Kissane, et. al., 2003

The intervention was cognitive- existential therapy (CEGT) provided in 9 Australian hospitals.

Existential themes of anxiety about death and uncertainty incorporated into six goals of therapy: promoting supportive environment; facilitating grief work over multiple losses, altering maladaptive cognitive patterns, enhancing problem solving and coping skills, fostering a sense of mastery, and sorting out priorities for future.

Randomized controlled trial; longitudinal study 303 women with stage I or II breast cancer stratified by nodal status, hormone receptor status and tumor size. Intervention group: CEGT + 3 relaxation classes. N=154 Control group: 3 relaxation classes. N=149 Measurements taken at baseline, 6 months, and 12 months after the intervention.

The intervention was offered by 15 therapists recruited from psychiatry, psychology, social work, Occupational Therapy and oncology nursing staff. All therapists received specialized training and supervision through a series of workshops using 68- page manual.

Monash Interview for Liaison Psychiatry-structured psychiatric interview validated with DSM-IIIR Affect Balance Scale

The intervention was offered by 15 therapists recruited from psychiatry, psychology, social work, Occupational Therapy and oncology nursing staff. All therapists received specialized training and supervision through a series of workshops using 68- page manual.

Hospital Anxiety & Depression Scale (HADS) Mental Adjustment to Cancer Scale (MAC) Family Assessment Device Satisfaction with therapy and other treatments.

Baseline screening showed 1/3 of entire sample of women suffered from a form of depressive disorder Reduced anxiety (p=0.05, 2 sided)

Overall effect size for group intervention was small (d=0.25). Conclusions: use the CEGT model for patients with early breast cancer and use supportive- expressive treatment model for patients with advanced breast cancer.

Minor design flaw: both groups received three relaxation classes.

Psychologist intervention group had moderate mean effect size (d=0.52)—training and experience of therapist makes the intervention more effective. Specialized training needs for therapists.