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Efficacy of dignity therapy for depression and anxiety in terminally ill patients: Early results of a randomized controlled trial

  • Miguel Julião (a1) (a2) (a3), António Barbosa (a1) (a4), Fátima Oliveira (a3), Baltazar Nunes (a5) and António Vaz Carneiro (a2)...

Dignity therapy (DT) is a short-term psychotherapy developed for patients living with a life-limiting illness. Our aim was to determine the influence of DT on symptoms of depression and anxiety in people with a life-threatening disease with high level of distress, referred to an inpatient palliative care unit.


This was an open-label randomized controlled trial. Sixty terminally ill patients were randomly assigned to one of two groups: intervention group (DT+ standard palliative care [SPC]) or control group (SPC alone). The main outcomes were symptoms of depression and anxiety, measured with the Hospital Anxiety and Depression Scale, assessed at baseline, day 4, day 15, and day 30 of follow-up.


Of the 60 participants, 29 were randomized to DT and 31 to SPC. Baseline characteristics were similar between the two groups. DT was associated with a significant decrease in depressive symptoms at day 4 and day 15 (mean = −4.46, 95% CI, −6.91–2.02, p = 0.001; mean= −3.96, 95% CI, −7.33 to −0.61; p = 0.022, respectively), but not at day 30 (mean = −3.33, 95% CI, −7.32–0.65, p = 0.097). DT was also associated with a significant decrease in anxiety symptoms at each follow-up (mean= −3.96, 95% CI, −6.66 to −1.25, p = 0.005; mean= −6.19, 95% CI, −10.49 to −1.88, p = 0.006; mean = −5.07, 95% CI, −10.22 to −0.09, p = 0.054, respectively).

Significance of results:

DT appears to have a short-term beneficial effect on the depression and anxiety symptoms that often accompany patients at the end of their lives. Future research with larger samples compared with other treatments is needed to better understand the potential benefits of this psychotherapy.

Corresponding author
Address correspondence to: Miguel Julião, Center of Bioethics, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal. E-mail:
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S.D. Block (2000). Assessing and managing depression in the terminally ill patient. ACP-ASIM End-of-Life Care Consensus Panel. American College of Physicians American Society of Internal Medicine. Annals of Internal Medicine, 132, 209218.

P. Boston , A. Bruce & R. Schreiber (2011). Existential suffering in the palliative care setting: An integrated literature review. Journal of Pain and Symptom Management, 41, 604618.

H.M. Chochinov (2007). Dignity and the essence of medicine: The A, B, C, and D of dignity conserving care. British Medical Journal, 335, 184187.

H.M. Chochinov , T. Hack , T. Hassard , (2005). Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology, 23, 55205525.

H.M. Chochinov , T. Hack , S. McClement , (2002). Dignity in the terminally ill: A developing empirical model. Social Science in Medicine, 54, 433443.

H.M. Chochinov , L.J. Kristjanson , W. Breitbart , (2011). Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. Lancet Oncology, 12, 753762.

J. Pais-Ribeiro , I. Silva , T. Ferreira , (2007). Validation study of a Portuguese version of the Hospital Anxiety and Depression Scale. Psychology, Health & Medicine, 12, 225235.

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Palliative & Supportive Care
  • ISSN: 1478-9515
  • EISSN: 1478-9523
  • URL: /core/journals/palliative-and-supportive-care
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