Ho, R.T., Fong, T.C., Lo, P.H., Ho, S.M., Lee, P.W., Leung, P.P., . . . Chan, C.L. (2016). Randomized controlled trial of supportive-expressive group therapy and body-mind-spirit intervention for Chinese non-metastatic breast cancer patients. Supportive Care in Cancer, 24, 4929–4937.

To examine the effect of two interventions on emotion suppression and psychological distress in patients with non-metastatic breast cancer

Each group met for eight weeks for two hours each week. There were three groups: 

1. Supportive expressive intervention model: Adapted 52-week version down to brief protocol focused on social support and interpersonal relationships, emotional expression, life priorities, fear of death, and coping skills
2. Body-mind-spirit: Sessions focused on holistic health lifestyle, including physical activities and discussions; developing resilience, normalizing traumatic experiences, looking for mutual support, promoting self-acceptance, and peace of mind; mental well-being and forgiveness 
3. Control: Social support self-help without structured programming. Self-led group discussed healthy living (diet, food, exercise) and self-care; shared worries; showed mutual support

• N = 157 (BMS, n = 51; SEG, n = 49; control, n = 57)   
• AGE: Range = 18-65 years; mean = 47.7 years
• FEMALES: 100%
• CURRENT TREATMENT: Not applicable; completion of active treatment  
• KEY DISEASE CHARACTERISTICS: Non-metastatic breast cancer

• SITE: Multi-site   
• SETTING TYPE: Multiple settings    
• LOCATION: Hong Kong, China

PHASE OF CARE: Transition phase after active treatment

Three-arm RCT with measurement at baseline (T0), 4 months (T1), 8 months (T2), and 12 months (T3)

• Emotional suppression–Chinese Courtauld Emotional Control Scale (how often suppress anger, anxiety, and depression)
• Perceived stress–Chinese Perceived Stress Scale (how often felt stressful in past month)
• Anxiety and Depression–Chinese Hospital Anxiety and Depression Scale 
• Baseline psychological functioning–Chinese General Health Questionnaire (higher scores indicate worse health)

No difference in groups except for cancer duration, which was longer in SEG group and shorter in the BMS group (p = 0.01). There were no significant improvements in anxiety or depression. Emotion suppression: significantly decreased in the first four months for SEG and BMS with no change in control group. Perceived stress: No change in control or SEG but significant decreases in first four months in BMS group.
SEG resulted in moderate decrease in emotional suppression at 4 and 8 months, with participant perceived benefits; method is applicable for increased expression of emotions. SEG minimal effect on anxiety, depression and perceived stress. 
BMS showed no effect on anxiety and depression (d = 0.38–0.46) and little (small to medium  d = 0.07–0.2) effect on emotional suppression and perceived stress.

No significant effectiveness of the named therapies: SEG or BMS

• Small sample per group
• Risk of bias (no random assignment)
• Measurement/methods not well described
• Findings not generalizable
• Subject withdrawals ≥ 10%
• Other limitations/explanation: Drop-out rate. 11.5% overall; 10.2% in SEG group and 17.5% in control group.
• Low statistical power and low-moderate effect sizes. Unclear which aspects of the abbreviated 52-week protocol were applied. Self-selection bias may be at play. Treatment adherence was not measured; participants completed seven sessions on average.

Conduct large-scale research with sufficient power to examine effectiveness of these therapies. Learn and apply these therapeutic approaches. Use full-scale 52-week protocol for expression support therapy.