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Potential mechanisms of the fatigue‐reducing effect of cognitive‐behavioral therapy in cancer survivors: Three randomized controlled trials.

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Title: Potential mechanisms of the fatigue‐reducing effect of cognitive‐behavioral therapy in cancer survivors: Three randomized controlled trials.
Authors: Müller, Fabiola (AUTHOR), Wijayanto, Feri (AUTHOR), Abrahams, Harriët (AUTHOR), Gielissen, Marieke (AUTHOR), Prinsen, Hetty (AUTHOR), Braamse, Annemarie (AUTHOR), van Laarhoven, Hanneke W.M. (AUTHOR), Groot, Perry (AUTHOR), Heskes, Tom (AUTHOR), Knoop, Hans (AUTHOR)
Source: Psycho-Oncology. Sep2021, Vol. 30 Issue 9, p1476-1484. 9p. 2 Diagrams, 2 Charts.
Subjects: Cognitive therapy, Treatment effectiveness, Cancer survivors, Cancer treatment, Mental depression, Sleep interruptions, Classical test theory, Pain catastrophizing
Abstract: Objective: Fatigue is a common symptom among cancer survivors that can be successfully treated with cognitive‐behavioral therapy (CBT). Insights into the working mechanisms of CBT are currently limited. The aim of this study was to investigate whether improvements in targeted cognitive‐behavioral variables and reduced depressive symptoms mediate the fatigue‐reducing effect of CBT. Methods: We pooled data from three randomized controlled trials that tested the efficacy of CBT to reduce severe fatigue. In all three trials, fatigue severity (checklist individual strength) decreased significantly following CBT. Assessments were conducted pre‐treatment and 6 months later. Classical mediation analysis testing a pre‐specified model was conducted and its results compared to those of causal discovery, an explorative data‐driven approach testing all possible causal associations and retaining the most likely model. Results: Data from 250 cancer survivors (n = 129 CBT, n = 121 waitlist) were analyzed. Classical mediation analysis suggests that increased self‐efficacy and decreased fatigue catastrophizing, focusing on symptoms, perceived problems with activity and depressive symptoms mediate the reduction of fatigue brought by CBT. Conversely, causal discovery and post‐hoc analyses indicate that fatigue acts as mediator, not outcome, of changes in cognitions, sleep disturbance and depressive symptoms. Conclusions: Cognitions, sleep disturbance and depressive symptoms improve during CBT. When assessed pre‐ and post‐treatment, fatigue acts as a mediator, not outcome, of these improvements. It seems likely that the working mechanism of CBT is not a one‐way causal effect but a dynamic reciprocal process. Trials integrating intermittent assessments are needed to shed light on these mechanisms and inform optimization of CBT. [ABSTRACT FROM AUTHOR]
Copyright of Psycho-Oncology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Psychology and Behavioral Sciences Collection
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  Data: Potential mechanisms of the fatigue‐reducing effect of cognitive‐behavioral therapy in cancer survivors: Three randomized controlled trials.
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  Data: <searchLink fieldCode="AR" term="%22Müller%2C+Fabiola%22">Müller, Fabiola</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Wijayanto%2C+Feri%22">Wijayanto, Feri</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Abrahams%2C+Harriët%22">Abrahams, Harriët</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Gielissen%2C+Marieke%22">Gielissen, Marieke</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Prinsen%2C+Hetty%22">Prinsen, Hetty</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Braamse%2C+Annemarie%22">Braamse, Annemarie</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22van+Laarhoven%2C+Hanneke+W%2EM%2E%22">van Laarhoven, Hanneke W.M.</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Groot%2C+Perry%22">Groot, Perry</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Heskes%2C+Tom%22">Heskes, Tom</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Knoop%2C+Hans%22">Knoop, Hans</searchLink> (AUTHOR)
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  Data: <searchLink fieldCode="JN" term="%22Psycho-Oncology%22">Psycho-Oncology</searchLink>. Sep2021, Vol. 30 Issue 9, p1476-1484. 9p. 2 Diagrams, 2 Charts.
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  Data: <searchLink fieldCode="DE" term="%22Cognitive+therapy%22">Cognitive therapy</searchLink><br /><searchLink fieldCode="DE" term="%22Treatment+effectiveness%22">Treatment effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Cancer+survivors%22">Cancer survivors</searchLink><br /><searchLink fieldCode="DE" term="%22Cancer+treatment%22">Cancer treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Mental+depression%22">Mental depression</searchLink><br /><searchLink fieldCode="DE" term="%22Sleep+interruptions%22">Sleep interruptions</searchLink><br /><searchLink fieldCode="DE" term="%22Classical+test+theory%22">Classical test theory</searchLink><br /><searchLink fieldCode="DE" term="%22Pain+catastrophizing%22">Pain catastrophizing</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: Objective: Fatigue is a common symptom among cancer survivors that can be successfully treated with cognitive‐behavioral therapy (CBT). Insights into the working mechanisms of CBT are currently limited. The aim of this study was to investigate whether improvements in targeted cognitive‐behavioral variables and reduced depressive symptoms mediate the fatigue‐reducing effect of CBT. Methods: We pooled data from three randomized controlled trials that tested the efficacy of CBT to reduce severe fatigue. In all three trials, fatigue severity (checklist individual strength) decreased significantly following CBT. Assessments were conducted pre‐treatment and 6 months later. Classical mediation analysis testing a pre‐specified model was conducted and its results compared to those of causal discovery, an explorative data‐driven approach testing all possible causal associations and retaining the most likely model. Results: Data from 250 cancer survivors (n = 129 CBT, n = 121 waitlist) were analyzed. Classical mediation analysis suggests that increased self‐efficacy and decreased fatigue catastrophizing, focusing on symptoms, perceived problems with activity and depressive symptoms mediate the reduction of fatigue brought by CBT. Conversely, causal discovery and post‐hoc analyses indicate that fatigue acts as mediator, not outcome, of changes in cognitions, sleep disturbance and depressive symptoms. Conclusions: Cognitions, sleep disturbance and depressive symptoms improve during CBT. When assessed pre‐ and post‐treatment, fatigue acts as a mediator, not outcome, of these improvements. It seems likely that the working mechanism of CBT is not a one‐way causal effect but a dynamic reciprocal process. Trials integrating intermittent assessments are needed to shed light on these mechanisms and inform optimization of CBT. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
  Label:
  Group: Ab
  Data: <i>Copyright of Psycho-Oncology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Value: 10.1002/pon.5710
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        Text: Welsh
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      – SubjectFull: Cancer survivors
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              Text: Sep2021
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