Brief Post-Surgical Stress Management Intervention Effects on Positive Psychological Well-Being and Self-Efficacy in Women Being Treated With Adjuvant Endocrine Therapy for Hormone-Receptor Positive Breast Cancer

Abstract

Background: Women prescribed adjuvant endocrine therapy (AET) for nonmetastatic breast cancer may experience a decline in positive psychological well-being (PPWB) and self-efficacy. Brief cognitive behavioral therapy (CBT) and relaxation training (RT) interventions have shown short-term efficacy in reducing distress, but their impact on PPWB and self-efficacy over longer periods among women prescribed AET is unknown. Aims: We aimed to investigate longitudinal effects of CBT and RT on PPWB and self-efficacy among women prescribed AET. Methods: This secondary analysis of a randomized controlled trial comparing 5-session CBT versus RT versus a time-matched health education (HE) control for women with nonmetastatic breast cancer examined PPWB (positive affect, benefit finding, positive states of mind, optimism), coping self-efficacy, and relaxation self-efficacy at four timepoints over the first-year post-diagnosis and at median 8-year follow-up. Piecewise hierarchical linear modeling tested intervention effects on longitudinal trajectories among women prescribed AET from the parent study (N = 135). Results: Over the first-year post-surgery, positive affect and relaxation self-efficacy increased across all conditions (ps < 0.03). Women in CBT reported enhanced positive states of mind compared to those in HE (p = 0.044) and enhanced coping self-efficacy versus those in RT (p = 0.029). Women in HE reported enhanced coping self-efficacy versus those in RT (p = 0.043). All intervention effects persisted at 8-year follow-up. There were no significant effects on optimism or benefit finding. Conclusions: Brief interventions may bolster aspects of PPWB and self-efficacy in women prescribed AET. Testing is warranted to determine whether more PPWB components can be incorporated into these interventions to further enhance outcomes.