Article

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

ABSTRACT

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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    • "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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    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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