Family therapy and other psychological treatments may help reduce symptoms of post-traumatic stress among teenaged survivors of childhood cancer--as well as among their parents.
In studying a group of 150 families, researchers at The Children's Hospital of Philadelphia found that participants had significantly fewer symptoms of post-traumatic stress after a one-day treatment program, compared to a control group who did not receive the treatment. Each family included an adolescent who had completed cancer treatment an average of five years previously.
The study, in the September 2004 issue of the Journal of Family Psychology, is the first reported large randomized clinical trial of treatment related to family adjustment to a serious pediatric illness. Half of the group, randomly chosen, received the treatment, which combined cognitive-behavioral therapy with family therapy. The other half of the group received the treatment after the study was completed.
"Because cancer is a life-threatening experience, it represents a traumatic stress that may leave aftereffects such as those found in survivors of war and natural disasters," says Anne E. Kazak, Ph.D., director of Psychology at The Children's Hospital of Philadelphia, and senior author of the study. Posttraumatic stress symptoms (PTSS) include intrusive, unwanted thoughts; avoidance of stress-inducing settings and situations; and heightened arousal, such as nausea or increased heart rate triggered by reminders of the original experience.
Researchers found the strongest effects of the treatment in the adolescent survivors, who had decreased arousal symptoms, and among the survivors' fathers, who had fewer intrusive thoughts.
"Fathers are often underrepresented in pediatric research samples, because so many studies occur in outpatient settings where mothers accompany their children," remarked Dr. Kazak. Dr. Kazak's previous studies found that fathers of childhood cancer survivors have PTSS at levels nearly as high as mothers. "Many of the fathers in this study said they had feared that expressing their upsetting memories would be detrimental to other family members," Dr. Kazak added. "They found that sharing those reactions with their family was a powerful experience, and helped to reduce their sense of being isolated with those feelings."
Surprisingly, mothers of survivors did not show a significant effect from the treatment. One complicating factor, said Dr. Kazak, is that families with higher PTSS levels were more likely to drop out of the study. A statistical analysis of their findings suggested that the treatment would have had stronger effects if the families with higher distress levels had completed the study.
"Delving into distressing memories is difficult," Dr. Kazak added. "Many families had reservations about opening this can of worms. However, families who did participate in the treatment benefited from it." She added that future treatments might occur away from a hospital setting, because people with PTSS may avoid locations such as hospitals that are associated with the cancer experience.