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It consists of eight sessions that occur during app. 90 minutes. A group therapist and a cotherapist will lead the therapy sessions. There will be one session per a week.

It consists of eight sessions that occur during app. 90 minutes. A group therapist and a cotherapist will lead the therapy sessions without using any psychological methods. There will be one session per a week.

We used a wait-list as a control group. After each participants in both online PTG group therapy and online support group completed the interventions, wait-list will be randomly assigned to one of these two interventions.

Online Group Therapy for PTG consists of eight sessions. Each sessions have specific themes. First session: psychoeducation, normalization of the experiences and emotions. Second session: emotion regulation skills. Third session: awareness of the negative thoughts that make patients worried, anxious, feared. Forth session: restructuring of the thoughts and practicing mindfulness technics. 5. session: practicing of self-disclosure skills 6. session: creating a breast cancer story with balancing losses and gains. 7. session: sharing of the effects of breast cancer on life and developing new life priorities 8. session: making life meaning and developing new life goals.

Online Group Therapy for PTG

Online support groups also consist of eight sessions. 1. session: introducing the program and learning the expectancies 2. session: sharing what is known about breast cancer 3. session: risk and protective factors for breast cancer 4. session: sharing side effects of surgical operation and treatments 5. session: sharing the reactions of family, close friends 6. session: patient-doctor relationship and also sharing the challenges and facilitators of healthcare system 7. session: sharing the current position in the treatment and of what has been done for improvement 8. session: sharing the reliable information sources for breast cancer and close

Online Support Group

Cennet Yastıbaş-Kaçar, MD

İmran Gökçen Yılmaz-Karaman, Dr

Breast cancer is a serious and life-threatening health problem that is increasing all over the world and in Turkey. Although the survival rate increases with the improvement of the diagnosis and treatment processes for breast cancer, cancer patients experience some psychosocial problems both due to their treatment and the disease. Decreases in quality of life, psychological distress, especially depression and anxiety, post-traumatic stress disorder as well as sleep disorders, fatigue, fear of cancer recurrence could be common negative outcomes that experienced by the breast cancer patients. Although, cancer could be such a life-threatening disease, some patients report that they experience positive changes in their lives after the diagnosis of cancer. The concept of Post-Traumatic Growth (PTG) was first developed by Tedeschi and Calhoun (1995). PTG is a concept that refers positive psychological changes after struggling an stressful life event. According to the Functional-Descriptive model of Tedeschi and Calhoun, post-traumatic growth occurs in five areas; relating to others, personal strength, spiritual changes and appreciation of life. In this context, a group intervention program has been developed for PTG, which will bring the person to a better functionality than before the trauma to enhance the Post-Traumatic Growth level of women with breast cancer. The current research project will consist of three arms; therapy group, support group and wait-list. Online group therapy consists of eight sessions that continue approximately 90 minutes. In addition to an active treatment group for PTG, an online support group has been developed by the researchers to investigate the effectiveness of the therapy. Online support group also consists of eight sessions during approximately 90 minutes as in intervention program. Wait-list is considered as a control group. A set of reliable and validated measurement tools will be administered and heart rate variability as a physical measurement will be used to examine the effects of the therapy. The research hypotheses are based on that patients who participated active treatment group will have better PTG level and other related concept with PTG (like higher score of deliberate rumination) and better Heart-Rate Variability scores than other groups. The researcher will plan to take three time measurement: pre-intervention, post-intervention, and 1-month follw-up.

Preliminary studies to development of the programs Before the development of protocol of the current treatment programs, the investigators reviewed related literature and published a systematic review about the related factors for PTG in women with breast cancer. After obtaining the ethical approval the study coordinator interviewed with eight women via telephone to explore the experiences of women with breast cancer. The investigators determined the needs and possible challenges of the illness. Besides, previous similar treatment programs were examined in detail. Later, the investigator developed the study protocol with the supervisor and send the content of the treatment programs to five specialists who have MD in clinical psychology and got feedback and the investigators revisited final version of the treatment programs.

In brief, the research hypotheses are 1) both online group therapy for PTG and online support groups will show better PTG levels and rumination scores, and other secondary measurements (such as psychological distress, heart rate variability, disclosure of distress) than wait-list control. 2) Participants who in online group therapy for PTG will improve better PTG and rumination scores, and secondary measurements' scores compared with the participants in online support groups. 3) The benefits of the treatment programs will be endured for 1-month follow-up measure.

Procedure Ethical approval: This study was approved by the institutional review board of Eskisehir Osmangazi University. All study participants gave written informed consent. Announcements will be posted in various departments of the hospital to participate in the research. First of all, volunteer participants will be assessed through the phone and informed about the research process. If they agree to participate, the investigators will organize a detailed interview. In this interview one of the researchers of the study who is a psychiatrist will apply SCID to eliminate the other possible mental disorder. Patients who meet the criteria will be informed about the group and informed consent forms will be obtained. Before beginning of the treatment program, baseline measurement and ECG Holter measurement will be scheduled by the telephone. After completing baseline measurement, the participants will then be randomly allocated to one of the three groups.

The online treatment programs will be delivered to groups of 6-8 participants by a psychologist and psychiatrist (therapist and co-therapist), eight weekly online sessions. Online sessions will be delivered through an online video-conferencing software (ZOOM). Sample size is determined by g-power analysis. For three-arm randomized controlled trial we plan to recruit at least 51 participants (each group should have at least 17 participants). Before the beginning of the study, the participants will be informed about online video-conferencing platform. The investigators will send a video about the use of platform and also step by step user manual. Each participant in treatment programs should join at least six sessions. If the participants could not complete six sessions, the investigators will admit them drop-out (This information will be declared during the interviews and written informed consent). The investigators will use SPSS 23.0 Package Program for Social Sciences. The descriptive analysis will be performed for frequencies of socio-demographics and clinical information such as cancer stage, treatments. To test the hypothesis, the investigators will conduct a repeated measure ANOVA. The investigators will employ intention to treat and as treated analysis.

We will recruit women who diagnosed breast cancer. Our sample is considered based on biological sex.

Online Group Therapy for Breast Cancer

Investigation of the Effectiveness of an Online Group Therapy Program for Post-Traumatic Growth in Women With Breast Cancer

The Turkish version of Post-traumatic Growth Inventory to measure PTG levels of the patients will be used. It is compromised of 21 item and scored ranging from 0 to 5. Higher scores refer higher PTG level.

The Turkish version of Event-Related Rumination Inventory (ERRI) that is reliable and validated measure will be used to assess rumination of the breast cancer. It has 20 items and two sub-scale; intrusive and deliberate rumination. The scores are changing from 0 to 3.

It will be used to asses stressful level of breast cancer to participate the treatment programs.The 20-item self-report measure of PTSD scored from 0 to 4, and yielding a scale score range of 0-80.

The Turkish version of Depression Anxiety and Stress Scale which is a reliable and validated study result will be used for secondary outcome. It consists of 21 items and three sub scale. Higher scores of each sub-scale sign higher distress level.

Holter electrocardiogram (ECG) Monitoring will be used to asses physical effects of intervention programs. It will be used 24 hour holter. A cardiologist will read the holter ECG results. Heart rate will be analyzed using the standard deviation of sequential interbeat intervals averaged over 5 min epochs (SDANN)

It will be used to evaluate emotional expression and repression. Our treatments may indirectly have impact on disclosure of the patients' emotions. The Turkish version of Distress Disclosure Index which has good reliability and variability scores has 12 items and rated on a five-point scale (scored 1-5). Higher scores refer higher expression of emotions.

The Scientific and Technological Research Council of Turkey

Dokuz Eylul University

Research Assistant, PhD candidate, clinical psychologist

Members assigned to 10-week online support group with a professional counsellor.

online support group

home study support materials

Kate MacGregor, MPH

Joanne Stephen, Ph.D.

Young women who have finished treatment for breast cancer regularly report a lack of psychological and social support in their lives. They often continue to struggle with survivorship issues such as ongoing distress and the challenge of how to rebuild their lives after treatment. This experiment will compare two online support group (OSG) options to determine if both forms of support help young breast cancer survivors adjust, by reducing treatment-related intrusions and helping women re-engage in valued activities and commitments. It will also test if these 2 types of OSG's help womens' mood, feelings of loneliness, confidence, and overall life satisfaction. It will explore the processes within support groups that help to create positive change for young women after cancer treatment.

Previous work by this team in a smaller study has shown that online support groups led by professional counselors can be carried out over the Internet, and that they produce helpful benefits for young women survivors of breast cancer. The online groups were comprised of 10 sessions of real time chats, with each session focused on a specific topic. Participants were provided with an educational manual designed to improve skills for coping after cancer, and they were instructed to read one chapter a week in preparation for the chats. The women enjoyed the groups and 3 months after completing the groups, they reported improved quality of life, lower emotional distress, and enhanced coping. However, a large study to determine the strength and reliability of these early promising findings is needed. The questions to be examined are whether trained peers (other young breast cancer survivors) might be able to facilitate the online groups and provide similar positive benefits for young breast cancer survivors, and what facilitators can do to maximize positive benefits in online support groups.

This is a multi-provincial, 3-arm study that will compare a professionally-led OSG (with an educational manual) and a peer-led OSG (with an education manual) with a group that just receives the educational manual. Psychological assessment measures given immediately following the 12 week group, and at 6 months and 12 months follow-up, will determine if one or both of the study groups effectively improve quality of life, reduce distress, and enhance self-efficacy and life satisfaction for young breast cancer survivors. Additionally, tests will be performed to investigate whether discussing emotional matters predicts greater improvements.

Problem to be investigated: Innovative psychosocial interventions that enhance quality of life as quickly and fully as possible are needed. The psychosocial burden of breast cancer treatments and their sequelae are especially high for younger women (45 years and younger) who are more likely to experience aggressive disease, multi-modal treatments, and higher mortality rates. Psychosocial interventions that can assist women in their return to valued activities and reduce suffering are urgently needed. Illness intrusiveness is a construct and a measure describing the degree to which disease and treatments interfere and disrupt important activities and commitments, and is a key component of quality of life. In previous work, we demonstrated that an internet-delivered psychosocial intervention appeared to reduce illness intrusiveness and distress at follow-up in preliminary pilot data. Professional-led internet-delivered psychosocial interventions are showing promise but there is a need to test efficacy, as well as to develop and test other, less costly interventions that can be utilized by this and other cancer populations. Objectives: To test the efficacy of a 12- week Professional-led Online Support Group plus Education (OSG+E) and a Peer-led OSG+E compared to an Education-alone (E) intervention for reducing illness intrusiveness in young breast cancer survivors, and to test a primary mediator, emotional processing. Secondary objectives are to test additional outcomes, specifically, emotional distress, emotional support, loneliness, self-efficacy and life satisfaction. A third objective is to explore the role of two potential mediators of outcome, emotional suppression and social constraint. Methodology: A 3-arm randomized controlled trial will be employed among Canadian women 45 years of age and younger (N =210 ) who have completed primary treatment for breast cancer. Measures of Illness Intrusiveness, Distress, Life Satisfaction, Self-efficacy, Loneliness and Perceived Support will be collected at baseline, completion of treatment (3 months) and at 6 and 12 months. A form of random regression modeling will be used to create individual slopes to test the primary hypotheses, while multiple regression analyses, based on the MacArthur Model, will test the role of mediators. Significance of the research to breast cancer: Women with breast cancer are using the internet for information gathering and support, and this study will determine the efficacy of two forms of internet-delivered interventions (Professional and Peer) for enhancing the adjustment process after primary treatment is completed. Understanding of mediators will inform understanding of how to enhance efficacy of the 2 models of OSG's. The results will be of value to women with breast cancer as well as health care and community-based supportive care organizations.

A Trial Testing Professional and Peer-led Support Online Support Groups for Young Canadian Breast Cancer Survivors

A Randomized Control Trial Testing the Efficacy of Professional and Peer-Led Online Support Groups for Young Canadian Breast Cancer Survivors

Psychological assessment measures given immediately following the 12 week group, and at 6 months and 12 months follow-up, will determine if one or both of the study groups effectively improve quality of life, reduce distress, and enhance self-efficacy and life satisfaction for young breast cancer survivors. Additionally, tests will be performed to investigate whether discussing emotional matters predicts greater improvements.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Online Group Therapy for Breast Cancer	NCT05259267	Breast Cancer	Online Group Th... Online Support ...	18 Years - 65 Years	Dokuz Eylul University
A Trial Testing Professional and Peer-led Support Online Support Groups for Young Canadian Breast Cancer Survivors	NCT01089699	Breast Cancer	online support ... online support ... home study supp...	18 Years - 45 Years	British Columbia Cancer Agency

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