Publication Date

2016-07-22

Availability

Embargoed

Embargo Period

2018-07-22

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PHD)

Department

Psychology (Arts and Sciences)

Date of Defense

2015-05-15

First Committee Member

Michael H. Antoni

Second Committee Member

Charles S. Carver

Third Committee Member

Suzanne C. Lechner

Fourth Committee Member

Amy G. Weisman de Mamani

Fifth Committee Member

Bonnie B. Blomberg

Abstract

Even while dealing with significant stressors related to breast cancer diagnosis and treatment, many women describe benefits derived from their cancer experience. Previous psychosocial interventions have been shown to increase benefit finding (BF) in post-surgical breast cancer patients, but these interventions have been rather lengthy and comprehensive in nature, raising the question of whether briefer, more specific psychosocial interventions would have similar effects on BF. Additionally, control groups were not attention-matched in previous studies, so the potential impact of group social support could not be controlled. Further, previous psychosocial interventions have examined intervention effects on women regardless of initial distress level. Given that some level of distress may be necessary for the development of BF, it is important to determine the impact of initial distress on BF outcomes. Hispanic breast cancer patients may represent an ethnic subgroup with proportionally greater distress than non-Hispanic White (NHW) women, but few studies have specifically examined potential differential intervention effects on BF in these two ethnic subgroups. The present study sought to address these limitations by testing whether a brief, 5-week group intervention with Cognitive-Behavioral Training [CBT] or Relaxation Training [RT] could increase BF relative to an attention-matched Health Education [HE] control group in women with breast cancer. This study also tested whether intervention-related changes in BF were moderated by women’s initial distress levels in order to determine if intervention effects were greater for women with higher initial distress. Finally, this study tested whether intervention-related changes in BF were moderated by ethnicity to determine if intervention effects were greater for Hispanic women compared to NHW women. The present sample included 183 women with non-metastatic breast cancer who were 2-10 weeks post-surgery at the time of their baseline assessment (T1) and were re-assessed post-intervention (T2; approximately 2 months post-baseline), 6 months post-baseline (T3), and 12 months post-baseline (T4). In uncontrolled regression analyses, BF increased from T1 to T2 for women in all three conditions, but controlled analyses demonstrated T1 to T2 BF increase only for women in CBT. Latent growth modeling (LGM) tested intervention effects on BF at the three follow-up assessments (T2 to T4). A linear LGM model revealed a significant difference between CBT and HE groups in T2 to T4 change in BF, but no difference in BF slope was found between RT and HE groups. LGM results showed no significant moderation effects. Neither measures of distress nor ethnicity were found to moderate intervention-related changes in BF over time. Hispanic women showed significantly higher levels of BF compared to NHW women at all assessment timepoints. Findings suggest that a brief, focused CBT intervention can help promote BF, with differences between CBT and HE increasingly evident with increased time since surgery. Results also suggest that Hispanic cultural factors may contribute to higher BF among Hispanic women compared to NHW women in the year following primary surgery for breast cancer. Future work should explore the specific factors contributing to higher BF among women receiving CBT intervention and among Hispanic women. Future studies could also expand upon this work by testing brief CBT and RT group interventions with additional study populations, by extending the study period, and by providing these interventions at different points along the cancer survivorship trajectory. Finally, implementation studies are needed to determine whether use of brief group-based psychosocial interventions can be of help to patients in real-world clinical settings.

Keywords

breast cancer; benefit finding; psychosocial intervention; cognitive-behavioral and relaxation training; distress; ethnicity

Available for download on Sunday, July 22, 2018

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