Patients with chronic or terminal illnesses often experience psychosocial problems that can exacerbate their medical condition, including alienation, anxiety, and depression. Women diagnosed with breast cancer, in particular, often struggle with the stigma associated with cancer, issues regarding body image, fear associated with death, and the stress the disease places on interpersonal relationships. The resulting psychological stress can be considerable. It is estimated that 22 to 50% of patients with breast cancer meet criteria for a psychiatric diagnosis of depression, 3 to 19% meet criteria for posttraumatic stress disorder, and 33% meet criteria for acute stress disorder. Although a full posttraumatic stress syndrome might afflict only a minority of breast cancer patients, most investigators have found that clinically significant symptoms are relatively common. As many as 80% of breast cancer patients report significant distress during initial treatment. Since adjustment to metastatic disease is often more difficult than adjustment to the initial diagnosis, the need to find effective treatments for trauma symptoms in metastatic patients is all the more pressing.
Several decades of research provide evidence that many of the psychosocial problems that chronically ill patients experience respond to psychotherapeutic intervention. For women with breast cancer, there is evidence indicating the effectiveness of group interventions, with positive effects on psychosocial adjustment, physical status, mood, quality of life, and survivorship.
Most randomized group intervention studies have involved brief interventions and have included a focus on education, coping strategies, and emotional support. Some have also included stress management or behavioral training such as hypnosis or progressive relaxation. Most interventions were structured, with a predetermined schedule of topics to be addressed. The supportive-expressive method used in the present study differs in being relatively more extensive and intensive.