Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors - Results from a nationwide randomized clinical trial

M. B. Jensen-Johansen, S. Christensen, H. Valdimarsdottir, S. Zakowski, A. B. Jensen, D. H. Bovbjerg, R. Zachariae

Research output: Contribution to journalArticlepeer-review

57 Scopus citations

Abstract

Objective 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. Methods 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. Results 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. Conclusions 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.

Original languageEnglish
Pages (from-to)1492-1500
Number of pages9
JournalPsycho-Oncology
Volume22
Issue number7
DOIs
StatePublished - Jul 2013

Keywords

  • cancer
  • cancer-related distress
  • emotional disclosure
  • expressive writing intervention
  • oncology

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