Character Strength-Based Cognitive-Behavioral Therapy Focusing on Adolescent and Young Adult Cancer Patients with Distress: A Randomized Control Trial of Positive Psychology

Abstract

Positive psychological therapy has been found to be effective in psychological health in the broader cancer patient population. However, specific evidence regarding its effectiveness for adolescent and young adult (AYA) cancer patients remains limited. More research is needed to determine the optimal approaches for alleviating distress in this particular group. We evaluated the efficacy of character strength-based cognitive-behavioral therapy (CS-CBT) versus cognitive-behavioral therapy (CBT) for distress in AYA patients with cancer. In a randomized controlled three-arm trial, cancer patients aged 15-39 years were assigned to one of three groups using a random number table to ensure equal group sizes: (1) CS-CBT, which incorporated specific exercises focused on identifying and utilizing character strengths within the CBT framework; (2) CBT; or (3) control group. The primary outcome was improvement in patients’ overall mental health on the Distress Thermometer and the Hospital Anxiety and Depression Scale 3 months after assignment to the groups. Analyses used generalized estimating equations. A total of 162 AYAs were randomly and equally assigned to three groups. Improvements in primary outcomes were significantly greater after CS-CBT than after CBT, and no significant differences were found between the CBT and control group. Among all primary and secondary outcomes, the only non-significant difference found was in quality of life with CS-CBT compared to CBT. AYA cancer patients rated their overall mental health and sense of thriving as more improved after CS-CBT than after CBT. However, quality-of-life indicators supported equal intervention effects in both groups. These findings support the effectiveness of the use of CS-CBT intervention in reducing distress and improving thriving.