Expressive writing intervention and self-reported physical health out-comes – Results from a nationwide randomized controlled trial with breast cancer patients

Abstract

The objective was to examine the effect of Expressive Writing Intervention (EWI) on self-reported physical symptoms and healthcare utilization in a nationwide randomized controlled trial with Danish women treated for primary breast cancer, and to explore participant characteristics related to emotion regulation as possible moderators of the effect. Women who had recently completed treatment for primary breast cancer (n = 507) were randomly assigned to three 20 min. home-based writing exercises, one week apart, focusing on emotional disclosure (EWI) of a distressing experience (their cancer or a non-cancer topic) or a non-disclosing topic (control). Outcomes were self-reported physical symptoms and healthcare utilization (visits and telephone contacts with GP) 3 and 9 months post-intervention. Potential moderators were repressive coping, alexithymia, rumination, social constraints, and writing topic. Results revealed no group by time interaction effects for any outcomes. Moderation analyses showed that 1) low alexithymic women in the EWI group showed larger decreases in GP telephone calls over time than both high alexithymic women and controls and 2) women in the EWI group writing about their own cancer, but not women writing about other topics, showed a larger decrease than controls. The results from this large randomized trial are concordant with previous findings showing that EWI is unlikely to be a generally applicable intervention to improve health-related outcomes in cancer patients and cancer survivors. However, written disclosure might have a beneficial impact for individuals who write about their own cancer, as well as for those low in alexithymia.

Linguistic Markers of the Emotion Elaboration Surrounding the Confinement Period in the Italian Epicenter of COVID-19 Outbreak

“…For these participants this high emotional activation probably led to the interruption of the task, which may have been too intense to be expressed and processed during the writing period. Some studies ( Jensen-Johansen et al, 2018 ; Renzi et al, 2020 ), in fact, evidenced that the degree of people’s emotional regulation ability have a moderating effect on writing disclosure effectiveness. People who score too low or too high in emotion regulation ability found it difficult to benefit from expressive writing.…”

The Effect of Emotional Disclosure by Writing on the Depression of Hemodialysis Patients in Iran: A Randomized Clinical Trial

“…38 Jensen-Johansen et al, evaluated the effects of emotional disclosure by writing on immunity of the patients with autoimmune disorder, and concluded that the emotional disclosure by writing could reduce depression especially when combined with a deep understanding, review, causation, and insight of the emotions associated with the event. 17 All of these studies suggest that emotional disclosure by writing is effective in reducing the depression of patients. The results of the studies above are consistent with ours.…”

“… 16 The use of writing alone or in combination with other therapies has significantly influenced mental and physical health. 17 Expressive emotion, a psychological and medical intervention, has shown favorable effects on physical and mental health. 18 According to Kennedy-Moore & Watson, expressive emotions include four main functions: 1. arranging arousal; 2. self-perception; 3. improving coping skills; 4. improving interpersonal relationships.…”

What is expressed in expressive writing: Gendered differences in narrative processes for low closure interpersonal and impersonal stressors.

“…However, they identified a few studies that suggested patients with little emotional support might benefit and recommended a continued search for possible moderators. A large nationwide RCT of EW for Danish women completing breast cancer treatment (Jensen-Johansen et al, 2018) found significant effects only in their moderation analyses, with women who wrote about their cancer using less healthcare than control women.…”