Efficacy of Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy for Anxiety, Depression, and Fatigue in Cancer Patients: A Randomized Clinical Trial
Objective: Cancer is associated with some psychological problems that play an important role in the severity and continuity of cancer. Cancer may lead to maladaptive psychological reactions such as anxiety, depression, and fatigue. Depression and anxiety are highly prevalent in cancer patients. This study aimed to compare the efficacy of mindfulness-based cognitive therapy (MBCT) and cognitive behavioral therapy (CBT) for anxiety, depression, and fatigue in cancer patients.
Method: The present study was a randomized clinical trial (RCT). Of the 100 patients diagnosed with cancer, 60 patients were eligible to participate in this study according to the inclusion / exclusion criteria. They were randomly assigned into 3 groups: MBCT, CBT, and wait-list group (WLG). Afterward, the experimental groups received 8 weekly treatment sessions. All the participants fulfilled the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and Cancer-Related Fatigue Scale (CFS) before and after the intervention. Data were analyzed using SPSS-16 software by Analysis of Covariance (ANCOVA).
Results: The results indicated a significant reduction in depression, anxiety, and fatigue scores in CBT and MBCT groups. There was a significant difference between both treatment groups with WLG in the anxiety and depression, but no significant difference was found between MBCT and CBT groups. Additionally, there was only a significant difference between the CBT group and WLG in terms of fatigue (P = 0.01).
Conclusion: CBT and MBCT performed equally well in decreasing anxiety and depression in cancer patients, and they were significantly better than WLG. It seems that MBCT is a good alternative to CBT for decreasing emotional symptoms in cancer patients. As a result, CBT and MBCT could be considered a good addition to pharmacological treatment of cancer patients with comorbid psychological symptoms. However, CBT was preferable to MBCT in decreasing fatigue.
The study was registered at the irct.ir database under registration number IRCT20180503039509N1.
2. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87-108.
3. Zendehdel K. Cancer statistics in IR Iran in 2018. Basic & Clinical Cancer Research. 2019;11(1):1-4.
4. Majidi A, Salimzadeh H, Beiki O, Delavari F, Majidi S, Delavari A, et al. Cancer research priorities and gaps in Iran: the influence of cancer burden on cancer research outputs between 1997 and 2014. Public health. 2017;144:42-7.
5. Seitz DC, Besier T, Debatin KM, Grabow D, Dieluweit U, Hinz A, et al. Posttraumatic stress, depression and anxiety among adult long-term survivors of cancer in adolescence. Eur J Cancer. 2010;46(9):1596-606.
6. Pirl WF. Evidence report on the occurrence, assessment, and treatment of depression in cancer patients. J Natl Cancer Inst Monogr. 2004; 2004(32):32-9.
7. American Cancer Society. Depression in cancer patient. 2009: www.cancer.org/docroot/RED
8. Thapa P, Rawal N, Bista Y. A study of depression and anxiety in cancer patients. Nepal Medical College journal: NMCJ. 2010;12(3) :171.
9. Baqutayan SM. The effect of anxiety on breast cancer patients. Indian J Psychol Med. 2012;34(2):119-23.
10. Banipal RPS, Singh H, Singh B. Assessment of Cancer-related Fatigue among Cancer Patients Receiving Various Therapies: A Cross-sectional Observational Study. Indian J Palliat Care. 2017;23(2):207-11.
11. Weis J. Cancer-related fatigue: prevalence, assessment and treatment strategies. Expert Rev Pharmacoecon Outcomes Res. 2011;11(4):441-6.
12. Prue G, Allen J, Gracey J, Rankin J, Cramp F. Fatigue in gynecological cancer patients during and after anticancer treatment. J Pain Symptom Manage. 2010;39(2):197-210.
13. Smith SK, Herndon JE, Lyerly HK, Coan A, Wheeler JL, Staley T, et al. Correlates of quality of life-related outcomes in breast cancer patients participating in the Pathfinders pilot study. Psychooncology. 2011;20(5):559-64.
14. Zhang MF, Wen YS, Liu WY, Peng LF, Wu XD, Liu QW. Effectiveness of Mindfulness-based Therapy for Reducing Anxiety and Depression in Patients With Cancer: A Meta-analysis. Medicine. 2015;94(45):e0897-0.
15. White CR. cognitive behavioral therapy for chronic medical Diseases, A practical Guide to the Evaluation and Treatment. translated by Molodi , R, Fatahi , K , Tehran : arjmand. First printing;2010.
16. Gautam M, Tripathi A, Deshmukh D, Gaur M. Cognitive Behavioral Therapy for Depression. Indian J psychiatry. 2020;62(Suppl 2):S223.
17. Goedendorp MM, Peters ME, Gielissen MF, Witjes JA, Leer JW, Verhagen CA, et al. Is increasing physical activity necessary to diminish fatigue during cancer treatment? Comparing cognitive behavior therapy and a brief nursing intervention with usual care in a multicenter randomized controlled trial. Oncologist. 2010;15(10):1122-32.
18. Cohen M, Kuten A. Cognitive-behavior group intervention for relatives of cancer patients: a controlled study. J Psychosom Res. 2006;61(2):187-96.
19. Eichler C, Pia M, Sibylle M, Sauerwald A, Friedrich W, Warm M. Cognitive behavioral therapy in breast cancer patients--a feasibility study of an 8 week intervention for tumor associated fatigue treatment. Asian Pac J Cancer Prev. 2015;16(3):1063-7.
20. Mohammad Khani P, Khanipoor H. Mindfulness based treatments. Theran: University of social welfare and rehabilitation sciences;2010.
21. Ost LG. Efficacy of the third wave of behavioral therapies: a systematic review and meta-analysis. Behav Res Ther. 2008;46(3):296-321.
22. Ryan RM, Brown KW. Why we don't need self-esteem: On fundamental needs, contingent love, and mindfulness. Psychological inquiry. 2003;14(1) :71-6.
23. Davidson RJ, Kabat-Zinn J, Schumacher J, Rosenkranz M, Muller D, Santorelli SF, et al. Alterations in brain and immune function produced by mindfulness meditation. Psychosom Med. 2003;65(4):564-70.
24. Kabat‐Zinn J. Mindfulness‐based interventions in context: past, present, and future. Clinical psychology: Science and practice. 2003;10(2):144-56.
25. Zare H, Mohammadi N, Mottaghi P, Afshar H, PourKazem L. The effect of modified Mindfulness-based cognitive therapy on Knowledge Disaster, acceptance and pain severity in patients with Fibromyalgia. Health Psychology. 2014; 3(4) :93-113.
26. Teasdale JD, Segal ZV, Williams JM, Ridgeway VA, Soulsby JM, Lau MA. Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. J Consult Clin Psychol. 2000;68(4):615-23.
27. Park S, Sado M, Fujisawa D, Sato Y, Takeuchi M, Ninomiya A, et al. Mindfulness-based cognitive therapy for Japanese breast cancer patients-a feasibility study. Jpn J Clin Oncol. 2018;48(1):68-74.
28. van der Lee ML, Garssen B. Mindfulness-based cognitive therapy reduces chronic cancer-related fatigue: a treatment study. Psychooncology. 2012;21(3):264-72.
29. Beck AT, Steer RA. Beck Anxiety Inventory Manual. San Anto: Psychological Corporation;1990.
30. Wetherell JL, Gatz M. The Beck Anxiety Inventory in older adults with generalized anxiety disorder. J Psychopathol Behav Assess. 2005 Mar 1;27(1) :17-24.
31. Kaviani H, Mousavi A. S. Psychometric properties of the Persian version of Beck Anxiety Inventory (BAI). Tehran Univ Med J. 2008; 66 (2) :136-40.
32. Beck AT, Steer RA, Brown G. Beck depression inventory–II. Psychological Assessment. 1996.
33. Rajabi G, Attari Y, Haghighi J. Factor analysis of Beck Depression Inventory items among the students of Shaheed Chamran University (Ahwaz). J Edu Psychol. 2001; 3:49-66.
34. Shun SC, Beck SL, Pett MA, Berry PH. Psychometric testing of three Chinese fatigue instruments in Taiwan. J Pain Symptom Manage. 2006;32(2):155-67.
35. Haghighat S, Akbari ME, Holakouei K, Rahimi A, Montazeri A. Factors predicting fatigue in breast cancer patients. Support Care Cancer. 2003;11(8):533-8.
36. Hatcher RL, Gillaspy JA. Development and validation of a revised short version of the Working Alliance Inventory. Psychother Res. 2006;16(1):12-25.
37. Rahimian Boogar I, Safarzade S, Talepasand S. Premature Termination of Psychotherapy in Outpatient Clinic Settings: Structural effects of Patients’ Expectations, Treatment Tolerance, Therapists’ Competencies and Therapeutic Alliance. Iranian J Health Psychology. 2020;2(2) :33-44.
38. Devilly GJ, Borkovec TD. Psychometric properties of the credibility/expectancy questionnaire. J Behav Ther Exp Psychiatry. 2000;31(2):73-86.
39. Segal Z, Williams M, Teasdele J. Mindfulness–based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press;2002.
40. Beak.AT, Beck J. Step by step Guide for Cognitive Therapy. Translation Durahaki. Iraj, Abadi. M. Isfahan. Flowers of Mohammadi; 2001.
41. Schellekens MP, van den Hurk DG, Prins JB, Molema J, Donders ART, Woertman WH, et al. Study protocol of a randomized controlled trial comparing mindfulness-based stress reduction with treatment as usual in reducing psychological distress in patients with lung cancer and their partners: the MILON study. BMC Cancer. 2014;14(1):1-9.
42. Sharplin GR, Jones SB, Hancock B, Knott VE, Bowden JA, Whitford HS. Mindfulness-based cognitive therapy: an efficacious community-based group intervention for depression and anxiety in a cancer sample. Med J Aust. 2010;193(5): 79-82.
43. Foley E, Baillie A, Huxter M, Price M, Sinclair E. Mindfulness-based cognitive therapy for individuals whose lives have been affected by cancer: a randomized controlled trial. J Consult Clin Psychol. 2010;78(1):72-9.
44. Fish JA, Ettridge K, Sharplin GR, Hancock B, Knott VE. Mindfulness-based cancer stress management: impact of a mindfulness-based programme on psychological distress and quality of life. Eur J Cancer Care (Engl). 2014;23(3):413-21.
45. Pedram M, Mohammadi M, Nazari Q, Ayenparast N. The Effectiveness of cognitive- behavioral group therapy on the treatment of anxiety, depression and hope in women with Breast cancer. Women and soc.2011;1(4) :61-71.
46. Greer JA, Park ER, Prigerson HG, Safren SA. Tailoring Cognitive-Behavioral Therapy to Treat Anxiety Comorbid with Advanced Cancer. J Cogn Psychother. 2010;24(4):294-313.
47. Johns SA, Brown LF, Beck-Coon K, Monahan PO, Tong Y, Kroenke K. Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors. Psychooncology. 2015;24(8):885-93.
48. Neff K. Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self and Identity. 2003;2(2):85-101.
49. Mohsenabadi H, Shabani MJ, Zanjani Z. Factor structure and reliability of the mindfulness attention awareness scale for adolescents and the relationship between mindfulness and anxiety in adolescents. Iran J Psychiatry Behav Sci. 2019;13(1): :e64097.
50. Conradi HJ, de Jonge P, Ormel J. Cognitive-behavioural therapy v. usual care in recurrent depression. Br J Psychiatry. 2008;193(6):505-6.
51. Matthews AK, Sellergren S. Use of cognitive-behavioral interventions in the treatment of cancer-related fatigue: A case study report. Cog and Behav Practice. 2001 Sep 1;8(4) :289-96.
52. Goedendorp MM, Gielissen MF, Verhagen CA, Bleijenberg G. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev. 2009;2009(1):Cd006953.
|Issue||Vol 16 No 3 (2021)|
|Anxiety Cognitive Behavioral Therapy (CBT) Depression Fatigue Mindfulness Randomized Clinical Trial (RCT)|
|Rights and permissions|
|This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|