Vos, P.J., Visser, A.P., Garssen, B., Duivenvoorden, H.J., & de Haes, H. (2007). Effectiveness of group psychotherapy compared to social support groups in patients with primary, non-metastatic breast cancer. Journal of Psychosocial Oncology, 25(4), 37–60.

To compare the effectiveness, for women with a primary breast cancer, of experiential-existential group psychotherapy (incorporating cancer into one’s life) with that of a social-support group in regard to psychosocial adjustment (including psychological, psychosexual, and social adjustment); to examine the effect of age, type of surgery, and stage of disease on psychosocial adjustment indicators at the end of the intervention and at one year after the intervention

After the participants provided informed consent, they were randomly assigned to treatment groups: one group that received group psychotherapy; one group,  social support. Data were collected at baseline (T0), then the intervention groups were conducted for three months. Data were collected after the intervention (T1) and at 12 months after completion of the intervention (T2). The interventions consisted of 12 weekly sessions of 2.5 hours each, including a 30-minute coffee break. The two follow-up sessions were at one and two months after the close of the intervention groups. The two follow-up sessions involved only 6–10 women and were conducted by trained leaders. Two trained therapists led the experiential-existential groups, and two trained leaders led the social-support groups. The study method required at least one of the therapists or leaders in each group to be a woman. Each group psychotherapy session, except the 1st and the 12th, followed a specific structure: opening, discussion of a specific topic, choosing the topic for the following week, and closing the session. The first session focused on introduction of the procedures and getting to know others. The 12th session was used to evaluate the group, to discuss what was learned or missed, to suggest improvements, and to say goodbye. Participants were allowed to choose the topics of the two follow-up sessions.

• The sample was composed of 67 participants.
• Mean age of participants in each group was 49 years.
• All participants were female.
• Participants had breast cancer with no distant metastasis. No participant had a diagnosed psychiatric illness. In the psychotherapy group, 12 participants had had breast-conserving surgery; in the social-support group, 10. In the psychotherapy group, 21 had had mastectomy;  in the social-support group, 24.
• No significant demographic differences existed between intervention groups.
   

• Multisite
• Outpatient
• Several hospitals in Rotterdam, The Netherlands
   

• Phase of care: transition phase after initial treatment
• Clinical applications: late effects and survivorship
   

A time-series randomized clinical trial

• Emotional adjustment: Dutch version of the Profile of Mood States (POMS) scale   
• Psychosexual functioning: Sexual Functioning subscale of the European Organization for Research and Treatment quality of life questionnaire (EORTC QLQ-C30)
• Psychosexual functioning: Body Image subscale of the the EORTC QLQ-C30
• Social adjustment: Social Interaction subscale of the Sickness Impact Profile (SIP)
• Social adjustment: Recreation subscale of the SIP
• Demographic questionnaire
   

In regard to distress, vitality, sexual functioning, and social intentions, the psychotherapy group did not benefit more from the intervention than did the social-support group. At the end of the sessions, participants reported positive changes in regard to body image and recreation; the disease had less impact on recreational activities than on body image. Type of surgery was related to body image: Participants who had had breast-conserving surgery reported a more positive body image than did participants who had not.

Psychologically well-adjusted women diagnosed with breast cancer do not benefit from the interventions described in this study: experiential-existential group psychotherapy and social-support groups.

• The study has a small sample size, with fewer than 100 participants.
• The details of the therapies limit generalizability and raise questions regarding study replication.
• Decrease in the impact of disease on recreation could be a function of time.
• The drop-out rate seemed higher among participants who had had mastectomy than among those who had had breast-conserving surgery.
• Participants were psychosocially well adjusted at the beginning of the study, which may account for the minimal improvements shown.
• Only 27.5% of the women asked to participate in the study agreed to participate; 23% who began the study dropped out.
   

Results do not make clear whether support groups or group psychotherapy are beneficial for women who do not have substantial distress. In clinical practice, screening patients for psychological distress makes sense, as does providing therapy and the specified support interventions only to those patients who have distress and who may benefit.