Evaluation of the clinical efficacy of emotionally focused couples therapy on psychological adjustment and natural killer cell cytotoxicity in early breast cancer

Abstract

Breast cancer has changed in recent years from a terminal condition to a chronic disease, which can significantly impact a couple's relationship and overall adjustment. The first objective was to survey the shared and reciprocally determined adjustment processes which unfold within couples who face breast cancer. Attachment theory was then used as the grounding framework to both understand interpersonal dynamics and to provide a rationale for offering empirically-supported Emotionally Focused Therapy (EFT) to couples experiencing unremitting psychological and relational distress following diagnosis and treatment for breast cancer. The second objective involved evaluating the clinical efficacy of EFT on couples' psychological adjustment and patients' Natural Killer Cell Cytotoxicity (NKCC)---an important immune parameter implicated in control of metastatic disease. Twelve couples were randomized to receive either twenty sessions of EFT or Psycho-education (PE). A multiple baseline experimental design across couples was used. Results indicated that, compared to couples randomized to PE, those who received EFT evidenced more variation on outcome variables following EFT. Specifically, more than 50% of couples who received EFT evidenced clinically significant improvement in dyadic adjustment, and quality of life, as well as attenuation in mood disturbance and trauma symptoms. Women randomized to EFT evidenced more variation in response to treatment, with half of the sample experiencing small, but clinically irrelevant up regulation, in NKCC, while the other half showed clinically significant down-regulation in NKCC. Women receiving PE showed no changes in NKCC. More importantly, shifts in NKCC were in keeping with trajectories in dyadic adjustment and clinical events unfolding during the course of treatment. Findings provided initial support for offering EFT to couples experiencing emotional and relational following diagnosis and treatment of early breast cancer. Changes observed in NKCC, though in keeping with established relationships with psychological distress, were more tentative in nature.