Cogniţie, Creier, Comportament / Cognition, Brain, Behavior
Copyright © 2008 Romanian Association for Cognitive Science. All rights reserved. ISSN: 1224-8398
Volume XII, No.1 (March), 115 – 129
The main purpose of the present study was to investigate the possible positive effects of the Expressive Writing paradigm on a sample of Romanian female cancer patients. The major tenet of this paradigm is that if individuals with high levels of distress express in writing, for three or four consecutive writing sessions, their deepest thoughts and emotions regarding the activating event and its consequences, on the follow-up assessment they would experience significantly lower levels of distress, and improved physical and/or psychological functioning. Our study has evinced, that the participants of the sample we investigated has experienced at the follow-up assessment significantly lower levels of distress, and significantly higher levels of positive meaning in life and benefit finding, however, the results may depend on the pre-intervention levels of depression. Nevertheless, the Expressive Writing task has not significantly contributed in our sample to the enhancement of the levels of positive emotions.
Patients at a comprehensive cancer center have participated in a weekly writing program for 7 years. Anecdotal evidence following writing in this clinical setting appeared congruent with the results of expressive writing studies conducted in laboratory settings. To move expressive writing research beyond the laboratory, we evaluated the feasibility of engaging a clinical population in a structured expressive writing task while they waited for an appointment in a cancer clinic. Adult leukemia and lymphoma patients (n = 71) completed a baseline assessment, 20-minute writing task, postwriting assessment, and 3-week follow-up; 88% completed the writing task and 56% completed the follow-up. Participants reported positive responses to the writing, and immediately postwriting about half (49.1%) reported that writing resulted in changes in their thoughts about their illness, while 53.8% reported changes in their thoughts at the 3-week follow-up. Reports of changes in thoughts about illness immediately postwriting were significantly associated with better physical quality of life at follow-up, controlling for baseline quality of life. Initial qualitative analyses of the texts identified themes related to experiences of positive change/transformation following a cancer diagnosis. Findings support the feasibility of conducting expressive writing with a clinical population in a nonlaboratory setting. Cancer patients were receptive to expressive writing and reported changes in the way they thought about their illness following writing. These preliminary findings indicate that a single, brief writing exercise is related to cancer patients’ reports of improved quality of life.
Health Psychol. 2017 Apr;36(4):370-379. doi: 10.1037/hea0000449. Epub 2016 Dec 8.
Despite the significant size of the Asian American population, few studies have been conducted to improve cancer survivorship in this underserved group. Research has demonstrated that expressive writing interventions confer physical and psychological benefits for a variety of populations, including Non-Hispanic White cancer survivors. The study aims to evaluate the health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors in the U.S. It was hypothesized that expressive writing would increase health-related quality of life (HRQOL).
Ninety-six Chinese breast cancer survivors were randomly assigned to 1 of 3 writing conditions: a self-regulation group, an emotional disclosure group, or a cancer-fact group. The self-regulation group wrote about one’s deepest feelings and coping efforts in addition to finding benefits from their cancer experience. The emotional disclosure group wrote about one’s deepest thoughts and feelings. The cancer-fact group wrote about facts relevant to their cancer experience. HRQOL was assessed by FACT-B at baseline, 1, 3, and 6-month follow-ups. Effect sizes and residual zed change models were used to compare group differences in HRQOL.
Contrary to expectations, the cancer-fact group reported the highest level of overall quality of life at the 6-month follow-up. The self-regulation group had higher emotional well-being compared to the emotional disclosure group.
The study challenges the implicit assumption that psychosocial interventions validated among Non-Hispanic Whites could be directly generalized to other populations. It suggests that Asians may benefit from writing instructions facilitating more cognitive than emotional processes.
Psychol Health. 2015;30(3):284-300. doi: 10.1080/08870446.2014.971798. Epub 2014 Oct 27.
This randomised trial tested (i) whether a home-based expressive writing (EW) intervention improves quality of life in patients with colorectal cancer (CRC) and (ii) whether the intervention is more beneficial for men or for people who feel constrained in disclosing cancer-related concerns and feelings.
Patients treated for CRC were randomised to an EW (n = 101) or control writing (CW; n = 92) group. Assessments were completed at 1 month pre- and post-intervention. Sex and perceived social constraints on disclosure were evaluated as moderators.
MAIN OUTCOME MEASURES:
Primary outcomes were depressive symptoms, sleep problems and quality of life indicators.
Eighty-one per cent of participants completed all writing assignments. Consistent with hypotheses, relative to the CW group, participants in the EW group expressed more negative emotion in writing and rated their writings as more meaningful, personal and emotionally revealing. There were no significant main effects of EW or moderating effects of sex or social constraints on outcomes.
Although EW is feasible to use with persons who have CRC, it was not effective as a stand-alone psychotherapeutic intervention. Neither was it more effective for men nor for people who felt they could not freely disclose cancer-related concerns and feelings.
Psychol Health. 2017 Jul;32(7):826-842. doi: 10.1080/08870446.2017.1307372. Epub 2017 Mar 30.
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.
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.
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.
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.
Health Psychol. 2012 Sep;31(5):548-51. doi: 10.1037/a0026834. Epub 2012 Jan 9.
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.
Psychol Health. 2013;28(6):701-13. doi: 10.1080/08870446.2012.754891. Epub 2013 Jan 7.
Amyotrophic lateral sclerosis (ALS) is a terminal neurological disease associated with progressive paralysis, loss of communicative ability and functional decline. Expressive disclosure may help people with ALS, particularly those who are emotionally or socially inhibited, meet psychological challenges associated with the disease. People with ALS (N = 48) were randomised to expressive disclosure about their disease or no disclosure. Psychological well-being (affect, depression and quality of life) was assessed pre-intervention and also three and six months later. Results of multi-level models indicated that the group that disclosed thoughts and feelings about ALS had higher well-being than the control group at three months post-intervention, but not six months. Ambivalence over emotional expression (AEE) moderated three-month post-intervention well-being. Those low in AEE had higher well-being than those high in AEE regardless of condition. Those high in AEE, who disclosed, had increased well-being from pre-intervention, whereas controls had decreased well-being from pre-intervention. Expressive disclosure may be helpful for people with ALS, but only those who have difficulty expressing emotions. In addition, the intervention had only temporary effects; the dynamic challenges of ALS progression may mean that the effect of processing thoughts and feelings about the disease in one stage may not generalise to later stages.
J Clin Oncol. 2014 Mar 1;32(7):663-70. doi: 10.1200/JCO.2013.50.3532. Epub 2014 Jan 27.
This randomized controlled trial examined the quality-of-life benefits of an expressive writing (EW) intervention for patients with renal cell carcinoma (RCC) and identified a potential underlying mechanism of intervention efficacy.
PATIENTS AND METHODS:
Patients (N = 277) with stage I to IV RCC were randomly assigned to write about their deepest thoughts and feelings regarding their cancer (EW) or about neutral topics (neutral writing [NW]) on four separate occasions. Patients completed the Center for Epidemiologic Studies Depression Scale (CES-D), MD Anderson Symptom Inventory (MDASI), Brief Fatigue Inventory (BFI), Pittsburgh Sleep Quality Index (PSQI), Medical Outcomes Study Short Form-36 (SF-36), and Impact of Event Scale (IES) at baseline and 1, 4, and 10 months after the intervention.
The mean age of participants (28% stage IV; 41% female) was 58 years. Multilevel modeling analyses, using a Bonferroni-corrected α = .021 for six outcomes adjusted for the correlation among outcomes, revealed that, relative to the NW group, patients in the EW group reported significantly lower MDASI scores (P = .003) and higher physical component summary scores on the SF-36 (P = .019) at 10 months after the intervention. Mediation analyses revealed that significant group differences for MDASI scores at 10 months were mediated by lower IES scores at 1 month after the intervention in the EW group (P = .042). No significant group differences were observed in the BFI, CES-D, PSQI, and mental component summary of the SF-36.
EW may reduce cancer-related symptoms and improve physical functioning in patients with RCC. Evidence suggests that this effect may occur through short-term improvements in cognitive processing.