Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors — results from a nationwide randomized clinical trial
Article first published online: 18 SEP 2012
Copyright © 2012 John Wiley & Sons, Ltd.
Volume 22, Issue 7, pages 1492–1500, July 2013
How to Cite
Jensen-Johansen, M. B., Christensen, S., Valdimarsdottir, H., Zakowski, S., Jensen, A. B., Bovbjerg, D. H. and Zachariae, R. (2013), Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors — results from a nationwide randomized clinical trial. Psycho-Oncology, 22: 1492–1500. doi: 10.1002/pon.3193
- Issue published online: 5 JUL 2013
- Article first published online: 18 SEP 2012
- Manuscript Accepted: 29 AUG 2012
- Manuscript Revised: 23 AUG 2012
- Manuscript Received: 23 DEC 2010
- Danish Cancer Society. Grant Number: PP04034
- Faculty of Business and Social Sciences, Aarhus University
- expressive writing intervention;
- emotional disclosure;
- cancer-related distress
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. Copyright © 2012 John Wiley & Sons, Ltd.