An Open Pilot Testing Solution-Focused Brief Therapy As a Strength-Based Approach for Depression in Adolescent and Young Adult Cancer Survivors

Background and Purpose: Adolescents and Young Adults (AYAs) with cancer (15 to 39) are disproportionately impacted by psychological distress, including depression. While there are efficacious depression treatments for AYAs without cancer, few have evaluated evidence-based depression treatment for AYAs with cancer, and almost none focused on a strength-based psychotherapeutic approach. This pilot study evaluates the acceptability and preliminary efficacy of solution-focused brief therapy (SFBT) for depression, anxiety, and hope among AYAs with cancer.

Methods: In this single group pre-/post-test and one-month follow-up study, 10 AYAs with a primary sarcoma diagnosis participated in an open pilot of SFBT for their depression. Trained graduate-level social work interns delivered a structured four-session SFBT to participants with moderate or greater depressive symptoms (measured by the Patient Health Questionnaire, 9-item (PHQ-9)) at baseline. Core clinical measures included PHQ-9, the Generalized Anxiety Scale, 7-item (GAD-7), and the Herth Hope Index (HHI). Participants were evaluated at baseline, immediate post-intervention, and one-month follow-up. Statistical analysis using an intent-to-treat framework included descriptive statistics, pre- and post-intervention differences using paired samples t-test, and ANOVA to identify the pattern of difference in outcomes across three time points. Within-group small sample size corrected Hedges' g was estimated to evaluate SFBT's clinical significance.

Results: All participants completed four planned sessions and reported strong acceptability of SFBT. Statistically significant improvements were observed for pre- and post-treatment scores for depression (t(9)=5.65, p<0.001, g=0.95), anxiety (t(9)=5.75, p<0.001, g=0.92), and levels of hope (t(9)=7.61, p<0.001, g=1.57). These improvements were maintained at 1-month follow-up, with significant patterns of difference in study participants’ depression (F(2)=33.26, p<0.001), anxiety(F(2)=19.16, p<0.001), and levels of hope (F(2)=69.90, p<0.001) over time. Notably, the significant correlations in the change of hope score and scores of depression and anxiety suggest a signal of hope's therapeutic value in managing depression and anxiety for AYA cancer survivors.

Conclusions and Implications: SFBT is an acceptable intervention approach for depression (and anxiety) among AYAs diagnosed with cancer. SFBT offers a brief, strength-based, and hope-engendering approach to address mental health concerns among young adults diagnosed with cancer.