280 Psychosocial Oncology
CBT for Pain
CBT strategies that have been suggested as being potentially
effective clinically for the reduction of cancer-related pain in-
clude relaxation, guided imagery and distraction, and cogni-
tive coping and restructuring (Breitbart & Payne, 1998).
However, actual investigations assessing their ef“cacy have
been few and provide somewhat con”icting results. The “rst
study to empirically evaluate CBT for cancer-related pain fo-
cused on oral mucositis pain related to the chemotherapy
treatment a group of patients received prior to a bone marrow
transplantation (Syrjala, Cummings, & Donaldson, 1992).
CBT (which in this study included relaxation training, cogni-
tive restructuring, and cognitive coping training) was not ef-
fective in reducing pain as compared to control participants,
whereas patients receiving hypnosis did report signi“cantly
less pain. However, in a subsequent study conducted by this
same group of investigators, CBT was found to be effective
in reducing cancer-related pain (Syrjala, Donaldson, Davis,
Kippes, & Carr, 1995). More recently, Liossi and Hatira
(1999) compared the effects of hypnosis and CBT as pain
management interventions for pediatric cancer patients un-
dergoing bone marrow aspirations. Their results indicated
that both treatment conditions, as compared to a no-treatment
control condition, were effective in reducing pain and pain-
related anxiety.
CBT for Emotional Distress
CBT protocols have also been increasingly implemented as
a means to decrease cancer patients• psychological distress
(e.g., depression, anxiety) and to improve their overall emo-
tional well-being and quality of life. This trend began with a
landmark study conducted by Worden and Weisman (1984).
Two interventions were evaluated, both focused on the devel-
opment of problem-solving skills as a means to promote ef-
fective coping and adaptation among newly diagnosed cancer
patients. One condition involved discussing the problems a
speci“c cancer patient was experiencing without teaching
speci“c skills, whereas the second focused on fostering
general problem-solving skills and also included relaxation
training. Both conditions were found to engender decreases
in psychological distress as compared to a nonrandomized
control condition. Despite this methodological limitation,
their study did have a major impact on the “eld of psychoso-
cial oncology (Jacobsen & Hann, 1998).
Behavioral stress management strategies (e.g., relaxation,
guided imagery) have been found to be especially effective in
reducing emotional distress and improving cancer patients•
quality of life (e.g., Baider, Uziely, & De-Nour, 1994; Bridge,
Benson, Pietroni, & Priest, 1988; Decker, Cline-Elsen, &
Gallagher, 1992; Gruber et al., 1993). Multicomponent CBT
protocols have also been found to be effective. For example,
Telch and Telch (1986) evaluated the differential effects of
a group-administered, multicomponent CBT coping skills
training protocol, as compared to a supportive group therapy
condition, and a no-treatment control. Their coping skills
training included instruction in (a) relaxation and stress man-
agement, (b) assertive communication, (c) cognitive restruc-
turing and problem solving, (d) management of emotions,
and (e) planning pleasant activities. Results indicated that
patients receiving the CBT protocol consistently fared sig-
ni“cantly better than participants in the other two conditions.
In fact, patients in the supportive group therapy condition
evidenced little improvement, whereas untreated patients
demonstrated signi“cant deterioration in their overall psy-
chological adjustment.
Another multicomponent CBT-based investigation in-
cluded patients who were newly diagnosed with malignant
melanoma (Fawzy, Cousins, et al., 1990; Fawzy, Kemeny,
et al., 1990). The cancer patients were assigned to one of
two conditions: a structured group intervention and a no-
treatment control. The six-week CBT-oriented intervention
was comprised of four components: health education, stress
management, problem-solving training, and group support.
At the end of the six weeks, patients receiving the structured
intervention began showing reductions in psychological
distress as compared to the control patients. However, six
months posttreatment, such group differences were very
pronounced. More impressively, “ve years following the in-
tervention, treated patients continued to show signi“cantly
lower levels of anxiety, depression, and total mood distur-
bance (Fawzy, Fawzy, & Canada, 2001). Their intervention
was later adapted to be applied to a Japanese population and
found to be effective for Japanese women with breast cancer
(Hosaka, 1996).
Greer et al. (1992) evaluated the effectiveness of an indi-
vidually administered CBT intervention geared to improve
emotional well-being. Their protocol included coping skills
training, cognitive restructuring, and relaxation training. At
a four-month follow-up assessment point, CBT participants
were found to be experiencing less emotional distress than
patients in the no-treatment control condition. Such bene“-
cial treatment effects were further found to be evident at a
one-year follow-up point (Moorey et al., 1994).Problem-Solving Therapy (PST) for Cancer PatientsAlthough training individuals to be more effective problem
solvers to improve their ability to cope with stressful life