title: Feasibility of an expressive-disclosure group intervention for post-treatment colorectal cancer patients: results of the Healthy Expressions study.
abstract: BACKGROUND
  Adjusting to cancer requires effective cognitive and emotional processing. Written and verbal disclosure facilitate processing and have been studied independently in cancer survivors. Combined written and verbal expression may be more effective than either alone, particularly for patients with difficult to discuss or embarrassing side effects. Thus, the authors developed and tested the efficacy of a 12-session combined written and verbal expression group program for psychologically distressed colorectal cancer (CRC) patients.
  
  
  METHODS
  Forty post-treatment patients with CRC (stages I-III) identified as psychologically distressed using the Brief Symptom Inventory (BSI) were randomized to an intervention group (Healthy Expressions; n = 25) or standard care (control group; n = 15). Assessments were completed at baseline, Month 2, and Month 4 (postintervention). Primary outcomes were psychological functioning and quality of life (QOL).
  
  
  RESULTS
  Most participants were women (63%), white (63%), and non-Hispanic (75%). The Healthy Expressions group demonstrated significantly greater changes in distress compared with the control group at Month 2 on the BSI Global Severity Index (GSI) and the Centers for Epidemiologic Studies Depression scale (CES-D) scores (P < .05 for each); differences in the European Organization for Research and Treatment of Cancer (EORTC) global QOL scores approached significance (P = .063). The BSI GSI and Positive Symptom Total, CES-D, and EORTC emotional functioning subscale scores were all significant at Month 4 (P < .05 for each).
  
  
  CONCLUSIONS
  The Healthy Expressions program improved psychological functioning in CRC patients who reported experiencing distress. Findings demonstrate the program's feasibility and provide strong support for conducting a larger randomized trial.
authors.affiliation: Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas 77230-1439, USA. ccarmack@mdanderson.org
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Carmack
authors.forename: Karen
authors.initials: K
authors.lastname: Basen-Engquist
authors.forename: Ying
authors.initials: Y
authors.lastname: Yuan
authors.forename: Anthony
authors.initials: A
authors.lastname: Greisinger
authors.forename: Miguel
authors.initials: M
authors.lastname: Rodriguez-Bigas
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wolff
authors.forename: Trina
authors.initials: T
authors.lastname: Barker
authors.forename: George
authors.initials: G
authors.lastname: Baum
authors.forename: James W
authors.initials: JW
authors.lastname: Pennebaker
mesh_terms: D000328:Adult; D000359:Aftercare; D000368:Aged; D015179:Colorectal Neoplasms / Q000523:psychology*; D003142:Communication; D030881:Disclosure; D005240:Feasibility Studies; D005260:Female; D006293:Health Promotion; D006801:Humans; D008297:Male; D011788:Quality of Life; D012657:Self-Help Groups; D017741:Survivors / Q000523:psychology*