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Eldesouky L, Gross JJ. Using expressive writing to improve cancer caregiver and patient health: A randomized controlled feasibility trial. Eur J Oncol Nurs 2024; 70:102578. [PMID: 38522170 DOI: 10.1016/j.ejon.2024.102578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/16/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE This study examined the feasibility and preliminary efficacy of Expressive Writing (EW) in improving informal cancer caregiver (IC) and patient health, and enhancing ICs' emotion regulation. METHOD Fifty-eight breast cancer ICs and patients participated in a randomized controlled feasibility trial of remote EW. ICs were randomly assigned to the EW or control group and completed 3 weekly writing sessions. ICs and patients completed health and emotion regulation assessments at baseline, intervention completion, and 3 months post-intervention. Screening, recruitment, assessment process, randomization, retention, treatment adherence, and treatment fidelity were computed for feasibility. Effect sizes were calculated using the PROMIS Depression Short Form, RAND Short Form 36 Health Survey, Breast Cancer Prevention Trial Hormonal Symptom checklist, healthcare utilization, and the Emotion Regulation Questionnaire for efficacy. RESULTS Of the 232 interested individuals, 82 were screened, and 60 enrolled (6 monthly). Two individuals withdrew and 19 were lost to follow-up, leaving 39 individuals. ICs completed at least one assessment and two sessions, and patients completed at least two assessments. All sessions were administered as intended. ICs generally followed instructions (88%-100%), wrote the full time (66.7%-100%), and were engaged (M(SD) = 3.00(1.29)-4.00(0.00)). EW had small-to-medium effects in improving IC health (g = -0.27-0.04) and small-to-large effects in improving patient health (g = -0.28-0.86). EW moderately decreased suppression (g = 0.53-0.54) and slightly increased reappraisal, at least 3 months post-intervention (g = -0.34-0.20). CONCLUSIONS Remote EW may be feasible with cancer ICs and improve cancer IC and patient health. However, it can benefit from additional retention strategies and rigorous testing. TRIAL REGISTRATION CenterWatch Clinical Trials Listing Service (#TX217874); ClinicalTrials.gov (#NCT06123416).
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Affiliation(s)
- Lameese Eldesouky
- Department of Psychology, Stanford University, Building 420, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - James J Gross
- Department of Psychology, Stanford University, Building 420, 450 Serra Mall, Stanford, CA, 94305, United States.
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Oishi A. Positive Expressive Writing as a Stress Management Strategy for Japanese Students: Willingness to Engage in Expressive Writing. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2021. [DOI: 10.1080/15401383.2021.1963902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ayano Oishi
- Graduate School Of Humanities And Sciences, Ochanomizu University, Tokyo, Japan
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Cosentino C, D'apice C, Del Gaudio M, Bertoletti C, Bini M, Liotti MC, Melli E, Tesa F, Sarli L, Artioli G. Effectiveness of Expressive Writing protocol in Palliative Care Healthworkers: a quantitative study. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021010. [PMID: 33855988 PMCID: PMC8138804 DOI: 10.23750/abm.v92is2.11468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Palliative Care professionals are exposed to intense emotional environment. This puts them at risk for Compassion Fatigue and Burnout. The protective factors that can counter their onset are Compassion Satisfaction, Organizational Commitment and Resilience. Expressive Writing is a valid tool for adapting to traumatic events and enhancing psychological well-being. Aim of this study is to evaluate the effect of the Expressive Writing in Palliative Care professionals on Compassion Satisfaction, Organizational Commitment, Resilience, Compassion Fatigue and perceived distress. METHODS Prospective experimental study with experimental/control groups and pre/post measurements. 50 Palliative Care professionals were recruited in Northern and Central Italy. Participants filled: Organizational Commitment Questionnaire; ProQol - revision III; Resilience Scale for Adults; Impact of Event-Scale Revised; Emotion Thermometer; ad hoc questionnaire for the evaluation of protocol usefulness. RESULTS Wilcoxon test demonstrated change in Continuative Commitment (Z = -3.357, p = .001), anger (Z = -2.214, p = .027), sleep (Z = -2.268, p = .023), help (Z = -2.184, p = .029), intrusiveness (Z = -2.469, p = .014), hyperarousal (Z = -2.717, p = .007), and total IES (Z = -2.456 , p =, 014). Mann Whitney test showed a significantly lower score on post-test Intrusiveness in the experimental group (U = 202, p = .038). CONCLUSIONS The Expressive Writing intervention was effective in improving organizational and emotional variables. Expressive Writing supports healthcare professionals in relieving the burden of traumatic episodes, ordering associated thoughts and emotions, and implementing a process of deep comprehension.
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Affiliation(s)
| | - Clelia D'apice
- Department of medicine and Surgery, University of Parma, Italy .
| | | | - Chiara Bertoletti
- Post Graduate Specialization in Palliative Care, University of Parma, Italy.
| | - Manuela Bini
- Post Graduate Specialization in Palliative Care, University of Parma, Italy.
| | | | - Elisa Melli
- Post Graduate Specialization in Palliative Care, University of Parma, Italy.
| | - Francesca Tesa
- Post Graduate Specialization in Palliative Care, University of Parma, Italy.
| | - Leopoldo Sarli
- Department of medicine and Surgery, University of Parma, Italy .
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Kupeli N, Chatzitheodorou G, Troop NA, McInnerney D, Stone P, Candy B. Expressive writing as a therapeutic intervention for people with advanced disease: a systematic review. BMC Palliat Care 2019; 18:65. [PMID: 31375118 PMCID: PMC6676535 DOI: 10.1186/s12904-019-0449-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 07/25/2019] [Indexed: 11/26/2022] Open
Abstract
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 synthesise the evidence of the effects of expressive writing on pain, sleep, depression and anxiety in people with advanced disease. Methods A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, CENTRAL, PsycINFO and PubMed were searched from January 1986 to March 2018. Other sources included clinical data registers and conference proceedings. Studies were included if they were randomised controlled trials that assessed the impact of an intervention involving expressive writing for adults with advanced disease and/or studies involving linguistic analysis on the expressive writing output. Methodological quality was assessed using the Cochrane risk of bias tool and the Mixed Methods Appraisal Tool. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the level of evidence for the outcomes of interest. The protocol of this systematic review has been registered on PROSPERO (CRD42017058193). Results Six eligible studies with a total of 288 participants were identified, including four randomised controlled trials. All of the trials were in cancer and recruited predominantly women. None of the interventions were tailored to the population. Studies had methodological shortcomings and evidence was generally of low quality. Combined analysis of the four trials, involving 214 participants in total, showed no clear difference in the effect of expressive writing on sleep, anxiety or depression compared to an active control. Pain was not evaluated in the trials. In contrast, analysis of the four studies that included linguistic analysis alluded to linguistic mechanisms for potential effects. Conclusion Although the trial results suggest there is no benefit in expressive writing for people with advanced disease, the current evidence is limited. There is a need for more rigorous trials. It would be of benefit first to undertake exploratory research in trial design including how best to measure impact and in tailoring of the intervention to address the specific needs of people with advanced disease. Trial registration The protocol of this systematic review has been registered on PROSPERO, which can be accessed here (registration number: CRD42017058193). Electronic supplementary material The online version of this article (10.1186/s12904-019-0449-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | | | - N A Troop
- Department of Psychology and Sport Sciences, University of Hertfordshire, Hertfordshire, UK
| | - D McInnerney
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - P Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - B Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
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Kupeli N, Schmidt UH, Campbell IC, Chilcot J, Roberts CJ, Troop NA. The impact of an emotionally expressive writing intervention on eating pathology in female students. Health Psychol Behav Med 2018; 6:162-179. [PMID: 30009092 PMCID: PMC6030678 DOI: 10.1080/21642850.2018.1491797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/23/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: Previous research demonstrating emotional influences on eating and weight suggest that emotionally expressive writing may have a significant impact on reducing risk of eating pathology. This study examined the effects of writing about Intensely Positive Experiences on weight and disordered eating during a naturalistic stressor. Method: Seventy-one female students completed an expressive or a control writing task before a period of exams. Both groups were compared on BMI (kg/m2) and the Eating Disorder Examination – Questionnaire (EDE-Q) before the writing task and at 8-week follow-up. A number of secondary analyses were also examined (to identify potential mediators) including measures of attachment, social rank, self-criticism and self-reassurance, stress and mood. Results: There was a significant effect of intervention on changes in the subscales of the EDE-Q (p = .03). Specifically, expressive writers significantly reduced their dietary restraint while those in the control group did not. There was no significant effect of the intervention on changes in BMI or the other subscales of the EDE-Q (Eating, Weight and Shape Concern). There was also no effect of writing on any of the potential mediators in the secondary analyses. Discussion: Emotionally expressive writing may reduce the risk of dietary restraint in women but these findings should be accepted with caution. It is a simple and light touch intervention that has the potential to be widely applied. However, it remains for future research to replicate these results and to identify the mechanisms of action.
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Affiliation(s)
- N Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - U H Schmidt
- Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - I C Campbell
- Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - J Chilcot
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - C J Roberts
- School of Health and Social Science, London South Bank University, London, UK
| | - N A Troop
- Department of Psychology and Sport Sciences, University of Hertfordshire, UK
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Middendorp H, Geenen R. Poor cognitive-emotional processing may impede the outcome of emotional disclosure interventions. Br J Health Psychol 2010; 13:49-52. [DOI: 10.1348/135910707x251199] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Dissanayake RK, Bertouch JV. Psychosocial interventions as adjunct therapy for patients with rheumatoid arthritis: a systematic review. Int J Rheum Dis 2010; 13:324-34. [PMID: 21199467 DOI: 10.1111/j.1756-185x.2010.01563.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To identify the psychological interventions for which there is consistent, high quality evidence of efficacy in the treatment of patients with rheumatoid arthritis (RA). METHOD A computer-aided search and manual screening of identified papers was conducted. Randomised controlled trials published in English in peer-reviewed journals, assessing the use of psychological interventions in adult patients with RA were included. RESULTS Thirty-four papers published between 1981 and 2009 encompassing 31 studies with 2021 patients were included. There is consistent supportive evidence for the efficacy of disclosure therapy (four studies) and cognitive behavioural therapy (CBT) with maintenance therapy (five studies). There is supportive evidence for improvement with CBT of greater than 6 weeks duration (six studies) in the short-term but conflicting evidence for its long-term efficacy. There is some evidence for improvement with biofeedback-based interventions (two studies). There is conflicting evidence for the benefits of counselling (three studies), psychotherapy (two studies) mindfulness and meditation (two studies), and CBT of less than 6 weeks duration (six studies). There is limited evidence regarding relaxation therapy (two studies). Methodological limitations of the reviewed literature included failure of allocation concealment, blinding and conduction of intention-to-treat analysis, as well as the heterogeneity and choice of outcome measures. CONCLUSIONS This review shows consistent supportive evidence for the use of disclosure therapy, and CBT with maintenance therapy as adjunct therapies in patients with RA. It also highlights methodological limitations in the current literature and the need for future research in this area.
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Affiliation(s)
- Rukmal Kumari Dissanayake
- Department of Medicine, Concord General Repatriation Hospital, Concord, Prince of Wales Hospital, Randwick, NSW, Australia.
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Danoff-Burg S, Mosher CE, Seawell AH, Agee JD. Does narrative writing instruction enhance the benefits of expressive writing? ANXIETY STRESS AND COPING 2010; 23:341-52. [PMID: 19705310 DOI: 10.1080/10615800903191137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examined whether instructing participants to write in a narrative fashion about stressful life events would produce superior physical and psychological health benefits relative to standard expressive writing instructions that do not specify the essay's structure. Undergraduates (N=101) were randomly assigned to engage in two, 20-minute narrative writing, standard expressive writing, or control writing tasks. Follow-up data were obtained one month later. The essays of the narrative writing group evidenced higher levels of narrative structure than did those of the expressive writing group. Greater narrative structure was associated with mental health gains, and self-rated emotionality of the essays was associated with lesser perceived stress at follow-up. In addition, the narrative and expressive writing groups reported lower levels of perceived stress and depressive symptoms relative to controls but did not differ from each other with regard to these outcomes. Health care utilization at follow-up did not vary by group assignment. Findings suggest that both emotional expression and narrative structure may be key factors underlying expressive writing's mental health benefits. Results also suggest that, among college students, instruction in narrative formation does not increase the positive effects of expressive writing relative to standard expressive writing instructions.
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Affiliation(s)
- Sharon Danoff-Burg
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
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A Preliminary Investigation into Whether Attentional Bias Influences Mood Outcomes Following Emotional Disclosure. Int J Behav Med 2010; 17:195-206. [DOI: 10.1007/s12529-009-9072-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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