Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer

Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
Brain Behavior and Immunity (Impact Factor: 5.89). 07/2009; 23(5):580-591. DOI: 10.1016/j.bbi.2008.09.005


BackgroundA diagnosis of breast cancer and treatment are psychologically stressful events, particularly over the first year after diagnosis. Women undergo many demanding and anxiety-arousing treatments such as surgery, radiation and chemotherapy. Psychosocial interventions that promote psychosocial adaptation to these challenges may modulate physiological processes (neuroendocrine and immune) that are relevant for health outcomes in breast cancer patients.MethodsWomen with Stages 1–3 breast cancer recruited 4–8 weeks after surgery were randomized to either a 10-week group-based cognitive behavioral stress management (CBSM) intervention or a 1-day psychoeducational control group and completed questionnaires and late afternoon blood samples at study entry and 6 and 12 months after assignment to experimental condition.ResultsOf 128 women initially providing psychosocial questionnaire and blood samples at study entry, 97 provided complete data for anxiety measures and cortisol analysis at all time points, and immune assays were run on a subset of 85 of these women. Those assigned to a 10-week group-based CBSM intervention evidenced better psychosocial adaptation (lower reported cancer-specific anxiety and interviewer-rated general anxiety symptoms) and physiological adaptation (lower cortisol, greater Th1 cytokine [interleukin-2 and interferon-γ] production and IL-2:IL-4 ratio) after their adjuvant treatment compared to those in the control group. Effects on psychosocial adaptation indicators and cortisol appeared to hold across the entire 12-month observation period. Th1 cytokine regulation changes held only over the initial 6-month period.ConclusionsThis intervention may have facilitated a “recovery or maintenance” of Th1 cytokine regulation during or after the adjuvant therapy period. Behavioral interventions that address dysregulated neuroendocrine function could play a clinically significant role in optimizing host immunologic resistance during a vulnerable period.

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    • "Evening cortisol was also retained as a separate variable to compare with baseline psychological measures, based on prior published research demonstrating that cortisol later in the day was lowered following a stress management intervention [4] [28]. Further, in ovarian cancer, evening cortisol is related to vegetative depressive symptoms [23]. "
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    ABSTRACT: Objective: The stress hormone cortisol exhibits a diurnal rhythm throughout the day, as well as within person variability. Recent statistical approaches allow for the estimation of intraindividual cortisol variability Clan and a greater ICV has been observed in some mood disorders (major depression, remitted bipolar disorder); however, ICV has not been examined following stress management. In this secondary analyses of an efficacious randomized clinical trial, we examine how ICV may change after cognitive behavioral stress management (CBSM) among healthy stressed women at risk for breast cancer. Second, we concurrently compare other calculations of cortisol that may change following CBSM. Methods: Multilevel modeling (MLM) was applied to estimate ICV and to test for a group by time interaction from baseline, post-intervention, to 1 month following CBSM. Forty-four women were randomized to the CBSM; 47 to the comparison group; mean age of the entire group was 442 (SD = 10.27). Results: After controlling for relevant covariates, a significant time by group interaction emerged (13 estimate = -.070; p < .05), such that CBSM participants demonstrated a lower ICV following CBSM compared to the comparison group. The interaction for cortisol slope and cortisol output (area under the curve) approached significance (13 estimates = -.10 and -.062, respectively; p's < .08), while other cortisol outcomes tested were not significantly changed following CBSM. Conclusion: ICV may represent a novel index of cortisol dysregulation that is impacted by CBSM and may represent a more malleable within-person calculation than other, widely applied cortisol outcomes. Future research should examine these relationships in larger samples, and examine ICV and health outcomes. Published by Elsevier Inc.
    Full-text · Article · Sep 2015 · Journal of Psychosomatic Research
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    • "In some of the above trials (e.g., Andersen et al., 2004; Antoni et al., 2009), effects were found for some indicators but not others. However, " matching " need not occur across indicators, considering both the specificity of cell functions and the specificity of responses to stress (see Thornton, Andersen, Crespin, & Carson, 2007, for an example). "
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    ABSTRACT: Over the last decade, there have been groundbreaking strides in our understanding of the multiple biological pathways by which psychosocial and behavioral factors can affect cancer progression. It is now clear that biobehavioral factors not only affect cellular immunity but both directly and indirectly modulate fundamental processes in cancer growth, including inflammation, angiogenesis, invasion, and metastasis. There is also an emerging understanding of how psychological and behavioral factors used in interventions can impact these physiological processes. This review outlines our current understanding of the physiological mechanisms by which psychological, social, and behavioral processes can affect cancer progression. The intervention literature is discussed, along with recommendations for future research to move the field of biobehavioral oncology forward. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Full-text · Article · Feb 2015 · American Psychologist
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    • "Importantly , these altered physiological functions associated with depression have been shown to normalize in response to treatment with electroconvulsive therapy (TNF-α), [25] antidepressant drug therapy (TNF-α, C-reactive protein, IL-1β, IL-6) [26]-[28], and psychological interventions (IL1-RA, IL-6, IFN-γ) [29]. Coping behaviors and psychological interventions that increase positive emotions and neutralize negative ones may also be effective in reducing pro-inflammatory markers such as IL-6 [30] [31], TNF-α [31], C-reactive protein (CRP) [31], and IFN-γ [31], and in normalizing catecholamine [31] and cortisol levels [32]-[33]. "
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    ABSTRACT: Background: Religious practices/experiences (RPE) may produce positive physiological changes in patients with major depressive disorder (MDD) and chronic medical illness. Here, we report cross-sectional relationships between depressive symptoms, RPE and stress biomarkers (pro-/ anti-inflammatory measures and stress hormones), hypothesizing positive associations between depressive symptoms and stress biomarkers and inverse associations between RPE and stress biomarkers. Methods: We recruited 132 individuals with both MDD and chronic illness into a randomized clinical trial. First, stress biomarkers in the baseline sample were compared to biomarker levels from a community sample. Second, relationships between depressive symptoms and biomarkers were examined, and, finally, relationships between RPE and biomarkers were * Corresponding author. D. L. Bellinger et al. 336 analyzed, controlling for demographics, depressive symptoms, and physical functioning. Results: As expected, inflammatory markers and stress hormones were higher in our sample with MDD compared to community participants. In the current sample, however, depressive symptoms were largely unrelated to stress biomarkers, and were unexpectedly inversely related to proinflam-matory cytokine levels (TNF-α, IL-1β). Likewise, while RPE were largely unrelated to stress biomarkers, they were related to the anti-inflammatory cytokine IL-1RA and the stress hormone norepinephrine in expected directions. Unexpectedly, RPE were also positively related to the pro-inflammatory cytokine IFN-γ and to IFN-γ/IL-4 and IFN-γ/IL-10 ratios. Conclusions: Little evidence was found for a consistent pattern of relationships between depressive symptoms or religiosity and stress biomarkers. Of the few significant relationships, unexpected findings predominated. Future research is needed to determine whether religious interventions can alter stress bio-markers over time in MDD.
    Full-text · Article · Oct 2014 · Open Journal of Psychiatry
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