When Cancer Takes a Toll on Your Mental Health, This Type of Therapy Can Help

Key Takeaways

• A meta-analysis of over 130 studies showed that cognitive behavioral therapy (CBT) was effective in improving mental health for cancer patients and survivors.
• This effect seemed to be stronger for younger people diagnosed with cancer.
• Cognitive behavioral therapy was more effective when delivered in person compared with virtually via telehealth or app.

Cognitive behavior therapy (CBT) improves mental health and quality of life for people with cancer and cancer survivors, a new systematic review found.

Those benefits were seen for people with all types of cancer , though the impact appeared stronger for younger people, and for in-person sessions compared with virtual ones.

The latest findings confirm that CBT can be helpful for many people to cope with the negative feelings that come up while living with cancer, says corresponding author Anao Zhang, PhD , an assistant professor of social work at the University of Michigan in Ann Arbor.

The analysis could also be used to identify people who could be most helped by CBT, which could impact how people are treated during and after their cancer treatment, says Dr. Zhang.

What Is Cognitive Behavioral Therapy (CBT)?

CBT is a type of psychotherapy that focuses on changing negative thought patterns and behaviors. It aims to help people identify and reevaluate any distorted, unhelpful, or inaccurate thought patterns that are negatively impacting their emotions or behavior.

"Imagine you're a woman sitting in her doctor's office who's just been told they have breast cancer. That's when intrusive thoughts can take over for a lot of patients," says Ian Sadler, PhD , a psychosocial oncology specialist at the Columbia University Cancer Center in New York City.

And unfortunately, many people, especially women, tend to blame themselves, says Dr. Sadler, who wasn't involved in the new research.

"They may think things like, ‘This is my fault because I smoked cigarettes in college,' or ‘I drank too much,' or ‘I didn't eat an organic diet.' So they have a lot of these negative thoughts come in," he says.

CBT therapy asks patients to acknowledge those thoughts and then gently challenge them, says Sadler.

"You can't stop them; these thoughts are going to come at us. We are designed as human beings to be ready for threats. It's our sympathetic nervous system doing what it's supposed to do," he says.

CBT Study Used Data From Over 13,000 People in Over 100 Trials

To assess the impact of CBT compared with other interventions like standard therapy, researchers used data from over 13,000 participants in about 130 trials. Subjects were between the ages of 4 and 76, with an average age of 58 years old, and 79 percent were female.

The analysis revealed that CBT moderately improved depression and anxiety in people with past or current cancer, regardless of cancer type. The treatment effects for quality of life improvements were small.

Researchers found that when CBT was delivered virtually, whether via telehealth or an app, the benefits for either mental health or quality of life were statistically nonsignificant, a finding which needs further investigation, according to the authors.

The authors also analyzed the benefits according to the age of the cancer patient or survivor and placed people into one of three groups: 4 to 39, 40 to 64, and 65 and older.

They found that while CBT was beneficial in the two younger groups for both quality of life and mental health, it was statistically ineffective for seniors. Given that the majority of people diagnosed with cancer are older, this finding is concerning and requires more investigation, the authors wrote.

This doesn't mean that CBT can't be highly effective for an older cancer population, but it may mean therapists may need better training to overcome potential obstacles, such as generational mismatches between clinician and patient, says Zhang.

How Does the New Research Match What's Already Known?

These findings are consistent with a number of other meta-analyses on CBT for cancer patients that show that the therapy can help with mood, anxiety, and quality of life, says Barbara Andersen, PhD , a professor in psychology and clinical psychologist who studies the biobehavioral aspects of cancer at The Ohio State University in Columbus.

Dr. Andersen suspects that the modest improvements in quality of life are likely because the quality of life measures used in most studies are "not particularly good" at measuring CBT's effectiveness.

"It's not because CBT doesn't make a positive impact on quality of life - it does so very directly in terms of changing negative mood and affect," says Andersen, who was not involved in the meta-analysis.

Andersen has doubts about the age-related findings of the study.

"That subgroup analysis finding may be because of how the researchers analyzed the data," she says.

For example, putting children as young as four years old in the same group as people in their thirties to look at CBT's impact seems problematic, says Andersen.

Here's How CBT Can Help People With Cancer Face Everyday Challenges

In CBT, it's helpful to picture a triangle, with thoughts, emotions, and behaviors at each corner, says Sadler. To illustrate, he offers an example of a patient coming home from a chemotherapy session who doesn't want to get out of bed.

"They may think, ‘I just want to stay under these covers and never wake up. What's the point of getting up? I feel horrible,'" he says.

That can lead to an emotion like sadness, anger, or hopelessness, and those emotions can reinforce the behavior of lying in bed. Behaviors impact thoughts and vice versa, and the same is true for emotions, Sadler explains.

"In CBT, we're trying to train the patient to identify where they're at. So in this case, when they feel like staying in bed, the thing they may actually need to do is get out of bed and get dressed and showered," he says.

It's not a bad thing to occasionally stay in bed if you feel you need to, but in many cases getting up and starting your day may help you get your thoughts out of the negative range and help you start to feel better, says Sadler.

That being said, CBT is not about always being positive or strong or avoiding your negative thoughts, he says.

"It's about learning to become a really astute observer of what's coming your way and identifying a negative thought and saying, ‘Wait a minute, that's not a helpful thought. I'm giving way too much time to it,'" says Sadler.

If you've gone through CBT, you've likely learned about methods that can help you stop ruminating.

"Try to do some mindful breathing for the next minute or two and allow those thoughts to move on. Realize that if you get pulled into that thought, you could spend the next five hours in a narrative that is pretty bad. But if you can learn how to recognize it, you have the ability to let it go and move on," says Sadler.

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Sources

1. Dils AT et al. The Efficacy of Cognitive Behavior Therapy for Mental Health and Quality of Life Among Individuals Diagnosed with Cancer: A Systematic Review and Meta-Analysis. Cancer Medicine . August 21, 2024.
2. Cognitive Behavioral Therapy (CBT). Cleveland Clinic . August 4, 2022.

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Becky Upham

Author

Becky Upham has been professionally involved in health and wellness for almost 20 years. She's been a race director, a recruiter for Team in Training for the Leukemia & Lymphoma Society, a salesperson for a major pharmaceutical company, a blogger for Moogfest, a communications manager for Mission Health, a fitness instructor, and a health coach.

She majored in English at the University of North Carolina and has a master's in English writing from Hollins University.

Upham enjoys teaching cycling classes, running, reading fiction, and making playlists.

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