The Effects of Psychotherapy on Psychological Well-Being and Diurnal Cortisol Patterns in Breast Cancer Survivors

Abstract

Background: Neuroendocrine dysregulation influenced by psychosocial stress is related to breast cancer recurrence. Very few studies examine the impacts of psychotherapy on diurnal cortisol patterns among breast cancer survivors. Methods: Forty-eight breast cancer patients who completed active cancer treatment were randomly assigned to receive either 8 weekly body-mind-spirit (BMS) group therapy sessions or 1 educational (EDU) session. Self-report measures included the Beck Depression Inventory-II (BDI-II), and the Meaning in Life questionnaire (MLQ) including two subscales: MLQ-Presence and MLQ-Search. Salivary cortisol levels were collected by the subjects in their homes at the time of awakening, 30 and 45 min after awakening, and at 12.00, 17.00, and 21.00 h. Measurement time points include baseline, the 2nd month (completion of BMS therapy), the 5th month, and the 8th month. Results: There were no significant differences in BDI-II scores (p>0.05) and MLQ-Presence scores (p >0.05) between BMS and EDU groups at baseline or across the three follow-ups. Nevertheless, greater MLQ-Search scores were found in the BMS group compared to the EDU group during the 5th month of follow-up (p <0.01). The higher level of cortisol at 21.00 h (p < 0.01) and a flatter diurnal cortisol pattern were more likely to occur in EDU than in BMS participants (p < 0.05) at the 8th month of follow-up. Conclusion: BMS group therapy likely contributed to enhancing an active search for meaning in life toward more opportunities for personal growth and to maintaining stable cortisol responses to everyday life stress for breast cancer survivors.