Psychosocial Interventions With Cognitive-Behavioral Components for the Treatment of Cancer-Related Traumatic Stress Symptoms: A Review of Randomized Controlled Trials.

Background: Cancer-related traumatic stress symptoms, including posttraumatic stress disorder (PTSD), can significantly impact the quality of lite and psychological adjustment of patients and survivors with cancer. Cognitive behavioral therapy (CBT) is an effective in- tervention previously shown to ameliorate non-cancer-related PTSD. Because of some of the unique aspects of cancer-related traumatic stress, such as the internal and ongoing nature of the traumatic stressor, it is important to review the overall efficacy of CBT interventions in populations with cancer. Objective: To review the findings of randomized clinical trials ( RCTs ) testing the efficacy of interventions with CBT components for cancer-related traumatic stress symptoms, including intrusion and avoidance, in adults with cancer. Methods: Eligible RCTs were identified via search of OVID, PubMed, EMBASE, and Scopus. Bayesian random effects analysis of treatment effect sizes ( ES ) was conducted in a portion of the studies for which data were available. Results: Nineteen RCTs met search criteria. Six trials reported reductions in traumatic stress symptoms as a result of the intervention and 13 studies reported null find- ings. Bayesian modeling based on 13 studies showed no overall discernible effect of interven- tions with CBT components on intrusion and avoidance symptoms. Conclusions: Most of the studies were not designed to target traumatic stress symptoms in highly distressed patients with cancer and did not include previously validated CBT components, such as cognitive restructuring and exposure. Thus, there was insufficient evidence from which to draw defin- itive conclusions about the efficacy of CBT interventions for the treatment of cancer-related traumatic stress symptoms, including PTSD. However, interventions with CBT components may have potential for the reduction of PTSD symptoms in highly distressed patients. Future research should focus on testing trauma-focused interventions in demographically and clini- cally diverse samples.Keywords: cancer; posttraumatic stress disorder; traumatic stress; cognitive behavioral therapyA large body of literature documents the efficacy of cognitive behavioral therapy (CBT) for the treatment of posttraumatic stress disorder (PTSD) in noncancer populations (Cahill & Foa, 2007; Foa, Keane, Friedman, & Cohen, 2009; U.S. Department of Veterans Affairs/ Department of Defense [VA/DoD], 2010). Existing guidelines recommend CBT as one of the treatments of choice in alleviating PTSD symptoms in survivors of a wide range of traumas, in- cluding sexual and physical assault, combat-related trauma, motor vehicle accidents, and natural disasters (Foa et al., 2009; Forbes et al., 2010; VA/DoD, 2010). Similar progress, however, has not been made with regards to recommendations for the treatment of cancer-related PTSD and trau- matic stress symptoms, even though posttraumatic stress responses following cancer diagnosis have received increasing attention over the past three decades and may represent a significant source of distress for a subset of patients and survivors with cancer (Deimling, Kahana, Bowman, & Schaefer, 2002; Gurevich, Devins, & Rodin, 2002; Kangas, Henry, & Bryant, 2002; Mosher, Redd, Rini, Burkhalter, & DuHamel, 2009; Smith, Redd, Peyser, & Vogl, 1999). Advances in the management of distress during the cancer trajectory have largely focused on the development and evaluation of interventions targeting general distress symptoms and quality of life concerns. For example, several meta-analyses and review articles address the efficacy of interventions with cognitive-behavioral components for some of the most common psychosocial issues in patients and survivors with cancer, including depression and anxiety (Jacobsen & Jim, 2008; Osborn, Demoncada, & Feuerstein, 2006), fatigue (Kangas, Bovbjerg, & Montgomery, 2008), and pain (Tatrow & Montgomery, 2006). Yet a large gap exists in our knowledge and understanding of the clinical management of cancer-specific distress and PTSD symptoms in adults with cancer. …