(121) Treatments for the Demoralization Syndrome: A Systematic Review

Abstract: Treatments for the Demoralization Syndrome: A Systematic Review



Background

Demoralization is a syndrome of poor coping, hopelessness, and loss of meaning-in-life (Robinson 2015), which is rather prevalent among end of life and palliative care (EOLPC) patients (≥25%) (Gan 2021). We currently lack systematic data on treatment responses of demoralization.



Methods

We conducted a systematic review following PRISMA guidelines, with publications found through a PubMed search ‘(demoralization AND (prevalence OR rate)) OR (demoralization AND treatment)’, plus hand-picked references; inclusion criteria included publication years 2013—present, patients with serious medical illness, data on clinical response to an intervention. We are performing a qualitative synthesis of outcomes.



Results

We found 15 publications reporting on 14 unique studies (n=1191, ages 22-90). Interventions included Meaning and Purpose Therapy, Dignity Therapy, Managing Cancer and Living Meaningfully (CALM), among others. Preliminary outcomes include that most studies evaluated existential psychotherapies in small (n< 100) trials, with some providing preliminary evidence of efficacy. Notably, among distressed oncology patients, medium-to-large between group treatment effects were detected both in a well-powered trial of a psychosocial intervention, CALM (n=305, d=0.5; Rodin 2018) and in an early-phase trial of psilocybin-assisted psychotherapy (n=29, d=1.0; Ross 2016). Analyses are on-going.



Discussion

There is a growing interest in studying interventions for the demoralization syndrome among EOLPC patients. Preliminary findings suggest that existential psychotherapies, and perhaps psychedelic-assisted psychotherapies, may relieve patient suffering in clinically significant ways. Limitations of this review include its small size (k=14), and the early phase of many of the included studies—most are small trials (n< 100) and lacking rigorous control groups (ie., they use waitlist or usual care controls). Also, trials were excluded that assessed treatment responses of meaning-related constructs, but did not explicitly assess change in demoralization (e.g., Breitbart 2018).



Conclusion

Early data suggest meaning-centered psychotherapies may significantly improve demoralization in EOLPC patients.



References



Breitbart, W., et al. Individual meaning‐centered psychotherapy for the treatment of psychological and existential distress: a randomized controlled trial in patients with advanced cancer. Cancer 124, 3231-3239 (2018).



Gan, L.L., Gong, S., & Kissane, D. W. Mental state of demoralisation across diverse clinical settings: A systematic review, meta-analysis and proposal for its use as a 'specifier' in mental illness. The Australian and New Zealand journal of psychiatry (2021).



Robinson 2015 A Systematic Review of the Demoralization Syndrome in Individuals With Progressive Disease and Cancer: A Decade of Research



Rodin, G., et al. Managing Cancer and Living Meaningfully (CALM): A randomized controlled trial of a psychological intervention for patients with advanced cancer. Journal of Clinical Oncology 36, 2422 (2018).



Ross, S., et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. Journal of Psychopharmacology 30, 1165-1180 (2016).