Published in final edited form as:
To identify differential health benefits of written emotional disclosure (ED).
Pain-coping style and demographic characteristics were examined as potential moderators of ED treatment efficacy in a randomized controlled trial with female fibromyalgia patients.
Of three pain-coping styles, only patients classified as interpersonally distressed (ID) experienced significant treatment effects on psychological well-being, pain, and fatigue. Treatment effects on psychological well-being were also significantly greater for patients with a high level of education.
Patients with an ID-coping style and/or high education appear to benefit most from ED.
Published in final edited form as:
Psychooncology. 2017 Sep; 26(9): 1361–1368.
Published online 2016 May 3. doi: 10.1002/pon.4148
,1,* Gabriel Lopez
,1 Amy Spelman
,1 Christopher Wood
,2 Surena F. Matin
,2 Nizar M. Tannir
,3 Eric Jonasch
,3 Louis Pisters
,2 Qi Wei
and Lorenzo Cohen1
To identify groups most likely to benefit from an Expressive Writing (EW) intervention, we examined psychosocial variables as intervention moderators. We hypothesized that EW would be particularly effective for participants with high levels of depressive symptoms and social support at study entry.
Patients (n = 277; 60.6% male) with kidney cancer were randomly assigned to either an expressive (EW) or neutral writing (NW) condition. Intervention outcomes included measures of depressive symptoms (CESD), cancer-related symptoms (MDASI), fatigue (BFI), and sleep disturbances (PSQI) assessed at baseline, 1, 4, and 10 months later. Moderators were measured at baseline.
As hypothesized, depressive symptoms and social support moderated intervention efficacy. When examining both moderators simultaneously, EW appeared to be most effective in terms of cancer-related symptoms (p < 0.05) and depressive symptoms (p < 0.01) for participants with elevated depressive symptoms who received high levels of social support at baseline relative to their counterparts in the NW condition. Moreover, participants in EW with high levels of social support at baseline reported lower levels sleep disturbances (p = 0.005) than their counterparts in NW.
Recognition of baseline depressive symptoms and social support as intervention moderators may lead to improved patient selection for EW interventions, as EW may be particularly beneficial regarding QOL outcomes for patients that have social support available including participants with depressive symptoms. EW may not be beneficial, or potentially even contraindicated, for participants lacking social support.
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.
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.
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.
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.
J Health Psychol. 2013 Jun;18(6):727-36. doi: 10.1177/1359105312462434. Epub 2012 Nov 23.
Martino ML1, Freda MF, Camera F.
This study assesses the effects of Guided Written Disclosure Protocol on psychological distress in mothers and fathers of off-therapy acute lymphoblastic leukemia children. An experimental group participated in the writing intervention with a control group subject only to test-taking standards. The Symptom Questionnaire and Profile of Mood States were administered at baseline, post-intervention, and follow-up. Guided Written Disclosure Protocol had significant effects on the progressive reduction of anxiety, depression, somatic symptoms, hostility, tension-anxiety, and fatigue-inertia within the experimental group. However, the control group distress levels tended to worsen over time. The mediating role of emotional processing was highlighted.
J Pers Soc Psychol. 1996 Sep;71(3):588-602.
Greenberg MA1, Wortman CB, Stone AA.
Health benefits derived from personal trauma disclosure are well established. This study examined whether disclosing emotions generated by imaginative immersion in a novel traumatic event would similarly enhance health and adjustment. College women, preselected for trauma presence, were randomly assigned to write about real traumas, imaginary traumas, or trivial events. Yoked real-trauma and imaginary-trauma participants wrote about real-trauma participants’ experiences. Imaginary-trauma participants were significantly less depressed than real-trauma participants at immediate posttest, but they were similarly angry, fearful, and happy. Compared with control group participants, both trauma groups made significantly fewer illness visits at 1-month follow-up; however, real-trauma participants reported more fatigue and avoidance than did the other groups. Imaginary-trauma group effects could reflect catharsis, emotional regulation, or construction of resilient possible selves.
Cancer Nurs. 2016 Jul-Aug;39(4):E51-60. doi: 10.1097/NCC.0000000000000300.
Gripsrud BH1, Brassil KJ, Summers B, Søiland H, Kronowitz S, Lode K.
Expressive writing has been shown to improve quality of life, fatigue, and posttraumatic stress among breast cancer patients across cultures. Understanding how and why the method may be beneficial to patients can increase awareness of the psychosocial impact of breast cancer and enhance interventional work within this population. Qualitative research on experiential aspects of interventions may inform the theoretical understanding and generate hypotheses for future studies.
The aim of the study was to explore and describe the experience and feasibility of expressive writing among women with breast cancer following mastectomy and immediate or delayed reconstructive surgery.
Seven participants enrolled to undertake 4 episodes of expressive writing at home, with semistructured interviews conducted afterward and analyzed using experiential thematic analysis.
Three themes emerged through analysis: writing as process, writing as therapeutic, and writing as a means to help others.
Findings illuminate experiential variations in expressive writing and how storytelling encourages a release of cognitive and emotional strains, surrendering these to reside in the text. The method was said to process feelings and capture experiences tied to a new and overwhelming illness situation, as impressions became expressions through writing. Expressive writing, therefore, is a valuable tool for healthcare providers to introduce into the plan of care for patients with breast cancer and potentially other cancer patient groups.
IMPLICATIONS FOR PRACTICE:
This study augments existing evidence to support the appropriateness of expressive writing as an intervention after a breast cancer diagnosis. Further studies should evaluate its feasibility at different time points in survivorship.
Sharon Danoff-Burg , John D. Agee , Norman R. Romanoff , Joel M. Kremer & James M. Strosberg
Volume 21, 2006 – Issue 5
An intriguing question within the expressive writing literature is whether writing interventions that focus on positive aspects of adverse experiences can produce health benefits, particularly among individuals with serious physical illness. Seventy-five adults with lupus or rheumatoid arthritis were randomly assigned to one of three 4-session writing interventions: benefit finding (BF), standard expressive writing (EW), or a control group. Follow-up questionnaires were completed one and three months later. At three months, fatigue was lower in the BF and EW groups than in the control group. BF appeared effective in reducing pain levels for participants with high trait anxiety, whereas EW appeared effective for participants with low trait anxiety. No significant group effects were found for psychological functioning or disability. Results are discussed with regard to the literature on BF and EW among medical patients.