Avenues - Winter 2004

What About Men?

In preparing our analysis of the relationship between psychotherapy or social support and health among people with cancer, it became apparent that most of the published research from medical journals has focused almost exclusively on women. The following is a review of some of the recent research on how men with cancer are seeking information and support and how they may be benefiting from this.

One of the more provocative studies we reviewed compared levels of participation, commitment, and benefit between men and women in a group therapy setting. This group of 47 people with major depression following the death of a spouse or other family member participated in a 12-week series of 90-minute psychotherapy sessions. The study found that none of the male participants reported any benefit from group therapy whereas up to 38% of the women showed improvement in depression, anxiety, and general distress.3

Questions that remain unanswered by this study are (1) whether differences in benefit were due to gender-specific characteristics of men and women or (2) whether changes in the way in which men and women interact or behave in a mixed-gender group setting may have produced results different from what would be seen if studying men or women separately.

It is also possible that different approaches to group therapy would be more effective in men than in women. An earlier study by the same group of authors compared two different approaches, interpretive therapy versus supportive therapy, for both men and women. Interpretive therapy is an approach in which the objective is to enhance participants’ insight about conflicts and trauma; the therapist attempts to create a climate of tolerable tension within which conflicts can be examined and helps participants find their own new ways to interpret what has happened. In supportive therapy, the focus is on improving participants' skills in adapting to their difficulties; the therapist provides support and assists in direct problem solving. Study authors found that men had a better response to interpretive therapy whereas women responded better to supportive therapy.4

It should be noted that most of the research on how men specifically respond to psychological therapy and support has been limited to prostate cancer, which is unfortunate given that men get many other types of cancer.

In one such study, close to 40% of men with prostate cancer experienced significant psychological distress related to their diagnosis.1 In contrast to the previously discussed studies, which showed that men do not typically respond to group support, other studies have demonstrated that this approach can help men find a better understanding of their illness, find reassurance, alleviate anxiety, find a more positive outlook, and become more actively involved in treatment decisions. 2, 5 Similar benefits have also been found by men with prostate cancer in one-on-one peer counseling with long-term survivors; significant improvement in depression has been seen.6

Together, these findings present more questions than answers. Nevertheless, they suggest that approaches to providing psychological and social support by both clinicians and researchers should take into account the different ways in which men and women respond. Gender aside, one important defining feature may also be simply asking what approach a person may prefer. See Becoming Your Own Advocate for a discussion on how wanted and unwanted support affects patients.

References:
1. Balderson, N. and T. Towell (2003). "The prevalence and predictors of psychological distress in men with prostate cancer who are seeking support." Br J Health Psychol8(Pt 2): 125-34.
2. Gregoire, I., D. Kalogeropoulos, et al. (1997). "The effectiveness of a professionally led support group for men with prostate cancer." Urol Nurs 17(2): 58-66.
3. Ogrodniczuk, J. S., W. E. Piper, et al. (2004). "Differences in men's and women's responses to short-term group psychotherapy." Psychotherapy Research 14(2): 231-43.
4. Ogrodniczuk, J. S., W. E. Piper, et al. (2001). "Effect of patient gender on outcome in two forms of short-term individual psychotherapy." J Psychother Pract Res 10(2): 69-78.
5. Weber, B. A., B. L. Roberts, et al. (2000). "Exploring the efficacy of support groups for men with prostrate cancer." Geriatr Nurs 21(5): 250-3.
6. Weber, B. A., B. L. Roberts, et al. (2004). "The effect of dyadic intervention on self efficacy,social support, and depression for men with prostate cancer." Psychooncology13(1): 47-60.

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