Evaluation of cognitive-behavioural counselling 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-behavioural counselling on the psychological adjustment of women who had previously been informed of an abnormal cervical smear result and subsequently required a further diagnostic procedure (colposcopy examination) 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 subsequent 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 pre-colposcopy, post-colposcopy, pre-treatment, post-treatment and at three- and six-month follow-ups. Additionally a counselling evaluation questionnaire was completed by women in the counselling group after their colposcopy examination. High levels of distress were reported by both groups of patients on all measures prior to the colposcopy examination, with a subsequent highly significant post-colposcopy reduction, again in both groups. There were no significant differences in psychological functioning between the two groups at post-colposcopy assessment. Some minor differences emerged between the two groups at treatment and follow-up assessments but following analysis of covariance these were interpreted as artifacts of baseline differences between the two groups on the measures concerned. Therefore, the hypothesis that cognitive-behavioural counselling plus information would have an incremental benefit over the simple provision of an information leaflet was not supported. Possible interpretations of these results are discussed.