Abstract
Objective
With the widespread use of computerized tomography (CT) examinations, the annual detection rate of pulmonary nodules has been increasing. However, early non-surgical patients often experience anxiety and depression during follow-up. This study aims to develop a novel intervention model to address these psychological issues and evaluate its clinical efficacy.
Methods
Our research team designed a psychological intervention model tailored to pulmonary nodule patients with anxiety and depressive symptoms. A total of 160 participants were randomly divided into two groups: an experimental group (80 patients) receiving cognitive behavioral group therapy (CBGT), and a control group (80 patients) receiving no CBGT intervention. Anxiety, depression, sleep quality, and social functioning were evaluated using validated standardized scales, including the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Pittsburgh Sleep Quality Index (PSQI), and General Overall Quality of Life-74 (GOQL-74). Data were collected at four time points: before the intervention, at 8 weeks, at 3 months, and at 6 months.
Results
The CBGT group showed significant improvements in anxiety symptoms, depressive symptoms, and sleep disturbances. Additionally, the CBGT group exhibited a superior psychological status in terms of social functioning, though no significant differences were observed in other indicators.
Conclusion
CBGT interventions positively contribute to the mental health of pulmonary nodule patients with anxiety and depression. The developed psychotherapy model is a relatively well-established protocol worthy of clinical application.
Supplementary Information
The online version contains supplementary material available at 10.1186/s40359-025-03310-x.
Keywords: Cognitive behavioral group therapy, Pulmonary nodules, Anxiety and Depression
Introduction
Lung cancer remains a leading cause of cancer-related deaths worldwide, posing a significant threat to human health[1, 2]. With the increasing use of high-resolution computed tomography (HRCT), pulmonary nodules, which can be indicative of early-stage lung cancer, are being detected more frequently[3, 4]. Some patients may experience nervousness, fear, and even anxiety and depression due to uncertain results, cognitive biases, insufficient scientific publicity, and poor communication among medical staff.
Patients often become excessively anxious about pulmonary nodules, leading to repeated doctor visits and frequent check-ups. This results in a significant waste of medical resources, worsens the doctor-patient relationship, and has a substantial impact on their mental health and quality of life. Currently, patients with pulmonary nodules who experience symptoms of anxiety and depression require further intervention and treatment. However, there is a lack of targeted psychological interventions, and new methods need to be actively explored[5].
Previous studies have shown that patients with pulmonary nodules are often accompanied by psychological issues such as anxiety and depression. For example, a study[6] on psychological disorders and personality traits in patients with pulmonary nodules found that approximately 50% of the patients exhibited negative emotional states. Among patients with pulmonary nodules, the prevalence of anxiety disorder is 47.8%, while the prevalence of depression is 44.2%. The study also indicated that the rate of anxiety disorder is higher among female patients than male patients, with mild anxiety being the predominant symptom. Patients suffering from anxiety and depression experience a significant reduction in their quality of life[7]. Emotional distress and anxiety are major concerns for many patients with pulmonary nodules[8]. A study indicates that CBGT is effective in treating depression and anxiety symptoms in patients with Parkinson's disease[9]. CBGT significantly alleviates symptoms of depression and anxiety, while also providing additional benefits for apathy, cognitive function, and social interaction. These benefits were maintained during follow-up assessments, demonstrating the long-lasting stability of the intervention's effects[10].
Our team focuses on treating the disease while also paying close attention to the psychological health of our patients, aiming to improve their overall quality of life. Thoracic surgeons and psychologists work in close collaboration to ensure comprehensive care for the patients'physical and mental well-being. In our daily practice, we employ specific intervention strategies to establish a cognitive-behavioral therapy model of collaboration between thoracic and psychological departments, helping patients understand the pathological features of pulmonary nodules, learn psychological regulation techniques, and coexist with their condition.
Therefore, we developed a psychological intervention model aimed at addressing anxiety and depression in patients with pulmonary nodules. The goal of this study was to assess the feasibility and effectiveness of this model. The results showed that the intervention successfully alleviated anxiety and depression symptoms, leading to significant improvements in patients'well-being.
Methods
Design
Participants were recruited from our hospital between November 2021 and December 2022. In accordance with strict inclusion and exclusion criteria, 160 patients with pulmonary nodules and comorbid depression and anxiety were enrolled and randomly assigned to either the observation group or control group. The observation group, consisting of 80 patients, received 8 weeks of cognitive-behavioral group therapy (CBGT). The process of participant selection and enrollment is outlined in Fig. 1. Sessions were conducted once a week in the hospital conference room for 1.5 h each, over a total of 8 weeks. In contrast, the control group, also comprising 80 patients, did not receive any treatment during the intervention and follow-up periods. All participants signed an informed consent form and agreed to follow the prescribed treatment protocols and follow-up procedures. The research team included one senior psychologist, one thoracic surgeon, and one graduate student in applied psychology. They were trained in cognitive-behavioral group counseling and were supervised prior to the intervention. The study was approved by the ethics committee of our institution. All participants and their families were fully informed and signed a consent form.
Fig. 1.
Flow diagram for patients recruited
Inclusion Criteria: (1) Diagnosis of pulmonary nodules in accordance with the 2021 Chinese expert consensus on the diagnosis and treatment of pulmonary nodules[11]; (2) Ablity to complete relevant examinations and psychological assessments; (3) Age between 18 and 65 years; (4) Self-rating Anxiety Scale (SAS) score > 50 and Self-rating Depression Scale (SDS) score > 50; (5) Minimum education level of primary school, with the ability to communicate for follow-up purposes, and good physical function; (6) Signed informed consent form and a clear understanding of the study details; (7) Pulmonary nodule size between 5–8 mm, with the solid component of the ground-glass nodule being less than 50%.
Exclusion Criteria: (1) Presence of multiple pulmonary nodules (more than 5); (2) Combined psychiatric or neurological diseases, or severe organic diseases; (3) Suspicion of other malignancies, lung metastases, or malignancy-related conditions; (4) Use of antidepressant or anti-anxiety medications; (5) Unwillingness to participate or inablity to complete 8-week intervention.
Cognitive-Behavioral Group Therapy (CBGT)
A psychotherapeutic model tailored for patients with pulmonary nodules and comorbid depression and anxiety was developed. The CBGT team comprised one senior psychologist trained in CBGT, one thoracic surgery expert in the treatment of pulmonary nodules, and one graduate student in applied psychology. Given that patients with pulmonary nodules neither developed symptoms simultaneously nor sought medical care concurrently, it was challenging to recruit all 80 participants within a short timeframe. Therefore, we adopted a phased approach: recruiting 20 participants per batch across four batches to complete the study. With eighty patients divided into four groups of 20 patients each. The treatment included confidence-building, relaxation training, and other therapeutic techniques, which are detailed in Fig. 2. This 8-week CBGT protocol integrates cognitive restructuring, behavioral training, and psychosocial support to address anxiety, maladaptive cognitions, and emotional distress in patients with pulmonary nodules. The structured program progresses through eight weekly modules, emphasizing therapeutic alliance-building, cognitive-behavioral skill acquisition, and real-world application.
Fig. 2.
This flowchart outlines an 8-week treatment strategy focusing on holistic patient support through structured weekly phases
Week 1 (Building Partnerships): Establishes a trusting foundation by fostering group rapport, introducing collaborative goals, and encouraging members to articulate personal objectives. Key activities include defining group rules and expectations, creating a supportive environment for open communication, and aligning individual needs with collective objectives.
Week 2 (Understanding Diseases): Shifts focus to cognitive-emotional awareness. Patients learn to link emotions, behaviors, and cognitions, identifying maladaptive thought patterns. Homework tasks (recording thoughts/behaviors) reinforce self-reflection, empowering them to recognize how their mindset influences well-being.
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Week 3 (Psychological Counseling): Integrates therapeutic techniques like music therapy and relaxation training (muscle relaxation, mindfulness meditation) to enhance emotional regulation. Patients explore life experiences holistically, developing skills to manage stress and cultivate calmness.
Weeks 4–5 (Improve Confidence): Centers on cognitive restructuring and value exploration. Patients rebuild self-belief by challenging irrational thoughts, engaging in activities to evoke positive emotions, and reinforcing adaptive beliefs. Homework emphasizes practicing critical thinking to counter negative patterns.
Weeks 6–7 (Relaxation Training): Delves into advanced relaxation methods (mindfulness, guided imagery) to sustain emotional resilience. Consistent practice of these techniques aims to reduce anxiety and instill long-term coping strategies for daily stress management.
The control group without any psychological intervention during the study period.
Scales for measurements
General Item Questionnaire
A self-prepared questionnaire that collected demographic information such as age, gender, height, weight, education level, marital status, history of hypertension, diabetes, smoking history, alcohol use, surgery history, and place of residence.
Self-Rating Anxiety scale (SAS)
Developed in 1971 by Dr. William W. K. Zung, a psychiatrist at Duke University[12]. This scale is used to assess the level of anxiety in adults. The cut-off value is 49 points. Scores of 50–59 indicate mild anxiety, 60–69 as moderate anxiety, and scores above 70 as severe anxiety.
Self-Rating Depression scale (SDS)
Developed by W.K. Zung in 1965 [13]. This scale measures depression severity. The cut-off value is 49 points. Scores of 50–59 indicate mild depression, 60–70 as moderate depression, and scores above 70 as severe depression.
Pittsburgh Sleep Quality index (PSQI)
Created by in 1989 Dr. Buysse, a psychiatrist at the University of Pittsburgh [14, 15]. This scale is suitable for patients with sleep disorder, mental disorders to evaluate sleep quality, and is also suitable for the evaluation of sleep quality of normal people. Each component score of the PSQI ranges from 0 to 3, with 3 indicating the greatest dysfunction or disturbance. The seven component scores are then summed to obtain a global PSQI score, which ranges from 0 to 21. A score greater than 5 indicates significant sleep disturbances. The PSQI includes a total of 7 indicators, namely Sleep Quality, Time to Fall Asleep, Sleep Time, Sleep Efficiency, Sleep Disturbance, Hypnotic Drug and Day Dysfunction.
Generic Quality of Life Inventory 74 (GQOL-74)
Developed by Lingjiang Li and Desen Yang in 1998[16]. this 74-item scale assesses health-related quality of life across four dimensions: physical function, psychological function, social function, and material living status.
Observation and comparison indicators
The baseline characteristics of all participants were recorded. Anxiety, depression, sleep quality, quality of life of were assessed for both groups. The study followed four phases of data collection: before the intervention, at the end of 8 weeks, at the end of March, and at the end of June. The scales were administered at each time point for both groups, and results were compared between the groups.
Statistics
Data analysis was performed using SPSS 22.0 statistical software (IBM, USA). The normality of continuous data was tested using the Shapiro–Wilk test, and all continuous variables were normally distributed, thus expressed as mean ± standard deviation (x ± s).
For intergroup comparisons at baseline (before intervention), an independent samples t-test was used to analyze differences in continuous variables (e.g., age, SAS, SDS scores) between the CBGT group and the control group. The chi-square test was applied to compare categorical variables (e.g., gender, education level, marital status) between the two groups.
For repeated measures data (assessments at 4 time points: baseline, 8 weeks, 3 months, and 6 months) of each outcome (SAS, SDS, PSQI, GQOL-74 scores), a two-way repeated measures analysis of variance (ANOVA) was used to examine the effects of group (between-subjects factor: CBGT group vs. control group), time (within-subjects factor: 4 measurement time points), and their interaction effect (group × time). Post-hoc tests (Bonferroni correction) were conducted to further analyze pairwise comparisons between time points within each group and between groups at each time point when significant interaction effects or main effects were observed. A P-value < 0.05 was considered statistically significant for all analyses.
Results
A total of 160 patients with pulmonary nodules, anxiety and depression were included in the study. All participants met the criteria for depression and anxiety according to the SAS and SDS questionnaires. The demographic and medical characteristics of the participants are shown in Table 1. The study indicators included gender, age, body mass index (BMI), education level, marital status, smoking history, alcohol consumption, surgery history, hypertension, diabetes, and area of residence..Data were comparable between both groups of enrolled patients. The age distribution and sex ratio were similar in both groups. No significant differences were found in comorbidities such as diabetes and hypertension. There were also no significant differences in smoking, drinking, or surgery history (P > 0.05).
Table 1.
Characteristics of study patients
| Characteristics |
CBTG (n=80) |
Control (n=80) |
t/χ2 | P |
|---|---|---|---|---|
| Gender(n) | 2.50 | 0.11 | ||
| Female | 35 | 45 | ||
| Male | 45 | 35 | ||
| Age (mean±SD) | 47±15.67 | 44.85±15.48 | 1.22 | 0.23 |
| Hyptension(n) | 0.15 | 0.70 | ||
| Yes | 16 | 18 | ||
| No | 64 | 62 | ||
| Diabetes(n) | 0.25 | 0.62 | ||
| Yes | 8 | 10 | ||
| No | 72 | 70 | ||
| BMI(mean±SD) | 23.64±4.49 | 23.22±4.13 | 0.62 | 0.54 |
| Education(n) | 0.91 | 0.34 | ||
| Middle/Primary School | 34 | 40 | ||
| High School/University | 46 | 40 | ||
| Marital status | 0.03 | 0.86 | ||
| Single | 23 | 22 | ||
| Married | 57 | 58 | ||
| Residence area | 3.60 | 0.06 | ||
| Rural | 33 | 45 | ||
| Urban | 47 | 35 | ||
| Somking history | 2.90 | 0.09 | ||
| Yes | 14 | 10 | ||
| No | 64 | 70 | ||
| Alcohol history | 2.63 | 0.11 | ||
| Yes | 11 | 19 | ||
| No | 69 | 61 | ||
| Surgery history | 2.93 | 0.09 | ||
| Yes | 6 | 13 | ||
| No | 74 | 67 |
All patients had SAS and SDS scale scores greater than 50 scores each. Patients were randomly assigned to either the CBGT group (n = 80) or 80 the control group (n = 80). Score between 50–59 were classified as mild anxiety or depressive symptoms, 60–69 as moderate anxiety or depressive symptoms, and scores of 70 or higher as severe anxiety and depression symptoms. Contingency table analyses showed no statistically significant difference in the severity of symptoms between the two groups (χ2 = 3.39, P = 0.18). (Table 2).
Table 2.
Patients with varying degrees of depression and anxiety, n (%)
| Group | Mild | Moderate | Severe | χ[2] | P |
|---|---|---|---|---|---|
| Depresson | 80 | 56 | 24 | 3.39 | 0.18 |
| Anxiety | 74 | 70 | 16 |
Anxiety and depression were using the SAS and SDS scales, as shown in Table 3. Four observation periods were defined: before the intervention, after 8 weeks, after 3 months, and after 6 months. At baseline, no significant difference was found between the two groups. After 8 weeks, anxiety symptoms in the CBGT group gradually decreased, and this reduction persisted at the 6-month follow-up. By 6 months, anxiety symptoms were significantly reduced in the CBGT group. In terms of depressive symptoms, the CBGT group also showed significant improvement, with the difference being statiscally significant. The corresponding data is visually presented in Fig. 3.
Table 3.
SAS and SDS scores were compared between the two groups (± S)
| Group | before | 8 week | 3 month | 6 month | |
|---|---|---|---|---|---|
| SAS | CBGT | 65.57 ± 5.25 | 52.26 ± 4.37 | 35.52 ± 1.56 | 38.78 ± 3.25 |
| Control | 64.23 ± 4.74 | 68.31 ± 1.09 | 60.52 ± 4.39 | 57.38 ± 2.85 | |
| Finteraction = 366.50, Frow = 2457, Fcolumn = 856.10, P < 0.01 | |||||
| SDS | CBGT | 58.91 ± 4.77 | 46.09 ± 2.24 | 45.74 ± 4.05 | 30.57 ± 1.27 |
| Control | 60.58 ± 5.43 | 59.98 ± 4.01 | 60.64 ± 3.76 | 57.69 ± 3.35 | |
Finteraction = 304.40, Frow = 2325, Fcolumn = 462.80, P < 0.01
Fig. 3.
The SAS scale was used to assess anxiety levels in both the CBGT intervention group and the control group. The SDS scale was used to assess depression levels. (A) The patients in the CBGT group exhibited significantly lower anxiety scores compared to those in the control group. (B) Patients in the CBGT group also reported lower levels of depressive symptoms compared to the control group
To evaluate sleep quality, the Pittsburgh Sleep Quality Index (PSQI), a well—known self-report tool, was utilized. The study defined four observation time—points: before the intervention, after 8 weeks, after 3 months, and after 6 months, comparing the GCBT group and Control group.
At baseline (before the intervention), there was no significant difference in sleep—related indicators between the two groups across all PSQI components. Over time, notable changes emerged in the GCBT group. After 3 and 6 months, the GCBT group showed significant improvements in the total sleep quality score (P < 0.05, Fig. 4A).
Fig. 4.
Pittsburgh Sleep Quality Index (PSQI) Scores in CBGT and Control Groups. This set of bar charts (A—H) presents the PSQI component scores for the CBGT (black bars) and Control (white bars) groups across four time points: before the intervention, after 8 weeks, after 3 months, and after 6 months. (A) Total (PSQI) Score shows the overall PSQI score. The CBGT group demonstrates significant improvements at 3 and 6 months compared to the Control group (*, P < 0.05). (B) Sleep Quality Score represents the sleep quality sub-score. Notable differences favoring the CBGT group emerge at 3 and 6 months (*, P < 0.05 for 3 months; **, P < 0.01 for 6 months). (C) Time to Fall Asleep Score displays the score for the time taken to fall asleep. A significant difference in the CBGT group is seen at 6 months (*, P < 0.05). (D) Sleep Time Score depicts the sleep duration sub-score. No significant differences between the two groups are observed across all time points. (E) Sleep Efficiency Score illustrates the sleep efficiency sub-score. No significant group differences exist at any observation time. (F) Sleep Disturbance Score represents the sleep disturbance sub-score. Significant differences in favor of the CBGT group occur at 3 and 6 months (*, P < 0.05). (G) Hypnotic Drug Score shows the score for hypnotic drug use. A significant difference in the CBGT group is noted at 6 months (*, P < 0.05). H: Day Dysfunction Score depicts the day dysfunction sub-score. No significant group differences are observed over time
A more in—depth look at the seven sleep—related sub—indicators (Figs. 4B - H) uncovered distinct patterns. Sleep Quality (Fig. 4B) and Sleep Disturbance (Fig. 4F) started to exhibit significant differences in favor of the GCBT group after 3 months. Time to Fall Asleep (Fig. 4C) and Hypnotic Drug use (Fig. 4G) showed significant differences after 6 months. In contrast, other indicators including Sleep Time (Fig. 4D), Sleep Efficiency (Fig. 4E), and Day Dysfunction (Fig. 4H) did not show significant differences between the two groups throughout the observation periods. Overall, these results suggest that GCBT has a positive impact on multiple aspects of sleep quality, with varying timelines for different sleep—related indicators. Detailed data for these analyses are available in Supplementary Material 1.
To assess patients'quality of life across multiple domains, the Generic Quality of Life Inventory—74 (GQOL—74) was employed, covering mental health, physical health, material life, and social functioning. The evaluation was conducted at four time points: before the intervention, after 8 weeks, after 3 months, and after 6 months, comparing the GCBT (presumably a specific intervention group) and Control groups.
As shown in Fig. 5A (Total—GQOL), at each of the observation time points, there was no significant difference in the total quality—of—life scores between the GCBT and Control groups. This indicates that, in terms of the overall quality—of—life measure, the GCBT intervention did not bring about a statistically significant change compared to the control condition over the observed period.
Fig. 5.
Quality of Life Assessment Using the Generic Quality of Life Inventory-74 (GQOL-74)
Figure 5B presents a radar chart of the GQOL-74 domain scores for the CBGT and Control groups. It visually depicts the scores across five domains: Psychological Function, Physical Function, Material Life State, Social Function, and the overall Total-GQOL. The chart shows the relative performance of the two groups in each domain, but consistent with the total score in Fig. 5A, there is no clear, significant separation between the CBGT and Control groups across these domains, suggesting that the intervention may not have had a substantial impact on quality of life domains as measured by GQOL-74 within this study's scope.
Impact of CBGT on Quality of Life Assessed by GQOL—74
To evaluate the influence of CBGT interventions on patients'quality of life, we analyzed scores from the Generic Quality of Life Inventory-74 (GQOL—74) across multiple domains, including Physical Function, Psychological Function, Material Life State, and Social Function, at different time points (before the intervention, after 8 weeks, after 3 months, and after 6 months).
For the Physical Function domain (Fig. 6A), there was no statistically significant difference in scores between the CBGT group (black bars) and the Control group (white bars) at any of the assessed time points. Similar results were observed for the Material Life State (Fig. 6C) and Social Function (Fig. 6D) domains, where no significant differences were detected between the two groups across all time points.
Fig. 6.
The Effect of CBGT on Patients’Quality of Life Assessed by GQOL-74. This set of bar charts (A-D) illustrates the scores of different quality of life domains from the Generic Quality of Life Inventory-74 (GQOL-74) for the CBGT (black bars) and Control (white bars) groups at four time points: before the intervention, after 8 weeks, after 3 months, and after 6 months. (A) Physical Function depicts scores related to physical health. No significant differences between the CBGT and Control groups were observed across all time points. (B) Psychological Function represents scores associated with mental health. A significant difference (*, P < 0.05) in favor of the CBGT group was noted after 6 months, indicating improved psychological well-being in the CBGT group at this time point. No significant differences were found before the intervention and within 3 months after the intervention. (C) Material Life State shows scores concerning material living conditions. No significant differences between the two groups were detected at any time point. (D) Social Function illustrates scores related to social interactions and functioning. No significant differences between the CBGT and Control groups were observed across all time points
In contrast, for the Psychological Function domain (Fig. 6B), while no significant differences were found between the CBGT and Control groups before the intervention and within 3 months after the intervention, the CBGT group exhibited an advantage in mental health scores after 6 months. A significant difference (*, P < 0.05, as indicated by the asterisk) was observed at this time point, suggesting that CBGT intervention may have a positive impact on patients’psychological well-being in the longer term.Detailed statistical results are provided in Supplementary Table 2
Discussion
Routine CT scans have shown that the detection rate of pulmonary nodules is approximately 31%, with a slightly lower detection rate observed in women (28.8%) compared to men (34.1%)[17]. Despite the high incidence of pulmonary nodules, it is crucial to emphasize that the presence of a nodule does not equate to lung cancer[18]. Furthermore, the likelihood of a nodule developing into malignancy remains low, especially for smaller nodules. Research has indicated that the incidence of lung cancer in nodules smaller than 1 cm is less than 5%[19, 20]. This aligns with our understanding that most pulmonary nodules are benign and often lack clinical significance.
However, the uncertainty surrounding pulmonary nodules can induce significant psychological distress, including anxiety and depression, particularly when patients are left without definitive answers regarding the nature of the nodules. In this study, nodules ranged in size from 5 to 8 mm, and the solid component of ground-glass nodules was less than 50%[21]. These characteristics suggest that the nodules may require observation rather than immediate intervention, which can contribute to patient anxiety during the waiting period for follow-up imaging.
A previous study analyzing anxiety in patients with pulmonary nodules found that factors such as gender, respiratory symptoms, family history of malignancy, and nodule size were significant predictors of anxiety[22]. Women, particularly those with larger nodules, respiratory symptoms (such as cough and shortness of breath), or a family history of cancer, were more likely to experience higher levels of anxiety. This underscores the need for addressing the psychological impact of pulmonary nodules, as these factors often intensify the emotional burden on patients.
Psychological treatments, such as Cognitive Behavioral Therapy (CBT), have proven to be effective in treating depression and anxiety in patients, with their efficacy supported by numerous studies[23]. One study demonstrated the effectiveness of CBGT in reducing depression and anxiety scores among breast cancer patients and survivors. Another study[24] highlighted the benefits of virtual reality-based Cognitive Behavioral Group Therapy (VR-CBGT) in alleviating anxiety and depression in patients with Parkinson's disease. Additionally, CBGT has been shown to effectively reduce depression and anxiety while also improving sleep quality and overall psychological well-being in patients undergoing hemodialysis[25].
Currently, patients with anxiety and depressive symptoms related to pulmonary nodules receive limited psychological support[25, 26]. The shortage of clinical mental health professionals has created a gap in timely intervention. As a solution, group therapy offers a cost-effective and scalable option to address this imbalance between the demand for psychological care and available resources. Cognitive Behavioral Group Therapy (CBGT) has proven effective for treating anxiety and depression in a variety of patient populations, including those with chronic conditions like type 2 diabetes, ankylosing spondylitis, and post-operative lung cancer [27–29]. Despite the promising results in these groups, there is limited research on the application of CBGT for patients with pulmonary nodules.
In our study, we developed a CBGT intervention model specifically designed for patients experiencing anxiety and depression due to pulmonary nodules. This innovative approach, focusing on the mental health of patients, contrasts with the traditional emphasis on physical disease management by surgeons. However, the study had limitations, including the small sample size (80 patients) and the splitting of training into multiple sessions, which could introduce potential biases. To further validate our model, multi-center studies are needed to explore its effectiveness across a broader patient population.
Conclusion
Our findings support the use of Cognitive Behavioral Group Therapy (CBGT) as an effective intervention for improving the mental health and quality of life in patients with pulmonary nodules. This therapy was beneficial in reducing symptoms of anxiety and depression and offers a promising approach to managing the psychological impact of pulmonary nodules.
Supplementary Information
Acknowledgements
Not applicable.
Authors’ contributions
Zheng Tao and Shuang Li (co-first authors) contributed to study design and manuscript drafting. Leijiang and Zhengzheng Ni participated in data analysis and result interpretation. Jun Nie assisted in participant recruitment and follow-up. Haitao Ma (corresponding author) supervised the entire research process, and revised the manuscript critically. All authors have read and approved the final manuscript.
Funding
The study received funding from the China Anhui Province Humanities and Social Science Foundation Group Project (No. SK2021ZD0071).
Data availability
To protect participant confidentiality, supporting data are anonymized and safeguarded. For legitimate research purposes, datasets may be requested from the first author, Zheng Tao (email address:1144015615@qq.com).
Declarations
Ethics approval and consent to participate
This study were reviewed and approved by the Research Ethics Review Committee at Wannan Medical College. Participant has provided written informed consent to participate in this study. Our research team has been conducting research in accordance with the guidelines and regulations of the 1963 Declaration of Helsinki and its subsequent amendments.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Zheng Tao and Shuang Li are co-author for first author.
Contributor Information
Zheng Tao, Email: 1144015615@qq.com.
Haitao Ma, Email: mht7403@163.com.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
To protect participant confidentiality, supporting data are anonymized and safeguarded. For legitimate research purposes, datasets may be requested from the first author, Zheng Tao (email address:1144015615@qq.com).