William Breitbart, M.D. is Chairman, The Jimmie C Holland Chair in Psychiatric Oncology, and Chief of the Psychiatry Service, Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY. He is the 2009 recipient of the Arthur Sutherland Lifetime Achievement Award for the International Psycho-oncology Society, the 2011 recipient of the Thomas Hackett Award for Lifetime Achievement from the Academy of Psychosomatic Medicine, and the 2013 recipient of the Jimmie Holland Award from the American Psychosocial Oncology Society. Dr Breitbart is a Past President of the Academy of Psychosomatic Medicine, as well as the International Psycho-oncology Society. Dr. Breitbart's research efforts have focused on psychiatric aspects of cancer and palliative care. He has had continuous NIH RO1 funding of investigator initiated research since 1989. His most recent efforts have focused on Meaning-Centered Psychotherapy for cancer patients. He has over 400 peer review publications, chapters and review papers. Dr. Breitbart has edited/written 10 textbooks including: Psycho-oncology - 1st , 2nd and 3rd Editions; and treatment manuals on Meaning-Centered Group Psychotherapy in Advanced Cancer Patients, and Individual Meaning-Centered Psychotherapy for Advanced Cancer Patient. Dr. Breitbart is Editor-in-Chief, of Cambridge University Press’ international palliative care journal entitled, “Palliative & Supportive Care”.
Questions and Answers
The intervention treatment manual has been published by Oxford University Press, and it is an accurate representation of the manualized treatment intervention that we studied in two randomized clinical trials which demonstrated efficacy in improving spiritual well-being, quality of life and diminishing depression, anxiety, hopelessness, desire for hastened death and physical symptom distress. This was mediated through an enhancement in the patient’s sense of meaning. The program, as described and outlined in the manual is somewhat structured, but allows for some room for clinicians using the intervention to interject psychotherapy techniques that might be considered more cognitive and behavioral in nature, or emotion focused, supportive, etc. An emphasis on existential psychotherapeutic concepts is more consistent with the focus of enhancing meaning in this treatment program. In utilizing the experiential exercises that are part of each session, therapists can choose to change the language slightly for clarity, or may focus on fewer stimulus questions in order to focus the sessions. There are some elements of the intervention that can also be de-emphasized or eliminated. These include the reading of Viktor Frankl’s Man’s Search for Meaning, or the focus on the creation of a Legacy project. What I recommend not be changed is the structure of the intervention where each session contains a didactic as well as an experiential component. The order of sessions is probably also something that should not be changed drastically, although there can be the option of changing the order of the middle sessions which focus on sources of meaning.
The facilitators to implementation include some training or background in existentially oriented psychotherapy. We are currently conducting 2 day intensive trainings in Meaning Centered Psychotherapy for clinicians, funded by NCI R25CA190169 at memorial Sloan Kettering Cancer Center. Clinicians interested in training can email firstname.lastname@example.org. In addition Oxford University has published the treatment manual for “Meaning Centered Group Psychotherapy for Patients with Advanced Cancer by WS Breitbart and SR Poppito.” In December 2016, Oxford University Press will publish a comprehensive new textbook entitled “ Meaning Centered Psychotherapy in the Cancer Setting, (W. Breitbart, Editor). The challenges to implementing the intervention reside in the fact that group interventions for patients with far advanced cancer are susceptible to attrition due to illness and death of group members. Implementation is facilitated by selecting patients who are ambulatory, have a life expectancy of at least 6 months and who do not have serious impediments to participations such as extensive travel, or competing scheduled treatments.
We do use treatment adherence measures for interventionists and these are included in the treatment manual for Meaning Centered Group psychotherapy. Common patient outcome measures that we have used in our clinical trials are available in our papers published in the Journal Of Clinical Oncology in 2015. We have used measures of spiritual well –being ( the Facit Spiritual Well Being Scale) to assess meaning and spiritual well being. Measures of depression, anxiety, hopelessness, quality of life, Symptom burden and distress, or desire for hastened death can also be used. The following paper contains the details of measures we have used in clinical trials: Breitbart W, Rosenfeld B, Pessin H, Lichtenthal W, Applebaum A, Kulikowski J. Meaning-Centered Group Psychotherapy: An effective intervention for reducing despair in patients with advanced cancer. J Clin Oncol 33(7):749-54, 2015. PMCID: PMC4334778.
We are currently focused on adaptations of meaning Centered Psychotherapy in different cancer populations and for different outcomes. My research group within the Psychotherapy Laboratory in the Department of Psychiatry and Behavioral Sciences at Memorial Sloan Kettering Cancer Center is currently conducting studies on the following adaptations of meaning Centered Psychotherapy ( MCP): MCP for Caregivers of cancer patient; MCP for Breast cancer Survivors; MCP for Bereavement; MCP for Adolescents and Young Adults, MCP for Hospice care; MCP linguistic and cultural adaptations for mandarin speaking Chinese immigrants, and for Spanish Speaking Latino Immigrants.