Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-20T01:42:57.975Z Has data issue: false hasContentIssue false
  • English
  • Français

Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C): Rationale and Overview

Published online by Cambridge University Press:  22 May 2015

Allison J. Applebaum ,
Julia R. Kulikowski  and
William Breitbart
Allison J. Applebaum*
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, New York
Julia R. Kulikowski
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, New York
William Breitbart
Affiliation:
Memorial Sloan Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: Allison J. Applebaum, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Ave., 7th Floor, New York, NY 10022. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

The multidimensional burden that results from providing care to a patient with cancer is well documented and a growing number of psychosocial interventions have been developed to address this burden. None, however, target existential distress, a critical, common element — and potentially driving mechanism — of caregiver burden. Meaning-Centered Psychotherapy (MCP) is a structured psychotherapeutic intervention originally developed by our group to target existential distress and spiritual well-being among patients with advanced cancer. We are currently developing Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C). The objective of this qualitative study is to describe the application of MCP to the unique experience of caregivers of patients with advanced cancer.

Methods:

A case study of a participant from an initial MCP-C group is presented, with a focus on the application of sources of meaning to the cancer caregiving experience.

Results:

The exploration of critical sources of meaning in the participant's life generally, and related to caregiving specifically, highlighted significant areas of growth, including an increased understanding of the historical context shaping her experience of providing care, the recognition of the need for improved self-care and reconnecting with meaningful activities, and the possibility for continued connectedness to others and the world, despite the limitations resulting from her husband's terminal illness.

Significance of results:

Existential distress is a critical and often overlooked element of burden among cancer caregivers. MCP-C is intended to target this component of burden and address this critical gap in the palliative care literature. Clinical trials are underway to evaluate the efficacy of MCP-C delivered over the Internet. Future studies are needed to evaluate the benefits of MCP-C for particularly burdened groups of caregivers, such as caregivers of patients with brain tumors and those undergoing hematopoietic stem cell transplantations, and to identify target points of delivery that will optimize the intervention's benefits.

Keywords

Caregivercancermeaningtherapyexistential
Type
Original Articles
Information
Palliative & Supportive Care , Volume 13 , Issue 6 , December 2015 , pp. 1631 - 1641
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Applebaum, A.J. & Breitbart, W. (2013). Care for the cancer caregiver: A systematic review. Palliative & Support Care, 11, 231–252.Google Scholar
Applebaum, A.J., Farran, C.J., Marziliano, A.M., et al. (2014). Preliminary study of themes of meaning and psychosocial service use among informal cancer caregivers. Palliative & Supportive Care, 12, 139–148.CrossRefGoogle ScholarPubMed
Ayers, L. (2000). Narratives of family caregiving: The process of making meaning. Research in Nursing & Health, 23, 424–434.3.0.CO;2-W>CrossRefGoogle Scholar
Baider, L. & De-Nour, A.K. (1988). Adjustment to cancer: Who is the patient — The husband or the wife. Isreal Journal of Medicine and Science, 24, 631–636.Google Scholar
Baider, L., Kaufman, B., Perez, T., et al. (1996). Mutality of fate: Adaptation and psychological distress in cancer patients and their partners. In Baider, L., Cooper, C. L. & De-Nour, A. K. (Eds.), Cancer and the Family (pp. 173–186). New York: Wiley.Google Scholar
Bauer-Wu, S. & Farran, C.J. (2005). Meaning in life and psycho-spiritual functioning: A comparison of breast cancer survivors and healthy women. Journal of Holistic Nursing, 23, 172–190.Google Scholar
Breitbart, W.S. & Alici, Y. (2009). Psycho-oncology. Harvard Review of Psychiatry, 17, 361–376.CrossRefGoogle ScholarPubMed
Breitbart, W., Rosenfeld, B., Gibson, C., et al. (2010). Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psychooncology, 19, 21–28.CrossRefGoogle Scholar
Breitbart, W., Poppito, S., Rosenfeld, B., et al. (2012). Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Journal of Clinical Oncology, 30, 1304–1309.Google Scholar
Breitbart, W., Rosenfeld, B., Pessin, H., et al. (2015). Meaning-Centered Group Psychotherapy: An effective intervention for reducing despair in patients with advanced cancer. Journal of Clinical Oncology, 33, 749–754.CrossRefGoogle Scholar
Calhoun, L.G. & Tedeschi, R.G. (2006). The foundations of posttraumatic growth: An expanded framework. In Calhoun, L. G. & Tedeschi, R. G. (Eds.), The handbook of posttraumatic growth: Research and practice (pp. 1–23). Mahwah: Lawrence Erlbaum.Google Scholar
Cherny, N.I., Coyle, N. & Foley, K.M. (1994). Suffering in the advanced cancer patient: A definition and taxonomy. Journal of Palliative Care, 10, 57–70.CrossRefGoogle Scholar
Chochinov, H.M., Krisjanson, H.L., Hack, T.F., et al. (2006). Dignity in the terminally ill: Revisited. Journal of Palliative Medicine, 9, 666–672.CrossRefGoogle ScholarPubMed
Christakis, N.A. & Allison, P.D. (2006). Mortality after the hospitalization of a spouse. New England Journal of Medicine, 354, 719–730.CrossRefGoogle ScholarPubMed
Cliff, A.M. & Macdonagh, R.P. (2000). Psychosocial morbidity in prostate cancer: II. A comparison of patients and partners. British Journal of Urology International, 86, 834–839.Google ScholarPubMed
Duggleby, W., Wright, K., Williams, A., et al. (2007). Developing a living with hope program for caregivers of family members with advanced cancer. Journal of Palliative Care, 23, 24–31.CrossRefGoogle ScholarPubMed
Dumont, S., Turgeon, J., Allard, P., et al. (2006). Caring for a loved one with advanced cancer: determinants of psychological distress in family caregivers. Journal of Palliative Medicine, 9, 912–921.CrossRefGoogle ScholarPubMed
Ey, S., Compas, B.E., Epping-Jordan, J.E., et al. (1999). Stress responses and psychological adjustment in patients with cancer and their spouses. Journal of Psychosocial Oncology, 16, 59–77.Google Scholar
Farran, C.J., Keane-Hagerty, E., Salloway, S., et al. (1991). Finding meaning: An alternative paradigm for Alzheimer's disease family caregivers. Gerontologist, 31, 483–489.Google Scholar
Fegg, M. J., Brandstätter, M., Kögler, M., et al. (2013). Existential behavioural therapy for informal caregivers of palliative patients: A randomised controlled trial. Psychooncology, 22, 2079–2086.Google Scholar
Folkman, S., Chesney, M.A. & Christopher-Richards, A. (1994). Stress and coping in caregiving partners of men with AIDS. The Psychiatric Clinics of North America, 17, 35–53.CrossRefGoogle ScholarPubMed
Frankl, V.E. (1963). Man's search for meaning. New York, NY: Washington Square Press.Google Scholar
Frankl, V.E. (1967). Psychotherapy and existentialism. New York: Washington Square Press.Google Scholar
Frankl, V.E. (1973). Meaninglessness: A challenge to psychologists. In Milton, T. (Ed.), Theories of Psychopathology and Personality (pp. 231–270). Philadelphia: Saunders.Google Scholar
Frankl, V.E. (1978). The Unheard Cry for Meaning. New York: Washington Square Press.Google Scholar
Gallagher, J., Parle, M. & Cairns, D. (2002). Appraisal and psychological distress six months after diagnosis of breast cancer. British Journal of Health Psychology, 7, 365–376.CrossRefGoogle ScholarPubMed
Given, B., Kozachik, S., Collins, C., DeVoss, , et al. (Eds.), Nursing care of older adult diagnoses: Outcome and interventions (pp. 679–695). St. Louis: Mosby.Google Scholar
Given, C.W., Stommel, M., Given, B., et al. (1993). The influence of cancer patient's sympstoms and functional states on patients' depression and family caregivers' reaction and depression. Health Psychology, 12, 277–285.Google Scholar
Hart, T., O'Neil-Pirozzi, T.M., Williams, K.D., et al. (2007). Racial differences in caregiving patterns, caregiver emotional function, and sources of emotional support following traumatic brain injury. Journal of Health Trauma Rehabiliation, 22, 122–131.Google Scholar
Hayes, S. (2003). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behavior Therapy, 35, 639–665.CrossRefGoogle Scholar
Henery, N. (2003). Constructions of spirituality in contemporary nursing theory. Journal of Advanced Nursing, 42, 550–557.Google Scholar
Henoch, I. & Danielson, E. (2009). Existential concerns among patients with cancer and interventions to meet them: An integrative literature review. Psychooncology, 18, 225–236.Google Scholar
Hudson, P.L., Hayman-White, K., Aranda, S., et al. (2006). Predicting family caregiver psychosocial functioning in palliative care. Journal of Palliative Care, 22, 133–140.Google Scholar
Hudson, P. & Payne, S. (2009). The future of family caregiving: Research, social policy and clinical practice. In Hudson, P. & Payne, S. (Eds.), Family Carers in Palliative Care: A guide for health and social care professionals (pp. 277–303). Oxford: Oxford University Press.Google Scholar
Kissane, D.W., Bloch, S., Burns, W.I., et al. (1994). Psychological morbidity in the families of patients with cancer. Psychooncology, 3, 47–56.CrossRefGoogle Scholar
Kornblith, A.B., Herr, H.R., Ofman, U.S., et al. (1994). Quality of life of patients with prostate cancer and their spouses. The value of a data base in clinical care. Cancer, 73, 2791–2802.Google Scholar
Kozachik, S.L., Given, C.W., Given, B.A., et al. (2001). Improving depressive symptoms among caregivers of patients with cancer: Results of a randomized clinical trial. Oncology Nursing Forum, 28, 1149–1157.Google ScholarPubMed
Kris, A.E., Cherlin, E.J., Prigerson, H., et al. (2006). Length of hospice enrollment and subsequent depression in family caregivers: 13-month follow-up study. American Journal of Geriatric Psychiatry, 14, 264–269.Google Scholar
Lazarus, R.S. & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer Publishing Company.Google Scholar
Lichtenthal, W.G. & Breitbart, W. (In press). The central role of meaning in adjustment to the loss of a child to cancer: Implications for the development of Meaning-Centered Grief Therapy. Current Opinions in Supportive Palliative Care.Google Scholar
Lichtenthal, W.G., Tuman, M., Corner, G., et al. (2014). Development of a meaning-centered group for breast cancer survivors (MCG-BCS): Focus group findings and preliminary effects. Poster presentation at the American Psychosocial Oncology Society 11th Annual Conference, Tampa.Google Scholar
Lichtenthal, W.G., Sweeney, C.R., Roberts, K.E., et al. (2015). Meaning-Centered Grief Therapy: Theory, practice, and promise. Oral presentation accepted for the Association for Death Education and Counseling 37th Annual Conference, San Antonio.Google Scholar
Lichtenthal, W.G., Poppito, S., Olden, M., et al. (2008). Facets of meaning: Differential effects of meaning-centered psychotherapy among advanced cancer patients. Paper presented at the Association for Death Education and Counseling 30th Annual Conference, Montreal, Canada.Google Scholar
Lichtenthal, W.G., Poppito, S., Olden, M., et al. (2009). Effects of meaning-centered psychotherapy on facets of meaning among advanced cancer patients: A closer look at the FACIT-Sp. Paper presented at the 30th Annual Meeting of the Society of Behavioral Medicine, Montreal, Canada.Google Scholar
Lichtenthal, W.G., Nilsson, M., Kissane, D.W., et al. (2011). Underutilization of mental health services among bereaved caregivers with prolonged grief disorder. Psychiatric Services, 62, 1225–1229.CrossRefGoogle ScholarPubMed
Manne, S., Ostroff, J., Winkel, G., et al. (2004). Posttraumatic growth after breast cancer: Patient, partner, and couple perspectives. Psychosomatic Medicine, 66, 442–454.Google Scholar
McLean, L.M., Jones, J.M., Rydall, A.C., et al. (2008). A couples intervention for patients facing advanced cancer and their spouse caregivers: Outcomes of a pilot study. Psychooncology, 17, 1152–1156.Google Scholar
McLean, L.M., Walton, T., Matthew, A., et al. (2011). Examination of couples’ attachment security in relation to depression and hopelessness in martially distressed patients facing end-stage cancer and their spouse caregivers: A buffer or facilitator of psychosocial distress? Supportive Care in Cancer, 19, 1539–1548.CrossRefGoogle ScholarPubMed
Institute of Medicine (2008). Retooling for an aging america: building the health care workforce. Washington, DC: The National Academies Press.Google Scholar
National Alliance for Caregiving, in Collaboration with AARP (2009). Caregiving in the U.S., 2009. http://www.caregiving.org/data/CaregivingUSAllAgesExecSum.pdf.Google Scholar
Northouse, L., Kershaw, T., Mood, D., et al. (2005). Effects of a family intervention on the quality of life of women with recurrent breast cancer and their family caregivers. Psychooncology, 14, 478–491.CrossRefGoogle ScholarPubMed
Pargament, K.I. & Ano, G.G. (2006). Spiritual resources and struggles in coping with medical illness. Southern Medical Journal, 99, 1161–1162.CrossRefGoogle ScholarPubMed
Park, C.L. (2010). Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful like events. Psychological Bulletin, 136, 257–301.CrossRefGoogle Scholar
Park, C.L. & Folkman, S. (1997). Stability and change in psychosocial resources during caregiving and bereavement in partners of men with AIDS. Journal of Personality, 65, 421–447.Google Scholar
Pearlin, L.I., Mullan, J.T., Semple, S.J., et al. (1990). Caregiving and the stress process: An overview of concepts and their measures. The Gerontologist, 30, 583–594.CrossRefGoogle ScholarPubMed
Pinquart, M. & Sörensen, S. (2003). Differences between Caregivers and noncaregivers in psychological health and physical health: A meta-analysis. Psychology and Aging, 18, 250–267.Google Scholar
Rhoades, D.R. & McFarland, K.F. (1999). Caregiver meaning: A study of caregivers of individuals with mental illness. Health & Social Work, 24, 291–298.CrossRefGoogle ScholarPubMed
Rivera, H.R. (2009). Depression symptoms in cancer caregivers. Clinical Journal of Oncology Nursing, 13, 195–202.Google Scholar
Rohleder, N., Marin, T.J., Ma, R., et al. (2009). Biologic cost of caring for a cancer patient: Dysregulation of pro- and anti-inflammatory signaling pathways. Journal of Clinical Oncology, 27, 2909–2915.Google Scholar
Scott, J., Halford, W.K. & Ward, B. (2004). United we stand? The effetcs of a couple-coping intervention on adjustment to early stage breast or gynecological cancer. Journal of Consulting and Clinical Psychology, 72, 1122–1135.Google Scholar
Shelby, R.A., Taylor, K.L., Kerner, J.F., et al. (2002). The role of community-based and philanthropic organizations in meeting cancer patient and caregiver needs. CA: A Cancer Journal for Clinicians, 52, 229–246.Google Scholar
Thornton, A.A. & Perez, M.A. (2006). Posttraumatic growth in prostate cancer survivors and their partners. Psychooncology, 15, 285–296.Google Scholar
Toseland, R.W., Blanchard, C.G. & McCallion, P. (1995). A problem solving intervention for caregivers of cancer patients. Social Science and Medicine, 40, 517–528.Google Scholar