Structured Group Reminiscence Therapy for Enhancing Distress Tolerance and Quality of Life in Breast Cancer Survivors: A Randomized Controlled Trial 

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This study aimed to evaluate the effectiveness of structured group reminiscence therapy in improving distress tolerance and quality of life in breast cancer survivors in Iran. Methods In this randomized controlled trial, 30 female breast cancer survivors who had completed active treatment at least six months prior were recruited from Larestan, a city in Fars Province, Iran. Participants were randomly assigned to either an intervention group (n = 15), which received eight weekly 90-minute sessions of structured group reminiscence therapy, or a control group (n = 15). Outcome measures included the Distress Tolerance Scale (DTS) and the EORTC QLQ-C30 Quality of Life Questionnaire. Data were analyzed using ANCOVA and MANCOVA. Results Compared to the control group, the intervention group demonstrated significantly greater improvement in overall quality of life (F = 13.08, p = 0.001, η² = 0.326) and overall distress tolerance (F = 22.44, p < 0.001, η² = 0.454). Within the quality of life dimensions, significant improvements were observed in global health status (F = 5.33, p = 0.029, η² = 0.176) and functional status (F = 13.96, p = 0.001, η² = 0.358), while no significant difference was found in symptom severity (p = 0.387). Regarding distress tolerance, significant group differences were observed in tolerance (F = 5.88, p = 0.023, η² = 0.197), appraisal (F = 11.06, p = 0.003, η² = 0.316), and regulation(F = 6.24, p = 0.020, η² = 0.206), but not in absorption (p = 0.255). Conclusion Structured group reminiscence therapy appears to be a feasible and cost-effective psychosocial intervention for improving distress tolerance and enhancing quality of life in breast cancer survivors. These findings support its integration into survivorship care. Future research with larger sample sizes and long-term follow-up is recommended to further validate these outcomes. Breast cancer survivors Distress tolerance Quality of life Reminiscence therapy Group intervention Psychosocial support Introduction Breast cancer remains the most frequently diagnosed malignancy among women worldwide, with approximately 2.3 million new cases and 685,000 deaths reported in 2020 alone [ 1 ]. The burden is especially pronounced in low- and middle-income countries, where incidence and mortality rates are rising disproportionately [ 2 ]. Although medical advances have significantly improved survival, many breast cancer survivors continue to struggle with emotional distress, diminished quality of life, and existential concerns long after treatment ends [ 3 ]. However, most psychosocial oncology studies have focused primarily on the active treatment phase, leaving survivors’ psychological needs—such as empathy, meaning-making, and emotional validation—largely unmet [ 4 , 5 ].Group-based psychological interventions offer a promising solution to this care gap. Compared to individual therapy, group modalities are more cost-effective, reduce therapist workload, and enable the simultaneous treatment of more individuals within limited clinical timeframes [ 6 , 7 ]. In addition, they foster social connection, emotional support, and mutual validation among peers—factors that are particularly beneficial for cancer survivors facing isolation and identity disruption [ 8 ]. In particular, fostering peer-based empathy and shared identity reconstruction may help survivors make sense of their cancer experience and reduce feelings of alienation [ 9 , 10 ]. Structured group reminiscence therapy is one such intervention that facilitates emotional processing through the guided recall and sharing of meaningful personal memories. Positive memory recall has been shown to activate neural pathways associated with reward and emotional regulation, suggesting a neurocognitive basis for its therapeutic impact in emotionally distressed individuals [ 10 ]. Although initially developed for use in older adult populations, this approach has demonstrated potential to enhance self-concept, life purpose, and emotional resilience in broader clinical contexts [ 11 ]. Its group-based format makes it practical for integration into routine psychosocial services, requiring minimal resources and enabling facilitation by trained non-specialist personnel [ 12 , 13 ]. Despite these advantages, structured group reminiscence therapy has been rarely examined in oncology populations. Its potential to improve distress tolerance and quality of life in cancer survivors remains underexplored, particularly in low-resource settings. Recent studies highlight the need for developing psychosocial models that are culturally sensitive and adaptable, especially in resource-constrained contexts [ 14 , 15 ]. This study aimed to evaluate the effectiveness of structured group reminiscence therapy in enhancing distress tolerance and quality of life among breast cancer survivors in Iran. The findings may inform the implementation of scalable, culturally relevant psychosocial interventions in survivorship care. Materials and Methods Study Design This study followed a parallel-group randomized controlled trial (RCT) design. Eligible participants were randomly allocated to either an intervention group receiving structured group reminiscence therapy or a control group receiving no psychological intervention. The study protocol was approved by the Ethics Committee of Islamic Azad University, Shiraz Branch (Ethics ID: IR.IAU.SHIRAZ.REC.1402.328), and conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Informed written consent was obtained from all participants prior to data collection. The trial was registered with the Iranian Registry of Clinical Trials (Registration ID: IRCT20230617058502N3). Participants Participants were recruited from three breast cancer screening and oncology centers affiliated with Larestan School of Medical Sciences, Iran. Eligible individuals were identified with the assistance of oncologists and through public announcements. Inclusion criteria were as follows : – Female breast cancer survivors aged 35–65 years – At least six months must have passed since completion of all active treatments (surgery, chemotherapy, and/or radiotherapy) – No clinical signs of disease recurrence – No concurrent participation in psychological therapy – Basic literacy and ability to participate in group sessions – Absence of major psychiatric disorders Exclusion criteria were as follows : – Unwillingness to continue participation – Physical inability to attend group sessions – Missing more than two intervention sessions A total of 32 women expressed interest and were screened for eligibility. Following minor attrition (one dropout per group), 30 participants were enrolled and randomly assigned to the intervention (n = 15) and control (n = 15) groups. Ethical Considerations Ethical approval was obtained from the Research Ethics Committee of Islamic Azad University, Shiraz Branch (IR.IAU.SHIRAZ.REC.1402.328). All participants provided written informed consent before enrollment. Procedure Following ethics approval and trial registration, participants were randomly assigned to either the intervention or control group using simple randomization. All participants completed baseline assessments, including demographic information, the Distress Tolerance Scale (DTS), and the EORTC QLQ-C30 quality of life questionnaire. The intervention group participated in eight weekly 90-minute sessions of structured group reminiscence therapy, conducted in two subgroups (8 and 7 participants). Session topics included childhood memories, personal achievements, coping with loss, resilience during hardship, and life meaning. Sessions were led by a trained clinical psychologist with experience in psycho-oncology. The control group received no psychological intervention during the study period and was placed on a waiting list. Upon completion of the intervention, both groups completed posttest assessments using the same instruments. Reminiscence Intervention Protocol The structured group reminiscence therapy implemented in this study was based on a general framework of reminiscence interventions but was extensively modified by the researcher to address the specific psychological needs of breast cancer survivors. The adaptation process also incorporated culturally relevant themes and content to reflect the values, beliefs, and lived experiences of women in the Iranian sociocultural context. To ensure content relevance and appropriateness, the culturally adapted protocol was reviewed and validated by five academic psychologists with expertise in reminiscence-based interventions. Each session was designed with a clear therapeutic focus, using guided memory prompts and supportive stimuli such as photographs, personal artifacts, and discussion topics aligned with Iranian cultural narratives. The final protocol consisted of eight structured sessions, each targeting a distinct psychological theme (e.g., childhood memories, achievements, coping with adversity, and meaning in life). Sessions were delivered in small groups by a trained clinical psychologist and followed a consistent structure involving memory sharing, emotional reflection, and group discussion.Table 1 presents the content, stimuli, and therapeutic objectives of each session. Table 1 Structure, Stimuli, and Therapeutic Objectives of the 8 Session Reminiscence Therapy Protocol Session Session Title Stimuli / Thematic Focus Therapeutic Objective 1 Childhood and Family Life National ID, marriage certificate, personal items; family photos; childhood games (e.g., marbles, jump rope) To foster emotional safety and engagement, initiate personal introductions, spark interest in reminiscence, and encourage sharing of early life memories, including those related to naming and family identity. 2 School Years and Early Career Blackboard, chalk, school supplies, report cards, educational globe, uniforms, teacher’s name; work tools, old currency, vocational certificates To promote group cohesion by revisiting both joyful and challenging school and work experiences, honor personal achievements, and explore the impact of cancer on occupational life and independence. 3 Outdoor Activities and Leisure Images or props related to parks, green spaces, local tourist sites To revive memories of youthful joy, beauty, and romantic experiences (e.g., cinema, first love, perfumes); and to explore how cancer affected one’s lifestyle, body image, and coping mechanisms. 4 Marriage and Intimacy Marriage certificate, wedding ring, photos, love letters, engagement gifts To reflect on marital relationships and shared moments, including emotional and relational challenges posed by cancer, while appreciating the empathy and support of one's spouse during illness. 5 Home, Garden, and Pets Paintbrushes, gardening tools, hammers, photos of old houses and neighborhoods To recall lived environments across the lifespan and revisit practical roles and meaningful activities such as gardening or home decoration that reflect personal identity and contribution. 6 Parenting and the Next Generation Baby bottles, safety pins, bibs, dolls, baby oil, name books, old baby photos To evoke memories of raising children, emotional connections with infants, and shared moments with family, including the challenges and mutual support during the illness period. 7 Food, Cooking, Travel, and Holidays Cookbooks, utensils, food images; souvenirs, maps, backpacks, shells To recall culinary traditions and changes caused by illness, foster group interaction through food sharing; and to revisit meaningful travels and the sense of adventure, success, and misfortune they brought. 8 Closing and Celebration Family-provided materials, session photos, participant writings or artworks To reflect on the personal meaning of the sessions, celebrate group efforts, and encourage planning for continued emotional growth and future participation in similar group experiences. Measures 1. Distress Tolerance Scale (DTS) The Distress Tolerance Scale (DTS) is a 15-item self-report instrument that evaluates four components of distress tolerance: Tolerance, Absorption, Appraisal, and Regulation. Each item is rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree), with item 6 reverse-scored. The total score ranges from 15 to 75, with higher scores indicating greater distress tolerance. The scale was originally developed by Simons and Gaher [ 16 ] and has been validated in Persian for clinical samples in Iran [ 17 ]. 2. Quality of Life – EORTC QLQ-C30 The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, version 3.0) is a 30-item instrument designed to assess cancer-related quality of life across five functional domains (physical, role, emotional, cognitive, and social), nine symptom domains, and two global health items. Items are scored using 4-point Likert scales, except for global health items which use a 7-point scale. Higher scores in the functional and global domains indicate better functioning; higher scores in symptom domains reflect greater symptom burden. The Persian version has been psychometrically validated in Iran with strong internal consistency (Cronbach’s alpha: 0.52–0.98) [ 18 ]. Statistical Analysis Data were analyzed using IBM SPSS Statistics version 28. Descriptive statistics (means and standard deviations) were calculated to summarize demographic characteristics and baseline variables. Independent samples t-tests were conducted to assess pre-intervention group equivalence. To examine the effects of the intervention, univariate analysis of covariance (ANCOVA) was performed on the total scores of distress tolerance and quality of life, controlling for baseline values. Multivariate analysis of covariance (MANCOVA) was also conducted to evaluate the intervention’s impact on the subscales of both outcome measures. All assumptions for ANCOVA and MANCOVA—including normality (Shapiro–Wilk test), homogeneity of variances (Levene’s test), absence of outliers (based on boxplots), and homogeneity of regression slopes—were checked and met. The significance threshold was set at p < 0.05. Partial eta-squared (η²) values were reported to indicate effect sizes. The intervention group showed significantly greater improvement than the control group in overall quality of life (F = 13.08, p = 0.001, η² = 0.326) and distress tolerance (F = 22.44, p < 0.001, η² = 0.454). Within the subscales of quality of life, significant effects were found for Global Health Status (η² = 0.326) and the Functional Domain (η² = 0.358), but not for the Symptoms domain (p > 0.05). For distress tolerance, significant improvements were observed in the subscales of Tolerance (η² = 0.197), Appraisal (η² = 0.316), and Regulation (η² = 0.206), while the Absorption subscale did not show a significant group difference (p = 0.255). Results Participants A total of 30 breast cancer survivors participated in the final analysis, with 15 assigned to the intervention group and 15 to the control group. No significant differences were observed between groups in baseline scores for quality of life (QoL) or distress tolerance. Pre-Post Comparisons: t-tests Table 2 presents the pretest and posttest means and standard deviations for the two primary outcome variables—Quality of Life and Distress Tolerance. Independent samples t-tests indicated no statistically significant differences at pretest for total QoL (t = − 0.67, p = 0.755) or total distress tolerance (t = − 0.67, p = 0.755). However, at posttest, the intervention group showed significantly higher scores in both total QoL (t = 4.27, p = 0.032) and distress tolerance (t = 4.27, p = 0.032) compared to the control group. Table 2 Means and Standard Deviations for Pretest and Posttest Scores (t-tests) Variable Time Intervention Group (M ± SD) Control Group (M ± SD) t p Quality of Life (Total) Pretest 70.47 ± 6.47 70.87 ± 6.22 -0.67 0.755 Posttest 74.47 ± 5.47 70.53 ± 4.90 4.27 0.032 Distress Tolerance (Total) Pretest 44.73 ± 6.33 45.40 ± 5.22 -0.67 0.755 Posttest 50.27 ± 5.43 46.00 ± 4.90 4.27 0.032 ANCOVA: Quality of Life Outcomes To examine group differences at posttest while controlling for pretest scores, analyses of covariance (ANCOVA) were performed. Table 3 shows the ANCOVA results for quality of life and its components. Significant differences were observed between groups in total quality of life (QoL) scores (F(1, 27) = 13.08, p = 0.001, partial η² = 0.326), the functional domain (F = 13.96, p = 0.001, partial η² = 0.358), and global health status (F = 5.33, p = 0.029, partial η² = 0.176). No significant group difference was found in the symptom domain (F = 0.775, p = 0.387, partial η² = 0.030). Furthermore, multivariate analysis using Wilks’ Lambda demonstrated a significant overall effect of the intervention on QoL components (Wilks’ Λ = 0.551, F(3, 24) = 6.52, p = 0.003, partial η² = 0.449). Table 3 ANCOVA Results for Quality of Life and Its Components Dependent Variable Intervention Group Control Group F(1, 27) p Partial η² Quality of Life (Total) 74.66 70.34 13.08 0.001 0.326 Functional Domain 39.17 36.29 13.96 0.001 0.358 Symptom Domain 30.04 29.43 0.775 0.387 0.030 Global Health Status 5.51 4.56 5.33 0.029 0.176 Multivariate (Wilks’ Λ) — — 6.52 0.003 0.449 ANCOVA: Distress Tolerance Outcomes Table 4 shows ANCOVA results for distress tolerance and its four subscales. The intervention group demonstrated significantly higher posttest scores in total distress tolerance (F = 22.44, p < 0.001, partial η² = 0.454), tolerance (F = 5.88, p = 0.023), appraisal (F = 11.06, p = 0.003), and regulation (F = 6.24, p = 0.020). No significant difference was found for absorption (F = 1.36, p = 0.255). A multivariate test further confirmed a significant group effect on distress tolerance: Wilks’ Λ = 0.443, F(4, 23) = 7.24, p = 0.001, partial η² = 0.557. Table 4 ANCOVA Results for Distress Tolerance and Its Components Dependent Variable Intervention Group Control Group F(1, 27) p Partial η² Distress Tolerance (Total) 50.52 45.75 22.44 < 0.001 0.454 Tolerance 10.52 9.28 5.88 0.023 0.197 Absorption 9.53 9.13 1.36 0.255 0.054 Appraisal 19.06 17.20 11.06 0.003 0.316 Regulation 11.38 10.15 6.24 0.020 0.206 Multivariate (Wilks’ Λ) — — 7.24 0.001 0.557 Discussion This randomized controlled trial provides empirical evidence for the effectiveness of structured group reminiscence therapy in enhancing both quality of life and distress tolerance among breast cancer survivors. Participants in the intervention group demonstrated significant improvements in global health status, functional domains of quality of life, and emotional regulation compared to those in the control group. These findings align with previous studies that support the role of reminiscence-based interventions in promoting psychological adjustment, self-acceptance, and adaptive coping, particularly in older adults and oncology populations【5,14,15】. Importantly, the primary benefits of the intervention emerged within psychological and social dimensions rather than in the physical symptom domain. This pattern is consistent with the proposed therapeutic mechanisms of structured reminiscence therapy, which emphasize the activation of positive affect, reconstruction of meaning, and facilitation of group cohesion. Prior research has indicated that hope and perceived social support are positively associated with quality of life among women with breast cancer【9】. The group-based format of the intervention further facilitates emotional validation, shared meaning-making, and interpersonal connection, which may contribute to enhanced psychological resilience. At a neurobiological level, positive autobiographical recall has been shown to engage reward-related circuits such as the striatum, modulate cortisol levels, and enhance subjective well-being【10】. Recent neuroimaging reviews suggest that reminiscence-based interventions activate neural networks involved in emotional regulation and reward anticipation—including the striatum and prefrontal cortex—thereby offering a plausible neurocognitive explanation for their efficacy in oncology contexts【19】. Moreover, the group setting offers a safe and supportive environment for processing distressing memories, which is particularly relevant in cancer survivors, given the established link between experiential avoidance, rumination, and reduced distress tolerance【20】. Furthermore, a recent meta-analysis confirmed the effectiveness of group-based psychological interventions in significantly reducing distress and improving adaptive coping strategies in oncology populations, thereby underscoring their broader clinical relevance【21】. This is supported by recent systematic reviews indicating that post-diagnosis rumination—especially brooding—significantly predicts emotional distress in cancer populations, highlighting the importance of distress tolerance as a transdiagnostic treatment target【22】. Reflecting on previous coping successes may also help survivors reclaim a sense of mastery and agency in the face of ongoing life challenges. Taken together, these findings support the inclusion of structured reminiscence therapy as a neurocognitively informed, evidence-based modality in psycho-oncological care. Clinical and Policy Implications From a clinical and policy perspective, structured group reminiscence therapy represents a low-cost, scalable, and culturally adaptable alternative to traditional individual psychotherapy. Meta-analytic evidence suggests that group-based interventions can significantly reduce treatment-related costs while delivering comparable outcomes【8,11】. This is particularly valuable for psycho-oncology settings with limited access to trained mental health professionals. Moreover, the structured and manualized nature of the intervention allows for easy adaptation to diverse cultural contexts and can be delivered by trained non-specialist facilitators within existing supportive care frameworks. Given the growing number of cancer survivors worldwide, incorporating such interventions into national psycho-oncology guidelines may help standardize low-cost, culturally appropriate psychological support across diverse health systems. Limitations and Future Research This study has several limitations. First, the relatively small sample size and short-term posttest-only design may limit the generalizability and long-term validity of the findings. Second, the sample was restricted to female breast cancer survivors within a specific cultural context, limiting external applicability to other cancer types, genders, or sociocultural groups. Future studies should employ larger, more heterogeneous samples and adopt longitudinal designs that include follow-up assessments to evaluate the durability of intervention effects. Moreover, qualitative or mixed-method approaches could enrich our understanding of how participants perceive the intervention and what mechanisms they find most meaningful. Exploring neurobiological or psychophysiological correlates may also deepen the mechanistic understanding of how reminiscence therapy exerts its effects. It is further recommended to examine the role of potential moderators—such as personality traits, emotional intelligence, and recovery stage—to identify subgroups that may derive the greatest benefit. Finally, employing condition-specific instruments such as the EORTC QLQ-BR23 alongside general QoL measures may enhance the precision of assessment. Clinical Applications In summary, this trial provides robust preliminary support for the use of structured group reminiscence therapy as an effective, feasible, and culturally sensitive intervention to improve mental health outcomes among breast cancer survivors. Its emotional depth, low resource requirements, and adaptability make it particularly well-suited for integration into psycho-oncology services in low- and middle-income settings, especially in healthcare contexts where mental health infrastructure is limited and cost-effective group approaches are essential. Conclusion This randomized controlled trial demonstrated that structured group reminiscence therapy significantly enhances both distress tolerance and quality of life in breast cancer survivors. Participants in the intervention group showed substantial improvements in global health status, functional domains, and emotion regulation, supporting the psychosocial value of this group-based intervention. The results suggest that reminiscence therapy, by encouraging positive memory recall and shared emotional experiences, promotes resilience, meaning-making, and adaptive coping. Its feasibility, cost-effectiveness, and potential for delivery by trained non-specialist personnel make it a promising adjunct to standard survivorship care, particularly in low-resource settings. Given the short-term design and small sample size, future studies are needed to replicate these findings using larger, more diverse samples and extended follow-up periods. Additionally, evaluating the intervention across different cancer types and incorporating disease-specific measures could further clarify its utility. Overall, structured group reminiscence therapy represents a promising, scalable, and neurocognitively informed strategy to address the unmet psychological needs of breast cancer survivors across diverse care settings. Declarations Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Trial Registration This study was registered with the Iranian Registry of Clinical Trials (IRCT) under registration number IRCT20230617058502N3, with the unique trial ID IRCT ID: 75725. The trial was registered on March 12, 2024. Ethics Approval This study was approved by the Ethics Committee of Islamic Azad University, Shiraz Branch (Approval Code: IR.IAU.SHIRAZ.REC.1402.328). All procedures were conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their inclusion in the study. Author Contribution A.J. developed and culturally adapted the structured group reminiscence therapy protocol based on the specific needs of breast cancer survivors. She was responsible for designing the study, collecting and analyzing the data, and drafting the manuscript. L.K. served as the corresponding author and thesis supervisor, providing academic supervision, critical feedback, and final approval of the manuscript. Both authors reviewed and approved the final version of the paper. Acknowledgement The authors wish to express their sincere gratitude to all breast cancer survivors who participated in this study, and to the administrative staff at Ansari Clinic, Ali ibn Musa al-Reza Clinic, and Imam Hassan Mojtaba Clinic in Larestan for their cooperation. Special thanks are extended to Dr. Leila Khabir, Dr. Farzaneh Hooman, Dr. Sahar al-Sadat Torabian, Dr. Zahra Saffarian, and Maryam Abbasnejadan for their valuable expert input in reviewing and approving the reminiscence therapy protocol. Data Availability The research data supporting the findings of this study were derived from the author’s thesis and are available in SPSS format. These data will be made available to the journal upon reasonable request. References Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209–249. doi: 10.3322/caac.21660 . Lei S, Zheng R, Zhang S, et al. Global patterns of breast cancer incidence and mortality: A population-based cancer registry data analysis from 2000 to 2020. Cancer Commun (Lond). 2021;41(11):1183–1194. doi: 10.1002/cac2.12207 . Quinto RM, JiménezFonseca P, Muñoz M, et al. Psychological distress and quality of life in cancer survivors: a cross-sectional study. Support Care Cancer. 2022;30(2):1835–1843. doi: 10.1007/s00520-021-06699-2 . LoFoWong DSW, de Haes HCJM, Aaronson NK, et al. Unmet needs and quality of life of breast cancer survivors: a cross-sectional study. Psychooncology. 2020;29(7):1166–1174. doi: 10.1002/pon.5379 . Zhu L, Sun Y. The effectiveness of reminiscence therapy on meaning in life and psychological outcomes in older adults: a meta-analysis. Aging Ment Health. 2021;25(10):1833–1843. doi: 10.1080/13607863.2020.1784863 . Abdollahzadeh F, Khabazi A. Feasibility of group reminiscence therapy implementation by para-clinical staff in cancer supportive care. Iran J Cancer Prev. 2017;10(1):e7286. (In Persian). AguileraMartín A, SerranoPintado I, GarcésGarcía M, et al. Group reminiscence therapy for elderly women with cancer: a randomized controlled trial. BMC Cancer. 2022;22:679. doi: 10.1186/s12885-022-09726-4 . Wang Y, Liu Z, Wei X. Economic evaluation of group psychological interventions: a review. Chin J Health Econ. 2011;30(5):56–58. Shen MJ, Pruthi S, Hoffman KE, et al. Hope and social support as predictors of quality of life among breast cancer survivors. Support Care Cancer. 2020;28(8):3921–3928. doi: 10.1007/s00520-019-05137-1 . Speer ME, Bhanji JP, Delgado MR. Savoring the past: positive memories evoke value representations in the striatum. Neuron. 2014;84(4):847–856. doi: 10.1016/j.neuron.2014.09.028 . Cai X. Costeffectiveness of group vs. individual psychotherapy in oncology settings: a meta-analytic perspective. Asian Pac J Cancer Prev. 2018;19(6):1501–1507. doi: 10.22034/APJCP.2018.19.6.1501 . Choi JA, Kim JH. Effects of group reminiscence therapy on psychological well-being and depression in older adults: A meta-analysis. Aging Ment Health. 2018;22(12):1545–1555. doi: 10.1080/13607863.2017.1358355 . Chae J, Lee C, Choi J. Peer emotional support and psychological adaptation among breast cancer survivors. Support Care Cancer. 2019;27(6):2297–2304. doi: 10.1007/s00520-018-4530-y . Wu W, Zheng Y. Structured group reminiscence improves emotional resilience among cancer survivors: a controlled trial. J Psychosoc Oncol. 2023;41(1):30–45. doi: 10.1080/07347332.2022.2114174 . Afshari A, Mozaffari N, Aghamohammadi V. Effects of group reminiscence therapy on psychological well-being in cancer patients: a quasi-experimental study. Iran J Nurs Midwifery Res. 2019;24(2):150–155. (In Persian). Simons JS, Gaher RM. The Distress Tolerance Scale: Development and validation of a self-report measure. Motiv Emot. 2005;29(2):83–102. doi: 10.1007/s11031-005-7955-3 . Alavi K. The effectiveness of dialectical behavioral group therapy on reducing depression symptoms among university students in Mashhad [Master’s thesis]. Mashhad: Ferdowsi University of Mashhad; 2009. (In Persian). Montazeri A, Harirchi I, Vahdani M, Khaleghi F, Jarvandi S, Ebrahimi M, HajiMahmoodi M. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQC30): translation and validation study of the Iranian version. Support Care Cancer. 1999;7(6):400–406. doi: 10.1007/s005200050278 . Sun X, Su W, Yin M, Xia L. Effects of a reminiscence therapyinvolved program on anxiety, depression, and the quality of life in cancer patients: a meta-analysis of randomized controlled trials. Front Psychol. 2024;15:1408941. doi: 10.3389/fpsyg.2024.1408941 . Sadeghi Arfaei F, Hasani J, Moin L. Experiential avoidance and distress tolerance in cancer patients: the mediating role of rumination. J Behav Sci. 2021;15(4):486–498. (In Persian). Paslaru AM, Plesea-Condratovici A, Moroianu LA, et al. Mind over Malignancy: A systematic review and metaanalysis of psychological distress, coping, and therapeutic interventions in oncology. Medicina. 2025;61(6):1086. doi: 10.3390/medicina61061086 . Lee CA, Sherman KA. Is rumination associated with psychological distress after a cancer diagnosis? A systematic review. Psychooncology. 2023;32(9):1545–1554. doi: 10.1002/pon.5803 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7096344","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":505498482,"identity":"6bfe0a7a-0af5-4089-b668-42c2fe88592c","order_by":0,"name":"Azar Jafari¹","email":"","orcid":"","institution":"Islamic Azad University of Shiraz","correspondingAuthor":false,"prefix":"","firstName":"Azar","middleName":"","lastName":"Jafari¹","suffix":""},{"id":505498484,"identity":"b539af4d-9240-40a1-ba78-c7e257f86ab6","order_by":1,"name":"Leila Khabir²","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIie3RsUoDMRzH8V846C3BWzNYfIU/uDiIz3J/Dm4KRXApOPiXg7oUXIWCvoLdO+S4oa8g6GAQOnUQXG7o4BUP6ZQWXBzynULgQ/5JgFjsH3YEdeuAPIdRgk/qt/MAGUDJL1EPhxGgJ0CiDxlskFbiWpSjbFZNvs4vL1jS5h1+ESC6lnoKe2Xe6mpmqWDRJSFfBYhhcRpjlheuEksJC2w3qAuQEy/1piNPW3JGNyzZeg/pHqrRsPy8JaCGxew7RbM0x1TyvLuLmtLydGJW5EIkS5fer8cFP77efaDdXA/vs8L7NkB+op11/1OxWCwW+0vfY4lUCFXDqHgAAAAASUVORK5CYII=","orcid":"","institution":"Islamic Azad University of Shiraz","correspondingAuthor":true,"prefix":"","firstName":"Leila","middleName":"","lastName":"Khabir²","suffix":""}],"badges":[],"createdAt":"2025-07-10 22:53:06","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7096344/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7096344/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":92820343,"identity":"fddfd237-188b-4310-8d08-cf4cf0daac62","added_by":"auto","created_at":"2025-10-06 01:16:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":683424,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7096344/v1/3156b473-7660-4cff-a505-467aea08b08b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Structured Group Reminiscence Therapy for Enhancing Distress Tolerance and Quality of Life in Breast Cancer Survivors: A Randomized Controlled Trial ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eBreast cancer remains the most frequently diagnosed malignancy among women worldwide, with approximately 2.3\u0026nbsp;million new cases and 685,000 deaths reported in 2020 alone [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The burden is especially pronounced in low- and middle-income countries, where incidence and mortality rates are rising disproportionately [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Although medical advances have significantly improved survival, many breast cancer survivors continue to struggle with emotional distress, diminished quality of life, and existential concerns long after treatment ends [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. However, most psychosocial oncology studies have focused primarily on the active treatment phase, leaving survivors\u0026rsquo; psychological needs\u0026mdash;such as empathy, meaning-making, and emotional validation\u0026mdash;largely unmet [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].Group-based psychological interventions offer a promising solution to this care gap. Compared to individual therapy, group modalities are more cost-effective, reduce therapist workload, and enable the simultaneous treatment of more individuals within limited clinical timeframes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In addition, they foster social connection, emotional support, and mutual validation among peers\u0026mdash;factors that are particularly beneficial for cancer survivors facing isolation and identity disruption [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In particular, fostering peer-based empathy and shared identity reconstruction may help survivors make sense of their cancer experience and reduce feelings of alienation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eStructured group reminiscence therapy is one such intervention that facilitates emotional processing through the guided recall and sharing of meaningful personal memories. Positive memory recall has been shown to activate neural pathways associated with reward and emotional regulation, suggesting a neurocognitive basis for its therapeutic impact in emotionally distressed individuals [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Although initially developed for use in older adult populations, this approach has demonstrated potential to enhance self-concept, life purpose, and emotional resilience in broader clinical contexts [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Its group-based format makes it practical for integration into routine psychosocial services, requiring minimal resources and enabling facilitation by trained non-specialist personnel [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eDespite these advantages, structured group reminiscence therapy has been rarely examined in oncology populations. Its potential to improve distress tolerance and quality of life in cancer survivors remains underexplored, particularly in low-resource settings. Recent studies highlight the need for developing psychosocial models that are culturally sensitive and adaptable, especially in resource-constrained contexts [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. This study aimed to evaluate the effectiveness of structured group reminiscence therapy in enhancing distress tolerance and quality of life among breast cancer survivors in Iran. The findings may inform the implementation of scalable, culturally relevant psychosocial interventions in survivorship care.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cb\u003eStudy Design\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study followed a parallel-group randomized controlled trial (RCT) design. Eligible participants were randomly allocated to either an intervention group receiving structured group reminiscence therapy or a control group receiving no psychological intervention.\u003c/p\u003e\u003cp\u003e The study protocol was approved by the Ethics Committee of Islamic Azad University, Shiraz Branch (Ethics ID: IR.IAU.SHIRAZ.REC.1402.328), and conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Informed written consent was obtained from all participants prior to data collection.\u003c/p\u003e\u003cp\u003eThe trial was registered with the Iranian Registry of Clinical Trials (Registration ID: IRCT20230617058502N3).\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Participants were recruited from three breast cancer screening and oncology centers affiliated with Larestan School of Medical Sciences, Iran. Eligible individuals were identified with the assistance of oncologists and through public announcements.\u003c/p\u003e\u003cp\u003e\u003cb\u003eInclusion criteria were as follows\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; Female breast cancer survivors aged 35\u0026ndash;65 years\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; At least six months must have passed since completion of all active treatments (surgery, chemotherapy, and/or radiotherapy)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; No clinical signs of disease recurrence\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; No concurrent participation in psychological therapy\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; Basic literacy and ability to participate in group sessions\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; Absence of major psychiatric disorders\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eExclusion criteria were as follows\u003c/b\u003e:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; Unwillingness to continue participation\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; Physical inability to attend group sessions\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u0026ndash; Missing more than two intervention sessions\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eA total of 32 women expressed interest and were screened for eligibility. Following minor attrition (one dropout per group), 30 participants were enrolled and randomly assigned to the intervention (n\u0026thinsp;=\u0026thinsp;15) and control (n\u0026thinsp;=\u0026thinsp;15) groups.\u003c/p\u003e\u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003cp\u003e was obtained from the Research Ethics Committee of Islamic Azad University, Shiraz Branch (IR.IAU.SHIRAZ.REC.1402.328). All participants provided written informed consent before enrollment.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eProcedure\u003c/b\u003e\u003c/p\u003e\u003cp\u003eFollowing ethics approval and trial registration, participants were randomly assigned to either the intervention or control group using simple randomization. All participants completed baseline assessments, including demographic information, the Distress Tolerance Scale (DTS), and the EORTC QLQ-C30 quality of life questionnaire.\u003c/p\u003e\u003cp\u003e The intervention group participated in eight weekly 90-minute sessions of structured group reminiscence therapy, conducted in two subgroups (8 and 7 participants). Session topics included childhood memories, personal achievements, coping with loss, resilience during hardship, and life meaning. Sessions were led by a trained clinical psychologist with experience in psycho-oncology.\u003c/p\u003e\u003cp\u003eThe control group received no psychological intervention during the study period and was placed on a waiting list. Upon completion of the intervention, both groups completed posttest assessments using the same instruments.\u003c/p\u003e\u003cp\u003e\u003cb\u003eReminiscence Intervention Protocol\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe structured group reminiscence therapy implemented in this study was based on a general framework of reminiscence interventions but was extensively modified by the researcher to address the specific psychological needs of breast cancer survivors. The adaptation process also incorporated culturally relevant themes and content to reflect the values, beliefs, and lived experiences of women in the Iranian sociocultural context.\u003c/p\u003e\u003cp\u003eTo ensure content relevance and appropriateness, the culturally adapted protocol was reviewed and validated by five academic psychologists with expertise in reminiscence-based interventions. Each session was designed with a clear therapeutic focus, using guided memory prompts and supportive stimuli such as photographs, personal artifacts, and discussion topics aligned with Iranian cultural narratives.\u003c/p\u003e\u003cp\u003eThe final protocol consisted of eight structured sessions, each targeting a distinct psychological theme (e.g., childhood memories, achievements, coping with adversity, and meaning in life). Sessions were delivered in small groups by a trained clinical psychologist and followed a consistent structure involving memory sharing, emotional reflection, and group discussion.Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e\u003cem\u003epresents the content, stimuli, and therapeutic objectives of each session.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eStructure, Stimuli, and Therapeutic Objectives of the 8 Session Reminiscence Therapy Protocol\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSession\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSession Title\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStimuli / Thematic Focus\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTherapeutic Objective\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChildhood and Family Life\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNational ID, marriage certificate, personal items; family photos; childhood games (e.g., marbles, jump rope)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo foster emotional safety and engagement, initiate personal introductions, spark interest in reminiscence, and encourage sharing of early life memories, including those related to naming and family identity.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSchool Years and Early Career\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBlackboard, chalk, school supplies, report cards, educational globe, uniforms, teacher\u0026rsquo;s name; work tools, old currency, vocational certificates\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo promote group cohesion by revisiting both joyful and challenging school and work experiences, honor personal achievements, and explore the impact of cancer on occupational life and independence.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOutdoor Activities and Leisure\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eImages or props related to parks, green spaces, local tourist sites\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo revive memories of youthful joy, beauty, and romantic experiences (e.g., cinema, first love, perfumes); and to explore how cancer affected one\u0026rsquo;s lifestyle, body image, and coping mechanisms.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMarriage and Intimacy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMarriage certificate, wedding ring, photos, love letters, engagement gifts\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo reflect on marital relationships and shared moments, including emotional and relational challenges posed by cancer, while appreciating the empathy and support of one's spouse during illness.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHome, Garden, and Pets\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePaintbrushes, gardening tools, hammers, photos of old houses and neighborhoods\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo recall lived environments across the lifespan and revisit practical roles and meaningful activities such as gardening or home decoration that reflect personal identity and contribution.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eParenting and the Next Generation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBaby bottles, safety pins, bibs, dolls, baby oil, name books, old baby photos\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo evoke memories of raising children, emotional connections with infants, and shared moments with family, including the challenges and mutual support during the illness period.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFood, Cooking, Travel, and Holidays\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCookbooks, utensils, food images; souvenirs, maps, backpacks, shells\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo recall culinary traditions and changes caused by illness, foster group interaction through food sharing; and to revisit meaningful travels and the sense of adventure, success, and misfortune they brought.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClosing and Celebration\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFamily-provided materials, session photos, participant writings or artworks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTo reflect on the personal meaning of the sessions, celebrate group efforts, and encourage planning for continued emotional growth and future participation in similar group experiences.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003eMeasures\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e1. Distress Tolerance Scale (DTS)\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe Distress Tolerance Scale (DTS) is a 15-item self-report instrument that evaluates four components of distress tolerance: Tolerance, Absorption, Appraisal, and Regulation. Each item is rated on a 5-point Likert scale (1\u0026thinsp;=\u0026thinsp;strongly disagree to 5\u0026thinsp;=\u0026thinsp;strongly agree), with item 6 reverse-scored. The total score ranges from 15 to 75, with higher scores indicating greater distress tolerance. The scale was originally developed by Simons and Gaher [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and has been validated in Persian for clinical samples in Iran [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e2. Quality of Life \u0026ndash; EORTC QLQ-C30\u003c/p\u003e\u003cp\u003eThe European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, version 3.0) is a 30-item instrument designed to assess cancer-related quality of life across five functional domains (physical, role, emotional, cognitive, and social), nine symptom domains, and two global health items. Items are scored using 4-point Likert scales, except for global health items which use a 7-point scale. Higher scores in the functional and global domains indicate better functioning; higher scores in symptom domains reflect greater symptom burden. The Persian version has been psychometrically validated in Iran with strong internal consistency (Cronbach\u0026rsquo;s alpha: 0.52\u0026ndash;0.98) [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using IBM SPSS Statistics version 28. Descriptive statistics (means and standard deviations) were calculated to summarize demographic characteristics and baseline variables. Independent samples t-tests were conducted to assess pre-intervention group equivalence.\u003c/p\u003e\u003cp\u003eTo examine the effects of the intervention, univariate analysis of covariance (ANCOVA) was performed on the total scores of distress tolerance and quality of life, controlling for baseline values. Multivariate analysis of covariance (MANCOVA) was also conducted to evaluate the intervention\u0026rsquo;s impact on the subscales of both outcome measures.\u003c/p\u003e\u003cp\u003eAll assumptions for ANCOVA and MANCOVA\u0026mdash;including normality (Shapiro\u0026ndash;Wilk test), homogeneity of variances (Levene\u0026rsquo;s test), absence of outliers (based on boxplots), and homogeneity of regression slopes\u0026mdash;were checked and met.\u003c/p\u003e\u003cp\u003eThe significance threshold was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Partial eta-squared (η\u0026sup2;) values were reported to indicate effect sizes.\u003c/p\u003e\u003cp\u003eThe intervention group showed significantly greater improvement than the control group in overall quality of life (F\u0026thinsp;=\u0026thinsp;13.08, p\u0026thinsp;=\u0026thinsp;0.001, η\u0026sup2; = 0.326) and distress tolerance (F\u0026thinsp;=\u0026thinsp;22.44, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, η\u0026sup2; = 0.454). Within the subscales of quality of life, significant effects were found for Global Health Status (η\u0026sup2; = 0.326) and the Functional Domain (η\u0026sup2; = 0.358), but not for the Symptoms domain (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). For distress tolerance, significant improvements were observed in the subscales of Tolerance (η\u0026sup2; = 0.197), Appraisal (η\u0026sup2; = 0.316), and Regulation (η\u0026sup2; = 0.206), while the Absorption subscale did not show a significant group difference (p\u0026thinsp;=\u0026thinsp;0.255).\u003c/p\u003e\u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cb\u003eParticipants\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA total of 30 breast cancer survivors participated in the final analysis, with 15 assigned to the intervention group and 15 to the control group. No significant differences were observed between groups in baseline scores for quality of life (QoL) or distress tolerance.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePre-Post Comparisons: t-tests\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e presents the pretest and posttest means and standard deviations for the two primary outcome variables\u0026mdash;Quality of Life and Distress Tolerance. Independent samples t-tests indicated no statistically significant differences at pretest for total QoL (t = \u0026minus;\u0026thinsp;0.67, p\u0026thinsp;=\u0026thinsp;0.755) or total distress tolerance (t = \u0026minus;\u0026thinsp;0.67, p\u0026thinsp;=\u0026thinsp;0.755). However, at posttest, the intervention group showed significantly higher scores in both total QoL (t\u0026thinsp;=\u0026thinsp;4.27, p\u0026thinsp;=\u0026thinsp;0.032) and distress tolerance (t\u0026thinsp;=\u0026thinsp;4.27, p\u0026thinsp;=\u0026thinsp;0.032) compared to the control group.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMeans and Standard Deviations for Pretest and Posttest Scores (t-tests)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTime\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntervention Group (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eControl Group (M\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003et\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality of Life (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePretest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e70.47\u0026thinsp;\u0026plusmn;\u0026thinsp;6.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e70.87\u0026thinsp;\u0026plusmn;\u0026thinsp;6.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.755\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePosttest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e74.47\u0026thinsp;\u0026plusmn;\u0026thinsp;5.47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e70.53\u0026thinsp;\u0026plusmn;\u0026thinsp;4.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistress Tolerance (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePretest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e44.73\u0026thinsp;\u0026plusmn;\u0026thinsp;6.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e45.40\u0026thinsp;\u0026plusmn;\u0026thinsp;5.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e-0.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.755\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePosttest\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e\u003cp\u003e50.27\u0026thinsp;\u0026plusmn;\u0026thinsp;5.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c4\"\u003e\u003cp\u003e46.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eANCOVA: Quality of Life Outcomes\u003c/p\u003e\u003cp\u003eTo examine group differences at posttest while controlling for pretest scores, analyses of covariance (ANCOVA) were performed. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the ANCOVA results for quality of life and its components. Significant differences were observed between groups in total quality of life (QoL) scores (F(1, 27)\u0026thinsp;=\u0026thinsp;13.08, p\u0026thinsp;=\u0026thinsp;0.001, partial η\u0026sup2; = 0.326), the functional domain (F\u0026thinsp;=\u0026thinsp;13.96, p\u0026thinsp;=\u0026thinsp;0.001, partial η\u0026sup2; = 0.358), and global health status (F\u0026thinsp;=\u0026thinsp;5.33, p\u0026thinsp;=\u0026thinsp;0.029, partial η\u0026sup2; = 0.176). No significant group difference was found in the symptom domain (F\u0026thinsp;=\u0026thinsp;0.775, p\u0026thinsp;=\u0026thinsp;0.387, partial η\u0026sup2; = 0.030).\u003c/p\u003e\u003cp\u003eFurthermore, multivariate analysis using Wilks\u0026rsquo; Lambda demonstrated a significant overall effect of the intervention on QoL components (Wilks\u0026rsquo; Λ\u0026thinsp;=\u0026thinsp;0.551, F(3, 24)\u0026thinsp;=\u0026thinsp;6.52, p\u0026thinsp;=\u0026thinsp;0.003, partial η\u0026sup2; = 0.449).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eANCOVA Results for Quality of Life and Its Components\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDependent Variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF(1, 27)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePartial η\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuality of Life (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74.66\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.08\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.326\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFunctional Domain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e39.17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e36.29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13.96\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.358\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSymptom Domain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e30.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.775\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.387\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.030\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGlobal Health Status\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5.51\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.56\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.176\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultivariate (Wilks\u0026rsquo; Λ)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.449\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eANCOVA: Distress Tolerance Outcomes\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows ANCOVA results for distress tolerance and its four subscales. The intervention group demonstrated significantly higher posttest scores in total distress tolerance (F\u0026thinsp;=\u0026thinsp;22.44, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, partial η\u0026sup2; = 0.454), tolerance (F\u0026thinsp;=\u0026thinsp;5.88, p\u0026thinsp;=\u0026thinsp;0.023), appraisal (F\u0026thinsp;=\u0026thinsp;11.06, p\u0026thinsp;=\u0026thinsp;0.003), and regulation (F\u0026thinsp;=\u0026thinsp;6.24, p\u0026thinsp;=\u0026thinsp;0.020). No significant difference was found for absorption (F\u0026thinsp;=\u0026thinsp;1.36, p\u0026thinsp;=\u0026thinsp;0.255).\u003c/p\u003e\u003cp\u003eA multivariate test further confirmed a significant group effect on distress tolerance: Wilks\u0026rsquo; Λ\u0026thinsp;=\u0026thinsp;0.443, F(4, 23)\u0026thinsp;=\u0026thinsp;7.24, p\u0026thinsp;=\u0026thinsp;0.001, partial η\u0026sup2; = 0.557.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eANCOVA Results for Distress Tolerance and Its Components\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDependent Variable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl Group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eF(1, 27)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePartial η\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDistress Tolerance (Total)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e50.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e45.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22.44\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.454\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTolerance\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10.52\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5.88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.197\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAbsorption\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9.53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.255\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.054\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAppraisal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11.06\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.003\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.316\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRegulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11.38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.020\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.206\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultivariate (Wilks\u0026rsquo; Λ)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026mdash;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7.24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.557\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis randomized controlled trial provides empirical evidence for the effectiveness of structured group reminiscence therapy in enhancing both quality of life and distress tolerance among breast cancer survivors. Participants in the intervention group demonstrated significant improvements in global health status, functional domains of quality of life, and emotional regulation compared to those in the control group. These findings align with previous studies that support the role of reminiscence-based interventions in promoting psychological adjustment, self-acceptance, and adaptive coping, particularly in older adults and oncology populations【5,14,15】.\u003c/p\u003e\u003cp\u003eImportantly, the primary benefits of the intervention emerged within psychological and social dimensions rather than in the physical symptom domain. This pattern is consistent with the proposed therapeutic mechanisms of structured reminiscence therapy, which emphasize the activation of positive affect, reconstruction of meaning, and facilitation of group cohesion. Prior research has indicated that hope and perceived social support are positively associated with quality of life among women with breast cancer【9】. The group-based format of the intervention further facilitates emotional validation, shared meaning-making, and interpersonal connection, which may contribute to enhanced psychological resilience.\u003c/p\u003e\u003cp\u003eAt a neurobiological level, positive autobiographical recall has been shown to engage reward-related circuits such as the striatum, modulate cortisol levels, and enhance subjective well-being【10】. Recent neuroimaging reviews suggest that reminiscence-based interventions activate neural networks involved in emotional regulation and reward anticipation\u0026mdash;including the striatum and prefrontal cortex\u0026mdash;thereby offering a plausible neurocognitive explanation for their efficacy in oncology contexts【19】.\u003c/p\u003e\u003cp\u003eMoreover, the group setting offers a safe and supportive environment for processing distressing memories, which is particularly relevant in cancer survivors, given the established link between experiential avoidance, rumination, and reduced distress tolerance【20】. Furthermore, a recent meta-analysis confirmed the effectiveness of group-based psychological interventions in significantly reducing distress and improving adaptive coping strategies in oncology populations, thereby underscoring their broader clinical relevance【21】.\u003c/p\u003e\u003cp\u003eThis is supported by recent systematic reviews indicating that post-diagnosis rumination\u0026mdash;especially brooding\u0026mdash;significantly predicts emotional distress in cancer populations, highlighting the importance of distress tolerance as a transdiagnostic treatment target【22】. Reflecting on previous coping successes may also help survivors reclaim a sense of mastery and agency in the face of ongoing life challenges.\u003c/p\u003e\u003cp\u003eTaken together, these findings support the inclusion of structured reminiscence therapy as a neurocognitively informed, evidence-based modality in psycho-oncological care.\u003c/p\u003e\u003cp\u003eClinical and Policy Implications\u003c/p\u003e\u003cp\u003eFrom a clinical and policy perspective, structured group reminiscence therapy represents a low-cost, scalable, and culturally adaptable alternative to traditional individual psychotherapy. Meta-analytic evidence suggests that group-based interventions can significantly reduce treatment-related costs while delivering comparable outcomes【8,11】. This is particularly valuable for psycho-oncology settings with limited access to trained mental health professionals. Moreover, the structured and manualized nature of the intervention allows for easy adaptation to diverse cultural contexts and can be delivered by trained non-specialist facilitators within existing supportive care frameworks.\u003c/p\u003e\u003cp\u003e Given the growing number of cancer survivors worldwide, incorporating such interventions into national psycho-oncology guidelines may help standardize low-cost, culturally appropriate psychological support across diverse health systems.\u003c/p\u003e\u003cp\u003eLimitations and Future Research\u003c/p\u003e\u003cp\u003eThis study has several limitations. First, the relatively small sample size and short-term posttest-only design may limit the generalizability and long-term validity of the findings. Second, the sample was restricted to female breast cancer survivors within a specific cultural context, limiting external applicability to other cancer types, genders, or sociocultural groups. Future studies should employ larger, more heterogeneous samples and adopt longitudinal designs that include follow-up assessments to evaluate the durability of intervention effects.\u003c/p\u003e\u003cp\u003eMoreover, qualitative or mixed-method approaches could enrich our understanding of how participants perceive the intervention and what mechanisms they find most meaningful. Exploring neurobiological or psychophysiological correlates may also deepen the mechanistic understanding of how reminiscence therapy exerts its effects. It is further recommended to examine the role of potential moderators\u0026mdash;such as personality traits, emotional intelligence, and recovery stage\u0026mdash;to identify subgroups that may derive the greatest benefit. Finally, employing condition-specific instruments such as the EORTC QLQ-BR23 alongside general QoL measures may enhance the precision of assessment.\u003c/p\u003e\u003cp\u003eClinical Applications\u003c/p\u003e\u003cp\u003eIn summary, this trial provides robust preliminary support for the use of structured group reminiscence therapy as an effective, feasible, and culturally sensitive intervention to improve mental health outcomes among breast cancer survivors. Its emotional depth, low resource requirements, and adaptability make it particularly well-suited for integration into psycho-oncology services in low- and middle-income settings, especially in healthcare contexts where mental health infrastructure is limited and cost-effective group approaches are essential.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis randomized controlled trial demonstrated that structured group reminiscence therapy significantly enhances both distress tolerance and quality of life in breast cancer survivors. Participants in the intervention group showed substantial improvements in global health status, functional domains, and emotion regulation, supporting the psychosocial value of this group-based intervention.\u003c/p\u003e\u003cp\u003eThe results suggest that reminiscence therapy, by encouraging positive memory recall and shared emotional experiences, promotes resilience, meaning-making, and adaptive coping. Its feasibility, cost-effectiveness, and potential for delivery by trained non-specialist personnel make it a promising adjunct to standard survivorship care, particularly in low-resource settings.\u003c/p\u003e\u003cp\u003eGiven the short-term design and small sample size, future studies are needed to replicate these findings using larger, more diverse samples and extended follow-up periods. Additionally, evaluating the intervention across different cancer types and incorporating disease-specific measures could further clarify its utility. Overall, structured group reminiscence therapy represents a promising, scalable, and neurocognitively informed strategy to address the unmet psychological needs of breast cancer survivors across diverse care settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003cp\u003eTrial Registration\u003c/p\u003e\u003cp\u003eThis study was registered with the Iranian Registry of Clinical Trials (IRCT) under registration number IRCT20230617058502N3, with the unique trial ID IRCT ID: 75725. The trial was registered on March 12, 2024.\u003c/p\u003e\u003cp\u003eEthics Approval\u003c/p\u003e\u003cp\u003e This study was approved by the Ethics Committee of Islamic Azad University, Shiraz Branch (Approval Code: IR.IAU.SHIRAZ.REC.1402.328). All procedures were conducted in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki. Written informed consent was obtained from all participants prior to their inclusion in the study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.J. developed and culturally adapted the structured group reminiscence therapy protocol based on the specific needs of breast cancer survivors. She was responsible for designing the study, collecting and analyzing the data, and drafting the manuscript. L.K. served as the corresponding author and thesis supervisor, providing academic supervision, critical feedback, and final approval of the manuscript. Both authors reviewed and approved the final version of the paper.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003e The authors wish to express their sincere gratitude to all breast cancer survivors who participated in this study, and to the administrative staff at Ansari Clinic, Ali ibn Musa al-Reza Clinic, and Imam Hassan Mojtaba Clinic in Larestan for their cooperation. Special thanks are extended to Dr. Leila Khabir, Dr. Farzaneh Hooman, Dr. Sahar al-Sadat Torabian, Dr. Zahra Saffarian, and Maryam Abbasnejadan for their valuable expert input in reviewing and approving the reminiscence therapy protocol.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe research data supporting the findings of this study were derived from the author\u0026rsquo;s thesis and are available in SPSS format. These data will be made available to the journal upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209\u0026ndash;249. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3322/caac.21660\u003c/span\u003e\u003cspan address=\"10.3322/caac.21660\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLei S, Zheng R, Zhang S, et al. Global patterns of breast cancer incidence and mortality: A population-based cancer registry data analysis from 2000 to 2020. Cancer Commun (Lond). 2021;41(11):1183\u0026ndash;1194. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/cac2.12207\u003c/span\u003e\u003cspan address=\"10.1002/cac2.12207\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQuinto RM, Jim\u0026eacute;nezFonseca P, Mu\u0026ntilde;oz M, et al. Psychological distress and quality of life in cancer survivors: a cross-sectional study. Support Care Cancer. 2022;30(2):1835\u0026ndash;1843. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00520-021-06699-2\u003c/span\u003e\u003cspan address=\"10.1007/s00520-021-06699-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLoFoWong DSW, de Haes HCJM, Aaronson NK, et al. Unmet needs and quality of life of breast cancer survivors: a cross-sectional study. Psychooncology. 2020;29(7):1166\u0026ndash;1174. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/pon.5379\u003c/span\u003e\u003cspan address=\"10.1002/pon.5379\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eZhu L, Sun Y. The effectiveness of reminiscence therapy on meaning in life and psychological outcomes in older adults: a meta-analysis. Aging Ment Health. 2021;25(10):1833\u0026ndash;1843. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/13607863.2020.1784863\u003c/span\u003e\u003cspan address=\"10.1080/13607863.2020.1784863\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAbdollahzadeh F, Khabazi A. Feasibility of group reminiscence therapy implementation by para-clinical staff in cancer supportive care. Iran J Cancer Prev. 2017;10(1):e7286. (In Persian).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAguileraMart\u0026iacute;n A, SerranoPintado I, Garc\u0026eacute;sGarc\u0026iacute;a M, et al. Group reminiscence therapy for elderly women with cancer: a randomized controlled trial. BMC Cancer. 2022;22:679. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12885-022-09726-4\u003c/span\u003e\u003cspan address=\"10.1186/s12885-022-09726-4\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWang Y, Liu Z, Wei X. Economic evaluation of group psychological interventions: a review. Chin J Health Econ. 2011;30(5):56\u0026ndash;58.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShen MJ, Pruthi S, Hoffman KE, et al. Hope and social support as predictors of quality of life among breast cancer survivors. Support Care Cancer. 2020;28(8):3921\u0026ndash;3928. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00520-019-05137-1\u003c/span\u003e\u003cspan address=\"10.1007/s00520-019-05137-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSpeer ME, Bhanji JP, Delgado MR. Savoring the past: positive memories evoke value representations in the striatum. Neuron. 2014;84(4):847\u0026ndash;856. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.neuron.2014.09.028\u003c/span\u003e\u003cspan address=\"10.1016/j.neuron.2014.09.028\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCai X. Costeffectiveness of group vs. individual psychotherapy in oncology settings: a meta-analytic perspective. Asian Pac J Cancer Prev. 2018;19(6):1501\u0026ndash;1507. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.22034/APJCP.2018.19.6.1501\u003c/span\u003e\u003cspan address=\"10.22034/APJCP.2018.19.6.1501\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChoi JA, Kim JH. Effects of group reminiscence therapy on psychological well-being and depression in older adults: A meta-analysis. Aging Ment Health. 2018;22(12):1545\u0026ndash;1555. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/13607863.2017.1358355\u003c/span\u003e\u003cspan address=\"10.1080/13607863.2017.1358355\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChae J, Lee C, Choi J. Peer emotional support and psychological adaptation among breast cancer survivors. Support Care Cancer. 2019;27(6):2297\u0026ndash;2304. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00520-018-4530-y\u003c/span\u003e\u003cspan address=\"10.1007/s00520-018-4530-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWu W, Zheng Y. Structured group reminiscence improves emotional resilience among cancer survivors: a controlled trial. J Psychosoc Oncol. 2023;41(1):30\u0026ndash;45. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/07347332.2022.2114174\u003c/span\u003e\u003cspan address=\"10.1080/07347332.2022.2114174\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAfshari A, Mozaffari N, Aghamohammadi V. Effects of group reminiscence therapy on psychological well-being in cancer patients: a quasi-experimental study. Iran J Nurs Midwifery Res. 2019;24(2):150\u0026ndash;155. (In Persian).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSimons JS, Gaher RM. The Distress Tolerance Scale: Development and validation of a self-report measure. Motiv Emot. 2005;29(2):83\u0026ndash;102. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s11031-005-7955-3\u003c/span\u003e\u003cspan address=\"10.1007/s11031-005-7955-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAlavi K. The effectiveness of dialectical behavioral group therapy on reducing depression symptoms among university students in Mashhad [Master\u0026rsquo;s thesis]. Mashhad: Ferdowsi University of Mashhad; 2009. (In Persian).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMontazeri A, Harirchi I, Vahdani M, Khaleghi F, Jarvandi S, Ebrahimi M, HajiMahmoodi M. The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQC30): translation and validation study of the Iranian version. Support Care Cancer. 1999;7(6):400\u0026ndash;406. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s005200050278\u003c/span\u003e\u003cspan address=\"10.1007/s005200050278\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSun X, Su W, Yin M, Xia L. Effects of a reminiscence therapyinvolved program on anxiety, depression, and the quality of life in cancer patients: a meta-analysis of randomized controlled trials. Front Psychol. 2024;15:1408941. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyg.2024.1408941\u003c/span\u003e\u003cspan address=\"10.3389/fpsyg.2024.1408941\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSadeghi Arfaei F, Hasani J, Moin L. Experiential avoidance and distress tolerance in cancer patients: the mediating role of rumination. J Behav Sci. 2021;15(4):486\u0026ndash;498. (In Persian).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePaslaru AM, Plesea-Condratovici A, Moroianu LA, et al. Mind over Malignancy: A systematic review and metaanalysis of psychological distress, coping, and therapeutic interventions in oncology. Medicina. 2025;61(6):1086. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/medicina61061086\u003c/span\u003e\u003cspan address=\"10.3390/medicina61061086\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLee CA, Sherman KA. Is rumination associated with psychological distress after a cancer diagnosis? A systematic review. Psychooncology. 2023;32(9):1545\u0026ndash;1554. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/pon.5803\u003c/span\u003e\u003cspan address=\"10.1002/pon.5803\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer survivors, Distress tolerance, Quality of life, Reminiscence therapy, Group intervention, Psychosocial support","lastPublishedDoi":"10.21203/rs.3.rs-7096344/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7096344/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBreast cancer survivors frequently experience persistent psychological distress and reduced quality of life long after the completion of treatment. This study aimed to evaluate the effectiveness of structured group reminiscence therapy in improving distress tolerance and quality of life in breast cancer survivors in Iran.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this randomized controlled trial, 30 female breast cancer survivors who had completed active treatment at least six months prior were recruited from Larestan, a city in Fars Province, Iran. Participants were randomly assigned to either an intervention group (n = 15), which received eight weekly 90-minute sessions of structured group reminiscence therapy, or a control group (n = 15). Outcome measures included the Distress Tolerance Scale (DTS) and the EORTC QLQ-C30 Quality of Life Questionnaire. Data were analyzed using ANCOVA and MANCOVA.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nCompared to the control group, the intervention group demonstrated significantly greater improvement in overall quality of life (F = 13.08, p = 0.001, η² = 0.326) and overall distress tolerance (F = 22.44, p \u0026lt; 0.001, η² = 0.454). Within the quality of life dimensions, significant improvements were observed in global health status (F = 5.33, p = 0.029, η² = 0.176) and functional status (F = 13.96, p = 0.001, η² = 0.358), while no significant difference was found in symptom severity (p = 0.387). Regarding distress tolerance, significant group differences were observed in tolerance (F = 5.88, p = 0.023, η² = 0.197), appraisal (F = 11.06, p = 0.003, η² = 0.316), and regulation(F = 6.24, p = 0.020, η² = 0.206), but not in absorption (p = 0.255).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003cbr\u003e\nStructured group reminiscence therapy appears to be a feasible and cost-effective psychosocial intervention for improving distress tolerance and enhancing quality of life in breast cancer survivors. These findings support its integration into survivorship care. Future research with larger sample sizes and long-term follow-up is recommended to further validate these outcomes.\u003c/p\u003e","manuscriptTitle":"Structured Group Reminiscence Therapy for Enhancing Distress Tolerance and Quality of Life in Breast Cancer Survivors: A Randomized Controlled Trial ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-26 13:35:02","doi":"10.21203/rs.3.rs-7096344/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"63f72c10-6281-4d6c-8fe8-f04be4a8b243","owner":[],"postedDate":"August 26th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-06T01:08:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-26 13:35:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7096344","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7096344","identity":"rs-7096344","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}