CBT for Breast Cancer Survivors? Nursing Student’s Doctoral Project Shows Promise

• A University of Central Florida nursing student’s doctoral scholarly project looks at the effects of CBT for breast cancer survivors.
• Cognitive Behavioral Therapy focuses on changing behavioral and thinking patterns.
• The project, according to UCF, is the first of its kind to look at the use of CBT in a breast cancer survivorship program.

A focus on cognitive behavioral therapy (CBT) could help breast cancer survivors manage anxiety and other mental health concerns.

That’s what Kaitlyn Hall, a University of Central Florida nursing student, discovered through her doctoral scholarly project at Orlando Health Cancer Institute’s Breast Cancer Survivorship Clinic.

“A lot of people think that medication is the go-to when it comes to mental health, but not everyone wants to take medication,” Hall stated in a university news release, “and for patients, medication can only take them so far. Cognitive behavioral techniques are things a patient can use that isn’t medication; these can be done at home, without having to go to a doctor.”

The study focuses on an aspect of the oncology specialty that nurses address on a regular basis — trying to evaluate a patient’s mental health — and builds on similar research about the effects CBT on breast cancer patients. 

CBT for Breast Cancer Survivors 

Hall conducted anxiety screenings on breast cancer survivors using the GAD-7, a scoring guide for general anxiety disorder. Anyone whose results “indicated the presence of mild to severe anxiety” received a booklet about CBT that featured information on meditation, breathing techniques, and other holistic resources, according to UCF. 

The American Psychological Association states that CBT treatment focuses on changing behavioral and thinking patterns, including the following strategies: 

• Gaining a better understanding of the behavior and motivation of others. 
• Using problem-solving skills to cope with difficult situations. 
• Using role playing to prepare for potentially problematic interactions with others. 
• Learning to calm one’s mind and relax one’s body. 

 Most patients who received the booklets showed a “statistically significant decrease” in anxiety about one month later.

The project, according to UCF, is the first of its kind to look at the use of CBT in a breast cancer survivorship program. Associate lecturer Jonathan Decker, Hall’s project committee chair, said the project exceeded his expectations.

“When you have anxiety, it can be frustrating and you want tools right then, right now,” Decker said. “Being able to give patients that was huge, and I’m excited about where the next steps of this project could lead.” 

Intersection of Mental Health and Breast Cancer

More than 300,000 people were estimated to have been newly diagnosed with breast cancer in the United States, according to 2023 data from the American Cancer Society. Breast cancer also ranked No. 2 for estimated deaths for women, though the mortality rate for females with a breast cancer diagnosis peaked in 1989 and, as of 2000, decreased more than 40%. 

Multiple studies have found a high prevalence of depression and anxiety among breast cancer patients — something research organizations and advocacy groups recognize. Breast Cancer Now, for example, provides resources, including information on CBT, to help manage symptoms of either diagnosis. 

Current Assessment Protocols

One study, published in “Integrative Cancer Therapies,” looked at the use of CBT to treat depression and anxiety among early-stage breast cancer patients and found only moderate improvements. However, the authors noted there were “methodological and clinical shortcomings” in the trials they reviewed.

Other researchers have examined the cross-section of mental health and breast cancer diagnoses, particularly how oncology nurses approach conversations about mental health with their patients.

A 2019 study found that nurses rely on “a number of emotional and behavioral indicators to assess distress,” but most notable was that the sole strategy to identify distress was asking patients directly.

“When I feel there’s mental health distress but the patient hasn’t talked about it, I sometimes check,” one respondent stated. “I can say something like: ‘It sounds like you’re very worried about X, Y, Z.,’ or I’m asking: ‘Are you feeling in distress? Are you feeling depressed?’”

Respondents also said that patients concealing their distress, a lack of training, and time constraints hindered their ability to accurately identify mental health concerns.

A separate study published three years later confirmed the importance of a “psychological nursing intervention” for breast cancer patients.

An investigation of the Rehabilitation After Breast Cancer (REBECCA) nurse navigation intervention found that breast cancer patients who were “psychologically vulnerable” experienced some, but not a significant, reduction in distress.

“The effect sizes were small, but effects were especially pronounced in subgroups with social vulnerabilities, and patient satisfaction was high,” the authors stated. 

The Bottom Line

A University of Central Florida nursing student’s doctoral scholarly project examined the use of cognitive behavioral therapy to address anxiety among breast cancer survivors. The research builds on other scholarly work that examines the relationship between mental health and a breast cancer diagnosis — particularly how exactly oncology nurses broach the subject of mental health with their patients. 

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