Health Psychol. 2010 Jul;29(4):460-6. doi: 10.1037/a0020153.
Low CA1, Stanton AL, Bower JE, Gyllenhammer L.
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.
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.
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).
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).
Cummings, J. A., Hayes, A. M., Saint, D. S., & Park, J. (2014). Expressive writing in psychotherapy: A tool to promote and track therapeutic change. Professional Psychology: Research and Practice, 45(5), 378-386.
Expressive writing (EW) can be a useful supplement to psychotherapy, regardless of therapeutic orientation. In an open trial of exposure-based cognitive therapy for depression, 43 participants used EW before each session, producing 928 EW samples. Using examples from these, we discuss how EW can be used to both promote and track therapeutic change. Specifically, we review the impact of EW on therapeutic growth, via self-monitoring, increased awareness, and exposure/emotional processing. We then discuss how EW can be used to track important predictors of change such as symptoms, therapeutic alliance, social support, avoidance, and hopelessness. We conclude by discussing potential limitations to the use of EW in therapy and by recommending specific strategies for incorporating EW into clinical practice.
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.
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.
BMC Psychiatry. 2014 Oct 3;14:262. doi: 10.1186/s12888-014-0262-3.
Zang Y1,2, Hunt N3, Cox T4,5.
Narrative exposure therapy (NET) is a brief, manualised treatment for Posttraumatic Stress Disorder (PTSD). It has been shown to have therapeutic benefits for a wide range of individuals and settings. This study, following our previous work applying the original NET in earthquake survivors, aimed to revise NET to be adaptable for treating PTSD after a natural disaster.
A randomised waiting-list controlled study was conducted with 30 adult participants with PTSD who were randomly allocated to NET (n = 10), revised NET (NET-R; n = 10) or a waiting list condition (WL; n = 10). Participants in NET and NET-R received treatment immediately; those in the WL condition received NET-R treatment after a waiting period. All groups were assessed on PTSD, general distress, anxiety, depression, social support, coping and posttraumatic change before and after treatment and three-month follow-up.
Compared with WL, both NET and NET-R groups showed significant reductions in PTSD and related symptoms. Significant increases were found in posttraumatic growth, active coping and perceived social support. The WL group showed similar improvements after treatment. Further reductions on PTSD symptoms were found at three months, showing that NET-R is as effective as the original NET in treating post-earthquake traumatic symptoms in adult Chinese earthquake survivors.
NET-R is a feasible and cost-effective intervention for Chinese earthquake survivors. Further studies are needed to replicate these findings in other survivor populations, and with larger samples and over longer periods. This study highlighted the value of oral narrative approach, which is well-accepted and useful in the context of single natural disaster and lower- income area.
Pers Soc Psychol Bull. 2005 Jun;31(6):818-30.
Langens TA1, Schüler J.
Empirical research shows that individuals high in fear of rejection typically report low levels of perceived social support and are more vulnerable to stressful experiences. At the same time, writing about stressful experiences in an emotional way seems to help people adapt to current stressors and not-yet-assimilated stressful experiences. Therefore, the authors suggest that written emotional expression may be a particularly effective strategy to manage negative emotions for individuals high in fear of rejection. Three studies were conducted to test these assumptions. Study 1 found that high fear of rejection is linked to a lack of perceived social support. Longitudinal Studies 2 and 3 supported our main hypothesis, demonstrating that written emotional expression is linked to lower levels of negative mood among individuals high (but not among individuals low) in fear of rejection.
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.
Dedicated to furthering research and promoting good practice
Volume 11, 2016 – Issue 2
Nils F. Toepfer, Uwe Altmann, Anne K. Risch & Gabriele Wilz
This study tested the hypothesis that benefits of positive and expressive writing accrue when the intervention matches or activates the participant’s personal resources. Students were randomly assigned to keep a newly developed resource diary (RD, n = 114), which asked the participants to write about positive experiences and personal resources, or an expressive writing diary (ED, n = 114), which asked the participants to engage with negative emotional experiences, at home on three consecutive days per week for four weeks. Participants keeping the RD perceived significantly more social support and reported a significantly better mood at post-test than participants keeping the ED. Compared to a control group (n = 81) treatment effects of both writing interventions were higher for participants with lower pre-test values of well-being and brooding as well as for participants who wrote in an ‘atmosphere of activated resources.’ It is suggested that research should move away from testing deficit-compensating hypotheses towards a stronger resource orientation.