b'fears of dependency, and social support networks.evidence for patients undergoing breast cancer Currently, there is a lack of literature examining treatment 173 . The methods of graded recommen-the impact of evidence-based psychotherapeuticdations for specific therapeutic modalities were modalities in patients with lymphedema; however, adapted from the U.S. Preventative Servicesthe current state of evidence supports their utilizationTask Force. Given the reportedly high incidencein cancer patients as well as those with chronic of secondary lymphedema following breast cancer conditions (e.g., chronic obstructive pulmonarytreatment, these guidelines may be suitably applieddisease). Specifically, cognitive behavioral therapyto patients with other lymphatic diseases. Meditation (CBT) is an established treatment that guides thereceived a Grade A recommendation indicating patient in challenging and changing cognitiveevidence for substantial benefit in the reduction of distortions and their connected behaviors, resulting anxiety, stress, depression, and mood disturbances. in an improved emotional state and mood regulation.Relaxation techniques also received a Grade A One meta-analysis concluded that CBT is effective inrecommendation for improving mood disturbances improving QoL in cancer patients and reducingand depressive symptoms. The National Cancer anxiety, depression, and stress symptoms 164 . OtherInstitute (NCI) recognizes relaxation techniques as studies have shown that brief CBT improved illnessprogressive muscle relaxation, guided imagery, intrusiveness in veterans 165and health outcomesautogenic training, biofeedback, self-hypnosis, and (anxiety, depression, breathlessness, QoL, and exercisedeep breathing exercises 173 . Relaxation methodscapacity) in patients with COPD 166 . The improvementmay be tailored to reduce stress surrounding the in psychological health is partially possible through rehabilitation process; for example, relaxation techniquesthe reduction of rumination about past events andcan improve pumping device tolerability by teaching persistent worries about the future 164 . Mindfulness- patients to visualize themselves in a relaxing environmentbased cognitive therapy (MBCT) incorporates cognitivewhile using their pumping device 174 . Additionally, behavioral methods like psychoeducation andyoga, massage, music therapy, and stress management cognitive restructuring; MBCT research has shownreceived Grade B recommendations for mood-related promising results in the reduction of anxiety andoutcomes. Studies of yoga have demonstrated depressive symptoms, fear of recurrence, and fatigueeffectiveness in improving QoL in patients with in patients with nonmetastatic breast cancer 167 , andBCRL 175,176 , COPD 177 , and chronic pain conditions 178 .other chronic conditions such as chronic migraine Social impairment may be reduced by encouraging and medication overuse headache 168 . Other studiespatients to find creative ways to feature positive are ongoing in the study of MBCT in patients withphysical attributes in their manner of dressing. inflammatory bowel disease 169 . Acceptance andTherapeutic role-playing of social situations (i.e., commitment therapy (ACT) is a robust therapeuticindividuals practice answering anxiety-provoking approach that focuses on increasing resilience toquestions about their condition) may help in the discomforting emotions; important aspects of ACTdevelopment of relevant vocabulary and emotional include acceptance, cognitive diffusion, contact withregulation in response to perceived negative the present moment, self-as-context values, andreactions 174 . Breast cancer survivors and those committed action. ACT has been effective in theexperiencing BCRL-related symptoms who feel unable short-term reduction of depressive symptoms andor hesitant to disclose health-related information to demonstrated positive effects on pain acceptance andthose in their social circle may benefit considerably psychological flexibility in women with breast cancer;from support programs in survivorship care planning 158 . however, effect sizes were small, and statisticallyInterventions may address return-to-work issuessignificant effects that lasted up to 12 months werein lymphedema, including assessments of functional only found for anxiety symptoms 170 . Reduced levels impairments through low-cost job accommodations of fatigue were also seen in a meta-analysis of patientslike changes in job responsibilities, schedules, or the with chronic conditions inclusive of fibromyalgia 171 .use of adaptive equipment. Rehearsal of responsesImprovements in depression and anxiety wereto interpersonal stressors associated with work (i.e., reported in patients with inflammatory bowel discussing necessary workplace accommodations) may disease treated with ACT 172 .serve to alleviate anxiety surrounding return to work 159 . Patients with lymphedema and lymphatic diseasesRelational counseling services may be employed in the frequently seek out complementary, integrativedevelopment of effective coping strategies and the therapies to address disease or treatment-relatedexploration of strategies for emotional support from physical impacts, enhance physical and mentalspouses and family members. Sex therapy may alsowellness, and improve QoL. The Society for Integrativebe beneficial in teaching intimate partners new or Oncology has published clinical practice guidelinescreative methods to express intimacy and navigate with information on the use of such integrativepatterns of sexual behavior in the context of their therapies and their respective strength of availablechronic condition 174 . | Standardized Approach for the Diagnosis and Management of Lymphedema (LE) and Lymphatic Diseases (LD)|40'