Our recent randomized trial tested the efficacy of a 10-week cognitive behavioral stress management (CBSM) intervention in women with breast cancer. We examined whether the intervention facilitated """"""""recovery"""""""" or adaptation after adjuvant therapy had been completed. Intervention participants showed improvements in multiple indicators of psychosocial adaptation (less intrusive thoughts and social disruption, greater benefit finding, positive affect, and positive states of mind), physiological adaptation (decreased cortisol and increased cellular immune function and Th1 cytokine production) and physical adaptation (less fatigue and improved sleep quality). We found evidence that one specific element of the multi-modal CBSM intervention, the perception of being able to use learned exercises to relax on demand appeared to mediate the effects of the intervention on many of the outcomes. However, we found that many women are unable to attend groups for the full 10-week period due to family responsibilities, work demands and different physical factors (e.g., fatigue). We also know that those attending approximately half of the sessions do experience treatment gains. This suggests that shorter forms of the intervention, focusing on elements of the full intervention such as cognitive behavioral therapy techniques or on relaxation training skills might be a cost-effective way to facilitate adaptation among a larger portion of the population of women receiving treatment for breast cancer. For this competitive renewal, we propose to test two active treatment conditions (a 5-week version of cognitive behavioral (CB) and a 5-week relaxation training (RT) intervention) and a 5- week attention-social support control. Thus, 240 (after attrition) White, Hispanic (both English- and Spanish- speaking), and Black women who are newly diagnosed with Stages l-lll breast cancer will be randomized to 5-week CB (N = 80), 5-week RT-only (N = 80) or a attention control (N = 80), and monitored across indices of adaptation at 6 months and 12 months after the intervention. The interventions are hypothesized to improve psychosocial adaptation (benefit finding, positive affect, positive states of mind, thought intrusions, depression, and better social and psychosexual functioning), decrease stress (lower cortisol) and improve immune function and physical adaptation (less fatigue and sleep disruption and better physical quality of life). ? ? ?
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