Immune responses in the intervention group were consistent with the psychological and behavioral changes. This study is a strong example of efforts to measure changes in a variety of biobehavioral (psychological, behavioral, immune) variables after a psychosocial intervention.
Other investigators evaluated an educational intervention consisting of 2-hour once-per-month group sessions for 4 consecutive months.[Level of evidence: I] Participants were 252 women younger than 50 years who had early-stage breast cancer, who had recently completed nonhormonal adjuvant treatment, and who were facing the transition from active treatment to posttreatment survivorship. They were randomly assigned to one of three groups:
- A standard medical care group.
- A nutrition education group.
- A psychosocial education group.
The psychosocial and nutrition education groups included information dissemination, discussion, and some activities/exercises. Topics rotated monthly, and participants could join a group at any time (i.e., the groups were open groups). In general, patient-to-patient interaction was minimal because sessions were more didactic presentations. The psychosocial education group presented topics relevant to younger women with breast cancer, such as the following:
- Talking with children about cancer.
- How to carry on with life after a diagnosis.
- Relationships/intimacy with partners.
- Hormones and cancer.
- Genetic bases of breast cancer.
The nutrition education group included information about choosing fruits, vegetables, and low-fat foods and how to consistently incorporate these foods into daily life. Shopping, low-fat cooking, eating out, and other related topics were presented. Results showed that patients in both of the intervention groups reported fewer depressive symptoms and better physical functioning at a 13-month follow-up. This study is an example of a more targeted intervention designed for a specific patient population (younger women with breast cancer) at a specific time in their treatment course (soon after completion of active treatment).
Problem-solving, focused, individual psychotherapy
A variety of individual psychosocial interventions have been studied. One study emphasized the development of problem-solving abilities.[Level of evidence: II] In this study, the psychosocial intervention consisted of ten 1.5-hour weekly individual psychotherapy sessions (either with or without a significant other present) that focused on training to become an effective problem solver. Four rational problem-solving tasks were emphasized that included skills in the following areas:
- Better defining and formulating the nature of problems.
- Generating a wide range of alternative solutions.
- Systematically evaluating potential consequences of a solution while deciding on the optimal ones.
- Evaluating the eventual outcome after solution implementation.
Between-session homework with tasks relevant to each step was assigned, and patients received a written manual and were encouraged to refer to it as problems arose. One hundred thirty-two adult cancer patients with mixed cancer diagnoses were randomly assigned to two treatment groups and one wait-list control. The two treatment groups included individual problem-solving therapy alone and problem-solving therapy with a significant other (e.g., spouse, friend, adult child) present.