New Approaches in Educational Management and Health Sciences

New Approaches in Educational Management and Health Sciences

Effectiveness of Existential Group Therapy on Treatment Adherence and Self-Compassion in Women with Breast Cancer Experiencing Chronic Pain

Document Type : Original Article

Authors
Parisa Shahrokhifard 1
Fatemeh Alijani 2
Vahideh Babakhani 2
Asghar Jafari 3
1 Department of Psychology, CT.C., Islamic Azad University, Tehran, Iran.
2 Department of Counseling, Ab.C., Islamic Azad University, Abhar, Iran
3 Department of Psychology, University of Kashan, Kashan, Iran.
10.22034/edus.2026.592784.1129
Abstract
Introduction: Chronic pain resulting from breast cancer treatment is one of the common and debilitating side effects that can significantly influence treatment adherence and patients' quality of life. The present study aimed to investigate the effectiveness of existential therapy on treatment adherence and self-compassion in women with breast cancer experiencing chronic pain.
Methods: This quasi-experimental study employed a pretest-posttest design with a control group and a three-month follow-up. The statistical sample consisted of 30 women with breast cancer and chronic pain, who were purposefully selected and randomly assigned to two groups of 15 participants each (existential therapy and control). The experimental group received eight 90-minute sessions of existential group therapy based on the May and Yalom protocol. Data collection instruments included the Chronic Pain Grading Scale (Von Korff et al., 1992), the Treatment Adherence Questionnaire (Seyed Fatemi et al., 2013), and the Self-Compassion Questionnaire (Manavipour et al., 2020). Data were analyzed using repeated measures analysis of variance and Bonferroni post-hoc test in SPSS version 25.
Results: The results showed that existential therapy significantly increased the overall score of treatment adherence in the post-test compared to the pre-test (p < 0.05), and this increase remained stable at the three-month follow-up. Additionally, self-compassion scores in the experimental group significantly increased compared to the control group (p < 0.05), and this effect was maintained at follow-up.
Conclusion: Existential therapy is an effective and sustainable intervention for improving treatment adherence and enhancing self-compassion in women with breast cancer experiencing chronic pain. Given the mechanisms of this approach, including confrontation with fundamental anxieties of death, loneliness, and meaninglessness, and creating meaning in suffering, the use of this intervention alongside medical treatments is recommended to improve treatment adherence and quality of life in these patients.
Keywords
Breast Cancer
Chronic Pain
Existential Therapy
Self-Compassion
Treatment Adherence

Ethics Approval ID: IR.IAU.CTB.REC.1404.213

1.         Manirakiza AVC, Mutesa L, Mathew CG, Olopade OI. Breast Cancer: Genetic Risk Assessment, Diagnostics, and Therapeutics in African Populations. Annu Rev Genomics Hum Genet. 2025;26(1):245-259. doi: 10.1146/annurev-genom-111522-013953
2.         Penberthy JK, Stewart AL, Centeno CF, Penberthy DR. Psychological Aspects of Breast Cancer. Psychiatr Clin North Am. 2023;46(3):551-570. doi: 10.1016/j.psc.2023.04.010
3.         Biswas A, Weitzner AS, Zhu L, et al. Characterization of post-mastectomy pain syndrome in breast cancer patients undergoing subsequent reconstruction: A scoping review. J Plast Reconstr Aesthet Surg. 2025;107:73-84. doi: 10.1016/j.bjps.2025.06.001
4.         Hartup S, Briggs M. Managing chronic pain after breast cancer treatments: are web-based interventions the future? Curr Opin Support Palliat Care. 2024;18(1):47-54. doi: 10.1097/SPC.0000000000000691
5.         Wang K, Yee C, Tam S, et al. Prevalence of pain in patients with breast cancer post-treatment: A systematic review. Breast. 2018;42:113-127. doi: 10.1016/j.breast.2018.08.105
6.         Hamood R, Hamood H, Merhasin I, Keinan-Boker L. Chronic pain and other symptoms among breast cancer survivors: prevalence, predictors, and effects on quality of life. Breast Cancer Res Treat. 2018;167(1):157-169. doi: 10.1007/s10549-017-4485-0
7.         Peddie N, Agnew S, Crawford M, Dixon D, MacPherson I, Fleming L. The impact of medication side effects on adherence and persistence to hormone therapy in breast cancer survivors: A qualitative systematic review and thematic synthesis. Breast. 2021;58:147-159. doi: 10.1016/j.breast.2021.05.005
8.         Yussof I, Mohd Tahir NA, Hatah E, Mohamed Shah N. Factors influencing five-year adherence to adjuvant endocrine therapy in breast cancer patients: A systematic review. Breast. 2022;62:22-35. doi: 10.1016/j.breast.2022.01.012
9.         Eliassen FM, Blåfjelldal V, Helland T, et al. Importance of endocrine treatment adherence and persistence in breast cancer survivorship: a systematic review. BMC Cancer. 2023;23(1):625. doi: 10.1186/s12885-023-11122-8
10. Tummarakota S, Zhang L, Mwita C, Mwaiselag J, Soliman AS. Factors Associated With Breast Cancer Treatment Adherence in Tanzania. JCO Glob Oncol. 2026;12:e2500182. doi: 10.1200/GO-25-00182
11.       Gast A, Mathes T. Medication adherence influencing factors-an (updated) overview of systematic reviews. Syst Rev. 2019;8(1):112. doi: 10.1186/s13643-019-1014-8
12.       Jang MK, Kim S, Park CG, et al. Barriers to Surveillance Mammography Adherence in Korean Breast Cancer Survivors. Oncol Nurs Forum. 2024;51(6):E37-E49. doi: 10.1188/24.ONF.E37-E49
13.       Lai HL, Chen CI, Lu CY, Huang CY. Cognitive Behavioral Therapy plus Coping Management for Depression and Anxiety on Improving Sleep Quality and Health for Patients with Breast Cancer. Brain Sci. 2021;11(12):1614. doi: 10.3390/brainsci11121614
14.       Daneshnia F, Davoudi H, Taghvaei D, Heydari H. The effectiveness of acceptance and commitment therapy on psychological distress and sleep problems in women with breast cancer. Med J Mashhad Univ Med Sci. 2020;63(6):3066-3077. doi: 10.22038/mjms.2020.17773
15.       Jalalpour F, Safarzadeh S. Comparing the Effectiveness of Acceptance and Commitment Therapy and Cognitive-Existential Therapy on the Psychological Flexibility of Women with Breast Cancer. ijbd 2025; 17 (4) :151-170. (In Persian). doi: 10.61186/ijbd.17.4.151
16.       Aiello-Puchol A, García-Alandete J. A systematic review on the effects of logotherapy and meaning-centered therapy on psychological and existential symptoms in women with breast and gynecological cancer. Support Care Cancer. 2025;33(6):465. doi: 10.1007/s00520-025-09519-1
17.       Fardi D, Lotfi Kashani F. Spiritual therapy and breast cancer: a scoping review of the Persian biomedical literature. Payesh. 2023;22(4):423-432. (In Persian). doi: 10.61186/payesh.22.4.423
18.       Solaymani A, Shariatnia K, Akbari H. Comparing the Effects of Cognitive Hypnotherapy and Spiritual Therapy on Death Anxiety in Women With Breast Cancer. J Prevent Med. 2022;9(3):280-291. (In Persian) doi: 10.32598/JPM.9.3.575.2
19.       Chow SC, Shao J, Wang H, Lokhnygina Y. Sample size calculations in clinical research. 3rd ed. New York: Chapman and Hall/CRC; 2017. doi: 10.1201/9781315183084
20.       Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50(2):133-149. doi: 10.1016/0304-3959(92)90154-4
21.       Seyed Fatemi N, Rafii F, Hajizadeh E, Modanloo M. Psychometric properties of the adherence questionnaire in patients with chronic disease: A mix method study. Soc Determ Health. 2018;20(2):179-191. (In Persian). doi: 10.1111/ejn.70024
22.       Manavipour D, Shahabi P, Pirkhaefi A. The psychometric properties of the questionnaire self-empathy. Social Cognition. 2020;9(2):173-82. (In Persian). doi: 10.30473/sc.2021.55706.2614
23.       Galiana L, Sansó N, Muñoz-Martínez I, Vidal-Blanco G, Oliver A, Larkin PJ. Palliative Care Professionals' Inner Life: Exploring the Mediating Role of Self-Compassion in the Prediction of Compassion Satisfaction, Compassion Fatigue, Burnout and Wellbeing. J Pain Symptom Manage. 2022;63(1):112-123. doi: 10.1016/j.jpainsymman.2021.07.004
24.       Carroll CP, Brandow AM. Chronic Pain: Prevalence and Management. Hematol Oncol Clin North Am. 2022;36(6):1151-1165. doi: 10.1016/j.hoc.2022.06.009.v
New Approaches in Educational Management and Health Sciences
Volume 3, Issue 3
Autumn 2026
Autumn 2026
Pages 61-76

  • Receive Date 12 April 2026
  • Revise Date 23 June 2026
  • Accept Date 20 August 2026