Expressive writing in patients receiving palliative care: a feasibility study. Linguistic predictors of adaptive bereavement. Dyadic psychological intervention for patients with cancer and caregivers in home-based specialized palliative care: The Domus model. Randomized controlled trial of expressive writing for psychological and physical health: the moderating role of emotional expressivity The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Enhanced wound healing after emotional disclosure intervention. Autonomic Effects of Expressive Writing in Individuals with Elevated Blood Pressure The effects of expressive writing following first myocardial infarction: a randomized controlled trial. The Knowledge Base for Evidence‐based Nursing: A Role for Mixed Methods Research? Effect of Written Emotional Expression on Immune Function in Patients With Human Immunodeficiency Virus Infection: A Randomized Trial Written emotional disclosure buffers the effects of social constraints on distress among cancer patients. Feasibility and induced cognitive-emotional change of an emotional disclosure intervention adapted for home application. Expressive Disclosure and Health Outcomes in a Prostate Cancer Population Emotional expression and physical health: revising traumatic memories or fostering self-regulation? Expressive disclosure and benefit finding among breast cancer patients: mechanisms for positive health effects. 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. Psychosocial Interventions for Patients With Advanced Cancer and Their Families
BACKGROUND Patients with advanced cancer receiving palliative care often experience severe physical and psychosocial symptoms . However , there are limited re sources for psychological and emotional support . Expressive writing has shown decreased anxiety level in young and healthy people suffering from a number of stressors . OBJECTIVE The purpose of this study was to determine the feasibility of expressive writing in patients receiving palliative care and the most suitable outcomes of expressive writing in this patient population . DESIGN In this pilot study , patients were r and omly assigned to either the expressive writing group ( EW ) or the neutral writing group ( NW ) . Anxiety level before and after the writing session was compared between the two groups . Writing material s were content analyzed using st and ard qualitative research methods . RESULTS A total of 24 patients ( 12 in EW and 12 in NW ) were enrolled in the study between October 2006 and January 2007 . Although the majority of patients ( 83%-100 % ) were able to complete all baseline assessment s , poor adherence was observed during the follow-ups . Only 8 % of patients completed the 2-week study . There was no significant difference in the State-Trait Anxiety Inventory ( STAI ) State-Anxiety scores at baseline , before and after each writing session between the EW and NW groups . DISCUSSION Our rapid accrual suggests that palliative care patients are interested in participating in studies such as expressive writing . The high level of adherence to the baseline assessment s indicates that these assessment s were not particularly difficult for our patients to complete . Future studies may need to include patients with better performance status , better patient education , means of emotional expression ( i.e. , audio recording , telephone interview ) and improved adherence . CONCLUSION We conclude that clinical trials of expressive writing in the palliative care setting are not feasible unless they undergo major modification in methods compared to those previous reported in other patient population . Our findings will hopefully assist research ers considering similar studies The words people use in  disclosing a trauma  were hypothesized to predict improvements in mental and physical health in 2 studies . The first study reanalyzed data from 6 previous experiments in which language variables served as predictors of health . Results from 177 participants in previous writing studies showed that increased use of words associated with insightful and causal thinking was linked to improved physical but not mental health . Higher use of positive relative to negative emotion words was also associated with better health . An empirical measure that was derived from these data correlated with subsequent distress ratings . The second study tested these models on interview transcripts of 30 men who had lost their partners to AIDS . Cognitive change and empirical models predicted postbereavement distress at 1 year . Implication s of using computer-based text analyses in the study of narratives are discussed ABSTRACT Objective : Patients with incurable cancer and their informal caregivers have numerous psychological and psychosocial needs . Many of these patients wish to receive their care and die at home . Few home-based specialized palliative care ( SPC ) interventions systematic ally integrate psychological support . We present a psychological intervention for patient-caregiver dyads developed for an ongoing r and omized controlled trial ( RCT ) of home-based SPC , known as Domus , as well as the results of an assessment of its acceptability and feasibility . METHOD The Domus model of SPC for patients with incurable cancer and their caregivers offered systematic psychological assessment and dyadic intervention as part of interdisciplinary care . Through accelerated transition to SPC , the aim of the model was to enhance patients ' chances of receiving care and dying at home . Integration of psychological support sought to facilitate this goal by alleviating distress in patients and caregivers . Psychologists provided needs-based sessions based on existential-phenomenological therapy .  Feasibility and acceptability were investigated by examining enrollment , nonparticipation , and completion of psychological sessions . RESULTS Enrollment in the RCT and uptake of the psychological intervention indicated that it was feasible and acceptable to patients and caregivers . The strengths of the intervention included its focus on dyads , psychological distress , and existential concerns , as well as interdisciplinary collaboration and psychological interventions offered according to need . Its main limitation was a lack of an intervention for other family members . SIGNIFICANCE OF RESULTS Our results show that psychological intervention can be systematic ally integrated into SPC and that it appears feasible to provide dyadic needs-based sessions with an existential therapeutic approach . The Domus RCT will provide evidence of the efficacy of a novel model of multidisciplinary SPC The current study assessed main effects and moderators ( including emotional expressiveness , emotional processing , and ambivalence over emotional expression ) of the effects of expressive writing in a sample of healthy adults . Young adult participants ( N=116 ) were r and omly assigned to write for 20 minutes on four occasions about deepest thoughts and feelings regarding their most stressful/traumatic event in the past five years ( expressive writing ) or about a control topic ( control ) . Dependent variables were indicators of anxiety , depression , and physical symptoms . No significant effects of writing condition were evident on anxiety , depressive symptoms , or physical symptoms . Emotional expressiveness emerged as a significant moderator of anxiety outcomes , however . Within the expressive writing group , participants high in expressiveness evidence d a significant reduction in anxiety at three-month follow-up , and participants low in expressiveness showed a significant increase in anxiety . Expressiveness did not predict change in anxiety in the control group . These findings on anxiety are consistent with the matching hypothesis , which suggests that matching a person 's naturally elected coping approach with an assigned intervention is beneficial . These findings also suggest that expressive writing about a stressful event may be contraindicated for individuals who do not typically express emotions Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVES Psychological stress is believed to impair wound healing via a down-regulation of the immune system . Since previous research suggests that disclosure of tra-umatic experiences can result in an up-regulation of immune function , the present study aim ed to investigate the impact of a disclosure intervention on the progress of wound healing . DESIGN The study used a prospect i ve , longitudinal design with r and om assignment to the control ( writing about time management ) and experimental group ( writing about a traumatic event ) . METHODS Participants ( N=36 ) completed question naires measuring perceived and emotional distress , loneliness , self-esteem , social support , dispositional optimism , and health-related behaviours . Accurate indication of the healing of a small punch biopsy wound was determined by using a high-resolution ultrasound scanner . RESULTS Repeated measures ANOVA indicated that the disclosure intervention impacted wound healing . Participants who wrote about traumatic events had significantly smaller wounds 14 and 21 days after the biopsy compared with those who wrote about time management . CONCLUSIONS It is concluded that a relatively brief and easy to administer intervention can have beneficial effects on wound healing . The potential for use in patient sample s is indicated We evaluated systolic and diastolic blood pressure , heart rate variability and skin conductance at basline , and 1 and 4 months in 38 participants with elevated blood pressure , r and omly assigned to  expressive writing or control groups . There was a significant interaction such that the very low frequency wave of heart rate variability increased over time only in controls , suggesting potentially protective buffering in expressive writing . Systolic and diastolic blood pressure also decreased significantly from baseline to 1 month in expressive writing . Consistent with inhibition , Anger-In moderated effects of writing on 4-month DBP . Overall , expressive writing demonstrated short-term autonomic benefits and longer-term moderated effects OBJECTIVE To assess the effects of expressive writing on health care utilization , clinical variables and subjective quality of life following first myocardial infa rct ion ( MI ) . METHODS One-hundred and seventy-nine first MI patients were r and omized to Intervention ( N = 88 ) or Control ( N = 91 ) groups . The intervention group wrote about their thoughts and feelings in relation to having had an MI . Controls wrote in a neutral way about daily activities . The main outcome measures were health care utilization , physical status and subjective quality of life ( QOL ) , assessed after one , two , and five months . RESULTS One-hundred and fifty-six ( 87 % ) completed the study . Five months post-intervention , the intervention group had significantly fewer recorded medical appointments compared to controls . The number of prescribed medicines decreased over time within the intervention group but increased within the control group . The intervention group attended significantly more rehabilitation sessions , reported fewer cardiac related symptoms and had lower diastolic blood pressure five months post-intervention . There was no significant group by time interaction on reported physical health . The group by time interaction on reported mental health approached significance , those in the intervention group reporting greater improvement . CONCLUSION Expressive writing may be a beneficial strategy which could be incorporated into rehabilitation interventions to help individuals adjust after first MI Evidence  -based nursing  is central to the knowledge base for nursing practice . Critics of evidence -based nursing dislike the central role that r and omized controlled trials ( RCTs ) take in providing evidence for nursing , cl aim ing that the context and experience of nursing care are removed from evaluation . Many nursing decisions involve questions regarding the effectiveness of interventions , best evaluated by RCTs . This article explores the epistemological and practical feasibility of combining  qualitative research with RCTs ( mixed methods research ) in evaluations of nursing practice . Through theoretical and practical examples , it proposes that mixed methods research has the potential to enhance the evidence base for nursing Objectives To determine whether writing about emotional topics compared with writing about neutral topics could affect CD4 + lymphocyte count and human immunodeficiency virus ( HIV ) viral load among HIV-infected patients . Methods Thirty-seven HIV-infected patients were r and omly allocated to 2 writing conditions focusing on emotional or control topics . Participants wrote for 4 days , 30 minutes per day . The CD4 + lymphocyte count and HIV viral load were measured at baseline and at 2 weeks , 3 months , and 6 months after writing . Results The emotional writing participants rated their essays as more personal , valuable , and emotional than those in the control condition . Relative to the drop in HIV viral load , CD4 + lymphocyte counts increased after the intervention for participants in the emotional writing condition compared with control writing participants . Conclusions The results are consistent with those of previous studies using emotional writing in other patient groups . Based on the self-reports of the value of writing and the preliminary laboratory findings , the results suggest that emotional writing may provide benefit for patients with HIV infection 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 OBJECTIVE Emotional engagement , cognitive restructuring , and positive future directedness are considered core elements to induce change in  emotional disclosure interventions . Our aim was to examine the induction of these elements and the feasibility of an emotional disclosure intervention adapted for home application . METHODS The intervention emphasized expression of negative and positive emotions ( session 1 - 4 ) , search for meaning ( session 3 ) , and a positive future-oriented ending ( session 4 ) . A r and omized clinical trial in patients with rheumatoid arthritis compared the adapted intervention ( n=40 ) with a time management control condition ( n=28 ) .  Feasibility was evaluated regarding adherence , compliance with instructions , perceived viability , and clinical safety . Induction of core elements was evaluated by analysis of change in immediate affective responses and by computerized text analysis of word use . RESULTS Feasibility criteria were successfully met . The disclosure condition produced higher immediate negative affect and use of emotion , insight , and optimism words compared to control , and induced the elements of change within sessions as intended . CONCLUSION The adapted intervention is feasible for home application and induces change in variables that indicate emotional engagement , cognitive restructuring , and positive future directedness . PRACTICE IMPLICATION S Empirical support of health benefits of this emotional disclosure intervention will extend its applicability in patient self-care Objective : This pilot study explored the feasibility and the efficacy of a brief , well-defined psychosocial intervention ( expressive disclosure ) in improving behavioral , medical , immunological , and emotional health outcomes in men with diagnosed prostate cancer . Method : Thirty prostate cancer patients receiving outpatient oncology care were r and omized into  experimental ( disclosure ) and control ( non-disclosure ) groups . All had been previously treated by surgery or radiation within the last 4 years and were being monitored without further intervention for change in PSA levels .  Psychological and physical health surveys were administered and peripheral blood for PSA levels and immune assays was obtained upon study enrollment and again at 3 and 6 months post enrollment . Multivariate analyses were used to examine how the expressive disclosure impacted the hypothesized domains of functioning : physical and psychological symptoms ; health care utilization ; and immunocompetence . Results : Compared to controls , patients in the expressive disclosure condition showed improvements in the domains of physical symptoms and health care utilization , but not in psychological variables nor in disease relevant aspects of immunocompetence . Conclusions : Study results support the feasibility of an expressive disclosure intervention for men with prostate cancer . The intervention was well accepted by this population , and participation/adherence was quite high . Results provide only limited support for the hypothesis that a written emotional disclosure task can positively impact health outcomes in a cancer population . However , this pilot study may have lacked adequate power to detect possible intervention benefits . Further studies with larger sample s are needed to better assess the intervention 's impact on psychological well-being and immunocompetence Health benefits derived from personal trauma disclosure are well established . This study examined whether disclosing emotions generated by imaginative immersion in a novel traumatic event would similarly enhance health and adjustment .  College women , preselected for trauma presence , were r and omly assigned to write about real traumas , imaginary traumas , or trivial events . Yoked real-trauma and imaginary-trauma participants wrote about real-trauma participants ' experiences . Imaginary-trauma participants were significantly less depressed than real-trauma participants at immediate posttest , but they were similarly angry , fearful , and happy . Compared with control group participants , both trauma groups made significantly fewer illness visits at 1-month follow-up ; however , real-trauma participants reported more fatigue and avoidance than did the other groups . Imaginary-trauma group effects could reflect catharsis , emotional regulation , or construction of resilient possible selves 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 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 Few r and omized controlled trials of family-based psychosocial interventions involving patients and at least one other family member have been conducted in the context of advanced cancer . Moreover , existing interventions have largely been st and -alone programs that have not been well integrated into routine palliative and clinical care . Programs that address this gap may not only improve patient and caregiver quality of life ( QOL ) but also the quality of palliative and supportive care services . The aim of this narrative review is to describe published interventions that have attempted to improve the QOL of advanced cancer patients and their family caregivers ( eg , spouses , partners , and other family members ) and to describe some of the challenges that make it difficult to implement such programs in clinical setting s. Toward that end , the added value that family-based psychosocial interventions can bring to advanced cancer care is first described . Next , the literature on family-based interventions in advanced cancer is review ed , and different theoretical approaches and outcomes are highlighted . This is followed by a description of some of the health system barriers to supportive family care in advanced cancer care . The article concludes with a synthesis of research findings and proposes directions for future research
Background Expressive writing involves writing about stressful or traumatic experiences .
Despite trials in people with advanced disease , no systematic review to date has critiqued the evidence on expressive writing in this population .
To synthesis e the evidence of the effects of expressive writing on pain , sleep , depression and anxiety in people with advanced disease .