Eleven years later, women who took a stress management course after being diagnosed with breast cancer were still reaping the benefits of the training.

Even after more than a decade, breast cancer patients who completed the 10 week stress management program early after diagnosis had higher mood and quality of life scores than others who hadn’t taken the course.

Depression is common during cancer treatment and afterward, said senior author Michael H. Antoni of the University of Miami, in Coral Gables, Florida.

Cognitive behavioral stress management techniques “such as progressive muscle relaxation and deep breathing techniques along with strategies for changing self-defeating and irrational thoughts about life stressors, a procedure called ‘cognitive restructuring,’ can be learned and applied to daily life and breast cancer specific stressors” Antoni told Reuters Health by email.

These techniques "have been shown to improve regulation of the adrenal stress hormone cortisol in women under treatment for breast cancer," he added. “Since better regulation of cortisol relates to less depression and inflammation, this suggests the health value of these techniques."

The researchers recruited women shortly after their breast cancer surgery between 1998 and 2005, randomly assigning them to either a one-day breast cancer education seminar, or a 10-week group-based stress management behavioral therapy program with guided sessions on coping skills, identifying sources of stress and modifying stress response, anger management, muscle relaxation and breathing exercises.

The one-day education group received information on breast cancer care and health. They also received printed handouts of a condensed version of some of the coping techniques the other group learned, but did not have time to practice them.

In earlier follow-up studies of this same set of women, the stress management group had lower depressive symptoms and better quality of life at six months, one year and five years after the original program, compared to the control group.

In 2013, the authors followed up again and were able to reassess 51 women in the stress management group and 49 in the comparison group, eight to 15 years after the original stress management program. Again, those in the stress management reported better quality of life and physical and emotional well-being, according to results in Cancer.

“Since we taught skills women could apply to daily stress it is plausible that they kept practicing them in order to keep depressive symptoms at bay,” Antoni said.

Women may be able to learn relaxation, deep breathing and cognitive restructuring techniques without a 10-week group program, but they would not get the camaraderie of being in a group of women in the same situation, he said.

“This is a package intervention and also developed in a group format,” so it’s difficult to determine which individual aspect of the program led to long-term results, said Julia Rowland, director of the Office of Cancer Survivorship at the National Cancer Institute, who was not part of the new study.

“Groups in and of themselves can be enormously helpful,” Rowland told Reuters Health by phone.

Cancer survivors never have a guarantee that the disease will not come back, which is stressful, and treatment itself can lead to other sources of stress, like fatigue or sexual dysfunction, she said.

The behavioral therapy techniques are available for therapists as a participant workbook, Antoni said.

If women do not have access to a therapist offering the program, they can seek out other sources of stress management techniques. Some people find the meditative aspect of yoga to be helpful, Rowland said.

It’s also important to stay physically active and foster a strong social network of friends and family, which have been linked to better physical and mental health, she said.

“You shouldn’t suffer in silence, you shouldn’t suffer at all,” she said. Cancer can be stressful, but if you feel depressed, you should tell your doctor.