Could Cognitive Behavioral Therapy Help Survivors with Chemobrain?

The Memory and Attention Adaptation Training (MAAT) program was designed to improve the quality of life and function of cancer survivors who are experiencing post-therapy cognitive issues.

Robert J. Ferguson, a clinical psychologist at Eastern Main Medical Center in Bangor, Maine, developed the cognitive behavioral therapy program to help cancer patients with cognitive issues as part of the center’s symptom management and support services.

“We teach compensatory strategies as well as stress management strategies, including relaxation or self regulation to control arousal,” Ferguson says, adding that teaching survivors how to think about memory failure differently is also important.

The MAAT program has four components:

1. Education around cognitive issues and the effects of chemotherapy

2. Self-awareness training to become aware of times when cognitive function is a challenge

3. Self-regulation training and stress management techniques

4. Cognitive compensatory strategies, which include self talk, using a day planner and visualizing.

“We emphasize in the program mastering a few of these strategies and not trying to master many,” Ferguson says. “For example, we had one participant who could come in her slippers that she wore around the house. In Texas that may not be a problem, but in Maine—in the winter--it is. Her compensatory strategy was to look at the floor before she left her house. That would remind her.”

[Read "Finding Solutions for Chemobrain"]

Ferguson also has patients talk themselves through tasks as their own play-by-plan announcer. “There is something important about vocalizing. Executive functions are those that help us with goal-directed behavior. And we have this internal monologue we don’t pay attention to, but when you lose function, you get distracted easily, so talking yourself through a task is helpful.”

Visualization is another technique he uses because it engages a different part of the brain. He tells patients to memorize the floor plan of their house and then put different things on a list in each room. Trying to remember just requires walking mentally through the house.

“It helps people who are visually oriented,” he says.

A small pilot study of patients treated for early-stage breast cancer demonstrated that MAAT reduced self-reported cognitive problems post-treatment at 2-month and 6-month follow-up assessments. A mild increase was found on a quality-of-life measure, and gains were also observed in verbal memory and processing speed. Participants reported overall high treatment satisfaction. A follow-up randomized controlled trial showed similar results and a third trial with MAAT being delivered via videoconferencing is being completed.

In short, breast cancer chemotherapy recipients reported improvements in quality of life, self-reported cognitive symptoms and improvements in neuropsychological test performance.