The Effects of Psychotherapy on Psychological Well-Being and Diurnal Cortisol Patterns in Breast Cancer Survivors

Abstract

Background: Neuroendocrine dysregulation influenced by psychosocial stress is related to breast cancer recurrence. Very few studies examine the impacts of psychotherapy on diurnal cortisol patterns among breast cancer survivors. Methods: Forty-eight breast cancer patients who completed active cancer treatment were randomly assigned to receive either 8 weekly body-mind-spirit (BMS) group therapy sessions or 1 educational (EDU) session. Self-report measures included the Beck Depression Inventory-II (BDI-II), and the Meaning in Life questionnaire (MLQ) including two subscales: MLQ-Presence and MLQ-Search. Salivary cortisol levels were collected by the subjects in their homes at the time of awakening, 30 and 45 min after awakening, and at 12.00, 17.00, and 21.00 h. Measurement time points include baseline, the 2nd month (completion of BMS therapy), the 5th month, and the 8th month. Results: There were no significant differences in BDI-II scores (p>0.05) and MLQ-Presence scores (p >0.05) between BMS and EDU groups at baseline or across the three follow-ups. Nevertheless, greater MLQ-Search scores were found in the BMS group compared to the EDU group during the 5th month of follow-up (p <0.01). The higher level of cortisol at 21.00 h (p < 0.01) and a flatter diurnal cortisol pattern were more likely to occur in EDU than in BMS participants (p < 0.05) at the 8th month of follow-up. Conclusion: BMS group therapy likely contributed to enhancing an active search for meaning in life toward more opportunities for personal growth and to maintaining stable cortisol responses to everyday life stress for breast cancer survivors.

Use of Salivary Diurnal Cortisol as an Outcome Measure in Randomised Controlled Trials: a Systematic Review

“…In addition, the types of cortisol parameters measured, along with their patterns of change, were not uniform across studies. Two studies, one evaluating mindfulness-based cancer recovery and supportive expressive therapy [25], and the other evaluating mind-body-spirit therapy [34], found that the diurnal slope remained unchanged in the treatments groups but that it became significantly flatter in the control group, suggesting that these treatments had a buffering effect on the HPA axis. This finding corresponded with clinical findings in only one of the studies [25], however.…”

Cancer-related fatigue shows a stable association with diurnal cortisol dysregulation in breast cancer patients

“…However, as fluctuations can be assumed to be at random, a systematic bias of the results is unlikely, rather the strength of the associations may have been underestimated. Cortisol patterns based on only single day collection have also shown meaningful associations with behavioral parameters as well as health outcomes in many other studies [43,[50][51][52][53]. Further, sampling times were self-reported and we had no control over whether the morning sample was really taken immediately after awakening.…”

Estrategias no farmacológicas en el paciente clínicamente enfermo, ¿qué nos dice la literatura?

“…El subtipo de psicoterapia breve más utilizada, derivada del proceso psicoanalítico, hace referencia a la terapia psicodinámicamente orientada [71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96], y en uno de los artículos se plantea la posibilidad de diseñar un estudio que compare este tipo de intervenciones con otros modelos psicoterapéuticos [96]. Si bien no se menciona el número mínimo de sesiones necesario para garantizar una adecuada intervención, se recomienda que, como todo proceso psicoterapéutico, se centre en el individuo que se beneficiaría de ella, más que en intentar plantear una fórmula o algoritmo para reproducirlo de manera autónoma.…”