The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients–a systematic review and meta-analysis.

Psychooncology. 2015 Nov;24(11):1349-59. doi: 10.1002/pon.3802. Epub 2015 Apr 14.

Zachariae R1, O’Toole MS2.

This study aimed to evaluate the effectiveness of expressive writing intervention (EWI) for improving psychological and physical health in cancer patients and survivors.


We searched databases and existing reviews for randomized controlled studies published between 1986 and 2014 that evaluated the effects of EWI on psychological and physical health outcomes. We computed and combined effect sizes and examined the role of methodological characteristics.


From 223 unique citations, we identified 16 independent randomized controlled trials published from 1999 to 2014, examining the effect of EWI on a range of psychological and physical health outcomes. No statistically significant effects were found for any of the individual or combined psychological (Hedges’s g: 0.04; 95% CI, -0.06 to 0.14; p = 0.42), physical (0.08; 95% CI, -0.05 to 0.20; p = 0.22), or quality-of-life outcomes (0.09; 95% CI, -0.05 to 0.24; p = 0.22). The results were unaffected by differences in study characteristics, for example, type of control condition, study setting, cancer type, and overall study quality ratings. Results from a subset of studies indicated a possible moderating effect of social constraints, suggesting that participants experiencing low levels of emotional support may be more likely to benefit from EWI.


Our results do not support the general effectiveness of EWI in cancer patients and survivors. However, given the practical and inexpensive intervention, it is possible that even small effects in subgroups of patients could be clinically relevant, and future studies are recommended to test the effects of potential moderators, including pre-intervention distress levels and context-dependent factors such as emotional support.

Narrowing the gap: the effects of an expressive writing intervention on perceptions of actual and ideal emotional support in women who have completed treatment for early stage breast cancer.

Psychooncology. 2010 Jan;19(1):77-84. doi: 10.1002/pon.1532.

Gellaitry G1, Peters K, Bloomfield D, Horne R.

To assess the effects of an expressive writing (EW) intervention on perceptions of emotional support in women completing treatment for early stage breast cancer.


Women were recruited to the study during their final week of treatment. Of 260 eligible patients, 104 (40%) agreed to participate, and 93 were randomised. Women in the writing group wrote for 20 min on four consecutive days. The control group received normal care. Women’s perceptions of emotional support, quality of life (QOL), mood, and healthcare utilisation were assessed at baseline, 1 month, 3 months and 6 months. Interviews were conducted to explore women’s experience of writing.


Eighty participants completed all follow-ups. There was a significant effect of group on women’s perceptions of social support with those in the intervention group being more satisfied with the emotional support they received (p<0.05). Satisfaction with emotional support was negatively correlated with depression/dejection (p<0.05) and anger/hostility (p<0.05) and positively correlated with social and family well-being (p<0.001) 6 months post intervention. There were no significant effects of the intervention on mood, QOL or healthcare utilisation. Most participants found writing valuable and did not report any long-term negative effects.


EW was associated with a higher level of satisfaction with emotional support compared with controls. Given the existing evidence supporting the importance of social support in adjustment to breast cancer, it seems feasible to suggest that EW may be a cost effective accessible treatment that could be incorporated into the ongoing care of women.