Hostname: page-component-77c78cf97d-kmjgn Total loading time: 0.001 Render date: 2026-04-23T19:08:13.645Z Has data issue: false hasContentIssue false
  • English
  • Français

The effectiveness of cognitive behavioural therapy for depression in women with breast cancer: a systematic review and meta-analysis

Published online by Cambridge University Press:  23 February 2024

Stephania Wieland Open the ORCID record for Stephania Wieland [Opens in a new window] ,
Sarah Melton ,
Anastasios Bastounis Open the ORCID record for Anastasios Bastounis [Opens in a new window]  and
Tim Carter Open the ORCID record for Tim Carter [Opens in a new window]
Stephania Wieland*
Affiliation:
Every Turn Services Ltd, Sir Bobby Robson Way, Newcastle upon Tyne, UK
Sarah Melton
Affiliation:
Derbyshire NHS Foundation Trust, Kingsway Hospital, Derby, UK
Anastasios Bastounis
Affiliation:
School of Health and Related Research (ScHARR), Regent Court, University of Sheffield, Sheffield, UK
Tim Carter
Affiliation:
School of Health Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
*
Corresponding author: Stephania Wieland; Email: stephania.wieland@everyturn.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Depression is a common co-morbidity in women with breast cancer. Previous systematic reviews investigating cognitive behavioural therapy (CBT) for depression in this population based their conclusions on findings from studies with varying and often limited specificity, quality and/or quantity of CBT within their interventions.

Aim:

To determine the effectiveness of a specific, well-evidenced CBT protocol for depression in women with breast cancer.

Method:

Online databases were systematically searched to identify randomised controlled trials (RCTs) testing CBT (aligned to Beck’s protocol) as a treatment for depression in women with breast cancer. Screening, data extraction and risk of bias assessment were independently undertaken by two study authors. Both narrative synthesis and meta-analysis were used to analyse the data. The meta-analysis used a random effects model to compare CBT with non-active/active controls of depression using validated, self-report measures.

Results:

Six RCTs were included in the narrative synthesis, and five in the meta-analysis (n = 531 participants). Overall, CBT demonstrated an improvement in depression scores in the CBT condition versus active and non-active controls at post-intervention (SMD = –0.93 [95% CI –1.47, –0.40]). Narratively, five out of six RCTs reported statistically significant improvements in depression symptoms for CBT over control conditions for women with breast cancer.

Conclusion:

CBT aligned to Beck’s protocol for depression appears effective for treating depression in women with breast cancer. However, further research is needed for women with stage IV breast cancer. The clinical recommendation is that therapists utilise Beck’s CBT protocol for depression, whilst considering the complex presentation and adapt their practice accordingly.

Keywords

Breast cancerCBTCognitive behavioural therapyDepressionOncologySystematic review

Information

Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 52 , Issue 4 , July 2024 , pp. 394 - 413
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of British Association for Behavioural and Cognitive Psychotherapies

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th edn). https://doi.org/10.1176/appi.books.9780890420249.dsm-iv-t CrossRefGoogle Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn, text rev.). https://doi.org/10.1176/appi.books.9780890425596.dsm05 CrossRefGoogle Scholar
Beatty, L., & Kissane, D. (2017). Anxiety and depression in women with breast cancer. Cancer Forum, 41, 55–61.Google Scholar
Beck, A. T., & Dozois, D. J. (2011). Cognitive therapy: current status and future directions. Annual Review of Medicine, 62, 397–409. https://doi.org/10.1146/annurev-med-052209-100032 CrossRefGoogle ScholarPubMed
Beck, A. T., Rush, A., Shaw, B., & Emery, G. (1979). Cognitive Therapy of Depression. New York: Guilford Press.Google Scholar
Beck, A. T., Steer, B., & Emery, G. (1996). Manual for the Beck Depression Inventory II. New York: Guilford Press.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571. https://doi.org/10.1001/archpsyc.1961.01710120031004 CrossRefGoogle ScholarPubMed
Binkley, J. M., Harris, S. R., Levangie, P. K., Pearl, M., Guglielmino, J., Kraus, V., & Rowden, D. (2012). Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer. Cancer, 118, 2207–2216. https://doi.org/10.1002/cncr.27469 CrossRefGoogle ScholarPubMed
Boland, A., Cherry, M. G., & Dickson, R. (2017). Doing a Systematic Review: A Student’s Guide, edited by Angela Boland, M. Cherry, Gemma and Dickson, Rumona (2nd edn). Los Angeles: Sage.Google Scholar
Brown, J. S. L., Murphy, C., Kelly, J., & Goldsmith, K. (2019). How can we successfully recruit depressed people? Lessons learned in recruiting depressed participants to a multi-site trial of a brief depression intervention (the ‘CLASSIC’ trial). Trials, 20, 131. https://doi.org/10.1186/s13063-018-3033-5 CrossRefGoogle ScholarPubMed
Burgess, C., Cornelius, V., Love, S., Graham, J., Richards, M. and Ramirez, A. (2005). Depression and anxiety in women with early breast cancer: five year observational cohort study, BMJ, 330, 702. doi: https://doi.org/10.1136/bmj.38343.670868.D3 CrossRefGoogle ScholarPubMed
Calderon, C., Carmona-Bayonas, A., Hernández, R., Ghanem, I., Castelo, B., Martinez de Castro, E., … & Jimenez-Fonseca, P. (2019). Effects of pessimism, depression, fatigue, and pain on functional health-related quality of life in patients with resected non-advanced breast cancer. Breast, 44, 108–112. https://doi.org/10.1016/j.breast.2019.01.012 CrossRefGoogle ScholarPubMed
Clancy, M. J. (2002). Overview of research designs. Emergency Medicine Journal, 19, 546–549. https://doi.org/10.1136/emj.19.6.546 CrossRefGoogle ScholarPubMed
Cohen, J. (1992). Statistical power analysis. Current Directions in Psychological Science, 1, 98–101. http://www.jstor.org/stable/20182143 CrossRefGoogle Scholar
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Canadian Journal of Psychiatry, 58, 376–385. https://doi.org/10.1177/070674371305800702 CrossRefGoogle ScholarPubMed
Deeks, J., Higgins, J., & Altman, D. (2002). Analysing data and undertaking meta-analysis. In Higgins, J. and James, T. (eds), Cochrane Handbook for Systematic Reviews of Interventions. Available at: https://training.cochrane.org/handbook/current Google Scholar
DeRubeis, R. J., Gelfand, L. A., Tang, T. Z., & Simons, A. D. (1999). Medications versus cognitive behavior therapy for severely depressed outpatients: mega-analysis of four randomized comparisons. American Journal of Psychiatry, 156, 1007–1013. https://doi.org/10.1176/ajp.156.7.1007 CrossRefGoogle ScholarPubMed
Desautels, C., Savard, J., Ivers, H., Savard, M.-H., & Caplette-Gingras, A. (2018). Treatment of depressive symptoms in patients with breast cancer: a randomized controlled trial comparing cognitive therapy and bright light therapy. Health Psychology, 37, 1–13. https://doi.org/10.1037/hea0000539 CrossRefGoogle ScholarPubMed
Dobson, K. S., Hollon, S. D., Dimidjian, S., Schmaling, K. B., Kohlenberg, R. J., Gallop, R. J., Rizvi, S. L., Gollan, J. K., Dunner, D. L., & Jacobson, N. S. (2008). Randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the prevention of relapse and recurrence in major depression. Journal of Consulting and Clinical Psychology, 76, 468–477. https://doi.org/10.1037/0022-006x.76.3.468 CrossRefGoogle ScholarPubMed
Edelman, S., Bell, D. R., & Kidman, A. D. (1999a). Group CBT versus supportive therapy with patients who have primary breast cancer. Journal of Cognitive Psychotherapy, 13, 189–202. https://doi.org/10.1891/0889-8391.13.3.189 CrossRefGoogle Scholar
Edelman, S., Bell, D. R., & Kidman, A. D. (1999b). A group cognitive behaviour therapy programme with metastatic breast cancer patients. Psychooncology, 8, 295–305. https://doi.org/10.1002/(sici)1099-1611(199907/08)8:4 3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
Elkin, I., Shea, M. T., Watkins, J. T., Imber, S. D., Sotsky, S. M., Collins, J. F., Glass, D. R., Pilkonis, P. A., Leber, W. R., Docherty, J. P., & et al. (1989). National Institute of Mental Health Treatment of Depression Collaborative Research Program. General effectiveness of treatments. Archives of General Psychiatry, 46, 971–982; discussion 983. https://doi.org/10.1001/archpsyc.1989.01810110013002 CrossRefGoogle ScholarPubMed
Furukawa, T. A., Weitz, E. S., Tanaka, S., Hollon, S. D., Hofmann, S. G., Andersson, G., Twisk, J., DeRubeis, R. J., Dimidjian, S., Hegerl, U., Mergl, R., Jarrett, R. B., Vittengl, J. R., Watanabe, N., & Cuijpers, P. (2017). Initial severity of depression and efficacy of cognitive–behavioural therapy: individual-participant data meta-analysis of pill-placebo-controlled trials. British Journal of Psychiatry, 210, 190–196. https://doi.org/10.1192/bjp.bp.116.187773 CrossRefGoogle ScholarPubMed
Greer, S., Moorey, S., Baruch, J. D., Watson, M., Robertson, B. M., Mason, A., Rowden, L., Law, M. G., & Bliss, J. M. (1992). Adjuvant psychological therapy for patients with cancer: a prospective randomised trial. BMJ, 304, 675–680. https://doi.org/10.1136/bmj.304.6828.675 CrossRefGoogle Scholar
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 56–62. https://doi.org/10.1136/jnnp.23.1.56 CrossRefGoogle ScholarPubMed
Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. New York: Guilford Publications.Google Scholar
Herbert, R., Moseley, A., & Sherrington, C. (1998). PEDro: a database of randomised controlled trials in physiotherapy. Health Information Management, 28, 186–188. https://doi.org/10.1177/183335839902800410 CrossRefGoogle Scholar
Hirayama, T., Ogawa, Y., Yanai, Y., Shindo, A., Tanaka, M., & Suzuki, S. I. (2023). Feasibility and preliminary effectiveness of behavioral activation for patients with cancer and depression in Japan. Palliative Medicine Reports, 4, 150–160.CrossRefGoogle ScholarPubMed
Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive Therapy Research, 36, 427–440. https://doi.org/10.1007/s10608-012-9476-1 CrossRefGoogle ScholarPubMed
Hollon, S. D., DeRubeis, R. J., Shelton, R. C., Amsterdam, J. D., Salomon, R. M., O’Reardon, J. P., Lovett, M. L., Young, P. R., Haman, K. L., Freeman, B. B., & Gallop, R. (2005). Prevention of relapse following cognitive therapy vs medications in moderate to severe depression. Archives of General Psychiatry, 62, 417–422. https://doi.org/10.1001/archpsyc.62.4.417 CrossRefGoogle ScholarPubMed
Hopko, D. R., Armento, M. E., Robertson, S., Ryba, M. M., Carvalho, J. P., Colman, L. K., … & Lejuez, C. W. (2011). Brief behavioral activation and problem-solving therapy for depressed breast cancer patients: randomized trial. Journal of Consulting and Clinical Psychology, 79, 834. https://doi.org/10.1037/a0025450 CrossRefGoogle ScholarPubMed
Hopko, D. R., Funderburk, J. S., Shorey, R. C., McIndoo, C. C., Ryba, M. M., File, A. A., … & Vitulano, M. (2013). Behavioral activation and problem-solving therapy for depressed breast cancer patients: preliminary support for decreased suicidal ideation. Behavior Modification, 37, 747–767.CrossRefGoogle ScholarPubMed
Hunter, M., Coventry, S., & Grunfeld, E. (2009). An evaluation of group cognitive behaviour therapy for menopausal symptoms in women following breast cancer treatment. Maturitas, 63, S34. https://doi.org/10.1016/s0378-5122(09)70128-8 CrossRefGoogle Scholar
Jassim, G. A., Whitford, D. L., Hickey, A., & Carter, B. (2015). Psychological interventions for women with non-metastatic breast cancer. Cochrane Database of Systematic Reviews (5), Cd008729. https://doi.org/10.1002/14651858.CD008729.pub2 Google ScholarPubMed
Kissane, D. W., Ildn, J., Bloch, S., Vitetta, L., Clarke, D. M., Smith, G. C., & McKenzie, D. P. (1998). Psychological morbidity and quality of life in Australian women with early-stage breast cancer: a cross-sectional survey. Medical Journal of Australia, 169, 192–196. https://doi.org/10.5694/j.1326-5377.1998.tb140220.x CrossRefGoogle ScholarPubMed
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., Clarke, M., Devereaux, P. J., Kleijnen, J., & Moher, D. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Medicine, 6, e1000100–e1000100. https://doi.org/10.1371/journal.pmed.1000100 CrossRefGoogle ScholarPubMed
Matthews, H., Grunfeld, E.A., & Turner, A. (2017). The efficacy of interventions to improve psychosocial outocmes following surgical treatment for breast cancer: a systematic review and meta-analysis. Psychooncology, 26, 593–607. https://doi.org/10.1002/pon.4199 CrossRefGoogle Scholar
McNair, D. M., Lorr, M., & Droppleman, L. F. (1981). Profile of Mood States. Educational and Industrial Testing Service Google Scholar
Microsoft Corporation (2018). Microsoft Excel, version 2019 (16.0). https://office.microsoft.com/excel Google Scholar
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ, 339, b2535. https://doi.org/10.1136/bmj.b2535 CrossRefGoogle ScholarPubMed
Moorey, S., & Greer, S. (2012). Oxford Guide to CBT for People with Cancer (2nd edn). Oxford Guides to Cognitive Behavioural Therapy Series. Oxford University Press.Google Scholar
Mustafa, M., Carson-Stevens, A., Gillespie, D., & Edwards, A. G. K. (2013). Psychological interventions for women with metastatic breast cancer. Cochrane Database of Systematic Reviews (6). https://doi.org/10.1002/14651858.CD004253.pub4 CrossRefGoogle ScholarPubMed
Naeem, F., Sajid, S., Naz, S., & Phiri, P. (2023). Culturally adapted CBT – the evolution of psychotherapy adaptation frameworks and evidence. the Cognitive Behaviour Therapist, 16, E10. doi: 10.1017/S1754470X2300003X CrossRefGoogle Scholar
National Institute for Health and Care Excellence (2009). Advanced Breast Cancer: Diagnosis and Treatment. Clinical Guideline [CG81]. Available at: https://www.nice.org.uk/guidance/cg81 (accessed 24 April 2023).Google Scholar
National Institute for Health and Care Excellence. (2018). Early and Locally Advanced Breast Cancer: Diagnosis and Management. NICE Guideline [NG101]. Available at: https://www.nice.org.uk/guidance/cg81 (accessed 24 April 2023).Google Scholar
National Institute for Health and Care Excellence. (2022). Depression in Adults: Treatment and Management. NICE Guideline [NG222]. Available at: https://www.nice.org.uk/guidance/ng222 (accessed 24 April 2023).Google Scholar
Office for National Statistics (2019). Cancer Survival in England – Adult Diagnosed. One-, Five-, Ten-, Year Survival for Breast Cancer. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/conditionsanddiseases/datasets/cancersurvivalratescancersurvivalinenglandadultsdiagnosed (accessed 12 April 2023).Google Scholar
Peoples, A., Garland, S., Pigeon, W., Perlis, M., Wolf, J., Heffner, K., Mustian, K., Heckler, C., Peppone, L., Kamen, C., Morrow, G., & Roscoe, J. (2019). Cognitive behavioral therapy for insomonia reduced depression in cancer survivors. Journal of Clinical Sleep Medicine, 15, 129–137. https://doi.org/10.5664/jcsm.7586 CrossRefGoogle ScholarPubMed
Pitman, A., Suleman, S., Hyde, N., & Hodgkiss, A. (2018). Depression and anxiety in patients with cancer. BMJ, 361, k1415. https://doi.org/10.1136/bmj.k1415 CrossRefGoogle ScholarPubMed
Porzsolt, F., Wiedemann, F., Becker, S. I., & Rhoads, C. J. (2019). Inclusion and exclusion criteria and the problem of describing homogeneity of study populations in clinical trials. BMJ Evidence-Based Medicine, 24, 92–94. https://doi.org/10.1136/bmjebm-2018-111115 CrossRefGoogle ScholarPubMed
Purkayastha, D., Venkateswaran, C., Nayar, K., & Unnikrishnan, U. G. (2017). Prevalence of depression in breast cancer patients and its association with their quality of life: a cross-sectional observational study. Indian Journal of Palliative Care, 23, 268–273. https://doi.org/10.4103/IJPC.IJPC_6_17 Google ScholarPubMed
Qiu, J., Chen, W., Gao, X., Xu, Y., Tong, H., Yang, M., Xiao, Z., & Yang, M. (2013). A randomized controlled trial of group cognitive behavioral therapy for Chinese breast cancer patients with major depression. Journal of Psychosomatic Obstetrics and Gynaecology, 34, 60–67. https://doi.org/10.3109/0167482x.2013.766791 CrossRefGoogle ScholarPubMed
Quinn, M. J., Cooper, N., Rachet, B., Mitry, E., & Coleman, M. P. (2008). Survival from cancer of the breast in women in England and Wales up to 2001. British Journal of Cancer, 99 (suppl 1), S53–55. https://doi.org/10.1038/sj.bjc.6604587 CrossRefGoogle ScholarPubMed
Rathod, S., Phiri, P., & Naeem, F. (2019). An evidence-based framework to culturally adapt cognitive behaviour therapy. the Cognitive Behaviour Therapist, 12, article e10.CrossRefGoogle Scholar
Reed, E., Simmonds, P., Haviland, J., & Corner, J. (2012). Quality of life and experience of care in women with metastatic breast cancer: a cross-sectional survey. Journal of Pain and Symptom Management, 43, 747–758. https://doi.org/10.1016/j.jpainsymman.2011.05.005 CrossRefGoogle ScholarPubMed
Ren, W., Qiu, H., Yang, Y., Zhu, X., Zhu, C., Mao, G., Mao, S., Lin, Y., Shen, S., Li, C., & et al. (2019). Randomized controlled trial of cognitive behavioural therapy for depressive and anxiety symptoms in Chinese women with breast cancer. Psychiatry Research, 271, 52–59. https://doi.org/10.1016/j.psychres.2018.11.026 CrossRefGoogle ScholarPubMed
Savard, J., Simard, S., Giguère, I., Ivers, H., Morin, C. M., Maunsell, E., Gagnon, P., Robert, J., & Marceau, D. (2006). Randomized clinical trial on cognitive therapy for depression in women with metastatic breast cancer: psychological and immunological effects. Palliative and Supportive Care, 4, 219–237. https://doi.org/10.1017/s1478951506060305 CrossRefGoogle ScholarPubMed
Serfaty, M., Armstrong, M., Vickerstaff, V., Davis, S., Gola, A., McNamee, P., Omar, R. Z., King, M., Tookman, A., Jones, L., & Low, J. T. S. (2019). Acceptance and commitment therapy for adults with advanced cancer (CanACT): a feasibility randomised controlled trial. Psychooncology, 28, 488–496. https://doi.org/10.1002/pon.4960 CrossRefGoogle ScholarPubMed
Serfaty, M., King, M., Nazareth, I., Moorey, S., Aspden, T., Mannix, K., Davis, S., Wood, J., & Jones, L. (2020). Effectiveness of cognitive-behavioural therapy for depression in advanced cancer: CanTalk randomised controlled trial. British Journal of Psychiatry, 216, 213–221. https://doi.org/10.1192/bjp.2019.207‘CrossRefGoogle ScholarPubMed
Tan, S. B., Chee, C. H., Ngai, C. F., Hii, S. L., Tan, Y. W., Ng, C. G., Capelle, D. P., Zainuddin, S. I., Loh, E. C., Lam, C. L., Chai, C. S., & Ng, D. L. C. (2022). Mindfulness-based supportive therapy on reducing suffering in patients with advanced cancer: randomised controlled trial. BMJ Supportive & Palliative Care, bmjspcare-2021-003349. https://doi.org/10.1136/bmjspcare-2021-003349 Google Scholar
The EndNote Team (2013). EndNote, version EndNote X9. Clarivate.Google Scholar
Tolin, D. F. (2010). Is cognitive-behavioral therapy more effective than other therapies? A meta-analytic review. Clinical Psychology Review, 30, 710–720. https://doi.org/10.1016/j.cpr.2010.05.003 CrossRefGoogle ScholarPubMed
Williams, J. M. G., & Penman, D. (2011). Mindfulness: A Practical Guide to Finding Peace in a Frantic World. London: Piatkus.Google Scholar
World Health Organization (2021). Breast Cancer. Available at: https://www.who.int/news-room/fact-sheets/detail/breast-cancer (accessed 24 April 2023).Google Scholar
Xiao, F., Song, X., Chen, Q., Dai, Y., Xu, R., Qiu, C., & Guo, Q. (2017). Effectiveness of psychological interventions on depression in patients after breast cancer surgery: a meta-analysis of randomized controlled trials. Clinical Breast Cancer, 17, 171–179. https://doi.org/10.1016/j.clbc.2016.11.003 CrossRefGoogle ScholarPubMed
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x CrossRefGoogle ScholarPubMed
Zimmermann, F. F., Burrell, B., & Jordan, J. (2018). The acceptability and potential benefits of mindfulness-based interventions in improving psychological well-being for adults with advanced cancer: a systematic review. Complementary Therapies in Clinical Practice, 30, 68–78. https://doi.org/10.1016/j.ctcp.2017.12.014 CrossRefGoogle ScholarPubMed
Supplementary material: File

Wieland et al. supplementary material

Wieland et al. supplementary material
Download Wieland et al. supplementary material(File)
File 12.9 KB
Submit a response

Comments

No Comments have been published for this article.