Liu, C.J., Hsiung, P.C., Chang, K.J., Liu, Y.F., Wang, K.C., Hsiao, F.H., . . . Chan, C.L. (2008). A study on the efficacy of body–mind–spirit group therapy for patients with breast cancer. Journal of Clinical Nursing, 17, 2539–2549.

To examine the effects of body–mind–spirit group therapy on anxiety, depression, and well-being in women with breast cancer

The intervention was 10 group sessions based on positive psychology and forgiveness therapy to enhance physical strength, increase emotional release, and develop positive meaning of life. Specific exercises included things such as self-care planning, massage of acupuncture points, drawing, creating love cards for others, and sharing strategies.

• The study reported on a sample of 28 female patients with breast cancer.
• Most patients had stage II disease and had undergone modified radical mastectomy.
• Of the sample, 61% were married and identified as “religious,” 63% were employed, and 55% had high school or higher level of education.

• Single site
• Outpatient setting
• Taiwan

Patients were undergoing the active treatment phase of care.

A mixed-methods study design was used: randomized controlled trial with focus group interview.

• Beck Depression Inventory, second edition (BDI-II)
• State-Trait Anxiety Inventory (STAI)
• Body–Mind–Spirit Well-being Inventory (BMSWBI): 10-point scale with 56 items (alpha = 0.87–0.92)
• Qualitative analysis of verbatim transcripts of focus group interview. Interview guide used open-ended questions structured according to a published set of suggested questions.

There was no difference over time for depression or well-being. The intervention group had a greater reduction in anxiety (p = 0.03) compared to the control group, with an effect size estimate of 0.56, suggesting a medium clinical significance. Qualitative analysis demonstrated that reduced anxiety was facilitated through a group process.

Results of focus group interviews demonstrated that these effects were facilitated through a group process. There were no apparent effects of the intervention on depression or well-being.

• The study had a small sample size.
• Attrition was a problem, with a 35% drop-out rate, more in the experimental group than the control group.

Qualitative results suggest that the main effects of the intervention were associated with provision of information and the peer group interactions. It is not clear if the philosophic foundations and exercises used in the interventions were essential to these effects.