Efficacy of dignity therapy on depression and anxiety in Portuguese terminally ill patients: a phase II randomized controlled trial

J Palliat Med. 2014 Jun;17(6):688-95. doi: 10.1089/jpm.2013.0567. Epub 2014 Apr 15.

Abstract

Background: Dignity therapy is a brief psychotherapy developed for patients living with a life-limiting illness.

Objective: To determine the influence of dignity therapy on depression and anxiety in inpatients with a terminal illness and experiencing a high level of distress in a palliative care unit.

Methods: A nonblinded phase II randomized controlled trial of 80 patients who were randomly assigned to one of two groups: intervention group (dignity therapy+standard palliative care [SPC]) or control group (SPC alone). The main outcomes were depression and anxiety scores, as measured with the Hospital Anxiety and Depression Scale, and assessed at baseline (T1), day 4 (T2), day 15 (T3), and day 30 (T4) of follow-up. This study is registered with www.controlled-trials.com/ISRCTN34354086.

Results: Of the final 80 participants, 41 were randomly assigned to SPC and 39 to dignity therapy. Baseline characteristics were similar between the two groups. Dignity therapy was associated with a decrease in depression scores (median, 95% confidence interval [CI]: -4.00, -6.00 to -2.00, p<0.0001; -4.00, -7.00 to -1.00, p=0.010; -5.00, -8.00 to -1.00, p=0.043, for T2, T3, and T4, respectively). Dignity therapy was similarly associated with a decrease in anxiety scores (median, 95% CI: -3.00, -5.00 to -1.00, p<0.0001; -4.00, -7.00 to -2.00, p=0.001; -4.00, -7.00 to -1.00, p=0.013, for T2, T3, and T4, respectively).

Conclusion: Dignity therapy resulted in a beneficial effect on depression and anxiety symptoms in end-of-life care. The therapeutic benefit of dignity therapy was sustained over a 30-day period. Having established its efficacy, future trials of dignity therapy may now begin, comparing it with other psychotherapeutic approaches within the context of terminal illness.

Publication types

  • Clinical Trial, Phase II
  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anxiety Disorders / psychology
  • Anxiety Disorders / therapy*
  • Depressive Disorder / psychology
  • Depressive Disorder / therapy*
  • Female
  • Humans
  • Inpatients
  • Male
  • Middle Aged
  • Neoplasms / pathology
  • Neoplasms / psychology
  • Palliative Care / methods
  • Personhood*
  • Portugal
  • Psychotherapy, Brief / methods*
  • Quality of Life / psychology
  • Terminal Care / methods
  • Terminal Care / psychology
  • Terminally Ill / psychology*