Herschbach, P., Berg, P., Waadt, S., Duran, G., Engst-Hastreiter, U., Henrich, G., … Dinkel, A. (2010). Group psychotherapy of dysfunctional fear of progression in patients with chronic arthritis or cancer. Psychotherapy and Psychosomatics, 79, 31–38.

To examine the effects of generic psychotherapeutic interventions on dysfunctional fear of progression (FoP)

Randomization was stratified by diagnosis, and participants were blinded with regard to group assignment. The intervention group received four sessions of group psychotherapy, each 90 minutes. The first group received cognitive behavioral group therapy (CBT) and a manual that was structured with content, topics, and interventions. The supportive experiential group therapy (SET) had a manual with regard to structure, but it was less prescriptive in content than was the CBT manual. The groups were led by psychotherapists who had had three years or more of clinical experience or were in the final phase of training. Sessions were recorded, to monitor integrity. Measures were taken at the initial session, before discharge, at three months, at 12 months, and after discharge. The control group provided data at the initial, before-discharge, and after-discharge points only. The intervention groups received booster telephone calls at six and nine months after discharge. The control group was sampled in the same clinics as were other patients and at one year after the completion of the intervention, using the same eligibility criteria.

• The sample was composed of 872 participants total; 174 had chronic arthritis (CA)  and 174 had cancer.
• All participants were at least 18 years old.
• Mean age of CA patients was 46.7 years (SD = 9.5 years); mean age patients with cancer, 53.7 years (SD = 10.2 years).
• The number of female patients in the CA group was 194; in the cancer group, 220. The number of male patients in the CA group was 64; in the cancer group, 45.
• Of participants with cancer, 58.8% had breast cancer, 8% had colon cancer, 9.5% had bladder or prostate cancer, 9.1% had gynecologic cancer, and 14.4% had some other kind of cancer.

• Multisite.
• Inpatient.
• Patients with chronic arthritis were from one rehabilitation clinic. Patients with cancer were from two rehabilitation clinics.

Active treatment and transition phase

Single-blind partially longitudinal randomized controlled study

• Fear of Progression Questionnaire (FoP-Q), consisting of 43 items relating to five dimensions
• German version of the Hospital Anxiety and Depression Scale (HADS)
• German version of the SF-12
• Questions on Life Satisfaction Modules (FLZM)

Both interventions were associated with a decrease in FoP over time, but only among cancer patients. The two interventions did not differ in reducing FoP. A significant interaction between time and illness group emerged for anxiety, depression, and the mental component of health-related quality of life, indicating an improvement in cancer patients. The intervention had no effect  on any of the secondary outcomes.

Dysfunctional FoP can be identified and targeted with brief group interactions. These interventions may reduce FoP, especially in populations with cancer. The intervention used here did not appear to have a long term benefit related to symptoms of depression.

• Randomization was incomplete.
• Participants in the rehabilitation setting may have had issues other than CA or cancer, and these issues may have affected outcomes.
• Authors did not specify the stage of disease. Stage would affect a patient’s perception of progression.
• Because of the settings involved, results may not be generalizable.

Dealing with FoP is important in the care of cancer survivors. Findings of this study suggest that dysfunctional fear can be identified and that interventions can be appropriately targeted. While the intervention in this study did not show a lasting benefit related to depression, the study does provide potential approaches to identifying patients who may benefit from interventions to address fear.