Comparing the Effectiveness of Psychodynamic Group Psychotherapy and Mindfulness-Based Stress Reduction on the Sense of Coherence and Death Anxiety in Patients with Colon Cancer

Colon cancer, being a prevalent and life-threatening illness, has consistently garnered the attention of healthcare centers. According to statistics published by the World Health Organization, 2.8 million deaths in 2018 were attributed to this disease, making it the second leading cause of cancer-related deaths (1). The diagnosis of cancer is often accompanied by an increased risk of common mental disorders, which may negatively impact treatment, recovery, quality of life, and survival (3). It may also lead to psychological coherence breakdown (4). Antonovsky introduced the concept of a sense of coherence in 1970 (5). Through a sense of coherence, it can be explained why an individual can withstand high-stress levels and remain healthy (7). Additionally, one of the psychological problems in cancer patients is death anxiety (10). According to Hong et al., cancer patients are at a high risk of death anxiety in facing various challenges, with 32% of advanced cancer patients showing death anxiety. Abnormally high levels of death anxiety can lead to psychological disorders and the avoidance of medical care (12). Accordingly, mindfulness is one of the psychological interventions with extensive evidence supporting its effectiveness in improving mental functioning in clinical and non-clinical populations (14). This treatment enables individuals to understand their experiences without judgment and change their relationships with others by accepting their beliefs and emotions (17). The use of group therapy is also a common therapeutic approach to reduce psychological distress and improve physical functioning in chronic patients (21). The goal of the Psychodynamics approach is to bring unconscious levels to consciousness. Dynamic therapists often bridge between reality and imagination, unconscious and conscious, logical and illogical, and thoughts and emotions (22). According to this approach, the presence of others increases the possibility of self-disclosure and provides an opportunity to observe internal problems (23). So far, no systematic study has been conducted in Iran on the impact of two dynamic group psychotherapy interventions on the sense of coherence and death anxiety in patients with colon cancer. Therefore, this research aims to determine whether there exists a difference between the effectiveness of dynamic group psychotherapy and mindfulness-based stress reduction therapy on the sense of coherence and death anxiety in patients with colon cancer.

This quasi-experimental research adopted a pretest-posttest control group design with follow-up. The statistical population included all patients with colon cancer treated at the Poursina-Hakim Treatment Center in Isfahan during the spring of 2022. Among them, 42 were selected using Purposive sampling and assigned randomly to one of three 14-member groups: the mindfulness-based stress reduction group (receiving 8 treatment sessions), the psychodynamic therapy group (receiving 12 treatment sessions), and the control group. The research instruments included the Sense of Coherence (SOC) Scale and the Death Anxiety Scale (DAS). The research data were analyzed using repeated measures ANOVA and the Bonferroni post hoc test in SPSS version 26.

The results demonstrated a significant difference in the average scores of the resource between the experimental and control groups in the post-test (F=5.68, P=0.007) and follow-up (F=4.72, P=0.015) assessments of sense of coherence, as well as in the post-test (F=4.37, P=0.020) assessment of death anxiety after eliminating pre-test effects . Additionally, the Bonferroni follow-up test revealed that both interventions effectively and equally increased the sense of coherence in patients, with these positive effects persisting over time (P<0.05). However, only dynamic group psychotherapy significantly reduced patients' death anxiety (P<0.05), although this effect did not remain stable over time.

To explain the effectiveness of mindfulness-based stress reduction therapy in improving the sense of coherence among cancer patients, it is important to note that mindfulness aims to cultivate non-judgmental awareness of the present moment. This can lead to considerable changes in the lives of patients and their psychological functioning. Developing defense mechanisms, and confronting and accepting physical and psychological challenges resulting from the illness, also contributes to improving psychological well-being and increasing internal coherence (38). Consequently, mindfulness moderates emotions without judgment increases cancer patients’ awareness of their mental and physical experiences, and helps them clearly see and accept their emotions and physical challenges as they occur (40). To elucidate the research findings on the effectiveness of dynamic group psychotherapy on cancer patient's sense of coherence and death anxiety, it's worth noting that the primary aim of group analytical therapy is to promote interaction among group members and enhance their awareness of group dynamics and individual intrapsychic conflicts (23). Group psychotherapy, in fact, encourages patients to access their true emotions by addressing their defense mechanisms, which often involve avoiding genuine emotional experiences and emotional intimacy due to past unsuccessful encounters. Indeed, a group serves as an environment that encourages participants to tap into their coping resources and, through self-disclosure, share their conflicts and stress-related experiences with others. This process helps dismantle emotional resistance and unveil ineffective defense mechanisms. One limitation of this study is its focus on colon cancer patients. Hence, caution should be exercised when generalizing the results to other patients with specific and chronic illnesses. Finally, considering the obtained results, it is recommended to conduct dynamic group psychotherapy sessions and mindfulness-based stress reduction therapy in hospitals, clinics, and medical centers to enhance coherence and psychological well-being and reduce anxiety disorders in cancer patients.