A closer examination of the structured written disclosure procedure. The feasibility and effectiveness of an expressive writing intervention for rheumatoid arthritis via home-based videotaped instructions The WRITTEN-HEART study (expressive writing for heart healing): rationale and design of a randomized controlled clinical trial of expressive writing in coronary patients referred to residential cardiac rehabilitation Randomized controlled trial of Mindfulness-based cancer recovery versus supportive expressive group therapy for distressed survivors of breast cancer. Health effects of emotional disclosure in rheumatoid arthritis patients. A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors. Written emotional disclosure buffers the effects of social constraints on distress among cancer patients. Expressive writing in early breast cancer survivors. Does Writing Affect Asthma? A Randomized Trial Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: a randomized trial. Psychological morbidity in the first year after breast surgery. Does emotional expression make a difference in reactions to breast cancer? Expressive disclosure and benefit finding among breast cancer patients: mechanisms for positive health effects. Expressive writing can increase working memory capacity. Randomized controlled trial of expressive writing for patients with renal cell carcinoma. Effect of written emotional disclosure interventions in persons with psoriasis undergoing narrow band ultraviolet B phototherapy. Emotional disclosure through patient narrative may improve pain and well-being: results of a randomized controlled trial in patients with cancer pain. Narrowing the gap: the effects of an expressive writing intervention on perceptions of actual and ideal emotional support in women who have completed treatment for early stage breast cancer. Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors - results from a nationwide randomized clinical trial. The benefits of expressive writing after the Madrid terrorist attack: Implications for emotional activation and positive affect. The effects of written emotional disclosure and coping skills training in rheumatoid arthritis: a randomized clinical trial. Written Emotional Expression Produces Health Benefits in Fibromyalgia Patients [Development and effectiveness of expressive writing program for women with breast cancer in Korea].
The current study examined psychological and physical health outcomes of the written disclosure paradigm and the hypothesis that the principles of therapeutic exposure account for the beneficial effects of the paradigm . Participants were r and omly assigned to either a  written disclosure condition  or a control condition .  Reactivity to the writing sessions was examined using both subjective and physiological measures . Measures of psychological and physical health were completed before and 1 month after the sessions . Participants assigned to the disclosure condition reported fewer psychological and physical symptoms at follow-up compared with control participants , though reductions were clinical ly significant for only 1 outcome measure . Physiological activation to the 1st disclosure session was associated with reduced psychological symptoms at follow-up for disclosure participants . Subjective reports of emotional responding corresponded with physiological reactivity . Implication s of these findings are discussed Background : Expressive emotional writing has demonstrated efficacy for improving health status in a wide variety of healthy persons and recently in patients with chronic disease . Purpose : This study was a r and omized , controlled effectiveness trial with 4 arms : 2 active treatment writing groups , 1 inactive writing group , and 1 attention control group . It represents the first attempt to translate the expressive writing intervention into a low-cost , community-based intervention in the form of a videotaped program . Methods : Feasibility of the approach and patient adherence were examined in a community rheumatology practice with rheumatoid arthritis patients ( N = 373 ) . Results : The videotape format was able to convey the intervention instructions accurately and produced the expected and differential ratings of stressfulness and emotional provocation across the 3 writing programs . Seventy-nine percent of eligible patients agreed to take the program home ; 49 % of these patients reported that they followed the protocol . Physician Disease Activity Rating and the Physical Component Summary of the SF36v2 Health Survey were assessed pre and post program . Conclusions : Intent-to-treat analyses found no effect of the treatment . Pretreatment differences among the protocol -adherent patients complicated treatment outcome interpretation . The st and ard writing instructions did not yield an effect ; a modified set of instructions to extract meaning from the traumatic event yielded equivocal results . Contrasts between efficacy and effectiveness trials and the challenge of achieving significant outcomes in effectiveness trials are discussed Background Coronary heart disease ( CHD ) is typically associated with many cardiovascular risk factors ( e.g. , elevated blood pressure ) , low health-related quality of life , depression , anxiety and psychological stress . Expressive writing ( EW ) has shown beneficial effects on such variables in both people from the community and in patients with a variety of chronic illnesses . However , no study to date has evaluated the physical and psychological effects of the expressive writing procedure on coronary patients referred to cardiac rehabilitation ( CR ) . Methods The clinical effectiveness of a 2-week disease-related expressive writing procedure ( writing about one 's deepest thoughts and feelings regarding the experience with heart disease ) compared with the st and ard writing task ( writing about one 's deepest thoughts and feelings about the most traumatic or negative event experienced in the life ) , a neutral writing condition ( writing about the facts regarding heart disease and its treatment ) and an empty control condition will be evaluated in a r and omized controlled clinical trial ( RCT ) with repeated follow-up measurements at 3 , 6 and 12 months after discharge from CR . The primary outcome is health-related quality of life ( SF-12 ) . Secondary outcome measures are depression ( BDI-II ) , anxiety ( BAI ) and post-traumatic growth ( PTGI ) . Furthermore , the study will explore the moderating effects of coping styles , type D personality , perceived emotional support and participants ' evaluative ratings of the writing interventions on the main experimental effects in order to identify sub-groups of patients showing different results . Discussion The WRITTEN-HEART study aims to explore and exp and the frontiers of the expressive writing research enterprise by investigating the feasibility , safety and clinical efficacy of brief and cost-effective  expressive writing interventions in patients with CHD referred to CR.Trial registration Clinical Trials.gov PURPOSE To compare the efficacy of the following two empirically supported group interventions to help distressed survivors of breast cancer cope : mindfulness-based cancer recovery ( MBCR ) and supportive-expressive group therapy ( SET ) . PATIENTS AND METHODS This multisite , r and omized controlled trial assigned 271 distressed survivors of stage I to III breast cancer to MBCR , SET , or a 1-day stress management control condition . MBCR focused on training in mindfulness meditation and gentle yoga , whereas SET focused on emotional expression and group support . Both intervention groups included 18 hours of professional contact . Measures were collected at baseline and after intervention by assessors blind to study condition . Primary outcome measures were mood and diurnal salivary cortisol slopes . Secondary outcomes were stress symptoms , quality of life , and social support . RESULTS Using linear mixed-effects models , in intent-to-treat analyses , cortisol slopes were maintained over time in both SET ( P = .002 ) and MBCR ( P = .011 ) groups relative to the control group , whose cortisol slopes became flatter . Women in MBCR improved more over time on stress symptoms compared with women in both the SET ( P = .009 ) and control ( P = .024 ) groups . Per- protocol analyses showed greater improvements in the MBCR group in quality of life compared with the control group ( P = .005 ) and in social support compared with the SET group ( P = .012 ) . CONCLUSION In the largest trial to date , MBCR was superior for improving stress levels , quality of life and social support [ CORRECTED ] for distressed survivors of breast cancer . Both SET and MBCR also result ed in more normative diurnal cortisol profiles than the control condition . The clinical implication s of this finding require further investigation This study examined the effects of emotional disclosure of stressful events on the pain , physical and affective dysfunction  ,  and joint condition of patients with rheumatoid arthritis ( RA ) . Patients were r and omly assigned to talk privately about stressful events ( disclosure group , n = 36 ) or about trivial topics ( control group ,  n = 36 ) for 4 consecutive days . Disclosure result ed in immediate increases in negative mood . At 2 weeks the 2 groups did not differ on any health measure , but at 3 months disclosure patients had less affective disturbance and better physical functioning in daily activities . There was no main effect of disclosure on pain or joint condition , but among the disclosure patients , those who experienced larger increases in negative mood after talking demonstrated improvements in the condition of their joints . This study concludes that , among RA patients , verbal disclosure and emotional processing of stressful life events induces an immediate negative mood followed by improved psychological functioning OBJECTIVE Little attention has been focused on Asian American breast cancer survivor 's psychological needs . No outcome -based psychosocial interventions have been reported to target at this population . Expressive writing interventions have been previously shown to improve health outcomes among non-Hispanic White breast cancer population s. This pilot study aim ed to test the cultural sensitivity , feasibility , and potential health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors . METHODS Participants ( N = 19 ) were asked to write about their deepest thoughts and feelings , their coping efforts , and positive thoughts and feelings regarding their experience with breast cancer each week for 3 weeks . Health outcomes were assessed at baseline , 3 , and 6 months after the intervention . A Community-Based Participatory Research Approach ( CBPR ) is used . RESULTS Expressive writing was associated with medium and large effect sizes ( η(p)² = 0.066∼0.208 ) in improving multiple health outcomes ( quality of life , fatigue , posttraumatic stress , intrusive thoughts , and positive affect ) at follow-ups . Participants perceived the study to be valuable . The study yielded high compliance and completion rates . CONCLUSION Expressive writing is associated with long-term improvement of health outcomes among Chinese breast cancer survivors and has the potential to be utilized as a support strategy for minority cancer survivors . In addition , CBPR is valuable in improving feasibility and cultural sensitivity of the intervention in understudied population s. Future studies employing r and omized , controlled trial design s are warranted The aims of the present study were to examine whether written emotional disclosure would reduce distress among cancer patients and whether it would buffer the effects of high levels of social constraint ( negative social responses to patients ' expressions of emotion regarding their cancer ) on distress . Cancer patients ( N=104 ) were r and omly assigned to write about their emotions regarding their cancer 20 min a day for 3 days or to write about a nonemotional topic . They completed question naires at baseline and 6 months postintervention . Results showed that written disclosure buffered the effects of social constraints on stress at the 6-month follow-up and that avoidance partly mediated these effects . The present data reinforce the notion that interventions should be tailored to patients ' needs AIMS This article is the report of a study aim ed at determining whether or not expressive writing improves the quality -of-life of early breast cancer survivors . An additional aim is the investigation of whether or not the type of writing prompt makes a difference in results . BACKGROUND The risk of distress can extend well beyond the time of a breast cancer diagnosis . Emotional expression may assist in dealing with this . DESIGN R and omized controlled study . METHODS Participants ( n = 120 ) were r and omized into one of four groups : a control group ( no writing ) or one of three expressive writing groups : breast cancer trauma , any self-selected trauma and facts related to breast cancer . Participants wrote 20 minutes a day for 4 consecutive days . Their quality -of-life was measured , using the ' Functional Assessment of Cancer Therapy-Breast Cancer Version ' , at baseline and at 1 month and 6 months after writing . Paired t-tests , multivariate analysis of variance and multiple regression were used to analyse the data of the 97 participants who completed the journaling assignment and at least the first assessment , collected in 2006 . Intention-to-treat analysis was used . RESULTS / FINDINGS Expressive writing about one 's breast cancer , breast cancer trauma and facts related to breast cancer , significantly improved the quality -of-life outcome . CONCLUSION Expressive writing , focusing the instructions on writing about one 's living and dealing with a diagnosis of breast cancer , is recommended for early breast cancer survivors as a feasible and easily implemented treatment approach to improve quality -of-life Objective : Nonpharmacologic treatments for asthma may act as useful adjuncts to pharmacotherapy but should be recommended to patients only after several well-controlled studies provide evidence of efficacy . Research demonstrating that written emotional expression can improve pulmonary function in patients with asthma consists of one impressive yet unreplicated study ( 1 ) . Our main objective was to test and extend previous research finding that written emotional expression improves pulmonary function in patients with asthma compared with writing on neutral topics . Methods : We conducted a r and omized , controlled trial of outpatient asthmatics recruited from hospitals and the community . Of the 137 adult patients with asthma who were r and omized , 117 began and 114 completed the study . Patients were r and omly assigned to write for 20 minutes , once per week , for 3 weeks about stressful experiences ( n = 41 ) , positive experiences ( n = 37 ) , or neutral experiences ( n = 36 ; control group ) . At baseline , postintervention , and 2-month follow up , patients were assessed by spirometry . Results : The mean change from baseline to 2-month follow up in percentage of predicted forced expiratory volume in 1 second ( FEV1 ) was 4.2 % in the stress-writing group , 1.3 % in the positive-writing group , and 3.0 % in the control group . In forced vital capacity ( FVC ) , there was 3.1 % improvement in the stress-writing group , 3.6 % in the positive-writing group , and 2.4 % in the control group . These changes were not statistically or clinical ly significant . Conclusions : The present study reduces confidence in the ability of written emotional expression to benefit the disease status of asthma patients . FEV1 = forced expiratory volume in 1 second ; FVC = forced vital capacity ; VAPAHCS = Veteran Affairs Palo Alto Health Care System ; PTSD = posttraumatic stress disorder ; COPD = chronic obstructive pulmonary disease CONTEXT Nonpharmacological treatments with little patient cost or risk are useful supplements to pharmacotherapy in the treatment of patients with chronic illness . Research has demonstrated that writing about emotionally traumatic experiences has a surprisingly beneficial effect on symptom reports , well-being , and health care use in healthy individuals . OBJECTIVE To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using st and ardized quantitative outcome measures . DESIGN R and omized controlled trial conducted between October 1996 and December 1997 . SETTING Outpatient community residents drawn from private and institutional practice . PATIENTS Volunteer sample of 112 patients with asthma ( n = 61 ) or rheumatoid arthritis ( n = 51 ) received the intervention ; 107 completed the study , 58 in the asthma group and 49 in the rheumatoid arthritis group . INTERVENTION Patients were assigned to write either about the most stressful event of their lives ( n = 71 ; 39 asthma , 32 rheumatoid arthritis ) or about emotionally neutral topics ( n = 41 ; 22 asthma , 19 rheumatoid arthritis ) ( the control intervention ) . MAIN OUTCOME MEASURES Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were clinical ly examined by a rheumatologist . Assessment s were conducted at baseline and at 2 weeks and 2 months and 4 months after writing and were done blind to experimental condition . RESULTS Of evaluable patients 4 months after treatment , asthma patients in the experimental group showed improvements in lung function ( the mean percentage of predicted forced expiratory volume in 1 second [ FEV1 ] improved from 63.9 % at baseline to 76.3 % at the 4-month follow-up ; P<.001 ) , whereas control group patients showed no change . Rheumatoid arthritis patients in the experimental group showed improvements in overall disease activity ( a mean reduction in disease severity from 1.65 to 1.19 [ 28 % ] on a scale of 0 [ asymptomatic ] to 4 [ very severe ] at the 4-month follow-up ; P=.001 ) , whereas control group patients did not change . Combining all completing patients , 33 ( 47.1 % ) of 70 experimental patients had clinical ly relevant improvement , whereas 9 ( 24.3 % ) of 37 control patients had improvement ( P=.001 ) . CONCLUSION Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences had clinical ly relevant changes in health status at 4 months compared with those in the control group . These gains were beyond those attributable to the st and ard medical care that all participants were receiving . It remains unknown whether these health improvements will persist beyond 4 months or whether this exercise will prove effective with other diseases In this prospect i ve study , the psychological morbidity associated with the treatment of breast cancer was assessed . The study population comprised all patients referred to one centre with a recently diagnosed breast lump , who were to undergo surgery .  Psychological morbidity was assessed preoperatively and at 6 and 12 months postoperatively by modified Rotterdam Symptom Checklist .  Three hundred and twenty patients completed all three question naires : 93 women undergoing mastectomy , 73 women having conservation therapy for breast cancer and 156 women having biopsy for benign breast disease . Patients with a breast malignancy smaller than 4 cm in diameter were treated by lumpectomy and radiotherapy , anti-oestrogen therapy or chemotherapy alone or in combination .  Psychological morbidity among patients with malignant disease was significantly greater than that seen in the group with benign disease . Among cancer patients , a significant decrease in anxiety and depression occurred during the year following surgery . The study failed to demonstrate any psychological advantage associated with breast conservation PURPOSE / OBJECTIVES To examine the feasibility of using an emotional expression intervention with patients with cancer and test the hypothesis that emotional expression improves psychosocial adjustment . DESIGN Sequentially r and omized pretest/post-test design with repeated measures . SETTING Two radiation therapy ( RT ) facilities . SAMPLE Women completing RT for stage I or II breast cancer , who spoke and read English , were independent in self-care , and provided written consent . Subjects ( N = 44 ) were middle-aged ( mean = 53.6 years ) , Caucasian , married , and well educated . METHODS Following a baseline interview , subjects were sequentially r and omized to an attentional control group , a single dose , or a three-dose emotional expression writing group . Interventions were administered at the time of completion of RT . Follow-up telephone interviews were completed at 1 , 4 - 6 , 16 , and 28 weeks post-RT . MAIN RESEARCH VARIABLES Positive and negative affect , intrusiveness of thoughts , use of avoidant coping , side effect severity , trait negative affectivity , content of written essay , and themes derived from content analysis . FINDINGS A high level of acceptance and completion of emotional expression existed , but no effect of the intervention on psychosocial adjustment was evident . Process measures in the three-dose group changed as expected . No relationship existed between content changes and outcome measures . CONCLUSIONS Emotional expression is feasible for patients with cancer , but the efficacy of the intervention in improving mood and decreasing cognitive intrusion and avoidance was not supported . Emotional expression processes were consistent with those seen in other sample s and may influence outcomes that were not addressed in this study . IMPLICATION S FOR NURSING PRACTICE More extensive testing is needed , including additional outcome variables . Essays reveal concerns around communication , recurrence , and health behavior changes that should be considered in practice A r and omized trial ( n = 60 ; A. L. Stanton , S. Danoff-Burg , L. A. Sworowski , et al. , 2002 ) revealed that 4 sessions of written expressive disclosure or benefit finding produced lower physical symptom reports and medical appointments for cancer-related morbidities at 3-month follow-up among breast cancer patients relative to a fact-control condition . The goal of this article is to investigate mechanisms underlying these effects . Within-session heart rate habituation mediated effects of expressive disclosure on physical symptoms , and greater use of negative emotion words in essays predicted a decline in physical symptoms . Postwriting mood and use of positive emotion and cognitive mechanism words in essays were not significant mediators , although greater cognitive mechanism word use was related to greater heart rate habituation and negative emotion word use The effect of emotional disclosure through expressive writing on available working memory ( WM ) capacity was examined in 2 semester-long experiments . In the first study , 35 freshmen assigned to write about their thoughts and feelings about coming to college demonstrated larger working memory gains 7 weeks later compared with 36 writers assigned to a trivial topic . Increased use of cause and insight words was associated with greater WM improvements . In the second study , students ( n = 34 ) who wrote about a negative personal experience enjoyed greater WM improvements and declines in intrusive thinking compared with students who wrote about a positive experience ( n = 33 ) or a trivial topic ( n = 34 ) . The results are discussed in terms of a model grounded in cognitive and social psychological theory in which expressive writing  reduces intrusive and avoidant thinking about a stressful experience , thus freeing WM re sources PURPOSE This r and omized controlled trial examined the quality -of-life benefits of an expressive writing ( EW ) intervention for patients with renal cell carcinoma ( RCC ) and identified a potential underlying mechanism of intervention efficacy . PATIENTS AND METHODS Patients ( N = 277 ) with stage I to IV RCC were r and omly assigned to write about their deepest thoughts and feelings regarding their cancer ( EW ) or about neutral topics ( neutral writing [ NW ] ) on four separate occasions . Patients completed the Center for Epidemiologic Studies Depression Scale ( CES-D ) , MD And erson Symptom Inventory ( MDASI ) , Brief Fatigue Inventory ( BFI ) , Pittsburgh Sleep Quality Index ( PSQI ) , Medical Outcomes Study Short Form-36 ( SF-36 ) , and Impact of Event Scale ( IES ) at baseline and 1 , 4 , and 10 months after the intervention . RESULTS The mean age of participants ( 28 % stage IV ; 41 % female ) was 58 years . Multilevel modeling analyses , using a Bonferroni-corrected α = .021 for six outcomes adjusted for the correlation among outcomes , revealed that , relative to the NW group , patients in the EW group reported significantly lower MDASI scores ( P = .003 ) and higher physical component summary scores on the SF-36 ( P = .019 ) at 10 months after the intervention . Mediation analyses revealed that significant group differences for MDASI scores at 10 months were mediated by lower IES scores at 1 month after the intervention in the EW group ( P = .042 ) . No significant group differences were observed in the BFI , CES-D , PSQI , and mental component summary of the SF-36 . CONCLUSION EW may reduce cancer-related symptoms and improve physical functioning in patients with RCC . Evidence suggests that this effect may occur through short-term improvements in cognitive processing The beneficial health effects of emotional writing disclosure ( ED ) on several chronic diseases have been reported . The aim of this pilot study was to investigate the effects of two ED techniques on psoriatic patients treated with ultraviolet B ( UVB ) therapy . Forty patients were r and omly assigned to two different ED treatments ( according to Pennebaker [ PW ] , writing about stressful events , to King [ KW ] , writing about major life goals ) , or to a control group ( CG ) . Disease severity and quality of life ( QoL ) were assessed at baseline , halfway through and at the end of UVB treatment , and 4 months after ED . Outcome measures were the PASI and SAPASI scores , the Skindex-29 , and the GHQ-12 , to assess disease severity , health-related QoL and psychological wellbeing , respectively . Increases in SAPASI scores were recorded between end of therapy and the final assessment in KW ( p : 0.07 ) and CG individuals ( p : < 0.05 ) , whereas no differences were found in PW patients . Significant differences in Skindex-29 values between PW and the other groups were reported . Patients allocated to the PW group had a longer period of remission after phototherapy . This provides preliminary evidence that such a simple and inexpensive tool may play a role in enhancing treatment efficacy and Narrative medicine is based upon physicians ' awareness of patients ' narration of their suffering , their hopes , and how illness has affected them . It offers a model for improving health outcomes . To determine whether incorporating a narrative approach in patients with cancer decreases pain intensity and improves their global sense of well-being , we performed a r and omized , single-blind controlled trial in adult patients with cancer and average pain intensity levels of at least 5/10 . Two hundred thirty-four patients were r and omized into three groups : ( 1 ) narrative ( n=79 ) , in which patients wrote a story about how cancer affected their lives for at least 20 minutes once a week for three weeks ; ( 2 ) question naire ( n=77 ) , in which patients filled out the McGill Pain Question naire ; and ( 3 ) control ( n=78 ) , in which patients came weekly to medical visits during which they received usual customary care . Patients rated their pain on a 0 - 10 scale and their well-being on a seven-point Likert scale weekly for eight weeks . Two raters independently evaluated the emotional content of the narratives . Pain intensity and sense of well-being were similar in all groups before and after treatment . Subgroup analyses showed that patients whose narratives had high emotional disclosure had significantly less pain and reported higher well-being scores than patients whose narratives were less emotional . Further study is needed to demonstrate whether the implementation of narrative medicine is associated with health benefits in this and other context OBJECTIVE To assess the effects of an expressive writing ( EW ) intervention on perceptions of emotional support in women completing treatment for early stage breast cancer . METHODS Women were recruited to the study during their final week of treatment . Of 260 eligible patients , 104 ( 40 % ) agreed to participate , and 93 were r and omised . Women in the writing group wrote for 20 min on four consecutive days . The control group received normal care . Women 's perceptions of emotional support , quality of life ( QOL ) , mood , and healthcare utilisation were assessed at baseline , 1 month , 3 months and 6 months . Interviews were conducted to explore women 's experience of writing . RESULTS Eighty participants completed all follow-ups . There was a significant effect of group on women 's perceptions of social support with those in the intervention group being more satisfied with the emotional support they received ( p<0.05 ) . Satisfaction with emotional support was negatively correlated with depression/dejection ( p<0.05 ) and anger/hostility ( p<0.05 ) and positively correlated with social and family well-being ( p<0.001 ) 6 months post intervention . There were no significant effects of the intervention on mood , QOL or healthcare utilisation . Most participants found writing valuable and did not report any long-term negative effects . CONCLUSION EW was associated with a higher level of satisfaction with emotional support compared with controls . Given the existing evidence supporting the importance of social support in adjustment to breast cancer , it seems feasible to suggest that EW may be a cost effective accessible treatment that could be incorporated into the ongoing care of women 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 r and omly 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 This study examined the effects of expressive narrative writing in 607 participants . Compared with a control group , the participants r and omly assigned to write about their feelings and thoughts after the  Madrid train attack on M11 report less negative emotions related to the recall of the collective trauma at a 2-month follow-up after the attacks . However , no effects were found on positive affect , probably because the study had only one writing session of brief duration . Stronger feelings of joy , use of positive words , and low use of negative words in the narratives predicted low emotional activation at follow-up OBJECTIVE Two psychological interventions for rheumatoid arthritis ( RA ) are cognitive-behavioral coping skills training ( CST ) and written emotional disclosure ( WED ) . These approaches have developed independently , and their combination may be more effective than either one alone . Furthermore , most studies of each intervention have method ological limitations , and each needs further testing . METHOD We r and omized 264 adults with RA in a 2 × 2 factorial design to 1 of 2 writing conditions ( WED vs. control writing )  followed by 1 of 2 training conditions ( CST vs. arthritis education control training )  . Patient-reported pain and functioning , blinded evaluations of disease activity and walking speed , and an inflammatory marker ( C-reactive protein ) were assessed at baseline and 1- , 4- , and 12-month follow-ups . RESULTS Completion of each intervention was high ( > 90 % of patients ) , and attrition was low ( 10.2 % at 12-month follow-up ) . Hierarchical linear modeling of treatment effects over the follow-up period , and analyses of covariance at each assessment point , revealed no interactions between writing and training ; however , both interventions had main effects on outcomes , with small effect sizes . Compared with control training , CST decreased pain and psychological symptoms through 12 months . The effects of WED were mixed : Compared with control writing , WED  reduced disease activity and physical disability at 1 month only , but WED had more pain than control writing on 1 of 2 measures at 4 and 12 months . CONCLUSIONS The combination of WED and CST does not improve outcomes , perhaps because each intervention has unique effects at different time points . CST  improves health status in RA and is recommended for patients , whereas WED has limited benefits and needs strengthening or better targeting to appropriate patients Objective : Written expression of traumatic experiences , an intervention found to have health benefits in rheumatoid arthritis , asthma , and breast cancer , was tested in a r and omized , controlled trial with female fibromyalgia patients . It was hypothesized that relative to controls , patients engaging in the writing intervention would experience improved status on psychological well-being and physical health variables . Methods : Patients ( N = 92 ) were r and omized into a trauma writing group , a control writing group , or usual care control group .  The two writing groups wrote in the laboratory for 20 minutes on 3 days at 1-week intervals . Psychological well-being , pain , and fatigue were the primary outcome variables . Assessment s were made at pretreatment , posttreatment , 4-month follow-up , and 10-month follow-up . Results : The trauma writing group experienced significant reductions in pain ( effect size [ ES ] = 0.49 ) and fatigue ( ES = 0.62 ) and better psychological well-being ( ES = 0.47 ) at the 4-month follow-up relative to the control groups . Benefits were not maintained at the 10-month follow-up . Conclusion : Fibromyalgia patients experienced short-term benefits in psychological and health variables through emotional expression of personal traumatic experiences . ED = written emotional disclosure ; RA = rheumatoid arthritis ; QOL = Quality of Life Scale ; STAI-S = state version , State-Trait Anxiety Inventory ; BDI = Beck Depression Inventory ; MOS = Medical Outcome Study ; CLINHAQ = Clinical Health Assessment Question naire ; FIQ = Fibromyalgia Impact Question naire ; VAS = visual analogue scale ; NW = neutral writing group ; UC = usual-care control group ; ANOVA = analysis of variance ; ES = effect size PURPOSE To develop a expressive writing program for women with breast cancer and to identify its effects on stress physical symptom , cancer symptom , anxiety , depression , and QOL . METHODS A non-equivalent control pre-post design was used . Participants were recruited from self-help groups in six hospitals and were assigned to the experimental  group ( 29 ) or control group ( 29 ) . Data were collected before , after , and at four weeks after the intervention program . Changes in the variables were evaluated to test effects of the developed program , using χ²-test , Fisher 's exact test , repeated measures ANOVA , and paired t-test . RESULTS The expressive writing program was developed for women with breast cancer based on Pennebaker 's expressive writing . Significant differences were found between the two groups for stress related to physical symptoms ( p<.00 ) and quality of life ( p=.024 ) . No significant differences were found in cancer symptoms , anxiety , or depression between the two groups . CONCLUSION The results indicate that the expressive writing program design ed to express cancer-related deep thoughts and emotions helps in decreasing physical symptoms and improving QOL . Further studies are needed to identify the effect on emotions such as anxiety and depression for women with breast cancer with above average levels of anxiety and depression
BACKGROUND Numerous r and omized controlled trials ( RCTs ) have arrived at conflicting conclusions on expressive writing ( EW ) as an intervention for breast cancer ( BC ) patients , but there has been no meta- analysis of these studies to assess the effectiveness of EW in BC population .