The Effects of Cognitive Behavioral Stress Management on Loneliness, Spiritual Well-Being, Anxiety, and Depression in Patients with Unresectable Advanced Gastric Carcinoma: A Randomized, Controlled Study.

Abstract

Cognitive behavioral stress management (CBSM) is an effective intervention for reducing psychological symptoms. This randomized, controlled study investigated the effects of CBSM on loneliness, spiritual well-being, anxiety, and depression in patients with unresectable advanced gastric carcinoma (GC). This study randomized 128 eligible patients into two groups: the CBSM group (N = 64), to receive 12-week CBSM plus normal care (NC), and the NC group (N = 64), to receive 12-week NC alone. The University of California-Los Angeles Loneliness Scale (UCLA-LS), functional assessment of chronic illness therapy-spiritual well-being scale (FACIT-Sp), and self-rating anxiety/depression scale (SAS/SDS) scores were assessed at week (W)0, W4, W8, and W12 in both groups. SAS-anxiety/SDS-depression was defined as SAS/SDS score ≥ 50. Compared to the NC group, the CBSM group showed lower UCLA-LS scores at W8 (P = 0.036) and W12 (P = 0.004), indicating an alleviation of loneliness. Compared with the NC group, the FACIT-Sp scores at W4 (P = 0.015), W8 (P = 0.023), and W12 (P < 0.001) were greater in the CBSM group, indicating a better spiritual status. Additionally, the CBSM group indicated reduced SAS score at W8 (P = 0.006) and W12 (P = 0.003), SAS-anxiety rate at W8 (P = 0.038) and W12 (P = 0.036), as well as SDS score at W12 (P = 0.015) than the NC group. Subgroup analyses revealed that CBSM had a greater beneficial effect on reducing the UCLA-LS, SAS, and SDS scores and increasing the FACIT-Sp score than NC in patients with SAS-anxiety or SDS-depression at W0. In conclusion, CBSM may ameliorate loneliness, enhance spiritual well-being, and reduce anxiety in patients with unresectable advanced GC.