title: Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors - results from a nationwide randomized clinical trial.
abstract: 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 randomly 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.
authors.affiliation: Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: M B
authors.initials: MB
authors.lastname: Jensen-Johansen
authors.forename: S
authors.initials: S
authors.lastname: Christensen
authors.forename: H
authors.initials: H
authors.lastname: Valdimarsdottir
authors.forename: S
authors.initials: S
authors.lastname: Zakowski
authors.forename: A B
authors.initials: AB
authors.lastname: Jensen
authors.forename: D H
authors.initials: DH
authors.lastname: Bovbjerg
authors.forename: R
authors.initials: R
authors.lastname: Zachariae
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms / Q000175:diagnosis / Q000523:psychology; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy*; D003718:Denmark; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D019260:Expressed Emotion; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D013315:Stress, Psychological / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013850:Thinking; D016896:Treatment Outcome; D014956:Writing; D055815:Young Adult