Psychotherapeutic Techniques for Dyspnea in Cancer and Chronic Illness: Systematic Review.

Abstract

Context: Psychotherapeutic interventions show promise for managing dyspnea in patients with cancer and other serious illnesses, but evidence synthesis has been limited by substantial heterogeneity. Additionally, the characteristics of interventional delivery remain poorly understood.

Objective: This systematic review examined the characteristics of psychotherapeutic techniques-mindful breathing, progressive muscle relaxation, meditation, and guided imagery-to inform standardization, clinical application, and digital development.

Methods: We searched PubMed, CINAHL, CENTRAL, and Scopus from inception through 17 January 2025 for quantitative interventional studies evaluating these techniques for dyspnea in adults. Two reviewers independently screened the studies and extracted data on the delivery methods, session structure, provider requirements, and self-practice components. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT).

Results: Forty-two studies were included, mindful breathing (n=5), progressive muscle relaxation (n=11), meditation (n=4), guided imagery (n=2), and multicomponent interventions (n=20). Substantial heterogeneity in intervention delivery was identified, even within the same technique, including session duration, frequency, provider training, and home practice components. Psychotherapeutic techniques were predominantly delivered through multicomponent interventions (20/42 studies), most frequently combined with education, breathing techniques (16 studies each), and exercise (11 studies). Most studies met only one to three of the five MMAT criteria, indicating early-stage evidence development.

Conclusions: Psychotherapeutic techniques for dyspnea demonstrate substantial delivery heterogeneity and are predominantly integrated into multicomponent programs. Future research should distinguish the core from adaptable components, integrate psychotherapeutic techniques with education and self-management strategies, and employ rigorous designs with standardised reporting to advance this clinically relevant field.