Kissane, D.W., Bloch, S., Smith, G.C., Miach, P., Clarke, D.M., Ikin, J., . . . McKenzie, D. (2003). Cognitive-existential group psychotherapy for women with primary breast cancer: A randomized controlled trial. Psycho-Oncology, 12, 532–546.

The intervention was cognitive-existential therapy (CEGT) provided in nine Australian hospitals. Existential themes of anxiety about death and uncertainty were incorporated into six goals of therapy: promoting a 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 the future. The CEGT group had 20 weekly sessions, 90 minutes each, over six months. The control group had three 50-minute relaxation classes using progressive muscle relaxation with guided imagery. Measurements were 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.

• The sample was comprised of 303 women with stage I or II breast cancer stratified by nodal status, hormone receptor status, and tumor size.
• The intervention group (n = 154) received CEGT plus three relaxation classes.
• The control group (n = 149) received three relaxation classes.

Nine Australian hospitals

A randomized controlled trial/longitudinal study design was used.

• Monash Interview for Liaison Psychiatry (structured psychiatric interview validated with DSM-IIIR)
• Affect Balance Scale
• Hospital Anxiety and Depression Scale (HADS)
• Mental Adjustment to Cancer Scale (MAC)
• Family Assessment Device
• Satisfaction with therapy and other treatments

• Baseline screening showed that one-third of the sample suffered from a form of depressive disorder.
• The CEGT intervention group had reduced anxiety (p = 0.05, two-sided) compared to controls.
• Overall effect size for group intervention was small (d = 0.25).

• The CEGT model is recommended for use in patients with early breast cancer, and the supportive-expressive treatment model is recommended for patients with advanced breast cancer.
• The psychologist intervention group had a moderate mean effect size (d = 0.52); training and experience of the therapist make the intervention more effective.

• Both groups received three relaxation classes (minor design flaw).
• The intervention required specialized training needs for therapists.