Smart-3rp Program

[Flaviana Bresee]

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Background: Chronic daily stress has significant physical, emotional, and financial implications; levels of stress are increasing in the US. Dr. Benson highlighted how the mind and body function together in one's experience of the stress response and proposed the existence of the relaxation response (RR).

Objective: The current paper describes the foundation and development of an 8-session multimodal treatment program for coping with chronic stress: the Relaxation Response Resiliency Program (3RP).

Results: Extensive research and clinical work have examined how eliciting the RR may combat stress through down-regulation of the sympathetic nervous system. Related to this work are the multidimensional constructs of resiliency and allostatic load. The 3RP is based on principles from the fields of stress management, cognitive-behavioral therapy, and positive psychology, and has three core target areas: (1) elicitation of the RR; (2) stress appraisal and coping; and (3) growth enhancement. An 8-week patient-centered treatment program has been developed, with the purpose of assisting patients with a variety of psychological and medical issues to better cope with chronic stress.

Conclusions: Mastery of the RR is theorized to maximize one's ability to benefit from multimodal mind body strategies. The goal of the 3RP is to enhance individuals' adaptive responses to chronic stress through increasing awareness and decreasing the physiological, emotional, cognitive, and behavioral effects of the stress response, while simultaneously promoting the effects of being in the RR.

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The program consists of nine 90-minute skills-based group sessions led by a licensed psychologist or psychiatrist on Zoom. The first session focuses on establishing treatment goals and a plan for achieving these goals based on the program structure. Thereafter, groups meet weekly and learn a range of stress management tools, with each session building on each other. Because individuals come with shared experiences given their cancer history, groups are supportive by nature; however, sessions are held with a spirit that supports learning and the application of learned techniques to identified stressors. Specific content areas include the following:

This program is billable to insurance, but copays likely apply. Please contact your insurer to inquire about coverage using billing code 90853. Click here to register. This program also has a nonrefundable $65 materials fee that is not billable to insurance. This fee covers the cost of the program manual, which will be shipped to you after you register.

Giselle Perez, PhD

Program Director, Mind Body Program for Cancer Survivors

Associate Director, Adolescent and Young Adult Cancer Survivor Program

Director of Adolescent and Young Adult Research

Assistant Professor, Harvard Medical School

Elyse Park, PhD

Founder and former Director of the Mind Body Program for Cancer Survivors

Staff Psychologist, Department of Psychiatry

Professor of Psychiatry and Medicine, Harvard Medical School

Group Facilitator, Mind Body Program for Cancer Survivors

Who is the program for?

This program is for adults who have completed their cancer treatment or who are living with cancer. It is not recommended for newly diagnosed patients; however, there are some exceptions. For more information about whether this program is the right fit for you, please send questions to mghsurv...@partners.org.

What is the goal of the group program?

This program is designed to support patients who have completed cancer treatment by providing critical tools to help them cope with the experience of their diagnosis and treatment as well as adjust to life after treatment.

What will group sessions be like?

During each group session, we will introduce a variety of mind-body and cognitive behavioral tools to help you adapt to and navigate some of the challenges that you may experience with the transition to post-treatment survivorship as well as other ongoing life challenges. We will also introduce other practical strategies for managing life stress and developing healthy physical activity, nutrition and sleep habits.

Will the groups talk specifically about cancer?

Conversations during sessions might naturally focus on the challenges of cancer survivorship. However, we also often talk about other chronic life stressors and goals. Importantly, this program encourages you to set goals and build skills that will be most relevant to you.

Can I join at any time?

We invite participants to join for the full 9-week program. New groups start approximately every 3 months. Please contact mghsurv...@partners.org for information about the next group start date.

Will I be billed for the group sessions?

Most health insurances provide coverage for this program. However, some patients will have a co-pay. We strongly encourage you to contact your health insurance carrier to find out whether you will have any co-pays or deductibles to consider for group therapy code 90853.

Are there any additional program fees?

There is a $65 fee for the program manual. We ask that you pay the materials fee in advance of the first group session. If you decide to join the group, we will provide you with detailed information about how to submit this fee online.

Can my friend/family join?

Unfortunately, because this group is geared toward individuals who have completed treatment, we are unable to accommodate individuals without a history of cancer. There is, however, the original program at the Benson-Henry Institute for Mind Body Medicine. If you believe your family/friend is interested, ask your group facilitator for more information.

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Dr. Park notes that, although receiving a cancer diagnosis and initiating treatment are life-changing and often extremely challenging, many of the psychological aftereffects of a cancer diagnosis occur long after the diagnosis is made. For patients, cancer survivorship, defined here as the period of care beginning immediately following the completion of initial treatment, presents certain challenges. The transition from the initial intensive phase of cancer diagnosis and treatment to survivorship encompasses many different stressors, including changes to self-identity, shifts in close relationships, worries about recurrence, adjustment to treatment side effects, and new responsibilities and routines for self-care.

In recent research, Dr. Perez has adapted this program to fit the needs of survivors of lymphoma and adolescent and young adult cancer survivors and demonstrated its feasibility, acceptability, and improvements were noted in resiliency, relaxation, positive affect, and general stress reduction (2021, 2022).

Elyse Park, PhD MPH is the Director of the Health Promotion and Resiliency Intervention Research Program and a Professor of Psychiatry & Medicine at Harvard Medical School. In addition, she directs behavioral research for the MGH Tobacco Research & Treatment Center, the Benson-Henry Institute for Mind Body Medicine, and the MGH Cancer Survivorship Program.

Giselle Perez, PhD is the Associate Director of the Adolescent and Young Adult Cancer Program at MGH, Director of the Adolescent and Young Adult Research and the Mind Body Program for Cancer Survivors, and an Assistant Professor of Psychology at Harvard Medical School. Her research focuses on the development of behavioral and mind-body interventions to promote stress management and overall physical and emotional health outcomes for patients throughout the cancer spectrum. Clinically, she specializes in working with adolescents and young adults with cancer.

This program is for patients who have completed treatment for cancer or are living with cancer. To participate, you must have a provider at the Massachusetts General Hospital, and you must be able to participate in the sessions from Massachusetts.

Adults with congenital heart disease (ACHD) often experience increased health anxiety when compared with the general population. Health anxiety involves a high level of worrying about an individual's health, physical symptoms, and maladaptive behaviors including excessively scanning the body for signs of illness or avoiding activities that may trigger anxiety, such as physical activity and medical tests (Behavior Therapy). These anxiety symptoms are also associated with poor cardiac health outcomes, including physical inactivity (International Journal of Behavioral Medicine), medication non-adherence (Journal of Psychosomatic Research), elevated blood pressure (Psychology, Health & Medicine), lower quality of life (Cardiology in the Young & Current Opinion in Cardiology) and suboptimal healthcare utilization (Current Psychiatry Reports, Behavior Modification & International Journal of Cardiology). Although research on behavioral treatments for healthy anxiety associated with adult congenital heart disease is undoubtedly required, there have been very few trials conducted to date, with only one trial for anxiety in ACHD and no trials for health-related anxiety specifically.

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