1. CBT For Chronic Illness And Palliative Care: A Workbook and Toolkit
Nigel Sage, Michelle Sowden,
Liz Chorlton and Andrea Edeleanu
Slide Set 2
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2. Does CBT work? With general psychological difficulties?
In cancer and palliative care?
In the book we also review research on using CBT with other physical health problems:
Cardiac problems, chronic pain, MS, diabetes, COPD, Parkinson’s Disease
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3. General psychological difficulties
DoH and N.I.C.E (2001)
Identified Treatment of Choice in psychological therapies
Meta-review (Mackay and Barkham,1998) of best available evidence
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4. Good evidence that CBT is effective with:
Social phobia
Obsessive compulsive disorder
Eating disorders
Generalised anxiety disorder
PMT
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5. CBT is the treatment of choice for:
Depression
Panic disorder
Chronic pain
Chronic fatigue
Pelvic pain
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6. Summary
CBT has an impressive evidence base for general psychological difficulties
No reason to assume this is not also the case for people with physical health care needs
Studies have addressed this specifically
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7. CBT in cancer and palliative care
Moorey, S. and Greer, S. (2002). Cognitive behaviour therapy for people with cancer, Oxford University Press
Chapters 3-4
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8. Is there evidence that:
CBT improves quality of life?
CBT affects duration of survival?
A fighting spirit helps?
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9. Quality of life
Is CBT more effective than supportive counselling / no treatment?
Is CBT better applied early or late after diagnosis?
Is CBT effective in later stages?
Is group work effective?
Should we select distressed patients for CBT or offer to all?
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10. Is CBT more effective than supportive counselling (SC) or no-treatment control (NTC)?
Studies largely support that CBT >SC or NTC
Specific CBT techniques e.g., graded task assignment, relaxation training, distraction, challenging negative thoughts, appear to be critical ingredients
E.g. Greer et al 1992, Moorey et al 1994, Linn et al, 1982
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11. Is CBT better applied early or late after diagnosis
Edgar, 1992
Compared 5 sessions CBT at 11 weeks and at 28 weeks after diagnosis
CBT applied late > CBT applied early
Initial emotions may impair ability to use CBT
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12. Can CBT be effective in the later stages of cancer?
Linn et al 1982
Men with L.E months
CBT included increasing meaningful activity, hope, self esteem and reducing denial
CBT > NTC
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13. Summary CBT >SC or NTC
CBT is more effective applied later than earlier after diagnosis
CBT can be effective in later stages of cancer
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14. Psycho-educational groups 1
Relaxation and stress management
Communication and assertiveness
Problem solving
Helpful thinking
Managing emotions
Activity planning
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15. Psycho-educational groups 2
Cunningham 1989
2 hours X 6 weeks
PsyEd > SC groups
PsyEd groups are effective across various cancers and stages
PsyEd groups can be delivered by therapists from different backgrounds
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16. CBT groups
More flexible in application of techniques than PsyEd groups
Results are mixed
More studies are required
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17. Edelman 1999 12 sessions CBT vs SC Breast cancer CBT > SC
By f/u CBT = SC
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18. CBT Groups cont. In contrast: Fawzy et al 1990
6 sessions CBT vs standard care
CBT > NTC
At f/u CBT > NTC
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19. Should we select distressed patients for CBT or offer to all?
Moynihan et al (1998) assessed whether CBT could help all patients with testicular cancer
Compared 6 sessions of CBT with treatment as usual
They concluded that routine CBT is not indicated
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20. Quality of the research
Results confounded by study design
Difficult to generalise findings
Effectiveness may be influenced by
type of cancer
stage of disease process
patient characteristics
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21. Summary: Can CBT improve quality of life?
CBT > routine care in improving quality of life
CBT is effective with selected patients exhibiting psychological distress
Structured PsyEd groups = treatment of choice for non-selected groups
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22. Summary cont.
Some evidence that people with advanced disease can benefit
Intervening too early may not be beneficial
Intervening too early may be detrimental
May interfere with existing coping resources
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23. Can CBT affect duration of survival?
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24. Ground breaking research did initially show this
E.g. Spiegel 1985 claimed survival increased by 18.9 months with group therapy
Led to a big debate within the field
Subsequently supported by other studies e.g. Richardson et al 1990, Fawzy et al, 1993
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25. Can CBT affect duration of survival cont.?
However, sample sizes small
With different cancer types and stages
More recent studies contradict earlier findings e.g. Edelman 1999a
Overall no consistent evidence to suggest that CBT increases duration of survival
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26. Is fighting spirit helpful?
Initially claimed that fighting spirit led to better adjustment and duration of survival (Moorey and Greer, 2002)
This work paved the way for CBT in c&p
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27. Is fighting spirit helpful cont.?
Earlier claims have subsequently been refuted (Petticrew et al, 2002)
It is no longer considered helpful to think in terms of adjustment style per se
More helpful to think about what strategies help individual patients to cope at different stages of different cancers
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28. Conclusions
CBT has an excellent evidence base for a broad range of psychological difficulties relevant to people with cancer
The benefits are in terms of QoL not duration of survival
Different coping styles are effective for different people at different stages of different cancers
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008

29. CBT For Chronic Illness And Palliative Care: A Workbook and Toolkit
Nigel Sage, Michelle Sowden,
Liz Chorlton and Andrea Edeleanu
Publisher: John Wiley & Sons (2008)
ISBN:
Sage, Sowden, Chorlton and Edeleanu Copyright John Wiley & Sons, 2008