Running Head: EXISTENTIAL THERAPIES AND CANCER

Existential Therapies and Cancer

Jay Key
Wake Forest University

EXISTENTIAL THERAPIES AND CANCER

Abstract
This paper explores two different existential based therapies, Meaning Centered Group Therapy
and the Meaning-Making Intervention and their impact on wellness and senses of meaning in
patients with severe cancer (Breitbart et al., 2010; Henry et al., 2010). These therapies were
created to increase the amount of empirical testing on existential theory and were compared
versus control therapies and groups. Meaning Centered Group Therapy is a highly structured
group therapy, while the Meaning-Making Intervention is a loosely structured, highly
individualized individual therapy. The Meaning Centered Group Therapy seemed to be effective
with patients with state III or IV cancers at reducing feelings of hopelessness, desire for death,
and anxiety, and increased feelings of optimism. The Meaning-Making Intervention appeared to
increase feelings of meaning in life and reduce levels of anxiety and depression in patients with
stage III or IV ovarian cancer.
Keywords: existential therapy, cancer

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Existential Therapies and Cancer

This research paper looks at the effects of meaning based existential treatment on patients
with advanced stages of cancer. Existential therapies are often not able to be empirically tested,
making it difficult to determine their effectiveness (Vos, Cooper, Correia, & Craig, 2015; Vos,
Craig, & Cooper, 2015). However there have been multiple studies indicating that meaningbased existential therapy can be effective in reducing negative feelings, improving quality of life,
and increasing coping skills in participants with cancer and other stressful health issues (Cain,
Kohorn, Quinlan, Latimer, & Schwartz, 1986; Lee, Cohen, Edgar, Laizner, & Gagnon, 2004;
Lee, Robin Cohen, Edgar, Laizner, & Gagnon, 2006; Payne, Lundberg, Brennan, & Holland,
1997; Spiegel & Yalom, 1978; Vos, Craig, et al., 2015). Breitbart et al. (2010) and Henry et al.
(2010) have both developed treatments that can be empirically tested, and thus proved effective,
on participants with advanced cancer. Because of the increased risk of negative psychopathology
associated with advanced cancer an effective treatment that focuses on meaning and on reducing
suffering can be helpful in clients who have been diagnosed with advanced cancer (Breitbart et
al., 2010; Henry et al., 2010).
Meaning Centered Group Psychotherapy
The research question for Breitbart et al. (2010) was whether Meaning Centered Group
Psychotherapy (MCGP) can positively impact the spiritual well-being and sense of meaning,
while decreasing psychological distress in a patient. Furthermore Breitbart et al. wished to
discern whether MCGP does so more effectively than Supportive Psychotherapy Intervention
(SGP). Meaning Centered Group Psychotherapy is an existential therapy based on the writings of
Viktor Frankl and intended to help patients with advanced cancer sustain or enhance a sense of
meaning, peace and purpose in their lives, even as they confront death (2010). Supportive

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Psychotherapy Intervention was first tested by Spiegel and Yalom (1978), then developed by
Cain et al. (1986) and manualized by Payne et al. (1997) (Breitbart et al., 2010). This
intervention focuses on a supportive existential approach that is designed to support patients and
help them cope with their cancer diagnosis and treatment (Breitbart et al., 2010).
Breitbart et al. (2010) initially recruited 160 patients, of which 90 participated in their
study. All patients were randomized into groups of 8-10 and participated in 8 sessions of either
MCGP or SGP with no control condition. There were 49 randomized to be in the MCGP
condition and 41 randomized to the SGP condition. Patients were recruited from outpatient
clinics at Memorial Hospital in New York City and all had state III or IV solid tumor cancers or
non-Hodgkins lymphoma and were over the age of 18 (2010). The cancer types that were most
common were prostate, breast, colorectal, and lung cancer. Patients were excluded if they had
serious cognitive and physical impairments. The sample had 44 men and 46 women, with an
average age of 60.1 years. There were 72 Caucasian participants, 7 African-American
participants, 4 Hispanic participants, and 7 participants of other ethnic backgrounds.
To determine whether any changes were affected by either the MCGP or the SGP
intervention, Breitbart et al. used data from pre-treatment, post-treatment, and 2-month follow-up
assessment scores from the FACIT Spiritual Well-Being Scale, the Beck Hopelessness Scale
(BHS), the Schedule of Attitudes toward hastened Death (SAHD), the Life Orientation Test
(LOT), and the Hospital Anxiety and Depression Scale (HADS) to assess impact of each
intervention (2010).

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Findings of the Meaning Centered Group Psychotherapy

T-test scores from each time frame for the FACIT SWB were used to compare the impact
of treatment on spiritual well-being and meaning for both treatments (2010). These scores
showed positive MCGP treatment effects for FACIT SWB total score, the Meaning/Peace
subscale, and the Faith subscale, although the Faith subscale changes were not as strong.
However, while SGP participants did increase in their FACIT SWB scores, they were not show
change that was statistically significant. These findings indicate that MCGP is more effective at
increasing the spiritual well-being and sense of meaning in cancer patients than SGP (2010).
Using the pre-treatment and post-treatment scores of the other assessments Breitbart et al.
found modest effects for measures of hopelessness, desire for death, and anxiety for the MCGP
treatment group, meaning that feelings of hopelessness, desire for death and anxiety all
decreased (2010). Members of the MCGP group showed higher increases of optimism than
members of the SGP group. The SGP treatment showed no significant changes in any of the
psychological functioning measures except for a reduced desire for death. There were no
significant differences for improvement on measures of depression, anxiety, or hopelessness
between scores for the MCGP group compared against the SGP group.
Meaning-Making Intervention
The research questions of Henry et al.s study was whether the Meaning-Making
intervention (MMi) could reduce the distress (both existential and general), depression and
anxiety while increasing the self-efficacy and improve overall quality of life of individual
patients who were recently diagnosed with Stage III or IV ovarian cancer (2010). The MMi is a
brief, individualized and manualized therapeutic approach designed to facilitate the search for

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meaning following a cancer diagnosis (2010). It was designed as a meaning based therapy for
patients with cancer that was standardized for empirical testing, something that other meaning
based therapies lack (Lee et al., 2006). It specifically focuses on situational, global, and
existential meaning. Henry et al. further modified it to be an individual treatment that could be
modified to meet patient needs (Henry et al., 2010).
Henry et al. selected 24 patients from three Montreal university teaching hospitals that
had been diagnosed with stage III or IV ovarian cancer in the two months before the study began
and were 18 years or older (2010). Only patients who were able to give consent and were
capable, both physically and emotionally, capable of participating were included in the study.
Patients were randomly assigned into either the treatment or the control groups (2010).
Henry et al. used the FACIT-Sp-12 Meaning subscale, the McGill Quality of Life
Questionnaire (MQOL) Existential subscale, the Hospital Anxiety and Depression Scale
(HADS), and the General Self-Efficacy Scale (GSES) to measure outcomes (2010). Scores were
acquired before patients were randomized into groups and at one and three months postintervention.
Findings of the Meaning-Making Intervention
Based off of scores from the FACIT-Sp-12 Meaning subscale patients in the MMi group
experienced higher feelings of meaning in life than patients in the control group both 1 month
and 3 months after undergoing the intervention (2010). The MQOL only showed changes in
feelings of meaning after 3 months, but did show positive changes in quality of life in the MMi
group that were not found in the control group. In addition to this, HADS scores possibly showed
that the MMi could reduce levels of anxiety and depression in cancer patients more effectively

EXISTENTIAL THERAPIES AND CANCER

than the control group after 3 months. No differences were found in self-efficacy after patients
finished the MMi.
Comparison
The most obvious comparison between the two studies was that both Breitbart et al.
(2010) and Henry et al. (2010) used meaning based therapy as an experimental group for patients
with advanced cancer. They were both pilot trials to determine how effective each intervention
might be before broader use. Both studies used part of the FACIT Scale and the Hospital Anxiety
and Depression scale to measure changes in patients. There was also a significant positive
change in meaning in both studies (2010, 2010).
Contrast
While both studies are meaning based interventions, Breitbart et al.s (2010) MCGP is
group therapy while Henry et al.s MMi is individual therapy. Breitbart et al.s MCGP is also 8
sessions and not flexible, while Henry et al.s MMi lasts 1-4 sessions and can be modified to
better suit the patient. Henry et al. used only one type of cancer, ovarian, and Breitbart et al. used
multiple types of cancer. Each study also used different outcomes and assessments to validate
their study, with Breitbart et al. measuring different aspects of meaning than Henry et al. Lastly
Henry et al. measured outcomes at one month and three months after completion of the
intervention, while Breitbart et al. measured outcomes two months after completion of the
intervention.
Implications
The primary implication of these studies are that both MCGP and MMi can increase
feelings of meaning in clients who are diagnosed with advanced stages of cancer. Both of these

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therapies, and other meaning based therapies, have shown to be both positively impactful on
psychopathology and improving on quality of life after participants have finished each
intervention(Breitbart et al., 2010; Henry et al., 2010; Vos, Craig, et al., 2015). Because of these
positive impacts, it is therefore likely that either MCGP or MMi could be used on future clients
to improve their lives after they have been diagnosed with advanced stages of cancer, easing their
suffering.
Because MCGP and MMi are structured differently, with MCGP being a highly
structured group therapy and MMi being a flexible individual therapy, it is possible that a wider
range of clients could have their needs met by being adept at both therapies. A client who might
excel with individual therapy may not receive as much benefit from MCGP, while a client who
requires the structure of MCGP might not finish the flexible MMi. In the same vein a counselor
who is more effective with group therapy can still use a meaning based therapy with clients with
cancer, while another counselor who is more effective at individual therapy can use MMi with
those same clients.
One possible negative implication is that neither MCGP nor MMi are as effective with
reducing psychopathology such as depression. This might mean that other techniques or
therapies might be necessary to alleviate suffering. How those other therapies effect the outcome
of MCGP or MMi is unclear at this time.
Limitations
The primary limitation of both studies were the small sample sizes. Because they were
pilot studies, Breitbart et al. (2010) had 49 patients undergo the MCGP intervention, while Henry
et al. (2010) had 12 patients undergo the MMi. Having a larger and more diverse (in terms of

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both demographics and presenting concern) sample for each group could allow for clearer effects
shown by each therapy and could allow for a measure of generalizability to patients with
advanced cancer or the population in general. There was also little information on patients who
had dropped out of each sample, which could imply a limitation to the effectiveness of either
therapy due to an inability of potential participants to complete the therapies. Studies could
further be improved with information about people who dropped out from their studies.
There was also a lack of information related to the demographics of each sample. Henry
et al. did not include race, gender, or other demographic information in their article. Neither
article provided information on how different demographic information might impact outcomes
such as gender and meaning.
Future Research
A primary concern for future research in meaning based therapy with cancer is increasing
the sample size for both MCGP and MMi to reduce error and increase generalizability. The level
that other factors, such as race and gender, might play in the outcomes of either therapy is not
known. An increase in participants might also shed light on whether type of cancer changes how
effective either therapy. Furthermore it is unclear if MCGP or MMi can be effective as therapy
for presenting concerns aside from advanced cancer.

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