Cancer-related psychological distress is a serious public health problem facing the American health care system. Cancer survivors experience psychological complications not only related to the cancer and treatment, but also to the side effects of treatment and other changes that can occur during the cancer experience [1,2]. Cancer-related distress may include emotional reactions ranging from fear and sadness to anxiety, depression, panic, and post-traumatic stress reactions . Some of the most compelling evidence of long-term psychological distress is from our prior research  with cancer survivors up to 11 years following hematopoietic stem cell transplant (HSCT) where we found that approximately half of survivors reported having experienced intrusive cognitions or physical reactions when reminded of their cancer experience . These long-term psychological symptoms occur irrespective of race, gender, or diagnosis, and have been associated with a serious disruption in quality of life (i.e., impairments in mental, social, physical, and vocational functioning) for cancer survivors. Recognizing this problem, the Institute of Medicine (IOM) has emphasized in its 2008 report, “Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs,” the importance of addressing psychosocial issues, such as distress, to providing quality cancer care . The National Cancer Institute (NCI) has reported a lack of trained professionals who can address these psychosocial needs using evidence-based psychosocial methods .
Cognitive Behavioral Therapy (CBT)  is one of the most effective, empirically-supported nonpharmacological interventions that have been shown to help cancer survivors cope with aversive aspects of their illness and its consequences. CBT is a type of psychotherapy that focuses on thoughts, emotions and behaviors and their role in maintaining psychological symptomatology. CBT has a demonstrated track record in reducing distress and other related symptoms in non-cancer populations and has promise in its use with cancer survivors. CBT interventions in cancer populations have been found to yield significant benefits, including reduction of anxiety, posttraumatic anxiety, depression, general distress, and fatigue [7,8]. A recent meta-analysis of CBT on depression, anxiety, and quality of life (QOL) found that with a pooled sample size of 1,492 adult cancer survivors ranging in age from 18 to 84, CBT demonstrated effect sizes of 1.2 for depression, 1.99 for anxiety, and 0.91 for Quality of Life . In specific cancer populations, CBT has been found to reduce distress symptoms among survivors of breast cancer [8, 10–11], head and neck cancer , melanoma , and prostate cancer . Consistent with this research, DuHamel and colleagues (2010) found that with survivors of HSCT found that CBT reduced cancer survivors’ distress on a scale of PTSD symptomatology compared to an assessment only control group (p = .0201) . Specifically, this study found evidence of statistically significant reductions in the PTSD symptoms of intrusive disturbing memories of cancer and its treatment (p = .011) and avoidance of recurrent and disturbing memories of cancer and its treatment (p < .001) as measured by the PTSD Checklist-Civilian Version (PCL-C). In addition, there have been statistically significant reductions in Global General Distress (p = .005) and depression (p = .023) as measured by the Brief Symptom Inventory (BSI).
The authors conducted a needs assessment survey to evaluate the level of interest in participating in CBT training by cancer health care professionals who provide supportive services for cancer patients and survivors. Responses were collected from 98 health care providers, 80% of which identified as social workers. Although two-thirds of practitioners reported using some CBT techniques in their current practice and 71% believe that CBT is effective in the treatment of cancer patients and survivors, only 5% reported mastery of CBT skills. In addition, more than 80% of respondents reported being highly motivated to learn CBT and would be willing to attend a CBT training workshop to learn such skills. Finally, 99% of professionals indicated they would apply their CBT training in their current practice once they had learned the skills.
The goal of the current CBT training program is to teach cancer health care professionals that changing survivors’ beliefs, behaviors, and cognitions can lead to reductions in distress and to give these professionals the means to help their patients learn effective coping skills. The training program focuses on CBT skill mastery using didactic instruction, interactive small group sessions, role playing, feedback, post course follow-up and evaluation. Trainees are encouraged to view implementation of CBT as a collaborative effort with the survivors they treat. This approach has been empirically validated with cross-disciplinary training  and is based on a training model developed by Knowles  who views adult learners as self-directed, ready to learn, problem-solving oriented and with a resource of life experience. This training model emphasizes that the adult learner needs immediate application of knowledge rather than delayed application. These principles of adult learning were emphasized in the workshop preparation and were used to plan appropriate education methods for the curriculum and its dissemination. The purpose of this paper is to describe in detail the successful recruitment and implementation of a unique CBT training model for frontline cancer care professionals.