EVALUATION OF COGNITIVE-BEHAVIORAL COUNSELING FOR THE DISTRESS ASSOCIATED WITH AN ABNORMAL CERVICAL SMEAR RESULT

A prospective randomized controlled trial was conducted to examine the relative effects of the provision of information and of cognitive-beh avioural counselling on the psychological adjustment of women who had previously been informed of an abnormal cervical smear result and subs equently required a further diagnostic procedure (colposcopy examinati on) and treatment. Altogether, 219 women were randomized to one of two groups: (a) counselling plus the provision of an information leaflet, and (b) information leaflet only. Patients in both groups received an information leaflet with their first colposcopy appointment. Patients in the counselling group also attended a counselling interview prior to their colposcopy examination. The Abnormal Smears Questionnaire (a measure of specific concerns relating to the smear result and subseque nt diagnostic and treatment procedures), together with the Spielberger State Anxiety Inventory (STAI-Y1), the General Health Questionnaire ( GHQ-30), and the Profile of Mood States (POMS-36) were administered pr e-colposcopy, post-colposcopy, pre-treatment, post-treatment and at th ree- and six-month follow-ups. Additionally a counselling evaluation q uestionnaire was completed by women in the counselling group after the ir colposcopy examination. High levels of distress were reported by bo th groups of patients on all measures prior to the colposcopy examinat ion, with a subsequent highly significant post-colposcopy reduction, a gain in both groups. There were no significant differences in psycholo gical functioning between the two groups at post-colposcopy assessment . Some minor differences emerged between the two groups at treatment a nd follow-up assessments but following analysis of covariance these we re interpreted as artifacts of baseline differences between the two gr oups on the measures concerned. Therefore, the hypothesis that cogniti ve-behavioural counselling plus information would have an incremental benefit over the simple provision of an information leaflet was not su pported. Possible interpretations of these results are discussed.