Psychopathological abnormalities like dissociative states, depressive and anxiety disorders are expected in patients with breast cancer compromising quality of life and course of tumor development. Due to the impact of cancer in the life of the patients several studies showed the importance and the goodness of the different psychiatric and psychotherapeutic interventions. Scientific literature confute the notion that several conditions are inevitable and therefore do not require treatment. Often most important factor precluding treatment for cancer patients is the misconception that for such patients being depressed or being anxious is normal.
The principal aim of our research project will be to define individual risk profiles of psychiatric suffering, using several psychometrics instruments and a structured interview (Dissociative Experiences Scale (DES) Zung Self-Rating Depression Scale (SDS) Zung Self-Rating Anxiety Scale (SAS) -Patient Dignity Inventory (PDI) - Raven's Standard Progressive Matrices (SPM) - Structured Clinical Interview for DSM-5 Clinical Version (SCID-5) among breast cancer patients. Moreover, we would like to ensure to our patients a hyper-specialized psychological assistance delivering a short psychotherapy based on Dignity therapy (DT). All female breast cancer patients who underwent to surgical intervention that reported scars or amputations consecutively admitted, over the study period, to the Breast Unit of Policlinico Umberto I, will be invited to participate to the research. Study design: a randomized-controlled cross-over study comparing DT versus a control intervention (Psychoeducation). Eight sessions in a two-months period for the two groups to complete the assigned treatment. In order to evaluate the effectiveness of DT all patients will be revalued after the last session and then again during two follow-up sessions 4 weeks and 8 weeks. Subsequently each group will receive the second treatment within 8 weeks.
Non-pharmacological therapies are by definition those treatments that are not registered as drugs but anyway they showed the improve patients' health, acting on the hypothalamic-hypophyseal-adrenal axis. An example of these is talking therapies, which may include meeting with a counselor, a health educator and/or survivors. In comparison with pharmacological antidepressants, non-pharmacological therapies do not interfere with cancer primary treatment or generate adverse reactions [Ostuzzi G et al., 2015] and are more frequently preferred by patients [Wu SM et al., 2014].
The Dignity therapy introduces a novel, brief, psychotherapeutic approach based on an empirically validated model of dignity among cancer patients, even not exclusively it is particularly useful, initially employed only in the terminally ill subjects.
Recent studies introduced Dignity therapy also in different patient groups. In several unit cancer the Dignity therapy [Buonaccorso L et al., 2012; Buonaccorso L et al., 2014; Maruelli A & Buonaccorso L, 2014] is used in oncological rehabilitation; the latter intended as the long journey from diagnosis, to treatments, to remission or relapse until the end life care. In this context, being the therapy of dignity used in a phase of illness other than palliative care, it aims at different goals. Indeed our intention is to use a version is intentionally focused on the specific dimensions and targets like: emotionally dependency, physical distressing symptoms, psychological distressing symptoms, uncertainty about illness and treatments, self continuity, roles maintenance, self-pride, optimist, resilience and fighting spirit, normalcy continuation, spirituality.
The Dignity therapy in oncological rehabilitation could have an important role in adapting to cancer on several aspects: reduce anxiety and depression, search for meaning post-traumatic, reinforce personal resources, new sense of identity, new role and emotional experience.
At the present time there are few researches on this kind of treatment in the early phases of breast cancer. Thus, our study would contribute to validate a new approach of brief psychotherapy for cancer patients.