Cohen, M., & Fried, G. (2007). Comparing relaxation training and cognitive-behavioral group therapy for women with breast cancer. Research on Social Work Practice, 17, 313–323.

Patients attended 90-minute weekly sessions for a total of nine weeks. The cognitive-behavior (CB) component of the intervention emphasized learning to identify negative thinking patterns and restructure them into more adaptive, stress-reducing patterns. Mental distraction, problem-solving, and decision-making strategies were also covered. The behavioral component emphasized activity scheduling, graded task assignment, behavioral distraction, and behavioral experiment techniques. Homework exercises were assigned, and written material was provided for the application of CB strategies. Relaxation and guided imagery (RGI) participants practiced deep breathing and autogenic relaxation. Each relaxation experience lasted 20 to 30 minutes, and after sessions, participants discussed their sensations, feelings, and experiences to identify and work on problems identified in the relaxation process. Strategies to overcome sleep problems were also discussed and practiced. Participants were given RGI audio cassettes for further use at home. Group size consisted of six to eight participants. Questionnaires were completed at preintervention, postintervention, and at a four-month follow-up.

The study included 114 women with early stage breast cancer (stages I and II) who were 2 to 12 months postsurgery and were receiving chemotherapy or radiotherapy.

CB Group

• Mean age was 55.9 years (range 28–74).
• Mean education was 13.5 years (range 9–20).
• Of the patients, 76.3% were married, 52.6% were unemployed, 57.9% were secular, and 60.5% received chemotherapy treatment.

RGI Group

• Mean age was 51.8 years (range 27–74).
• Mean education was 13.2 years (range 8–19).
• Of the patients, 64.1% were married, 61.5% were unemployed, 61.5% were secular, and 64.1% received chemotherapy treatment.

Control Group

• Mean age was 52.9 years (range 27–70).
• Of the patients, 81.1% were married, 64.9% were unemployed, 56.8% were secular, and 56.8% received chemotherapy treatment.

The study was conducted at a large oncology department in northern Israel.

Patients were undergoing the active treatment phase of care.

The study was a randomized, controlled trial with three groups:
•    CB (n = 38)
•    Relaxation and guided imagery (n = 39)
•    Control (n = 37).

Fatigue Symptom Inventory (FSI)

Means of the fatigue symptoms declined in both intervention groups between pre- and posttest time points, but only the decline in the RGI group was statistically significant. Similar results were observed at the four-month follow-up, and fatigue means remained significantly lower in the RGI group compared to the CB and control groups.

Study participants may have been more motivated or suffered from less psychological distress than those who did not agree to participate; therefore, the generalizability of the results is questionable. Four-month follow-up may have been too short. The authors did not measure the compliance of patients in the intervention protocols (i.e., using audiotapes on their own time).