Meaning-Centered Group Psychotherapy for Patients with Advanced Cancer

2015 ◽  
Author(s):  
William S. Breitbart ◽  
Shannon R. Poppito
Keyword(s):  
Group Psychotherapy ◽  
Advanced Cancer ◽  
Well Being ◽  
Cancer Center ◽  
Advanced Cancer Patients ◽  
Expression Of Emotion ◽  
Spiritual Well Being ◽  
The Face ◽  
Desire For Death

The importance of spiritual well-being and the role of "meaning" in moderating depression, hopelessness and desire for death in terminally-ill cancer and AIDS patients has been well-supported by research, and has led many palliative clinicians to focus on the development of non-pharmacologic interventions that can help their patients address these issues. Individual Meaning-Centered Group Psychotherapy (IMCP), an intervention developed and rigorously tested by the Department of Psychiatry & Behavioral Sciences at Memorial Sloan-Kettering Cancer Center, is a seven-week program based around the work of Viktor Frankl, and which utilizes a mixture of didactics, discussion and experiential exercises that focus around particular themes related to meaning and advanced cancer. Patients are assigned readings and homework that are specific to each session's theme and which are utilized in each session. While the focus of each session is on issues of meaning and purpose in life in the face of advanced cancer and a limited prognosis, elements of support and expression of emotion are inevitable in the context of each group session.

Meaning-Centered Group Psychotherapy for Advanced Cancer Patients

2017 ◽  
Author(s):  
William Breitbart ◽  
Allison J. Applebaum ◽  
Melissa Masterson
Keyword(s):  
Cancer Patients ◽  
Group Psychotherapy ◽  
Advanced Cancer ◽  
Symptom Burden ◽  
Well Being ◽  
Evidence Base ◽  
Advanced Cancer Patients ◽  
Spiritual Well Being ◽  
Desire For Death ◽  
Anxiety Depression

The ability to sustain a sense of meaning is significantly associated with important elements of end-of-life despair. Meaning-centered group psychotherapy (MCGP), an eight-session group psychotherapy intervention, was developed to help patients with advanced cancer sustain or enhance a sense of meaning. MCGP has been shown to significantly improve spiritual well-being, sense of meaning, and quality of life and to diminish anxiety, depression, hopelessness, symptom burden distress, and desire for death. The mechanism of this benefit is through the enhancement of meaning. MCGP appears to be a beneficial intervention for emotional and spiritual suffering in advanced cancer patients. This chapter describes the theoretical framework and research basis for pursuing an intervention to enhance or sustain meaning. It also describes the development of MCGP, its evidence base for clinical efficacy, and outlines the intervention in great detail.

Meaning-Centered Psychotherapy

2021 ◽  
pp. 489-494
Author(s):  
Melissa Masterson Duva ◽  
Wendy G. Lichtenthal ◽  
Allison J. Applebaum ◽  
William S. Breitbart
Keyword(s):  
End Of Life ◽  
Advanced Cancer ◽  
Psychosocial Care ◽  
Well Being ◽  
Cancer Center ◽  
Existential Psychology ◽  
Patients With Cancer ◽  
Spiritual Well Being ◽  
The Face

Existential concerns carry significant distress, particularly among patients with advanced cancer. For patients who are facing death, a sense of meaning—and the preservation of that meaning—is not only clinically and existentially important but also central to providing holistic, high-quality end-of-life care. Nearly two decades ago, the authors’ research group at Memorial Sloan Kettering Cancer Center began to understand that a meaning-centered approach to psychosocial care was imperative to alleviate the existential distress that plagued many patients with advanced cancer. Based on Viktor Frankl’s work on the importance of meaning and principles of existential psychology and philosophy, they developed Meaning-Centered Psychotherapy (MCP) to help patients with advanced cancer sustain or enhance a sense of meaning, peace, and purpose in their lives in the face of terminal cancer. This chapter provides an overview of MCP in working with patients with cancer. It summarizes the ever-growing body of research that has demonstrated the effectiveness of MCP in improving meaning, spiritual well-being, and quality of life and in reducing psychological distress and despair at end of life. Adaptations of MCP for other purposes and populations, such as cancer survivors, caregivers, and bereavement, are mentioned but are elaborated on in other specific chapters related to these issues in this textbook.

Individual Meaning-Centered Psychotherapy for Advanced Cancer Patients

2017 ◽  
Author(s):  
William Breitbart ◽  
Wendy G. Lichtenthal ◽  
Allison J. Applebaum ◽  
Melissa Masterson
Keyword(s):  
Clinical Trials ◽  
End Of Life ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Therapeutic Intervention ◽  
Well Being ◽  
Existential Psychology ◽  
Advanced Cancer Patients ◽  
Spiritual Well Being ◽  
Existential Concerns

Among the advanced cancer population, existential concerns are major issues that promote significant distress. For patients who are facing death, meaning and the preservation of meaning are not only clinically and existentially important but also central concepts to a therapeutic intervention. Based on Viktor Frankl’s logotherapy and the principles of existential psychology and philosophy, “meaning-centered psychotherapy” was developed to help patients with advanced cancer sustain or enhance a sense of meaning, peace, and purpose in their lives. This chapter provides an overview of work developing and testing individual meaning-centered psychotherapy (IMCP). It provides an overview of the session content in the IMCP intervention. It also presents findings from clinical trials, which support the efficacy of IMCP as an intervention to increase a sense of meaning, spiritual well-being, and hope while decreasing end-of-life despair. Furthermore, it presents difficult scenarios that may arise when delivering IMCP for clinicians interested in this work.

Unmet spiritual care needs impact emotional and spiritual well-being in advanced cancer patients

2011 ◽  
Vol 20 (10) ◽  
pp. 2269-2276 ◽  
Author(s):  
Michelle J. Pearce ◽  
April D. Coan ◽  
James E. Herndon ◽  
Harold G. Koenig ◽  
Amy P. Abernethy
Keyword(s):  
Cancer Patients ◽  
Advanced Cancer ◽  
Spiritual Care ◽  
Well Being ◽  
Advanced Cancer Patients ◽  
Care Needs ◽  
Spiritual Well Being

Spiritual well-being of Italian advanced cancer patients in the home palliative care setting

2017 ◽  
Vol 26 (4) ◽  
pp. e12677 ◽  
Author(s):  
A. A. Martoni ◽  
S. Varani ◽  
B. Peghetti ◽  
D. Roganti ◽  
E. Volpicella ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Care Setting ◽  
Well Being ◽  
Advanced Cancer Patients ◽  
Palliative Care Setting ◽  
Spiritual Well Being

Frequency and characteristics of cancer-related drowsiness (CRD or excessive daytime sleepiness) in patients with advanced cancer: Results of a prospective survey at a tertiary cancer center.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 131-131
Author(s):  
Sriram Yennu ◽  
Dave Balachandran ◽  
Sandra L. Pedraza ◽  
Elyssa A Berg ◽  
Gary B. Chisholm ◽  
...  
Keyword(s):  
Advanced Cancer ◽  
Depression Scale ◽  
Symptom Assessment ◽  
Well Being ◽  
Severity Index ◽  
Cancer Center ◽  
P Value ◽  
Advanced Cancer Patients ◽  
Opioid Dose ◽  
Edmonton Symptom Assessment Scale

131 Background: CRD is extremely distressing but treatable symptom to the advanced cancer patients (ACP). There are limited studies to evaluate the frequency and characteristics of CRD. The aim of this study was to identify the frequency, and factors associated with severity of CRD. Secondary aim was to determine the screening performance Edmonton Symptom Assessment Scale (ESAS)-drowsiness item against the Epworth Sleepiness Scale (ESS). Methods: We prospectively assessed 180 consecutive ACP at a tertiary cancer hospital. After obtaining signed consent, the patients completed ESAS, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI); ESS (≥10 diagnostic of CRD), Hospital Anxiety Depression Scale (HADS), STOP-Bang Screening Scale (SBS), and Screening tool for RLS. We determined epidemiological performance, spearman correlations, regression analysis, receiver operated characteristics of CRD. Results: Of the180 patients assessed, 51% were female, CRD was found in 50% ACP, median scores(IQR) ESS: 11(7-14); ESAS- drowsiness item was 5 (2-6); PSQI was 8(5-11); ISI (13 (5-19); SBS 3(2-4); HADS-D 6(3-10). Sleep apnea was found in 61%; and RLS in 38%. ESAS-D was associated with other ESAS items[r, p-value] Sleep (0.38, < 0.0001); pain (0.3, < 0.0001); fatigue(0.51, < 0.0001); depression(0.39, < 0.0001); anxiety(0.44, < 0.0001); shortness of breath(0.32, < 0.0001); anorexia(0.36, < 0.0001), FWB(0.41, < 0.0001), and ESS (0.24, 0.001), Opioid dose [MEDD] (0.19, 0.01). Multivariate analysis found no independent predictors except ISI (OR 2.35; 0.036), ESAS Fatigue (OR 9.08, <0.0001), ESAS Anxiety (3.0, 0.009); feeling of well-being (OR 2.27, p=0.04). An ESAS- drowsiness cut-off score of ≥ 3(of 10) resulted in a sensitivity and specificity of 81% and 32% and of 70% and 44% in the training and validation samples, respectively. Conclusions: Clinically significant CRD was associated with increased fatigue, anxiety, sleep disturbance and worse feeling of well-being. These symptoms should be routinely assessed and treated in ACP with CRD. ESAS-drowsiness score of ≥3 of 10 is most useful for screening CRD.

Spiritual well-being mediates the association between attachment insecurity and psychological distress in advanced cancer patients

2019 ◽  
Vol 27 (11) ◽  
pp. 4317-4325 ◽  
Author(s):  
Katharina Scheffold ◽  
Rebecca Philipp ◽  
Sigrun Vehling ◽  
Susan Koranyi ◽  
Dorit Engelmann ◽  
...  
Keyword(s):  
Psychological Distress ◽  
Cancer Patients ◽  
Advanced Cancer ◽  
Well Being ◽  
Advanced Cancer Patients ◽  
Attachment Insecurity ◽  
Spiritual Well Being

Psychological aspects of meaning-centered group psychotherapy: Spanish experience

2017 ◽  
Vol 16 (3) ◽  
pp. 317-324 ◽  
Author(s):  
Clara Fraguell ◽  
Joaquín T. Limonero ◽  
Francisco Gil
Keyword(s):  
Quantitative Analysis ◽  
Cancer Patients ◽  
Group Psychotherapy ◽  
Advanced Cancer ◽  
Latin American ◽  
Well Being ◽  
Psychological Aspects ◽  
Advanced Cancer Patients ◽  
Spanish Speaking ◽  
Foundational Work

ABSTRACTObjective:Our aim was to identify the themes that arise when applying adapted meaning-centered group psychotherapy (MCGP) in Spanish-speaking advanced cancer patients.Method:A mixed qualitative–quantitative analysis was performed on the transcripts of interviews with 22 advanced cancer patients who had been assigned to three MCGP subgroups.Results:We found six new emergent themes in addition to the originally constructed themes of MCGP. Threat and uncertainty were the two most frequent emergent issues for our Spanish patients.Significance of results:The implementation of MCGP in Spanish patients validated the themes proposed by Breitbart and colleagues' foundational work on MCGP and also suggested new issues relevant to patient well-being (classified as “emergent themes”). Taking our findings into account, we propose that these new themes be considered in the Spanish adaptation of MCGP as well as in future adaptations of this form of psychotherapy in treating Latin American patients.

scholarly journals Meaning-Centered Group Psychotherapy: An Effective Intervention for Improving Psychological Well-Being in Patients With Advanced Cancer

2015 ◽  
Vol 33 (7) ◽  
pp. 749-754 ◽  
Author(s):  
William Breitbart ◽  
Barry Rosenfeld ◽  
Hayley Pessin ◽  
Allison Applebaum ◽  
Julia Kulikowski ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Group Psychotherapy ◽  
Outcome Measures ◽  
Advanced Cancer ◽  
Well Being ◽  
Physical Symptom ◽  
Symptom Distress ◽  
Spiritual Well Being ◽  
Hastened Death

Purpose To test the efficacy of meaning-centered group psychotherapy (MCGP) to reduce psychological distress and improve spiritual well-being in patients with advanced or terminal cancer. Patients and Methods Patients with advanced cancer (N = 253) were randomly assigned to manualized eight-session interventions of either MCGP or supportive group psychotherapy (SGP). Patients were assessed before and after completing the treatment and 2 months after treatment. The primary outcome measures were spiritual well-being and overall quality of life, with secondary outcome measures assessing depression, hopelessness, desire for hastened death, anxiety, and physical symptom distress. Results Hierarchical linear models that included a priori covariates and only participants who attended ≥ three sessions indicated a significant group × time interaction for most outcome variables. Specifically, patients receiving MCGP showed significantly greater improvement in spiritual well-being and quality of life and significantly greater reductions in depression, hopelessness, desire for hastened death, and physical symptom distress compared with those receiving SGP. No group differences were observed for changes in anxiety. Analyses that included all patients, regardless of whether they attended any treatment sessions (ie, intent-to-treat analyses), and no covariates still showed significant treatment effects (ie, greater benefit for patients receiving MCGP v SGP) for quality of life, depression, and hopelessness but not for other outcome variables. Conclusion This large randomized controlled study provides strong support for the efficacy of MCGP as a treatment for psychological and existential or spiritual distress in patients with advanced cancer.

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