Am J Psychiatry 163:10, October 2006
Reduction of Cancer-Specific Thought Intrusions and
Anxiety Symptoms With a Stress Management Intervention
Among Women Undergoing Treatment for Breast Cancer
Michael H. Antoni, Ph.D.
Sarah R. Wimberly, M.S.
Suzanne C. Lechner, Ph.D.
Aisha Kazi, M.S.
Tammy Sifre, Ph.D.
Kenya R. Urcuyo, M.S.
Kristin Phillips, M.S.
Roselyn G. Smith, Ph.D.
Vida M. Petronis, Ph.D.
Sophie Guellati, Ph.D.
Kurrie A. Wells, M.S.
Bonnie Blomberg, Ph.D.
Charles S. Carver, Ph.D.
After surgery for breast can-
cer, many women experience anxiety
relating to the cancer that can adversely
affect quality of life and emotional func-
tioning during the year postsurgery.
Symptoms such as intrusive thoughts may
be ameliorated during this period with a
structured, group-based cognitive behav-
A 10-week group cognitive be-
havior stress management intervention
that included anxiety reduction (relax-
ation training), cognitive restructuring,
and coping skills training was tested
among 199 women newly treated for
stage 0-III breast cancer. They were then
followed for 1 year after recruitment.
The intervention reduced re-
ports of thought intrusion, interviewer
ratings of anxiety, and emotional distress
across 1 year significantly more than was
seen with the control condition. The ben-
eficial effects were maintained well past
the completion of adjuvant therapy.
cognitive behavior stress management
may ameliorate cancer-related anxiety
during active medical treatment for
breast cancer and for 1 year following
treatment. Group-based cognitive behav-
ior stress management is a clinically use-
ful adjunct to offer to women treated for
(Am J Psychiatry 2006; 163:1791–1797)
pproximately 216,000 new cases of breast cancer were
diagnosed in the United States in 2004 (1). Diagnosis and
treatment of breast cancer are clearly stressful events (2) in-
volving invasive medical procedures with aversive side ef-
fects of treatment such as pain, nausea, vomiting, and fatigue
(3). Recurring thoughts about the diagnosis and treatment
are common (4). Although diagnostic levels of posttraumatic
stress disorder (PTSD) are relatively rare (5), PTSD-like symp-
toms and subthreshold levels of PTSD are more frequent (6,
7). After treatment, many survivors experience residual psy-
chological strain from the diagnosis, shifts in social support,
fear of recurrence, and fear of death (8).
Factors that influence distress after breast cancer treat-
ment include coping style and social support (6, 9, 10).
Prospective studies reveal that optimism (11), coping
strategies such as positive reframing and acceptance (11,
12), and social support (13) yield less distress in the
months after treatment. Similarly, psychosocial interven-
tions that foster optimistic appraisals, build coping strate-
gies, and bolster social support should benefit women
treated for breast cancer (14).