Individual meaning-centered psychotherapy for the treatment of psychological and existential distress: a randomized controlled trial in patients with advanced cancer
Open accessAbstract
BACKGROUND: Patients with advanced cancer have high rates of psychological distress, including depression, anxiety, and spiritual despair. This study examined the effectiveness of individual meaning‐centered psychotherapy (IMCP) in comparison with supportive psychotherapy (SP) and enhanced usual care (EUC) in improving spiritual well‐being and quality of life and reducing psychological distress in patients with advanced cancer. METHODS: Patients (n = 321) were randomly assigned to IMCP (n = 109), SP (n = 108), or EUC (n = 104). Assessments were conducted at 4 time points: before intervention, midtreatment (4 weeks), 8 weeks after treatment, and 16 weeks after treatment. RESULTS: Significant treatment effects (small to medium in magnitude) were observed for IMCP, in comparison with EUC, for 5 of 7 outcome variables (quality of life, sense of meaning, spiritual well‐being, anxiety, and desire for hastened death), with Cohen's d ranging from 0.1 to 0.34; no significant improvement was observed for patients receiving SP ( d < 0.15 and P > .05 for all variables). The effect of IMCP was significantly greater than the effect of SP for quality of life and sense of meaning ( d = 0.19) but not for the remaining study variables. CONCLUSIONS: This study provides further support for the efficacy of IMCP as a treatment for psychological and existential/spiritual distress in patients with advanced cancer. Significant treatment effects (small to moderate effect sizes) were observed in comparison with usual care, and somewhat more modest differences in improvement (small effect sizes) were observed in comparison with SP. Thus, the benefits of meaning‐centered psychotherapy appear to be unique to the intervention and highlight the importance of addressing existential issues with patients approaching the end of life. Cancer 2018. © 2018 American Cancer Society .
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Only one-sided interventions with limited effect have been developed to manage death anxiety and its effect on individual behavior or well-being.
“Consequentially, only one-sided interventions with limited effect have been developed to manage death anxiety and its effect on individual behavior or well-being (Greenberg et al., 2014; Breitbart et al., 2018).”
From Mediator role of presence of meaning and self-esteem in the relationship of social support and death anxiety (2022) · cites this paper as Breitbart et al., 2018
The paper’s introduction says earlier interventions for spiritual and existential distress in patients with advanced cancer had not shown strong effects in large clinical trials. But it does not characterize interventions as “one-sided” or assess effects on individual behavior, and its own Results report significant benefits of individual meaning-centered psychotherapy for several outcomes, including anxiety and quality of life. Page numbers are unavailable in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMCP has been shown to be effective for advanced breast cancer patients in both group and individual formats.
“MCP has been shown to be effective for advanced breast cancer patients in both group and individual formats [18].”
From Psychological Intervention and Breast Cancer (2024) · cites this paper as [18]
The Conclusions report benefits from individual MCP in patients with advanced cancer and describe earlier trials showing benefits from group MCP. The Participants section describes a mixed-cancer sample, not a breast-cancer-specific study; the paper does not establish effectiveness in advanced breast cancer patients in both formats. Page numbers are not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredLarge RCTs of both group and individual meaning-centered psychotherapy have shown that these programs improve spiritual well-being and QL and significantly reduce depression, hopelessness, desire for hastened death, and physical symptom distress.
“Large RCTs of both group and individual meaning-centered psychotherapy have shown that these programs improve spiritual well-being and QL and significantly reduce depression, hopelessness, desire for hastened death, and physical symptom distress (Breitbart et al. 2015(Breitbart et al. , 2018)).”
From Psychosocial and Integrative Oncology: Interventions Across the Disease Trajectory. (2023) · cites this paper as Breitbart et al. 2018
The Results report that individual meaning-centered psychotherapy significantly improved spiritual well-being and quality of life and reduced desire for hastened death compared with enhanced usual care. The Discussion says depression and hopelessness did not improve significantly more than in usual care, and the Methods do not list physical symptom distress as an outcome. This 2018 trial studied the individual intervention; it does not itself establish the full set of effects claimed for both group and individual programs. (LLM, conf=0.90)
Experimental — accuracy not yet measuredPatients are recommended various forms of psychotherapy such as relaxation, guided imagery, mindfulness meditation, music therapy, occupational therapy, and breathing exercises.
“Patients are also recommended various forms of psychotherapy [10,11,12], such as relaxation and guided imagery [13,14], mindfulness meditation (mindfulness-based stress reduction) [14], music therapy [15,16], occupational therapy [17,18,19], and breathing exercises [20,21,22].”
From The Effect of Vinyasa Yoga Practice on the Well-Being of Breast-Cancer Patients during COVID-19 Pandemic (2023) · cites this paper as [12]
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- Authors
- Breitbart, W., Pessin, H., Rosenfeld, B., Applebaum, A. J., Lichtenthal, W. G., Li, Y., Saracino, R. M., Marziliano, A. M., Masterson, M., Tobias, K., & Fenn, N.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Fordham University (US)
- Corresponding author
- Breitbart, William
- ORCID
- Venue
- Cancer
- Publisher
- Wiley
- Published
- 2018-05-14
- Volume
- 124
- Issue
- 15
- Pages
- 3231-3239
- ISSN
- 0008-543X (ISSN-L)
- 1097-0142
- PMC
- PMC6097940
- OpenAlex
- W2803238382
- Cited by
- 396
- References
- 35
- Citations by year
- 2026: 37 · 2025: 63 · 2024: 73 · 2023: 50 · 2022: 57 · 2021: 51 · 2020: 32 · 2019: 25 · 2018: 7
- FWCI
- 30.66
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cancer (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (R01 CA128134)
- Topics
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- meaning-centered therapy, advanced cancer, psychological distress, existential suffering, spiritual distress, spiritual well-being, quality of life, meaningfulness, anxiety, depression, supportive therapy, end-of-life care, hastening death
- MeSH terms
- Adult, Aged, Aged, 80 and over, Depression, Emotions, Existentialism, Female, Humans, Male, Middle Aged, Neoplasms, Person-Centered Psychotherapy, Palliative Care, Quality of Life, Spirituality
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