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Table 3 Characteristics and Findings of Psychotherapeutic Interventions by Treatment Approach

From: Psychosocial-spiritual interventions among Muslims undergoing treatment for cancer: an integrative review

Authors & year Purpose Design Country/ Settings Population Description of intervention or treatment Key Findings/ outcome measures Comments Quality
1 = high;
2 = low
Intervention category
Sample characteristics Cancer type / stage
17 To evaluate the effectiveness of laughter yoga on the mental well-being of cancer patients undergoing chemotherapy. Randomized, double-blind, clinical trial Iran/ Medical Center 69 patients with cancer
67.7%
females
47.1%
digestive cancer
Mage = 49 years
Digestive
Breast
Respiratory
Reproduction
Bone/ Not specified
Four 20–30 min laughter yoga sessions consisted of 15 steps: “clapping in rhythm with chanting of ho-ho-ho,ha-ha-ha, deep breathing, warming up and stretching the neck and shoulders, hearty laugh technique, greeting laughter technique, appreciation laughter technique, one-meter laughter technique, silent laughter technique, humming laughter technique, swinging laughter technique, lion laughter technique, cell phone laughter technique, argument laughter technique, gradient laughter technique, heart to heart laughter technique, laughter yoga exercises.” Warwick-Edinburgh Mental Well-being Scale (WEMWBS)
There were statistical differences between the intervention group and the control group in the three dimensions of mental health scores (optimism, positive relationship, and vitality).
A low number of the chemotherapy sessions thus low number of laughter yoga sessions 1 Complementary
18 To investigate the effectiveness of lavender oil aromatherapy on anxiety and sleep quality in patients undergoing chemotherapy. Randomized controlled trial Turkey/ Private hospital 70 patients with cancer, Mage = 58.22 years. a large percentage of participants women, married, and with graduates of primary school Breast, lung, urothelial, ovarian, gastrointestinal, and renal/ Not specified Lavender oil and tea tree oil (aromatherapy) were administered to the participants in the experimental group. Three drops of aromatherapy were placed on a piece of cotton near the nose. State-Trait Anxiety Inventory
Pittsburgh Quality Sleep Index (PSQI)
The authors found a statistically significant improvement in the sleep quality and anxiety state in the lavender group.
Inability to blind the nurse and patients to the aromatic oils used
Not stated what participants received in the control group
Not clear if all participants are Muslims
2 Complementary
19 To evaluate the effect of chemotherapy counseling on self-esteem, anxiety, and depression of cancer patients. Randomized control trial Malaysia/ government hospitals 2120 participants with cancer, Age range = 45–65, 58.2% females, 67.1% married, 52.2% with diploma education Not specified/ Stage 1–4 A “Managing Patients on Chemotherapy” module through an interactive format was administered by a trained pharmacist-in-charge from 3 to 6 weeks. The model’s content includes an introduction to chemotherapy and its related emotions (such as depression, anxiety, and fear). Patient health questionnaire-9 (PHQ-9), Generalized anxiety disorder-7(GAD-7) questionnaire, & Rosenberg self-esteem scale (RSES)
A significant difference in depression, anxiety, and optimism scores for both groups over time (1st, 2nd, and 3rd follow-up counseling sessions) in the intervention group were reported.
Low attrition rate
Large sample size
No controlling to participants in the control group with exposing to different education sources
1 Psychoeducation
20 To evaluate the impact of individualized patient education and emotional support on the quality of life of breast cancer patients undergoing chemotherapy. Quasi-experimental design Pakistan/ Public hospital 50 patients with breast cancer, 78% 40 years and above, 66% married Breast Cancer/ Stage 2, 3 A clinical oncologist nurse specialist conducted an intervention for 6 weeks that included four stages: in-person oral and written patient education (in a booklet), the nurse visiting the patients during chemotherapy administration (the nurse re-evaluate patients’ reported concerns, analyzed their improvement, and implemented accordingly), follow-up phone calls with the patients or their family members (the nurse evaluated patients’ problems and intervened accordingly), and the patients and family members’ reached out to the nurse via phone (the nurse addressed the patients’ problems or referred them for seeking medical help). The Functional Assessment of Cancer Therapy-Breast (FACT-B version 4)
The intervention group participants scored improvement in the overall quality of life and emotional well-being compared to the control group.
Small sample size
Lack randomization
Conducting the intervention and collecting data by the same nurse leading to research bias
Temporal bias because of non-randomized time blocks between recruitment of the experimental and control groups
Not clear what the control group was
Women participants only
1 Psychoeducation
21 To assess a chemotherapy counseling module’s effect on quality of life and psychological outcomes among cancer patients. A single-blind randomized controlled trial Malaysia/G government hospital 162 patients with cancer,
Mage = 67.46, 58% females, 66.7 married, 47% with diploma education
Not specified, stage 1–4 The therapy module (45 min ±10 min) focused on different topics, including education about the psychological aspects of patients undergoing chemotherapy, such as depression and anxiety WHO quality of life-BREF (WHOQOL-BREF), Patient health questionnaire-9 (PHQ-9), & Generalized anxiety disorder-7 (GAD-7)
Statistical
differences in the overall quality of life (physical health, mental health, social relationships, and environment) and psychological effects (anxiety and depression) between the study populations were reported.
Using self-reported measures
participants recruited from one hospital which limits generalization
1 Psychoeducation
22 To examine the effectiveness of CBT and spiritual-religious intervention in enhancing coping responses and quality of life among breast cancer survivors. Quasi-experimental trial of pre-post-test study Iran/ Cancer Research Center 45 survivors, Mage = 45.15, 80% married, &
60% with diploma education
Breast Cancer/
Clinical stage 1, 2, 3
Cognitive-Behavioral Therapy (CBT) & Spiritual-Religious Intervention (SRI)- Eight sessions
The authors followed the CBT protocol developed by Kvillemo and Branstrom [16]. The first sessions included a preface about the CBT, assignments, “diaphragmatic breathing practices,” relaxation techniques. The middle sessions encompassed assertiveness, stress management, problem-solving, and identification of negative thoughts. The final session focused on reforming negative thinking and review the contents.
A Cleric man, an expert in psychology, revised a model proposed by Richards and Bergin [17] to guide the spiritual-religious intervention for this study. This intervention included eight sessions, which begin with an introduction to the intervention and practicing meditation. Sessions 2 to 5 focused on practicing Zekr (holy words repetition), Doa (prayer), Tawakkol (trust in God), and Sabr (patience). During these sessions, a discussion about the association between these religious practices and mental peace was conducted. In the last sessions, self and others’ forgiveness was argued, and a revision for the intervention sessions was conducted.
Coping Response Inventory & QLQ-C30
Although no statistically significant findings were reported in the control and experimental groups, both interventions were found to be effective in improving the quality of life and coping responses of survivors.
No controlling for some confounding variables “such as the physical, mental, economic, and socio-cultural status of participants”
Limitation in generalizing the study results
Small sample size
Waitlist control group
The control group participants did not receive any psychological treatment until the experimental group ended treatment and collected post-intervention data.
1 CBT
26 To test the effect of mindfulness-based cognitive therapy on posttraumatic growth, self-management, and functional disability among patients with breast cancer. Randomized controlled trial with repeated measures design Iran / Department of Oncology and
Radiotherapy
20 women with breast cancer, Mage = 38.8 years, 60% with diploma education, 80% homemaker Breast cancer / Stage 2 Eight sessions of mindfulness-based cognitive of 2.5 h each Williams and colleagues’ (2016) manual of Mindfulness-Based Cognitive Therapy was used to conduct the study intervention.
This intervention included different strategies, including assignments, confronting obstacles, re-examining previous session activities. The first sessions encompassed “an automatic guidance system,” creating relationships, providing feedback, and discussing body exercises and mindfulness meditation. The middle sessions included breathing mindfulness meditation, distributing materials about meditation, practicing breathing, sitting meditation, mindfulness of breathing, and determining patients’ responses to stress and its link to pain. These middle sessions also included learning differences between thought and fact, conscious yoga, relaxing, and meditation sessions. The last sessions involved testing and discussing the program, clarifying the significance of self-care, repeating previous activities, naming enjoyable activities, and distributing brochures.
Structured Clinical Interview for DSM-5, Posttraumatic Growth Inventory (PTGI), Patient Activation Measure and WHO Disability Assessment Schedule 2.0
The findings demonstrated that the effect of mindfulness-based cognitive therapy on psychosocial aspects (self-management, posttraumatic growth, and functional disability) was statistically significant in the post-test (P < 0.008) and follow-up (P = 0.014) between the intervention and control group.
Small sample size
Participation limited to married women, which limits the generalization of the study findings
1 CBT
25 To examine the effectiveness of mindfulness-based cognitive therapy on relief of hopelessness symptoms among women with breast and gynecological cancer. Pretest-posttest with group-control group design Iran/ Cancer Research Center 82 patients, age range = 24–65 years Breast and gynecological cancer/ Not specified Eight weekly mindfulness-based cognitive therapy sessions were conducted with a focus on guided relaxation and mindfulness meditations, group discussions, psychoeducation (about cancer, mindfulness, relaxation techniques and exercises, and cognitive restructuring skill development), and homework assignments. Beck Hopelessness Scale (BHS)
Mindfulness-based cognitive therapy had a statistically significant effect on hopelessness, and there was a significant difference between the study arms in terms of hopelessness due to loss of motivation.
Lack randomization 1 CBT
24 To compare the effect of the metacognition treatment (MCT) and mindfulness-based cognitive therapy (MBCT) on anxiety, depression, and stress in females with breast cancer. Quasi-experimental pretest and posttest study with control group Iran/ General hospitals for breast cancer 36 patients with cancer, age range = 38–49 years Breast cancer/ Not specified Eight sessions of mindfulness-based cognitive therapy were conducted with an introduction about “automatic guidance system/knowledge on how to use present moment awareness of bodily sensation”, thoughts to alleviate stress, homework, distributing educational material about meditation and yoga practices, examining of body exercises, practicing breathing in mindfulness meditation. The middle sessions focused on re-practicing sitting meditation, identifying participants’ reactions to stress, and practicing knowing about sounds and thoughts. Participants in the last few sessions practiced mountain meditation, listed some exciting activities, checked physical exercise, and discussed procedures. The metacognition treatment included introducing this intervention, practicing strategies for enhancing attention, homework, identifying negative thoughts, practicing detached mindfulness, and examining uncontrollable beliefs. The middle sessions focused on re-examining uncontrollable beliefs, challenging with positive beliefs about rumination, identifying negative thoughts. The last sessions addressed negative beliefs and useless strategies, remodeling recurrent fears, examining the other cognitive beliefs, and discussing using a new program. Depression, Anxiety, and Stress Scale - 21 items (DASS-21) questionnaire
The authors reported a statistically significant difference in the rate of depression, anxiety, and stress in the experimental, post-test, and follow-up group.
Small sample size
Limitations in generalization of the findings
Women only
1 CBT
27 To evaluate the effect of the mindfulness-based stress reduction program and conscious yoga on women’s mental fatigue severity and life quality with breast cancer. Quasi-experimental study with a pre-test, post-test, and control group Iran/
Division of Oncology
24 patients with breast cancer, 30 to 55 years/ Mage = 44.8 ± 3.28 Breast cancer/ stages 1,2, 3 The Mindfulness-Based Stress and conscious yoga program consisted of 8-week in which every session lasted about 2 h. The first third sessions of the Mindfulness-Based Stress Reduction Program included an introduction for “automatic guidance system/knowing how to use present moment awareness of bodily sensation,” alleviating thoughts associated with emotions, feedback, homework, deep breathing exercise, discussion about examining body exercise, practicing breathing mindfulness meditation/ yoga stretching exercise, sitting meditation), and videotape of yoga practices. The middle sessions focused on practicing conscious yoga, awareness of breathing, body, sounds and thoughts, sitting meditation. The final sessions included practicing mountain meditation/sleep hygiene/ repeating exercises of the previous session/making a list of enjoyable activities. In all sessions, educational materials were distributed for each session. Fatigue Severity Scale, Global Life Quality of Cancer Patient, and Specific Life Quality of Cancer Patient questionnaires
Results showed that mindfulness-based stress reduction treatment significantly enhanced the overall quality of life (cognitive, emotional, and social functions) in the interventional group compared to the control group.
At the end of the study, participants in the control group were provided with CDs of yoga exercises.
Small sample size
Lack of contextual
and individual factors control
Women only
1 CBT
23 To evaluate occupational therapy’s effectiveness in fostering the quality of life for men who treat Metastatic prostate cancer. Randomized controlled study Turkey/ Department of Occupational Therapy 34 patients, age ≥ 50 years Prostate cancer/ Stage 3 & 4 Participants in the intervention group (cognitive behavioral therapy based occupational therapy) received daily training about self-care, productivity, and/or leisure. The intervention lasted 12 weeks and included 30-min recreational activity; 40-min didactic cognitive behavioral therapy based on occupational therapy education and information on the diagnosis and treatment of metastatic prostate cancer; 20 min of practical relaxation skills training. The study indicated that participants’ quality of life increased significantly in statistical terms for the interventional group, compared to the participants’ results in the control group.
Interventionists prompted participants in the control group to practice independent self-care, recreational group activities, relaxation techniques in daily life outside of hormonal therapy. Participants were provided with a printed home program after the initial assessment and instructed on these activities’ effects.
The lack of control at home
Small sample size
Limitations of the generalizability of the findings to those who have no significant cognitive impairment
1 CBT
10 To evaluate spiritual psychotherapy’s effectiveness, emphasizing prayers’ significance on psychological health and pain in cancer patients. Quasi-experimental study Iran/ Not specified 76 patients with cancer, 64.9 females, 51.4% married, & 32.4% with middle school education Not specified The religious psychotherapy focused on presenting the impacts of religious attitudes, and the investigator assisted the patients in promoting participants’ religious beliefs. These meetings also focused on wisdom, God’s mercy, and hope for God’s mercy. The participants prayed and were directed to consider prayer’s meaning to adopting proper religious strategies to improve psychological health using the Quranic instructions and the mental mechanisms existing in these prayers. Richards and Bergin’s religious principles were utilized to focus on Islamic perceptions, including prayer, reciting Holy books, visiting religious places, and forgiving others. GHQ-28 General Health Questionnaire
The authors found that the mean and standard deviation of mental health scores after the intervention were statistically significantly increased.
Small sample size
Lack randomization
1 Religious principles and practice
16 To explore the structure of spiritual counseling sessions among patients who experience chemotherapy. Qualitative descriptive thematic analysis-case study Iran/ oncology departments 22 patients, age range = 18 to 85, Mage = 53 years, 16 females and 6 males Breast, gastrointestinal, & blood cancer/ Not specified Through spiritual counseling, the counselor implemented strategies to settle the patient’s problems, depending on faith and spiritual powers. Counselors urge patients to talk about their religious or spiritual problems and concerns. Four themes emerged:
(1) “history-Taking”: The counselor asked questions on religious and spiritual behaviors first and then about cognitive behaviors. This aspect addresses the relationship between the patient and God, the patient’s beliefs, and religious practices and teachings during the illness and hospitalization period.
(2) “general advice”: The spiritual counselor afforded general advice to solve the patient’s challenges and concerns in various fields. The advice involved hope for healing, promotion of self-confidence, and the necessity for self-care, which occasionally consist of mental health care.
(3) “spiritual-religious advice”: Spiritual-religious advice encompassed reciting many verses and stories linked to the disease. The counselor addressed the causes of illness and adversity from the perspective of religion, spiritual reinforcement after the diseases, and faith in everlasting life. The counselor recommended them to trust in God and to pray for the Creator. Other topics were related to some religious teachings and practices and resolving religious issues associated with the means of worship.
(4) “dealing with patients’ spiritual or religious ambiguities and paradoxes”: Patients often face contradictory situations, especially in the case of existing conflict between the patients’ beliefs and counselor’s interpretations. Some situations could be vague for the patient, such as spirituality and the philosophy of praying. Other ambiguous situations include the patient’s challenges regarding God and the validity of the said stories.
Small sample size
Limitations in generalizing the findings
Single arm case analysis
2 Religious principles and practice
31 To evaluate spiritual group therapy’s effect on quality of life and spiritual well-being among patients with breast cancer. Quasi-experimental pretest-posttest study with a control group Iran/ General hospital 24 participants with breast cancer, 57% under 50 years old, 79% married, 50% with high school diploma Breast cancer/ Not specified The intervention included 12 sessions, with a focus on spiritual group therapy. The initial meeting included the following activities: meeting members, discussing spiritual and religious beliefs and their impact on life, listening to the inner voice, and communicating with God or any superpower. The middle sessions addressed altruism, holy relationships, resentment, and lack of forgiveness, feeling guilty, and forgiveness. The final sessions focused on death and fear of death, faith and trust in God, and attitude and thanksgiving. The module focused on different topics, including education about patients’ psychological aspects undergoing chemotherapy, such as depression and anxiety. Structured Clinical Interview for DSM-IV (SCID-I), Quality-of-Life Questionnaire (WHOQOL-26), and
Spiritual Health Scale (SWB-20)
There are statistical differences in the quality of life and spiritual well-being between the study groups.
Small sample size
Lack randomization
Inadequate experience in treating patients with cancer using group therapy and spiritual therapy
The control group did not receive any spiritual therapy until the experimental group was fully treated
1 Religious principles and practice
30   Randomized clinical trial Iran/ referral center for cancer 42 women with cancer, Age range = 26–74 years, 78.6% married, 38.1% illiterate, 45.2% with breast cancer Breast cancer, gastrointestinal, and other types/ Early stages Trained counselors, under the supervision of clinical psychologist, conducted individual intervention of spiritual counseling eight times a week. These sessions included educational materials about Islam as a part of the intervention. The spiritual counseling encompassed a question and answer period, sharing, reflecting, providing feedback, homework about reciting of Holy Qur’an, relaxation exercises, and meditation. Spiritual Well-Being Scale
The authors found statistically significant differences in spiritual well-being scores between the study arms post-intervention.
Small sample size
No follow-up after the intervention, limitation in generalization the findings beyond Shiite Muslim
Women with cancer
1 Religious principles and practice
28 To examine the effectiveness of spiritual/religious intervention on the illness perception of women with breast cancer. Pretest-posttest design Iran/ not specified 45 patients, 37 to 58 years/ Mage = 43.68, 34.1% with high school, 95.1% married Breast cancer/ Not specified Ten sessions were conducted that focused on Islamic religious practices and beliefs, building communication bridges, analyzing the patients’ views, expressing the benefits and effects of spirituality on health, asserting religion’s belief in the purposefulness and value of life, and the benefits of hope. The sessions also included positive thinking, optimism, and vitality, expressing the causes and outcomes of disasters, and strengthening faith. Illness Perception Questionnaire
Spiritual intervention has a positive impact on the enhancement of illness perception in women with breast cancer.
Small sample size
Limitation in generalization
The intervention had too many elements and not clear what the moderator was (positive thinking, optimism, or religious practices and beliefs)
The control group received the usual medical care
Only women
1 Religious principles and practice
29 To explore patients’ experiences about spiritual care and spiritual interventions among patients living with cancer. Qualitative content analysis Iran/ Oncology units 10 patients with cancer, age range = 20–61 years, 4 women and 6 men Leukemia, breast cancer, colon cancer, lymphoma, sarcoma, stomach cancer, and liver cancer/ Not specified Patients regarded their beliefs in God is the main source of their power, and this source promotes their inner strength contesting the fears of death through the close relationship and trust in God. Patients believe in Islamic beliefs about life, death.
The absolute faith in God and strengthen this faith among the participants resulted in more coping responses to cope with cancer and its associated problems. Patients pray for the aim of healing and seek that from God and through people who have superior status among Muslims like Holy Imams.
Most Muslim patients in this study used a strategy of acceptance of divine providence in which they bolster spirituality dimension faith in the divine providence. They believe that each person has a destiny from God and is in God’s hands, which precludes them from getting frustrated.
Limitations to generalize findings to other areas and cultures
Small sample size
2 Religious principles and practice
15 To evaluate the effectiveness of spiritual therapy intervention in improving Iranian women’s spiritual well-being and quality of life with breast cancer. Randomized controlled clinical trial Iran/ Cancer Research Center 65 women with breast cancer,
47.9 years, 95.3% married, & 50.7% homemakers
Breast cancer/ Not specified Over six sessions, each lasting 20–30 min, the spiritual therapy intervention included a theme embracing guided relaxation, and meditation exercise, exploring the negative and positive thoughts, and prayer therapy. Participants received a manual and a CD-ROM containing materials and PowerPoint slides covered in these sessions. Functional Assessment of Chronic Illness Therapy Spiritual Well-being scale (FACIT-Sp12) and cancer quality-of-life questionnaire (QLQ-C30)
After six sessions of the intervention, a statistical significance was reported regarding improving spiritual well-being and quality of life between the study’s arms (푃 <  0.001).
Patients in the control group received standard management and treatment and routine educational program.
Small sample size
Lack of an attention control group
No follow-up after the intervention
Women only
1 Religious principles and practice