Antoni, M.H., Lehman, J.M., Kilbourn, K.M., Boyers, A.E., Culver, J.L., Alferi, S.M., . . . Carver, C.S. (2001). Cognitive-behavioral stress management intervention decreases the prevalence of depression and enhances benefit finding among women under treatment for early-stage breast cancer. Health Psychology, 20, 20–32.

Participants were randomly assigned to the intervention or control group. The intervention one was a closed, structured group that met weekly for 10 two-hour sessions. It included didactic material, experiential exercises, and homework assignments (practicing relaxation exercises) and focused on learning to cope better. The control group participants received a condensed version of the intervention during a five- to six-hour seminar; it provided information but lacked the therapeutic group environment and support. Participants were assessed initially, post-treatment, at three months, and at nine months. The study was advertised by letters and posters, and participants phoned for eligibility screening.

• N = 100
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Stage 0, I, or II breast cancer

• SITE: Multi-site
• LOCATION: Several hospitals and medical practices in Miami, FL

• Outcomes measured: Distress (mood disturbance, depressive symptoms, and thought intrusion and avoidance), perceptions of benefit from having breast cancer, and general optimism regarding the future
• Scales: Profile of Mood States (POMS), Center for Epidemiological Studies-Depression (CES-D), Impact of Events Scale (IES), Life Orientation Test-Revised (LOT-R), and a 17-item measure of perceived benefits

The intervention group showed reduced prevalence of moderate depression per the CES-D. The intervention also influenced two measures of positive well-being—increasing reports of experiencing benefit from having had breast cancer and increasing general optimism about the future.

An implication here is that it is important to collect information on positive experiences as well as negative. Responding to adversity presents an opportunity to experience growth and positive change.

Although this is a well-designed RCT, several flaws exist.

• The sample is made up of volunteers who were relatively educated, affluent, and motivated. Only 26% identified themselves as an ethnic minority.
• The participants had non-metastatic cancers and were free from physical and mental health comorbidities at the time of recruitment, so generalizability is constrained.
• The measure of benefit finding is new; more information is needed regarding its validity.
• Levels of distress reported in this sample were generally low.