The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients—a systematic review and meta‐analysis

Abstract

Objective: This study aimed to evaluate the effectiveness of expressive writing intervention (EWI) for improving psychological and physical health in cancer patients and survivors.Methods: 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.Results: 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, À0.06 to 0.14; p = 0.42), physical (0.08; 95% CI, À0.05 to 0.20; p = 0.22), or quality-of-life outcomes (0.09; 95% CI, À0.05 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.Conclusions: 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.

Coordinación emocional en el afrontamiento del cáncer: alexitimia, apego y estrategias de afrontamiento como predictores de bienestar emocional en mujeres sometidas a radioterapia

“…In this respect, the literature does not enable clearer conclusions. Contradictory results have been found on the repercussions of emotional expressiveness in psychological adjustment in women with cancer (Stanton et al, 2000;Stanton & Low, 2012;Zacharie & O´Toole, 2015), so the effect of emotional expression on well-being may be very dependent on context, especially the quality of the relationship it takes place in.…”

Review systematischer Übersichtsarbeiten zu nicht medikamentösen Interventionen zur Verbesserung der Lebensqualität von Krebsüberlebenden

“…Dreizehn Übersichtsarbeiten behandelten unterschiedliche Tumorgruppen [10,11,12,13,14,15,16,17,18,19,20,21,22], in 7 ging es speziell um Brustkrebs [8,9,23,24,25,26,27] und in einer um Prostatakrebs [28]. …”

“…Ein Review verglich multidimensionale mit monodimensionalen Interventionen [18] und eines untersuchte multidisziplinäre Rehabilitationsmodelle [8]. Ein Review schließlich befasste sich mit den Effekten von expressivem Schreiben [22]. Dauer und Häufigkeit der Interventionen unterschieden sich stark und reichten von einer einzelnen 20-minütigen Einheit [17] bis zu 60 wöchentlichen Einheiten [10].…”

“…So fanden sich Vorteile in Bezug auf internetbasierte Schulungen und Internetforen, jedoch gemischte Effekte für interaktive Internetseiten, und eine Studie zu E-Mail-basierten Interventionen zeigte verschlechterte Outcomes. Ein Review zu expressivem Schreiben war interessant, ergab jedoch keinen Vorteil in Hinblick auf die QoL, wobei leichte Effekte allerdings unerkannt geblieben wären [22]. Patienten mit geringer sozialer Unterstützung schienen stärker zu profitieren als andere.…”

Expressive Writing Intervention Improves Quality of Life Among Chinese-American Breast Cancer Survivors: A Randomized Controlled Trial

“…Despite the demonstrated benefits from those studies, a recent meta-analysis reviewed 16 randomized controlled trials and concluded no overall evidence for benefits of writing in psychological, physical, or quality of life outcomes [14]. Conversely, the review did suggest that those who experience low levels of emotional support may benefit from expressive writing.…”