de Souza Institute, University Health Network, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Division of Medical Oncology, Sunnybrook Health Sciences Centre, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Psychooncology. 2020 Apr;29(4):671-680. doi: 10.1002/pon.5304. Epub 2020 Feb 5.
Body image (BI) remains a significant survivorship challenge among breast cancer (BC) survivors. We describe an 8-week group intervention-restoring body image after cancer (ReBIC)-developed to target BI distress for BC survivors.
The intervention was informed by interviews with BC survivors and by a descriptive, exploratory approach which adapted guided imagery exercises to address BI. Educational material was selected to address sociocultural factors that may contribute to BI distress and affect adjustment. Videotape reviews and content analyses further refined the intervention.
The intervention incorporates three active components: psychotherapeutic group principles; guided imagery exercises to address BI; and psychoeducation on relevant socialization factors and gender-based messages internalized by women in Western society. The therapeutic group was a supportive and effective way to assist BC survivors to gain insight on BI impacts, their histories, and relevant sociocultural factors contributing to BI distress. The group also facilitated the working through of grief over multiple losses. Guided imagery was well-received, and appeared to help survivors identify negative and emerging self-schema, as well as facilitate new self-views. Specific themes included negative emotions associated with an altered body and self, grief and loss, isolation, difficulties with sexual intimacy, relationship challenges, and uncertainty around sense of self and future.
An empirically tested group therapy intervention is described and has implications for survivorship programs to help address BI-related challenges. Future work could consider testing a similar approach tailored for other cancer populations.
身体意象（BI）仍然是乳腺癌（BC）幸存者面临的一个重大生存挑战。我们描述了一个为期 8 周的团体干预措施——癌症后身体意象恢复（ReBIC），旨在针对 BC 幸存者的 BI 困扰。
该干预措施的灵感来自于对 BC 幸存者的访谈，以及一种描述性、探索性的方法，该方法改编了引导意象练习来解决 BI。选择教育材料来解决可能导致 BI 困扰并影响适应的社会文化因素。录像带审查和内容分析进一步完善了干预措施。
该干预措施包含三个积极组成部分：心理治疗团体原则；解决 BI 的引导意象练习；以及关于相关社会化因素和女性在西方社会内化的基于性别的信息的心理教育。治疗小组是一种支持和有效的方法，可以帮助 BC 幸存者深入了解 BI 的影响、他们的病史以及导致 BI 困扰的相关社会文化因素。该小组还促进了对多次丧失的悲痛的处理。引导意象受到了很好的欢迎，似乎有助于幸存者识别负面和新兴的自我图式，并促进新的自我观点。具体主题包括与改变的身体和自我相关的负面情绪、悲伤和失落、孤立、性亲密困难、关系挑战以及对自我和未来的不确定性。
描述了一种经过实证检验的团体治疗干预措施，对生存方案有影响，可以帮助解决与 BI 相关的挑战。未来的工作可以考虑测试针对其他癌症人群量身定制的类似方法。
