONS: The present results did not demonstrate overall effectiveness for either BMS or SEG therapy in the present sample of Chinese non-metastatic breast cancer patients. The participants appear to derive only modest benefits in terms of their psychological well-being from either intervention.

Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results.

BACKGROUND: Mindfulness-based cancer recovery (MBCR) and supportive expressive group therapy (SET) are two well-validated psychosocial interventions, but they have not been directly compared, and little is known about long-term outcomes. This comparative effectiveness study measured the effects of these two interventions immediately following the groups and for 1 year thereafter in distressed breast cancer survivors. METHODS: Two hundred fifty-two distressed Stage I-III breast cancer survivors were randomized into either MBCR or SET. Women completed questionnaires addressing mood, stress symptoms, quality of life, social support, spirituality and post-traumatic growth before and after the interventions, and 6 and 12 months later. RESULTS: Immediately following the intervention, women in MBCR reported greater reduction in mood disturbance (primarily fatigue, anxiety and confusion) and stress symptoms including tension, sympathetic arousal and cognitive symptoms than those in SET. They also reported increased emotional and functional quality of life, emotional, affective and positive social support, spirituality (feelings of peace and meaning in life) and post-traumatic growth (appreciation for life and ability to see new possibilities) relative to those in SET, who also improved to a lesser degree on many outcomes. Effect sizes of the time × group interactions were small to medium, and most benefits were maintained over 12 months of follow-up. CONCLUSIONS: This study is the first and largest to demonstrate sustained benefits of MBCR in distressed breast cancer survivors relative to an active control. MBCR was superior to SET for improving psychological well-being with lasting benefits over 1 year, suggesting these women gained long-lasting and efficacious tools to cope with cancer. TRIAL REGISTRATION: Registered on clinicaltrials.gov number NCT00390169, October 2006. Copyright © 2016 John Wiley & Sons, Ltd.

Developing a prototype for short-term psychodynamic (supportive-expressive) therapy: An empirical study with the psychotherapy process Q-set.

OBJECTIVE: A Psychotherapy Process Q-set (PQS) prototype characteristic of short-term psychodynamic therapy (STPP) does not yet exist. METHOD: Experts in supportive-expressive (SE) therapy used the 100-Item PQS questionnaire to rate an ideal short-term SE therapy. RESULTS: Agreement between raters was high (Cronbach's alpha = 0.94). The prototype for SE therapy showed a significant correlation with the psychoanalytic prototype, but with 28% of variance explained, the majority of variance of the former was not explained by the latter or vice versa. Furthermore, the SE prototype showed significant correlations with the cognitive-behavioral prototype and the prototype of interpersonal therapy by Ablon and Jones (r = 0.69, 0.43). CONCLUSIONS: We recommend using the PQS prototype presented here for future process research on STPP.

Mindfulness-based cancer recovery and supportive-expressive therapy maintain telomere length relative to controls in distressed breast cancer survivors.

BACKGROUND: Group psychosocial interventions including mindfulness-based cancer recovery (MBCR) and supportive-expressive group therapy (SET) can help breast cancer survivors decrease distress and influence cortisol levels. Although telomere length (TL) has been associated with breast cancer prognosis, the impact of these two interventions on TL has not been studied to date. METHODS: The objective of the current study was to compare the effects of MBCR and SET with a minimal intervention control condition (a 1-day stress management seminar) on TL in distressed breast cancer survivors in a randomized controlled trial. MBCR focused on training in mindfulness meditation and gentle Hatha yoga whereas SET focused on emotional expression and group support. The primary outcome measure was relative TL, the telomere/single-copy gene ratio, assessed before and after each intervention. Secondary outcomes were self-reported mood and stress symptoms. RESULTS: Eighty-eight distressed breast cancer survivors with a diagnosis of stage I to III cancer (using the American Joint Committee on Cancer (AJCC) TNM staging system) who had completed treatment at least 3 months prior participated. Using analyses of covariance on a per-protocol sample, there were no differences noted between the MBCR and SET groups with regard to the telomere/single-copy gene ratio, but a trend effect was observed between the combined intervention group and controls (F [1,84], 3.82; P = .054; η(2) = .043); TL in the intervention group was maintained whereas it was found to decrease for control participants. There were no associations noted between changes in TL and changes in mood or stress scores over time. CONCLUSIONS: Psychosocial interventions providing stress reduction and emotional support resulted in trends toward TL maintenance in distressed breast cancer survivors, compared with decreases in usual care.

An expressive therapy group disclosure intervention for women living with HIV improves social support, self-efficacy, and the safety and quality of relationships: a qualitative analysis.

Women living with HIV (WLHIV) face high rates of morbidity and mortality. HIV disclosure interventions have been identified as a promising but under-evaluated approach for WLHIV to improve their health and well-being. The Medea Project is an expressive therapy group intervention that was first developed to help incarcerated women develop the confidence and skills to tell their stories publicly in theatrical performances. The intervention was subsequently adapted as a community-based disclosure intervention for WLHIV. Our study describes an analysis of the impact of the Medea Project on the lives of the WLHIV who participated. All participating WLHIV publicly disclosed their HIV status during the performances. Five impact themes emerged from the data: sisterhood, catharsis, self-acceptance, safer and healthier relationships, and gaining a voice. Our study identifies a voluntary, effective, and broadly beneficial disclosure intervention for women living with HIV.

Terapia expressiva: veículo de cuidado integral num hospital universitário / Expressive therapy: instrument to integral care in an universitary hospital

Caracterizamos a Terapia Expressiva como um veículo para o Cuidado Integral, e relatamos a experiência do Programa de Terapia Expressiva no Hospital Universitário Antonio Preto (HUAP), da Universidade Federal Fluminense (UFF). Contribuir para a humanização e integralidade do cuidado; desenvolver o Cuidado de Si entre profissionais de saúde; aprimorar a qualidade do cuidado aos usuários, remodelando o conceito de doença; contribuir para a formação em saúde e cultura do UFF; produzir evidências sobre a eficácia da Terapia Expressiva. O Programa inclui diversas ações: Curso de Extensão "Cuidar de si com Arte" para profissionais de saúde; "Infusão de Vida" - sessões coletivas da Terapia Expressiva durante a quimioterapia, no Núcleo de Atenção Oncológica (NAO); "Tempo de Espera" - intervenções na sala de espera do mesmo serviço, para pacientes, familiares e cuidadores; "O HUAP vai dançar" - rodas semanais abertas de Danças Circulares no saguão do hospital; "Pra todo mundo se ver" - produção de vídeos e documentários para divulgação do programa; encontros anuais para troca de experiências. Conta com uma equipe interdisciplinar: docentes, alunos de diversos cursos e terapeutas voluntários, sob a liderança da idealizadora - médica, artista plástica e professora de Terapia Expressiva. Integra ensino, pesquisa e assistência, sob uma ética da compaixão e emancipatória. Com um ano e meio de duração, o programa atingiu resultados acima das expectativas: grande aceitação por parte de pacientes e staff, que referem mudança na qualidade do cuidado. Resultados das pesquisas serão brevemente publicados. Há perspectivas de ampliação para outros serviços.(AU)

We characterize Expressive Therapy as an instrument to Integral Care, and we relate the experience of the Program of Expressive Therapy in the University Hospital Antonio Pedro (HUAP), at the Fluminense Federal University (UFF). To contribute to humanization and integrality of care, remodeling concepts of disease; to contribute to health and culture education in UFF; to join evidences about the efficacy of Expressive Therapy. The program includes diverse actions: the Course "Self-caring with Art", for health professionals; "Infusion of Life" - collective sections of Expressive Therapy during chemotherapy in the Oncologic Service and Caregivers; "HUAP dances" - open circles of Sacred Circle Dance at the entrance hall of the hospital; ging experience. The interdisciplinary team includes teachers, students from different areas and voluntary therapists, under the leadership of the supervisor - a medical doctor, artist and a master in Expressive Therapy. The program integrates education, research and assistance, under a compassionate and emancipatory ethics. After one year and a half the program has achieved results above all expectations: a broad acceptance by patients and staff, who relate an improvement in the quality of care. The results of the researches will be soon published. There are prospects of extension of the program to other services.(AU)