Face-to-Face and Internet-Based Counseling Therapy Both Help Ease Fear and Anxiety in People With Cancer

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After a cancer diagnosis, many people are angry, scared, confused, and depressed. All these feelings are a perfectly normal reaction. Still, if your feelings are getting in the way of you living your life and focusing on treatment and healing, you might want to consider seeking help from someone who has experience in helping people navigate the emotional roller coaster of cancer.

A number of small studies have shown that a specific type of counseling therapy, called mindfulness-based cognitive therapy, can help ease pain, fatigue, depression, and other psychological distress in women diagnosed with breast cancer.

Still, not everyone has the ability to see a mindfulness-based cognitive therapist in person. A small Dutch study suggests offering this type of counseling via the internet offers the same benefits as face-to-face counseling.

The research was published online on June 28, 2018 by the Journal of Clinical Oncology. Read the abstract of “Face-to-Face and Internet-Based Mindfulness-Based Cognitive Therapy Compared With Treatment as Usual in Reducing Psychological Distress in Patients With Cancer: A Multicenter Randomized Controlled Trial.”

The study included 245 people who had been diagnosed with cancer and were experiencing anxiety, depression, and/or other psychological distress related to the cancer diagnosis, based on regularly used assessment tools:

  • 210 (85.7%) of the participants were women
  • 151 (61.6%) of the participants had been diagnosed with breast cancer

The people were randomly assigned to one of three groups:

  • Face-to-face mindfulness-based cognitive behavioral therapy (77 people; 53 were diagnosed with breast cancer): This therapy was tailored to people diagnosed with cancer and included 8 weekly 2.5-hour group sessions, a 6-hour silent day, and daily assignments to be done at home that were guided by audio files; the participants received a folder with information on each session.
  • Internet-based mindfulness-based cognitive therapy (90 people; 53 were diagnosed with breast cancer): This therapy also was tailored to people diagnosed with cancer and was delivered individually, rather than in a group setting; the program included weekly written discussions with a therapist over email. Participants had access to a secure website with materials for 8 weekly sessions, plus a silent day, and an inbox. Each session included an introduction and daily meditation exercises, along with meditation audio files. Participants also wrote diary entries about their meditation practice and were given fictional examples of diary entries to emphasize common experiences. At the end of the silent day, the participants wrote an essay about their experiences. The therapist provided written feedback on the diary entries and the essay via email. This group also received a folder with information on each session.
  • Treatment as usual (78 people; 45 were diagnosed with breast cancer): This group was free to access all the health care services that they usually received, except for not participating in mindfulness-based therapy during the study period.

After the participants completed the therapy, the researchers again assessed their psychological distress using the same standardized tools.

Compared to people in the treatment as usual group, people in both the face-to-face and internet-based mindfulness-based cognitive behavioral therapy groups had less psychological distress, including:

  • lower fear of cancer recurrence
  • less repetitive thinking about the cancer diagnosis
  • better mental health-related quality of life
  • better positive mental health

These differences were statistically significant, which means that they were likely due to the difference in treatment and not just because of chance.

The researchers found that both face-to-face and internet-based therapy offered the same benefits.

“Although the group-based setting is considered important for mindfulness-based [therapies], this study suggests that individual guided Internet-based mindfulness-based cognitive therapy with limited teacher feedback is also effective, thus improving the accessibility of this intervention for patients with cancer,” the researchers wrote. “…[I]mplementation of Internet-based mindfulness-based cognitive behavioral therapy could make mindfulness-based interventions more accessible for patients with cancer without having to compromise intervention efficacy.”

While this study was small, the results are encouraging and suggest that both internet-based and face-to-face mindfulness-based cognitive behavioral therapy are good choices for people who are struggling with emotional distress after a breast cancer diagnosis.

If you feel depressed and anxious or are constantly thinking about your diagnosis, you may want to talk to your doctor about this study and ask if mindfulness-based cognitive behavioral therapy makes sense for you. If traveling to a clinic for therapy would be difficult for you, you may want to ask a member of your healthcare team if internet-based therapy is available.

In the Breastcancer.org Complementary and Holistic Medicine pages, you can learn about 16 therapies, including meditation and guided imagery, as well as what to expect and how to find a qualified practitioner.


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