Dealing With Distress for Cancer Patients: Using Brief Dialectical Behaviour Therapy Skills Groups for Patients With Cancer
The global incidence of cancer is rising due to the ageing of the population and population growth (Conley et al., 2016). In New Zealand, cancer is the leading cause of death (Ministry of Health, 2018b). The literature suggests that quality of life is enhanced by psychosocial treatments. Dialectical Behaviour Therapy (DBT) (Linehan, 2014a) is a psychological treatment for emotional dysregulation and complex presentations that has been well researched, but there is little literature related to its use for cancer patients.
This mixed-methods pilot study examined whether DBT groups are an effective psychological intervention in reducing distress, increasing resilience and increasing quality of life for cancer patients. The quantitative component measured the outcomes of distress, quality of life, and resilience using the Distress Anxiety Stress scale (DASS-21), the European Organisation for Research and Treatment of Cancer Quality of Life C30 Questionnaire (EORTC QLQ-C30 Version 3) and the Connor-Davidson Resilience Scale (CD-RISC) respectively. The qualitative component sought participants’ experiences of the group programme through interviews and an Appreciative Inquiry process, creating an opportunity for participants to identify what worked well and suggest modifications to improve the programme. Qualitative data were audio-recorded and transcribed and then analysed using Braun and Clarke’s (2012) thematic analysis process.
There were two conditions in this study that were presented as single-case designs due to the small sample size (n=6). Condition One involved two cancer patient participants, who suggested the modification of including supporter/ family members in the group. Condition Two involved four cancer patient participants, two of whom also had family members attend.
Condition One results indicated some improvements in distress scores (as measured by the DASS-21) by one participant whilst resilience scores improved for the other participant. Additionally for both participants, some EORTC QLQ-30 functioning and symptom scores also improved. The participants found learning and using the skills taught in the group helpful. Findings for the second condition (modified group) showed improvements in distress, a consistent positive long-term impact on quality of life (global health) and fatigue, and relatively consistent impacts on physical function, role function, pain, and dyspnoea. Although resilience and depression (as well as emotional and cognitive functioning) improved during the time of the group, these variables were not maintained at follow-up for all participants. During interviews, participants reported the helpful effect the group had on general psychosocial stressors. Several modifications of the group programme are recommended, including the involvement of careers/support people as part of the DBT programme; the use of a manual; and using non-psychologists to facilitate the group programme to allow for wider community reach. Future research could include trials with a larger and more diverse group of participants, measuring outcomes on support/carer participant’s anxiety and/or stress, and the benefits of a follow-up group and web-based support.