Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors – results from a nationwide randomized clinical trial.

Psychooncology. 2013 Jul;22(7):1492-500. doi: 10.1002/pon.3193. Epub 2012 Sep 19.

Jensen-Johansen MB1, Christensen S, Valdimarsdottir H, Zakowski S, Jensen AB, Bovbjerg DH, Zachariae R.

To examine the effects of an expressive writing intervention (EWI) on cancer-related distress, depressive symptoms, and mood in women treated for early stage breast cancer.


A nationwide sample of 507 Danish women who had recently completed treatment for primary breast cancer were randomly assigned to three 20-min home-based writing exercises, one week apart, focusing on either emotional disclosure (EWI group) or a non-emotional topic (control group). Cancer-related distress [Impact of Event Scale (IES)], depressive symptoms (Beck Depression Inventory-Short Form), and negative (37-item Profile of Moods State) and positive mood (Passive Positive Mood Scale) were assessed at baseline and at 3 and 9 months post-intervention. Choice of writing topic (cancer versus other), alexithymia (20-item Toronto Alexithymia Scale), and social constraints (Social Constraints Scale) were included as possible moderators.


Significant (p<0.01) group differences in mood change from before to immediately after each session suggested successful manipulation. Reductions over time in psychological symptoms were seen in both groups (p<0.05), but no time × group interactions were found. Choice of writing topic moderated effects on IES, with women writing about other themes showing greater reductions in cancer-related avoidance than women writing about their cancer. Fewer depressive symptoms and higher levels of positive mood were seen 3 months post-intervention in women writing about their cancer when compared with the control group. Difficulties describing feelings and externally oriented thinking (20-item Toronto Alexithymia Scale) moderated effects on positive mood and IES-total, while no moderating effects were found of social constraints.


In concordance with the majority of previous results with cancer patients, no main effects of EWI were found for cancer-related distress, depressive symptoms, and mood. Moderator analyses suggested that choice of writing topic and ability to process emotional experiences should be studied further.


The use of expressive writing in the course of care for cancer patients to reduce emotional distress: analysis of the literature

Prof Inferm. 2015 Jan-Mar;68(1):29-36. doi: 10.7429/pi.2015.681029.

[Article in Italian; Abstract available in Italian from the publisher]

The emotional distress represents one of the symptoms most frequently reported in the cancer patient in therapy, increasing the risk of developing a disease depressive. Through the analysis of the literature we want to assess whether the use of expressive writing on cancer patients in their care pathway compared to the use of writing neutral reduces emotional distress.


The bibliographic search was conducted using the databases CINAHL, PubMed, Cochrane Library and PsycInfo.


The results of research conducted on 7 randomized controlled trials, including 3 pilot studies have shown after expressive writing sessions (experimental group) versus neutral writing (control group) a significant reduction in distress in the experimental group early stages of cancer (p = 0,0183); in patients with a diagnosis of metastatic assigned to the group expressive writing there was a statistically significant relevance in the reduction of mood disorders (p = 0,03).Were determined statistically significant group differences also with respect to some measure on the quality of sleep (p = 0,04). The expressive writing did not produce significant reductions in psychological distress and improvements in physical health (p > 0,20) in patients diagnosed with metastatic disease of long duration and, in the palliative care there have been results of feasibility for poor adherence at follow-up.


From the results it is evident that the strategies of expressive writing improves the management of the disease, reduce the physical and psychological symptoms related to the tumor while reducing the emotional distress in patients at an early stage of the disease.