Expressive writing intervention and self-reported physical health out-comes – Results from a nationwide randomized controlled trial with breast cancer patients

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825018/

Expressive Writing Intervention Improves Quality of Life Among Chinese-American Breast Cancer Survivors: A Randomized Controlled Trial

https://academic.oup.com/abm/article/52/11/952/4825804

Expressive writing intervention and self-reported physical health out-comes – Results from a nationwide randomized controlled trial with breast cancer patients

https://pure.au.dk/portal/en/persons/anders-bonde-jensen(bc1410f2-b563-4741-8f04-b019a2562102)/publications/expressive-writing-intervention-and-selfreported-physical-health-outcomes–results-from-a-nationwide-randomized-controlled-trial-with-breast-cancer-patients(28b0b1b2-7871-4288-b51a-0410171cd1f9)/export.html

How Does Insightful and Emotional Disclosure Bring Potential Health Benefits?: Study Based on Online Support Groups for Women with Breast Cancer.

J Commun. 2011 Jun;61(3):432-464.

Shim M1, Cappella JN2, Han JY3.

PMID:25568496PMCID:PMC4283796DOI:10.1111/j.1460-2466.2011.01555.x

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283796/

 

Despite much research on the beneficial effects of written disclosure, relatively little attention has been paid to specifying the mechanism underlying the effects. Building upon the two theoretical models (the cognitive adaptation model and the emotional exposure-habituation model), this research focused on two aspects of disclosure content—insights and emotions—and examined how women with breast cancer benefit from written disclosure in online support groups. Using survey data collected at baseline and after four months and messages posted in bulletin-board-type online groups in between, we analyzed how the content of disclosive messages predicted health outcomes. Disclosure of insights led to greater improvements in health self-efficacy, emotional well-being, and functional well-being, which was mediated by lowered breast cancer concerns. Disclosure of negative emotions did not have main effects on health outcomes; instead, it weakened the unfavorable association between concerns at baseline and functional well-being at follow-up. Our findings support both theoretical models, but in regard to different aspects of disclosure content.

A randomized controlled trial of emotionally expressive writing for women with metastatic breast cancer.

Health Psychol. 2010 Jul;29(4):460-6. doi: 10.1037/a0020153.

Low CA1, Stanton AL, Bower JE, Gyllenhammer L.

 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3128513/

 

Objective

To test the effects of emotionally expressive writing in a randomized controlled trial of metastatic breast cancer patients and to determine whether effects of the intervention varied as a function of perceived social support or time since metastatic diagnosis.

Design

Women (N = 62) living with Stage IV breast cancer were randomly assigned to write about cancer-related emotions (EMO; n = 31) or the facts of their diagnosis and treatment (CTL; n = 31). Participants wrote at home for four 20-min sessions within a 3-week interval.

Main Outcome Measures

Depressive symptoms, cancer-related intrusive thoughts, somatic symptoms, and sleep quality at 3 months postintervention.

Results

No significant main effects of experimental condition were observed. A significant condition × social support interaction emerged on intrusive thoughts; EMO writing was associated with reduced intrusive thoughts for women reporting low emotional support (η2 = .15). Significant condition × time since metastatic diagnosis interactions were also observed for somatic symptoms and sleep disturbances. Relative to CTL, EMO participants who were more recently diagnosed had fewer somatic symptoms (η2 = .10), whereas EMO participants with longer diagnosis duration exhibited increases in sleep disturbances (η2 = .09).

Conclusion

Although there was no main effect of expressive writing on health among the current metastatic breast cancer sample, expressive writing may be beneficial for a subset of metastatic patients (including women with low levels of emotional support or who have been recently diagnosed) and contraindicated for others (i.e., those who have been living with the diagnosis for years).

Using Expressive Writing to Explore Thoughts and Beliefs about Cancer and Treatment among Chinese American Immigrant Breast Cancer Survivors

Psychooncology. Author manuscript; available in PMC 2017 Nov 1.
Published in final edited form as:
Psychooncology. 2016 Nov; 25(11): 1371–1374.

Published online 2015 Sep 25. doi:  10.1002/pon.3991

Qian Lu, Ph.D., M.D.,1 Nelson C. Y. Yeung, M.Phil.,1 Jin You, Ph.D.,2 and Jiajie Dai, M.S.1

A randomized controlled trial of expressive writing in breast cancer survivors with lymphedema.

Psychol Health. 2017 Jul;32(7):826-842. doi: 10.1080/08870446.2017.1307372. Epub 2017 Mar 30.

Sohl SJ1, Dietrich MS2, Wallston KA2, Ridner SH2.

Breast cancer survivors who develop lymphedema report poorer quality of life (QoL) than those without lymphedema. Expressive writing is a potential intervention to address QoL.

DESIGN:

Adult women (N = 107) with breast cancer and chronic Stage II lymphedema were randomised to writing about thoughts and feelings specific to lymphedema and its treatment (intervention) or about daily activities (control) for four, 20-min sessions.

MAIN OUTCOME MEASURES:

Outcome measures were several indicators of QoL assessed at baseline, one, three, and six months post-intervention (total scores and subscales of Upper Limb Lymphedema 27 and Functional Assessment of Cancer Therapy-Breast). Hypothesised moderators of change in QoL were dispositional optimism, avoidant behaviours, and time since lymphedema diagnosis.

RESULTS:

There was no statistically significant intent-to-treat main effects of expressive writing on QoL. Statistically significant moderating effects on change in different indicators of QoL were observed for all three moderators. Expressive writing was more effective for improving QoL in women who were higher on optimism, lower on avoidance and had less time since a lymphedema diagnosis.

CONCLUSION:

These results provide further evidence that there are subsets of individuals for whom expressive writing is more effective. Future research may investigate targeting expressive writing based on identified moderators.

https://www.ncbi.nlm.nih.gov/pubmed/28355890

A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors.

Health Psychol. 2012 Sep;31(5):548-51. doi: 10.1037/a0026834. Epub 2012 Jan 9.

Lu Q1, Zheng D, Young L, Kagawa-Singer M, Loh A.

Little attention has been focused on Asian American breast cancer survivor’s psychological needs. No outcome-based psychosocial interventions have been reported to target at this population. Expressive writing interventions have been previously shown to improve health outcomes among non-Hispanic White breast cancer populations. This pilot study aimed to test the cultural sensitivity, feasibility, and potential health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors.

METHODS:

Participants (N = 19) were asked to write about their deepest thoughts and feelings, their coping efforts, and positive thoughts and feelings regarding their experience with breast cancer each week for 3 weeks. Health outcomes were assessed at baseline, 3, and 6 months after the intervention. A Community-Based Participatory Research Approach (CBPR) is used.

RESULTS:

Expressive writing was associated with medium and large effect sizes (η(p)² = 0.066∼0.208) in improving multiple health outcomes (quality of life, fatigue, posttraumatic stress, intrusive thoughts, and positive affect) at follow-ups. Participants perceived the study to be valuable. The study yielded high compliance and completion rates.

CONCLUSION:

Expressive writing is associated with long-term improvement of health outcomes among Chinese breast cancer survivors and has the potential to be utilized as a support strategy for minority cancer survivors. In addition, CBPR is valuable in improving feasibility and cultural sensitivity of the intervention in understudied populations. Future studies employing randomized, controlled trial designs are warranted.

https://www.ncbi.nlm.nih.gov/pubmed/22229930

Linguistic Markers of Processing Trauma Experience in Women’s Written Narratives During Different Breast Cancer Phases: Implications for Clinical Interventions

Eur J Psychol. 2015 Nov; 11(4): 651–663.
Published online 2015 Nov 27. doi:  10.5964/ejop.v11i4.991
Research into the change processes underlying the benefits of expressive writing is still incomplete. To fill this gap, we investigated the linguistic markers of change in cognitive and emotional processing among women with breast cancer, highlighting the differences and peculiarities during different treatment phases. A total of 60 writings were collected from 20 women: 10 receiving chemotherapy and 10 receiving biological therapy. We performed a series of repeated measures ANOVA for the most meaningful LIWC linguistic categories, including positive/negative emotions and cognitive processes, to assess change over three sessions. Results demonstrated a significant increase in the positive emotions category for the entire group of women, with particular relevance for the biological therapy group of women, and a marginally significant (p = .07) greater use of words indicating cognitive processes for women receiving biological therapy. For the negative emotions category time was significant for the whole group of women, showing a peak of use in the second session of writing. Peculiar differences in the linguistic markers of processing trauma were observed between the two groups. Although the writing intervention is a support for both groups of women, it seems to be beneficial when there is a large time gap since the administration of chemotherapy and, thus, when the patient can revisit the experience. The relationship of the illness with life can be rearticulated, and the writing becomes a space for resignifying the traumatic cancer experience.