Developing emotion focused therapy for CAD in women with breast cancer : an analysis of six case studies

Abstract

Aims: The aim of the current study is to develop a variant of Emotion Focused Therapy (EFT) for Comorbid Anxiety and Depression (CAD) in women with breast cancer by presenting a series of case studies followed by a cross case analysis. The aim is to move from an EFT understanding of working with depression and anxiety (respectively), and to make the first steps towards understanding the application of EFT to CAD in the context of breast cancer. The study will collect qualitative and quantitative process and outcome data that should inform the development of EFT for CAD. Method: This was a mixed methods study. Participants (n=6) were recruited from a psycho-oncology service in a radiotherapy hospital. Participant suitability for participation was based on their initial intake assessment, their score on the Hospital Anxiety and Depression Scale (HADS; Zigmond & Snaith, 1983) and the Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P; First, Spitzer, Gibbon & Williams, 2002). Participants underwent 14-21 sessions of therapy that were audio and video recorded. Quantitative pre-post outcome measures were completed pre, mid, post, and six month follow up. Descriptive analyses and t-test for dependent samples were carried out on the quantitative data. Effect sizes were calculated which were standardised pre-post differences. Qualitative data were collected at the end of each session from patients and at the end of treatment from both patients and therapists. Qualitative data were analysed in accordance with a descriptive and interpretive qualitative research method described by Elliott and Timulak (2005). Result: Findings indicate that the pre-post difference in mean scores for the treatment group was statistically significant, with large effect sizes across all measures and suggests that findings are comparable with results for other currently accepted, empirically supported treatments of distress in women with breast cancer. Findings from qualitative outcomes are broadly consistent with the literature on the qualitative aspects of humanistic and experiential therapies to date (Timulak & Creaner, 2010). Case accounts establish core painful emotion schemes and track the transformation of emotion schemes across therapy sessions, with verbatim clinical interactions provided to illustrate change and explore the potential implications of these findings. The current study supports EFT’s case formulation of depression and anxiety, and contributes a conceptual framework around the particularities of loneliness, shame, maladaptive guilt and disenfranchised losses that are part of the core painful experiences in women with breast cancer and CAD. Conclusion: From a review of the six case studies, the results of the current study appear promising, suggesting that both EFT theory and CAD in women with breast cancer, and EFT theory of treatment for CAD in women with breast cancer warrant further examination. An examination of qualitative and quantitative results indicates that therapy appears to have been effective, to varying degrees across all cases. A significant amount of material concerning therapy process in terms of case conceptualisation and emotion transformation has contributed to the development of EFT as a treatment for CAD in women with breast cancer.