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

Jensen-Johansen, Mikael Birkelund; Christensen, Søren; Valdimarsdottir, Heiðdís; Zakowski, Sandra G.; Jensen, Anders Bonde; Bovbjerg, Dana H.; Zachariae, Robert

doi:10.1002/pon.3193

Cited by 69 publications

(94 citation statements)

References 38 publications

(70 reference statements)

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“…identifying and describing emotions, is stimulated during MBI by fostering a more open and accepting way of relating to bodily sensations and emotional discomfort [8], patients with high levels of alexithymia could be hypothesized to experience greater treatment gains through the targeting of maladaptive pain cognitions in the intervention. Furthermore, higher levels of alexithymia have previously been found to predict persistent pain in breast cancer patients [13], and results from a randomized controlled trial (RCT) suggested that higher levels of alexithymia were associated with larger reductions in cancer-related distress in breast cancer patients [14]. However, the intervention investigated was Expressive Writing, and it remains unknown whether these results can be generalized to MBI.…”

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confidence: 81%

Clinical and psychological moderators of the effect of mindfulness-based cognitive therapy on persistent pain in women treated for primary breast cancer – explorative analyses from a randomized controlled trial

et al. 2017

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confidence: 81%

Clinical and psychological moderators of the effect of mindfulness-based cognitive therapy on persistent pain in women treated for primary breast cancer – explorative analyses from a randomized controlled trial

et al. 2017

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“…Of the 64 included studies, 9,51-58,66-119 59 9,51,[54][55][56][57][58][66][67][68][71][72][73][74][75][76][77][79][80][81][82][83][84][85][86]88,89,91, were RCTs, and four 52,78,87,92 were non-randomised studies. The remaining study 53 was a matched case-control study.…”

Section: Systematic Review Resultsmentioning

confidence: 99%

“…The patients in Jensen-Johansen et al 76 had recently completed treatment with surgery, radiotherapy or chemotherapy. Participants in Craft et al, 74 Gellaitry et al, 75 Hughes 54 and Walker et al…”

Section: Overviewmentioning

confidence: 99%

“…The number of studies published by year is shown in Figure 2, and the frequency of outcomes evaluated across the included studies is shown in Figure 3. 74 Gellaitry 2010, 75 Henry 2010, 53 Hughes 2007, 54 Jensen-Johansen 2013, 76 Mosher 2012, 77 Park 2012, 78 (Golkaramnay 2007 68 ), Graf 2008, 95 Krpan 2013, 96 …”

Section: Included Studiesmentioning

confidence: 99%

“…Almost all studies were conducted in the USA except for Park and Yi, 78 which was conducted in Korea and published in the Korean language (which was translated into English), and Jensen-Johansen et al, 76 which was conducted in Denmark and published in English.…”

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Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations

Nyssen

Taylor

Wong

et al. 2016

Health Technol Assess

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BackgroundWriting therapy to improve physical or mental health can take many forms. The most researched model of therapeutic writing (TW) is unfacilitated, individual expressive writing (written emotional disclosure). Facilitated writing activities are less widely researched.Data sourcesDatabases, including MEDLINE, EMBASE, PsycINFO, Linguistics and Language Behaviour Abstracts, Allied and Complementary Medicine Database and Cumulative Index to Nursing and Allied Health Literature, were searched from inception to March 2013 (updated January 2015).Review methodsFour TW practitioners provided expert advice. Study procedures were conducted by one reviewer and checked by a second. Randomised controlled trials (RCTs) and non-randomised comparative studies were included. Quality was appraised using the Cochrane risk-of-bias tool. Unfacilitated and facilitated TW studies were analysed separately underInternational Classification of Diseases, Tenth Revision chapter headings. Meta-analyses were performed where possible using RevMan version 5.2.6 (RevMan 2012, The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark). Costs were estimated from a UK NHS perspective and three cost–consequence case studies were prepared. Realist synthesis followed Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines.ObjectivesTo review the clinical effectiveness and cost-effectiveness of TW for people with long-term conditions (LTCs) compared with no writing, or other controls, reporting any relevant clinical outcomes. To conduct a realist synthesis to understand how TW might work, and for whom.ResultsFrom 14,658 unique citations, 284 full-text papers were reviewed and 64 studies (59 RCTs) were included in the final effectiveness reviews. Five studies examined facilitated TW; these were extremely heterogeneous with unclear or high risk of bias but suggested that facilitated TW interventions may be beneficial in individual LTCs. Unfacilitated expressive writing was examined in 59 studies of variable or unreported quality. Overall, there was very little or no evidence of any benefit reported in the following conditions (number of studies): human immunodeficiency virus (six); breast cancer (eight); gynaecological and genitourinary cancers (five); mental health (five); asthma (four); psoriasis (three); and chronic pain (four). In inflammatory arthropathies (six) there was a reduction in disease severity [n = 191, standardised mean difference (SMD) –0.61, 95% confidence interval (CI) –0.96 to –0.26] in the short term on meta-analysis of four studies. For all other LTCs there were either no data, or sparse data with no or inconsistent, evidence of benefit. Meta-analyses conducted acrossallof the LTCs provided no evidence that unfacilitated emotional writing had any effect on depression at short- (n = 1563, SMD –0.06, 95% CI –0.29 to 0.17, substantial heterogeneity) or long-term (n = 778, SMD –0.04 95% CI –0.18 to 0.10, little heterogeneity) follow-up, or on anxiety, physiological or biomarker-based outcomes. One study reported costs, no studies reported cost-effectiveness and 12 studies reported resource use; and meta-analysis suggested reduced medication use but no impact on health centre visits. Estimated costs of intervention were low, but there was insufficient evidence to judge cost-effectiveness. Realist synthesis findings suggested that facilitated TW is a complex intervention and group interaction contributes to the perception of benefit. It was unclear from the available data who might benefit most from facilitated TW.LimitationDifficulties with developing realist synthesis programme theory meant that mechanisms operating during TW remain obscure.ConclusionsOverall, there is little evidence to support the therapeutic effectiveness or cost-effectiveness of unfacilitated expressive writing interventions in people with LTCs. Further research focused on facilitated TW in people with LTCs could be informative.Study registrationThis study is registered as PROSPERO CRD42012003343.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Handing the pen to the patient: Reflective writing for children and families affected by genetic conditions

Murali

Fernbach

Potocki

2014

American J of Med Genetics Pt A

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Genetic diagnoses impact the Quality of Life (QoL) of patients and their families. While some patients and families report a positive impact on QoL, others are affected negatively by a genetic diagnosis. No matter the impact, it is clear that social support is needed for this population. Genetic healthcare providers should be aware of the need for psychosocial support and be equipped to provide or direct patients and families to the appropriate resources. Reflective writing offers a unique opportunity for families and health care providers to engage in self-reflection and expression, activities which have the potential to enhance QoL in a positive manner. The therapeutic potential of writing has been studied in many populations, from caregivers of elderly individuals with dementia, to cancer survivors, to survivors of traumatic experiences. Some of these interventions have shown promise for improving participants' QoL. However, reflective writing has never been studied in patients and families affected by genetic conditions. We propose that reflective writing therapy is a feasible, reproducible, and enjoyable approach to providing psychosocial support for our patients. Get it Write is a reflective writing workshop pilot project for those who have a personal or family history of a genetic diagnosis. Our hypothesis is that reflective writing will help engender acceptance and alleviate feelings of isolation. Get it Write does not focus on the stressful factors in the participants' lives, rather it serves to facilitate interactions with peers facing the same struggles, and with medical students in a non-medical context.

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

Cited by 69 publications

References 38 publications

Clinical and psychological moderators of the effect of mindfulness-based cognitive therapy on persistent pain in women treated for primary breast cancer – explorative analyses from a randomized controlled trial

Clinical and psychological moderators of the effect of mindfulness-based cognitive therapy on persistent pain in women treated for primary breast cancer – explorative analyses from a randomized controlled trial

Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations

Handing the pen to the patient: Reflective writing for children and families affected by genetic conditions

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