Can cognitive behavioral therapy (CBT) relieve the fatigue that many breast cancer patients experience when they undergo radiation treatment? Would the addition of hypnosis (CBTH) make a difference? Yes and yes, according to Guy Montgomery, PhD, associate professor and director of the Integrative Behavioral Medicine Program in the Department of Oncological Sciences, Icahn School of Medicine at New York’s Mount Sinai Hospital.1 


Many patients with breast cancer find fatigue to be the most severe and predominant symptom they experience while undergoing radiation therapy. To add to the discomfort, their fatigue increases over the course of radiation therapy, and even when the treatment has concluded, survivors of breast cancer often struggle with residual fatigue. In one study, 40% of patients with breast cancer had fatigue 1 year after their radiation treatment.2 Fatigue, which has negative effects on many areas of a patient’s functioning, is the strongest predictor of quality of life after radiation treatment for patients with breast cancer.1


According to the researchers, cancer treatment has a psychological component as well as the physical one.1 Past meta-analyses have demonstrated that CBT and other psychological interventions are effective at reducing cancer-related fatigue, and hypnosis can potentiate that effect. Montgomery and his group wrote, “During hypnosis, patients can be given suggestions for reduced fatigue that change patients’ expectations for fatigue, which in turn may directly lead to reductions in patients’ experiences of fatigue.”1 Thus the Mount Sinai group hypothesized that patients receiving CBT with the addition of hypnosis might experience lower levels of fatigue than patients in a control group.

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To test their theory the group undertook a randomized controlled trial. There were 200 women in the study, randomly divided into a treatment group and control group. The investigators measured the participants’ levels of fatigue at four points: baseline, after the course of radiotherapy, at 4 weeks after completion of radiotherapy, and at 6 months after the radiotherapy. 


Cognitive behavioral therapy The patients in the intervention group received CBT following the ABC model: A, activating events; B, beliefs; C, consequences. They learned how to identify negative beliefs and their effects in terms of emotional, behavioral, and physical consequences. Then they learned to use new behavioral strategies for managing their fatigue, such as changing how they schedule their activities.1  

Hypnosis After CBT came hypnosis. Each weekly session began with images designed to relax the patient, and progressed to suggestions for reducing fatigue and stress while undergoing radiation treatment. At the end of each session, the therapist gave the patient instructions on how to utilize the suggestions with self-hypnosis.