The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients--a systematic review and meta-analysis
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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, -0.06 to 0.14; p = 0.42), physical (0.08; 95% CI, -0.05 to 0.20; p = 0.22), or quality-of-life outcomes (0.09; 95% CI, -0.05 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.
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Externalization and processing of stressful events related to the disease probably encourage the ability to express emotions, thereby reducing associated negative thoughts and feelings.
“The externalization and processing of stressful events related to the disease probably encourage the ability to express emotions, thereby reducing the associated negative thoughts and feelings [16].”
From Effectiveness of Expressive Writing in Kidney Transplanted Patients: A Randomized Controlled Trial Study (2022) · cites this paper as [16]
The Introduction (page unavailable) suggests that expressing cancer-related thoughts and emotions may aid adjustment, and Results > Moderators reports reduced distress or intrusive thoughts in some subgroups. But the paper does not establish that processing stressful events increases the ability to express emotions or that this pathway reduces negative thoughts and feelings. The Discussion reports no significant overall psychological benefit from expressive writing in cancer patients. (LLM, conf=0.86)
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- Authors
- Zachariae, R., & O'Toole, M. S.
- Affiliations
- Aarhus University Hospital (DK)
- Department of Psychology and Behavioural Science Aarhus University Aarhus Denmark
- Corresponding author
- Zachariae, Robert
- ORCID
- Zachariae, Robert
- Venue
- Psycho-Oncology
- Publisher
- Wiley
- Published
- 2015-04-14
- Volume
- 24
- Issue
- 11
- Pages
- 1349-1359
- ISSN
- 1057-9249 (ISSN-L)
- 1099-1611
- PMC
- PMC6680178
- OpenAlex
- W1962072152
- Cited by
- 88
- References
- 69
- Citations by year
- 2026: 15 · 2025: 7 · 2024: 8 · 2023: 10 · 2022: 12 · 2021: 7 · 2020: 7 · 2019: 4 · 2018: 9 · 2017: 5 · 2016: 4
- FWCI
- 0.94
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Psycho-Oncology (publishedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health via Writing
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Arts and Humanities › Conservation › Art Therapy and Mental Health
- Keywords
- expressive writing intervention, cancer patients, cancer survivors, mental health outcomes, physical health outcomes, quality of life, emotional support, social constraints, psychological distress
- MeSH terms
- Humans, Neoplasms, Writing, Randomized Controlled Trials as Topic, Treatment Outcome, Survivors, Expressed Emotion
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