In Psycho-Spiritual Integrative Therapy for Women with Primary Breast Cancer, What Factors Account for the Benefits?

By John Rettger, Kathleen Wall, Diana Corwin, Alexandra N. Davidson, David Lukoff  and Cheryl Koopman*

images.jpegPSIT is an integrated psychotherapeutic approach explicitly targeting treatment of the whole person. CAM approaches described in the literature for breast cancer patients typically address the dimensions of thought, body, and emotions; most do not specifically aim to integrate spirituality, with few exceptions. PSIT specifically addresses physical, psychological, existential, and spiritual factors. Preliminary studies of PSIT have shown promise in promoting health and well-being among breast cancer survivors.

PSIT is both an approach to psychotherapy and a spiritual practice focused on a lived spirituality. As such, PSIT supports breast cancer patients seeking meaning and purpose as well as deepened spirituality. PSIT integrates psychotherapy and spiritual practices in order to help clarify and fulfill the individual’s life purpose and to build skills for resolving obstacles in life transitions, including cancer survivorship.

PSIT is non-sectarian, relying on a personal sense of the sacred, and is therefore potentially acceptable to people of most religious/spiritual orientations as well as to people who do not identify as religious/spiritual but who embrace the pursuit of inspiration and life meaning in coping with cancer and other life challenges.

This study sought to add to the body of qualitative research describing the relationship between spirituality, SWB, and QL. A multiple case analysis design was chosen to allow deeper inquiry into how and why changes in SWB and QL occur during the PSIT group intervention.

Four participants’ experiences were investigated in detail to understand how spirituality is or is not promoted and to further explore the relationship between spirituality and QL. Through this qualitative analysis, we sought to identify both individual participant and PSIT intervention factors that contributed to positive or negative changes in SWB and QL.

Describing individual factors associated with greater or less benefit may identify potential moderators of treatment efficacy for future research on PSIT. Similarly, describing PSIT components associated with greater or less benefit may identify potential mediators of treatment efficacy for future research. Exploring the relationship between spirituality and QL in this context may generate insights about how PSIT can enhance QL through its focus on spirituality.

meditation-567593_960_720.jpgThe FACT-B uses a 37-item self-report scale to measure multidimensional areas of quality of life for breast cancer patients. Participants rate the veracity of the statements using a Likert scale. It includes questions about physical well-being (e.g., “I have a lack of energy”), social/family well-being (e.g., “I feel close to my friends”), emotional well-being (e.g., “I feel sad), and functional well-being (e.g., “I am able to enjoy life”). Pre and post quality of life scores for all participants were assessed using this scale.

Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp-Ex). The spiritual well-being of the participants was assessed through the Functional Assessment of Chronic Illness Therapy-Spiritual (FACIT-Sp-Ex). The FACIT-Sp-Ex is a 23-item instrument that yields scores on two sub-scales, Meaning/Peace and Spirituality, as well as a total score of Spiritual Well-Being (with a possible range of scores of 0–92).

Higher scores on these sub-scales indicate greater meaning/peace and spirituality, with possible score ranges of 0–32 and 0–16, respectively. Sample questions include “I have a sense of purpose in my life” and “I find comfort in my faith or spiritual beliefs.” For this study, improvement was operationalized by calculating change scores for spiritual well-being (SWB) from the baseline and post-treatment scores obtained with this scale.

Conclusions.

These findings suggest that there is a relationship between changes in SWB and changes in QL, with the women experiencing the greatest changes in SWB also showing the greatest improvements in QL. Furthermore, participant changes in SWB and QL in the context of the PSIT intervention appear to be related to participant characteristics including spiritual and religious backgrounds, doubts, and trials as well as the application of metacognitive psychological skills.

Other benefits of PSIT stemmed from use of core components of the intervention. Participants reported they benefited by clarifying an aspirational life purpose and by developing mindful non-judgmental witnessing of the personal factors that helped and hindered the actualization of that life purpose. These processes lead to cognitive restructuring and developing alternative perspectives. In a group setting that emphasized inner processing, participants reported learning a set of skills useful in dealing with cancer survivorship and other life stressors.

 

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