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A Structured Psychiatric Intervention for Cancer Patients: I. Changes Over Time in Methods of Coping and Affective Disturbance

A Structured Psychiatric Intervention for Cancer Patients: I. Changes Over Time in Methods of... Abstract • We evaluated the immediate and long-term effects on psychological distress and coping methods of a 6-week, structured, psychiatric group intervention for postsurgical patients with malignant melanoma. The intervention consisted of health education, enhancement of problem-solving skills, stress management (eg, relaxation techniques), and psychological support. In spite of good prognosis, most patients had high levels of psychological distress at baseline, comparable with other patients with cancer. However, at the end of brief psychiatric intervention, the experimental subjects (n = 38), while not without some distress, exhibited higher vigor and greater use of active-behavioral coping than the controls (n = 28). At 6 months' follow-up, the group differences were even more pronounced. The intervention-group patients then showed significantly lower depression, fatigue, confusion, and total mood disturbance as well as higher vigor. They were also using significantly more active-behavioral and active-cognitive coping than the controls. These results indicate that a short-term psychiatric group intervention for patients with malignant melanoma effectively reduces psychological distress and enhances longer-term effective coping. References 1. American Cancer Society. Facts and Figures . New York, NY: American Cancer Society; 1988. 2. Weisman AD, Worden JW, Sobel HJ. Psychosocial Screening Intervention With Cancer Patients . Boston, Mass: Project Omega; 1980. 3. Cohen J, Cullen J, Martin L. Psychosocial Aspects of Cancer . New York, NY: Raven Press; 1982. 4. Fawzy FI, Fawzy NW. Psychosocial aspects of cancer . In: Nixon DW, ed. Diagnosis and Management of Cancer . Reading, Mass: Addison-Wesley Publishing Co; 1982;16:111-123. 5. Schmale AH. Perspective: the psychosocial interaction of the patient, the cancer and their physicians . In: Clinical Oncology for Medical Students and Physicians, a Multidisciplinary Approach . 4th ed. New York, NY: American Cancer Society; 1974. 6. Brantner J. Life-threatening disease as a manageable crisis . Semin Oncol . 1974;1:153-157. 7. Parkes CM. Bereavement: Studies of Grief in Adult Life . New York, NY: International Universities Press Inc; 1972. 8. Holland J. Psychological aspects of cancer . In: Holland JF, Frei E, eds. Cancer Medicine . Philadelphia, Pa: Lea& Febiger; 1973;24:991-1021. 9. Pfefferbaum B, Pasnau RO, Jamison K, Wellisch DK. A comprehensive program of psychosocial care for mastectomy patients . Int J Psychiatry Med . 1977;8:63-71.Crossref 10. Greer S, Morris T, Pettingale KW. Psychological response to breast cancer: effect on outcome . Lancet . 1979;2:785-787.Crossref 11. Peck A. Emotional reactions to having cancer . Am J Roentgenol Radium Ther Nucl Med . 1972;114:591-599.Crossref 12. Parkes CM. The emotional impact of cancer on patients and their families . J Laryngol Otol . 1975;89:1271-1279.Crossref 13. Morris T, Greer HS, White P. Psychological and social adjustment to mastectomy: a two-year follow-up study . Cancer . 1977;40:2361-2387.Crossref 14. Maguire GP, Lee EG, Bevington DJ, Kuchemann C, Crabtree RJ, Cornell CE. Psychiatric problems in the first year after mastectomy . BMJ . 1978;1:963-965.Crossref 15. Petty F, Noyles R. Depression secondary to cancer . Biol Psychol . 1981;16:1203-1217. 16. Kennedy AM. Coping with cancer: new ways to deal with psychic devastation . Med World News . 1979;20:36-46. 17. Fiore N. Fighting cancer: one patient's perspective . N Engl J Med . 1979;300:284-289.Crossref 18. Bahnson C. Psychologic and emotional issues in cancer: the psychotherapeutic care of the cancer patient . Semin Oncol . 1975;2:293-309. 19. Moos R, Tsu V. The crisis of the physical illness: an overview . In: Moos R, ed. Coping With Physical Illness . New York, NY: Plenum Medical Book Co; 1977:3-21. 20. Lazarus RS, Folkman S. Stress, Appraisal and Coping . New York, NY: Springer-Verlag NY Inc; 1984. 21. Zegans LS. Emotions in health and illness: an attempt at integration . In: Temoshok L, Van Dyke C, Zegans LS. Emotions in Health and Illness . New York, NY: Grune & Stratton; 1983;14:235-256. 22. Billings AG, Moos RH. The role of coping responses and social resources in attenuating the stress of life events . J Behav Med . 1981;4:139-157.Crossref 23. Namir S, Wolcott DL, Fawzy FI, Alumbagh MJ. Coping with AIDS: psychological and health implications . J Appl Psychol . 1987;17:309-328. 24. Bloom JR. Social support, accommodation to stress and adjustment to breast cancer . Soc Sci Med . 1982;16:1329-1338.Crossref 25. Holahan CJ, Moos RH. Life Stress and Health: Personality, Coping and Family Support in Stress Resistance . Palo Alto, Calif: Stanford University; 1983. 26. Billings AG, Moos R. The role of coping responses and social resources in attenuating the stress of life events . J Behav Med . 1981;4:139-157.Crossref 27. Felton BJ, Revenson TA, Hinrichsen GA. Stress and coping in the explanation of psychological adjustment among chronically ill adults . Soc Sci Med . 1984;18:889-898.Crossref 28. Rogentine GN Jr, Van Kammen DP, Fox BH, Docherty JP, Rosenblatt JE, Boyd SC, Bunney WE Jr. Psychological factors in the prognosis of malignant melanoma: a prospective study . Psychosom Med . 1979;41:647-655.Crossref 29. Derogatis LR, Abeloff MD, Melisaratos N. Psychological coping mechanisms and survival time in metastatic breast cancer . JAMA . 1979;242:1504-1508.Crossref 30. Spiegel D, Bloom JR, Yalom ID. Group support for metastatic cancer patients: a randomized prospective outcome study . Arch Gen Psychiatry . 1981;38:527-533.Crossref 31. Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer . Lancet . 1989;2:888-891.Crossref 32. Yalom ID, Greaves C. Group therapy with the terminally ill . Am J Psychiatry . 1977;134:396-400. 33. Fawzy FI, Wellisch D, Yager J. Psychiatric liaison to the bone-marrow transplant project . In: Hollingsworth CE, Pasnau RO, eds. The Family in Mourning . New York, NY: Grune & Stratton; 1977:181-189. 34. Gordon WA, Freidenbergs I, Diller L, Hibbard M, Wolf C, Levine L, Lipkins R, Ezrachi O, Lucido D. Efficacy of psychosocial intervention with cancer patients . J Consult Clin Psychol . 1980;48:743-759.Crossref 35. Bloom JR. Social support systems and cancer: a conceptual view . In: Cohen J, Cullen J, Martin RL, eds. Psychosocial Aspects of Cancer . New York, NY: Raven Press; 1982;16:129-149. 36. Holland JC, Rowland JH. Psychiatric, psychosocial, and behavioral interventions in the treatment of cancer: an historical perspective . In: Weiss SM, Herd JA, Fox BH, eds. Perspectives on Behavioral Medicine . Orlando, Fla: Academic Press Inc; 1981:235-260. 37. Massie MJ, Holland JC, Straker N. Psychotherapeutic interventions . In: Holland JC, Rowland J, eds. Handbook of Psychooncology . New York, NY: Oxford University Press Inc; 1989:455-469. 38. Ferlic M, Goldman A, Kennedy BJ. Group counseling in adult patients with advanced cancer . Cancer . 1979;43:760-766.Crossref 39. Vachon ML, Lyall WA. Applying psychiatric techniques to patients with cancer . Hosp Community Psychiatry . 1976;27:582-584. 40. Parsell S, Taglarena EM. Cancer patients help each other . Am J Nurs . 1975;74:650-651. 41. Fawzy FI, Cousins N, Kemeny ME, Fawzy NW, Elashoff R, Morton D, Fahey JL. A Structured Psychiatric Intervention for Cancer Patients: II. changes over time in immunological measures . Arch Gen Psychiatry . 1990:000:000-000. 42. Nixon DW. Melanoma . In: Nixon DW, ed. Diagnosis and Management of Cancer . Reading, Mass: Addison-Wesley Publishing Co; 1982;16:238-247. 43. McNair DM, Lorr M, Doppelman LF. Profile of Mood States instrument . In: McNair DM, Lorr M, Doppelman LF, eds. Manual for the Profile of Mood States . San Diego, Calif: Educational and Industrial Testing Service; 1971:3-29. 44. Donlou JN, Wolcott DL, Gottlieb MS, Landsverk J. Psychosocial aspects of AIDS: a pilot study . J Psychosoc Oncol . 1985;3:39-55.Crossref 45. Fawzy FI, Namir S, Wolcott DL. Structured group intervention model for AIDS patients . Psychiatr Med . 1989;7:35-45. 46. Fawzy FI, Namir S, Wolcott DL, Mitsuyasu RT, Gottlieb MS. The relationship between medical and psychological status in newly diagnosed gay men with AIDS . Psychiatr Med . 1989;7:23-33. 47. Cella DF, Tross S, Orav JE, Holland JC, Silberfarb PM, Rafla S. Mood states of patients after the diagnosis of cancer . J Psychosoc Oncol . 1989;7:45-54.Crossref 48. Sobel HJ, Worden JW. Helping Cancer Patients Cope: Practitioner's Manual . New York, NY: Guilford Press; 1982. 49. Wolcott DL, Wellisch DK, Fawzy FI, Landsverk J. Adaptation of adult bone marrow transplant recipient long-term survivors . Transplantation . 1986;41:478-484.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of General Psychiatry American Medical Association

A Structured Psychiatric Intervention for Cancer Patients: I. Changes Over Time in Methods of Coping and Affective Disturbance

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References (49)

Publisher
American Medical Association
Copyright
Copyright © 1990 American Medical Association. All Rights Reserved.
ISSN
0003-990X
eISSN
1598-3636
DOI
10.1001/archpsyc.1990.01810200028004
Publisher site
See Article on Publisher Site

Abstract

Abstract • We evaluated the immediate and long-term effects on psychological distress and coping methods of a 6-week, structured, psychiatric group intervention for postsurgical patients with malignant melanoma. The intervention consisted of health education, enhancement of problem-solving skills, stress management (eg, relaxation techniques), and psychological support. In spite of good prognosis, most patients had high levels of psychological distress at baseline, comparable with other patients with cancer. However, at the end of brief psychiatric intervention, the experimental subjects (n = 38), while not without some distress, exhibited higher vigor and greater use of active-behavioral coping than the controls (n = 28). At 6 months' follow-up, the group differences were even more pronounced. The intervention-group patients then showed significantly lower depression, fatigue, confusion, and total mood disturbance as well as higher vigor. They were also using significantly more active-behavioral and active-cognitive coping than the controls. These results indicate that a short-term psychiatric group intervention for patients with malignant melanoma effectively reduces psychological distress and enhances longer-term effective coping. References 1. American Cancer Society. Facts and Figures . New York, NY: American Cancer Society; 1988. 2. Weisman AD, Worden JW, Sobel HJ. Psychosocial Screening Intervention With Cancer Patients . Boston, Mass: Project Omega; 1980. 3. Cohen J, Cullen J, Martin L. Psychosocial Aspects of Cancer . New York, NY: Raven Press; 1982. 4. Fawzy FI, Fawzy NW. Psychosocial aspects of cancer . In: Nixon DW, ed. Diagnosis and Management of Cancer . Reading, Mass: Addison-Wesley Publishing Co; 1982;16:111-123. 5. Schmale AH. Perspective: the psychosocial interaction of the patient, the cancer and their physicians . In: Clinical Oncology for Medical Students and Physicians, a Multidisciplinary Approach . 4th ed. New York, NY: American Cancer Society; 1974. 6. Brantner J. Life-threatening disease as a manageable crisis . Semin Oncol . 1974;1:153-157. 7. Parkes CM. Bereavement: Studies of Grief in Adult Life . New York, NY: International Universities Press Inc; 1972. 8. Holland J. Psychological aspects of cancer . In: Holland JF, Frei E, eds. Cancer Medicine . Philadelphia, Pa: Lea& Febiger; 1973;24:991-1021. 9. Pfefferbaum B, Pasnau RO, Jamison K, Wellisch DK. A comprehensive program of psychosocial care for mastectomy patients . Int J Psychiatry Med . 1977;8:63-71.Crossref 10. Greer S, Morris T, Pettingale KW. Psychological response to breast cancer: effect on outcome . Lancet . 1979;2:785-787.Crossref 11. Peck A. Emotional reactions to having cancer . Am J Roentgenol Radium Ther Nucl Med . 1972;114:591-599.Crossref 12. Parkes CM. The emotional impact of cancer on patients and their families . J Laryngol Otol . 1975;89:1271-1279.Crossref 13. Morris T, Greer HS, White P. Psychological and social adjustment to mastectomy: a two-year follow-up study . Cancer . 1977;40:2361-2387.Crossref 14. Maguire GP, Lee EG, Bevington DJ, Kuchemann C, Crabtree RJ, Cornell CE. Psychiatric problems in the first year after mastectomy . BMJ . 1978;1:963-965.Crossref 15. Petty F, Noyles R. Depression secondary to cancer . Biol Psychol . 1981;16:1203-1217. 16. Kennedy AM. Coping with cancer: new ways to deal with psychic devastation . Med World News . 1979;20:36-46. 17. Fiore N. Fighting cancer: one patient's perspective . N Engl J Med . 1979;300:284-289.Crossref 18. Bahnson C. Psychologic and emotional issues in cancer: the psychotherapeutic care of the cancer patient . Semin Oncol . 1975;2:293-309. 19. Moos R, Tsu V. The crisis of the physical illness: an overview . In: Moos R, ed. Coping With Physical Illness . New York, NY: Plenum Medical Book Co; 1977:3-21. 20. Lazarus RS, Folkman S. Stress, Appraisal and Coping . New York, NY: Springer-Verlag NY Inc; 1984. 21. Zegans LS. Emotions in health and illness: an attempt at integration . In: Temoshok L, Van Dyke C, Zegans LS. Emotions in Health and Illness . New York, NY: Grune & Stratton; 1983;14:235-256. 22. Billings AG, Moos RH. The role of coping responses and social resources in attenuating the stress of life events . J Behav Med . 1981;4:139-157.Crossref 23. Namir S, Wolcott DL, Fawzy FI, Alumbagh MJ. Coping with AIDS: psychological and health implications . J Appl Psychol . 1987;17:309-328. 24. Bloom JR. Social support, accommodation to stress and adjustment to breast cancer . Soc Sci Med . 1982;16:1329-1338.Crossref 25. Holahan CJ, Moos RH. Life Stress and Health: Personality, Coping and Family Support in Stress Resistance . Palo Alto, Calif: Stanford University; 1983. 26. Billings AG, Moos R. The role of coping responses and social resources in attenuating the stress of life events . J Behav Med . 1981;4:139-157.Crossref 27. Felton BJ, Revenson TA, Hinrichsen GA. Stress and coping in the explanation of psychological adjustment among chronically ill adults . Soc Sci Med . 1984;18:889-898.Crossref 28. Rogentine GN Jr, Van Kammen DP, Fox BH, Docherty JP, Rosenblatt JE, Boyd SC, Bunney WE Jr. Psychological factors in the prognosis of malignant melanoma: a prospective study . Psychosom Med . 1979;41:647-655.Crossref 29. Derogatis LR, Abeloff MD, Melisaratos N. Psychological coping mechanisms and survival time in metastatic breast cancer . JAMA . 1979;242:1504-1508.Crossref 30. Spiegel D, Bloom JR, Yalom ID. Group support for metastatic cancer patients: a randomized prospective outcome study . Arch Gen Psychiatry . 1981;38:527-533.Crossref 31. Spiegel D, Bloom JR, Kraemer HC, Gottheil E. Effect of psychosocial treatment on survival of patients with metastatic breast cancer . Lancet . 1989;2:888-891.Crossref 32. Yalom ID, Greaves C. Group therapy with the terminally ill . Am J Psychiatry . 1977;134:396-400. 33. Fawzy FI, Wellisch D, Yager J. Psychiatric liaison to the bone-marrow transplant project . In: Hollingsworth CE, Pasnau RO, eds. The Family in Mourning . New York, NY: Grune & Stratton; 1977:181-189. 34. Gordon WA, Freidenbergs I, Diller L, Hibbard M, Wolf C, Levine L, Lipkins R, Ezrachi O, Lucido D. Efficacy of psychosocial intervention with cancer patients . J Consult Clin Psychol . 1980;48:743-759.Crossref 35. Bloom JR. Social support systems and cancer: a conceptual view . In: Cohen J, Cullen J, Martin RL, eds. Psychosocial Aspects of Cancer . New York, NY: Raven Press; 1982;16:129-149. 36. Holland JC, Rowland JH. Psychiatric, psychosocial, and behavioral interventions in the treatment of cancer: an historical perspective . In: Weiss SM, Herd JA, Fox BH, eds. Perspectives on Behavioral Medicine . Orlando, Fla: Academic Press Inc; 1981:235-260. 37. Massie MJ, Holland JC, Straker N. Psychotherapeutic interventions . In: Holland JC, Rowland J, eds. Handbook of Psychooncology . New York, NY: Oxford University Press Inc; 1989:455-469. 38. Ferlic M, Goldman A, Kennedy BJ. Group counseling in adult patients with advanced cancer . Cancer . 1979;43:760-766.Crossref 39. Vachon ML, Lyall WA. Applying psychiatric techniques to patients with cancer . Hosp Community Psychiatry . 1976;27:582-584. 40. Parsell S, Taglarena EM. Cancer patients help each other . Am J Nurs . 1975;74:650-651. 41. Fawzy FI, Cousins N, Kemeny ME, Fawzy NW, Elashoff R, Morton D, Fahey JL. A Structured Psychiatric Intervention for Cancer Patients: II. changes over time in immunological measures . Arch Gen Psychiatry . 1990:000:000-000. 42. Nixon DW. Melanoma . In: Nixon DW, ed. Diagnosis and Management of Cancer . Reading, Mass: Addison-Wesley Publishing Co; 1982;16:238-247. 43. McNair DM, Lorr M, Doppelman LF. Profile of Mood States instrument . In: McNair DM, Lorr M, Doppelman LF, eds. Manual for the Profile of Mood States . San Diego, Calif: Educational and Industrial Testing Service; 1971:3-29. 44. Donlou JN, Wolcott DL, Gottlieb MS, Landsverk J. Psychosocial aspects of AIDS: a pilot study . J Psychosoc Oncol . 1985;3:39-55.Crossref 45. Fawzy FI, Namir S, Wolcott DL. Structured group intervention model for AIDS patients . Psychiatr Med . 1989;7:35-45. 46. Fawzy FI, Namir S, Wolcott DL, Mitsuyasu RT, Gottlieb MS. The relationship between medical and psychological status in newly diagnosed gay men with AIDS . Psychiatr Med . 1989;7:23-33. 47. Cella DF, Tross S, Orav JE, Holland JC, Silberfarb PM, Rafla S. Mood states of patients after the diagnosis of cancer . J Psychosoc Oncol . 1989;7:45-54.Crossref 48. Sobel HJ, Worden JW. Helping Cancer Patients Cope: Practitioner's Manual . New York, NY: Guilford Press; 1982. 49. Wolcott DL, Wellisch DK, Fawzy FI, Landsverk J. Adaptation of adult bone marrow transplant recipient long-term survivors . Transplantation . 1986;41:478-484.Crossref

Journal

Archives of General PsychiatryAmerican Medical Association

Published: Aug 1, 1990

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