Expressive Writing Therapy for Cancer Survivors

Overseen By William Tsai, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: New York University

Disqualifiers: Writing difficulties, Active support groups

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 7

Duration: 4 weeks

108 Participants Needed

Trial Summary

What is the purpose of this trial?

The Chinese American Cancer Survivors Writing Study is a Randomized Controlled Trial (RCT) testing the feasibility and efficacy of the Expressive Helping (EH) intervention among Chinese American cancer survivors.

Will I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications. It seems likely that you can continue your medications, especially since the trial includes those still on medication for managing cancer-related symptoms.

What data supports the effectiveness of the treatment Expressive Writing Therapy for Cancer Survivors?

Research shows that expressive writing can improve the quality of life and self-care confidence in breast cancer patients undergoing chemotherapy, and it offers psychological and physical health benefits for cancer patients and survivors. ^{1 2 3 4 5}

Is expressive writing therapy safe for cancer survivors?

Research on expressive writing therapy for cancer patients, including those undergoing chemotherapy, suggests it is generally safe and can offer psychological benefits without reported adverse effects. ^{2 4 6 7 8}

How is the Expressive Helping treatment different from other treatments for cancer survivors?

Expressive Helping is unique because it involves writing about personal traumatic experiences to improve mental and physical health, unlike other treatments that may focus solely on medical or physical interventions. It combines emotionally expressive writing with peer support, offering a psychological approach to enhance quality of life and self-care in cancer survivors. ^{1 2 3 4 9}

Eligibility Criteria

This trial is for Chinese American cancer survivors over 18 who prefer Mandarin or Cantonese and can read/write in Chinese. They should be within 5 years of completing treatment for stage I-III cancer. Those with writing difficulties or active in support groups more than once a week cannot join.

Inclusion Criteria

I am over 18 years old.

I finished my main cancer treatment within the last 5 years or am still on medication for cancer symptoms.

I prefer speaking Mandarin or Cantonese and can read and write in Chinese.

Exclusion Criteria

Difficulties with writing

Current active participation in support groups (i.e., attending more than once per week)

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in writing sessions, including expressive and factual writing, over four weeks

4 weeks

4 sessions (virtual)

Follow-up

Participants are monitored for psychological symptoms and quality of life at multiple intervals post-intervention

6 months

3 follow-up assessments (virtual)

Treatment Details

Interventions

• Expressive Helping
• Expressive Writing
• Factual Writing

Trial Overview The study tests the Expressive Helping (EH) intervention's feasibility and effectiveness compared to Expressive Writing and Factual Writing among participants, randomly assigning them to one of these activities.

Participant Groups

Group I: Expressive Helping Experimental Treatment 1 Intervention

Participants complete a 20-minute expressive writing session once per week for the first three weeks. During Week 4, participants complete a 20-minute peer support writing session.

Group II: Expressive Writing Active Control 1 Intervention

Participants complete a 20-minute expressive writing session once per week for four weeks.

Group III: Factual Writing Active Control 1 Intervention

Participants complete a 20-minute factual writing about their cancer diagnosis and treatment every week for four weeks.

Who Is Running the Clinical Trial?

New York University

Lead Sponsor

Trials

249

Recruited

229,000+

National Institute on Minority Health and Health Disparities (NIMHD)

Collaborator

Trials

473

Recruited

1,374,000+

Findings from Research

Expressive writing (EW) interventions showed a small but significant effect in relieving cancer symptoms among 1,718 patients, based on a meta-analysis of 14 trials.

While EW did not significantly improve psychological and cognitive outcomes, it did enhance health-related quality of life compared to usual care, suggesting potential benefits that may require further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Expressive Writing Interventions for Patients With Cancer: A Meta-Analysis. Oh, PJ., Kim, SH.[2017]

Expressive writing, involving four 20-minute sessions focused on emotional disclosure, significantly improved the quality of life for breast cancer patients undergoing chemotherapy, with noticeable effects observed two weeks after the intervention.

The study, which included 82 participants, also indicated that expressive writing positively influenced self-care self-efficacy over time, suggesting it is a beneficial and low-cost psychological intervention for patients lacking emotional support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Structured Expressive Writing on Quality of Life and Perceived Self-Care Self-Efficacy of Breast Cancer Patients Undergoing Chemotherapy in Central China: A Randomized Controlled Trial. Wang, R., Li, L., Xu, J., et al.[2023]

A systematic review of 16 randomized controlled trials involving cancer patients and survivors found no significant overall benefits of expressive writing intervention (EWI) on psychological or physical health outcomes.

While EWI did not show general effectiveness, there may be potential benefits for individuals with low emotional support, suggesting that future research should explore specific subgroups that might respond better to this intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients--a systematic review and meta-analysis. Zachariae, R., O'Toole, MS.[2022]

A study involving 90 Chinese breast cancer survivors showed that expressive writing interventions, particularly writing about cancer facts, significantly improved quality of life (QOL) compared to writing about stress and coping efforts.

Writing about positive aspects of the cancer experience also improved QOL, but not as effectively as writing about cancer facts, indicating that both approaches can be beneficial for patients undergoing chemotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The impact of an expressive writing intervention on quality of life among Chinese breast cancer patients undergoing chemotherapy. Lu, Q., Dong, L., Wu, IHC., et al.[2022]

The expressive writing (EW) intervention significantly improved women's perceptions of emotional support after treatment for early-stage breast cancer, with participants reporting greater satisfaction compared to the control group.

While EW did not show significant effects on mood, quality of life, or healthcare utilization, most participants found the writing experience valuable and reported no long-term negative effects, suggesting it could be a beneficial and cost-effective addition to cancer care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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. Gellaitry, G., Peters, K., Bloomfield, D., et al.[2009]

Expressive writing significantly reduces emotional distress in early-stage cancer patients compared to neutral writing, as shown in a review of 7 randomized controlled trials.

While expressive writing helps improve mood and sleep quality in early-stage cancer patients, it does not significantly benefit those with long-term metastatic disease or in palliative care, indicating its effectiveness may be limited to specific patient groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[The use of expressive writing in the course of care for cancer patients to reduce emotional distress: analysis of the literature]. Gallo, I., Garrino, L., Di Monte, V.[2018]

In a systematic review of 24 randomized controlled trials involving 1558 participants, positive writing (PW) was found to improve mood more effectively than expressive writing (EW) in the general population.

For patients, while PW was better at generating positive emotions, EW was more effective in stimulating cognitive changes, suggesting that both writing techniques can be beneficial depending on the population's needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of expressive writing versus positive writing in different populations: Systematic review and meta-analysis. Lai, J., Song, H., Wang, Y., et al.[2023]

In a study of 112 breast cancer patients undergoing chemotherapy, higher emotional expressivity was linked to better quality of life, particularly for those using more positive or fewer negative words in their expressive writing, although it did not affect physical or psychological well-being.

The study suggests that while emotional expressivity and word patterns in expressive writing can influence quality of life, they do not mediate the overall health outcomes, indicating that these factors may help identify patients who could benefit most from expressive writing interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can emotional expressivity and writing content predict beneficial effects of expressive writing among breast cancer patients receiving chemotherapy? A secondary analysis of randomized controlled trial data from China. Wu, Y., Yang, D., Jian, B., et al.[2023]

The WISE trial is a randomized controlled study designed to evaluate the efficacy of a brief psychological intervention called expressive helping for adult hematological cancer patients undergoing hematopoietic stem cell transplant, aiming to reduce physical and psychological symptoms during and after the transplant process.

Expressive helping combines emotionally expressive writing and peer support, and is expected to improve health-related quality of life and reduce distress and fatigue, potentially preventing long-term survivorship issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of expressive helping in adult hematologic cancer patients undergoing stem cell transplant: protocol for the Writing for Insight, Strength, and Ease (WISE) study's two-arm randomized controlled trial. Whitmore, L., Schulte, T., Bovbjerg, K., et al.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

The Effects of Expressive Writing Interventions for Patients With Cancer: A Meta-Analysis. [2017]

2. Switzerland pubmed.ncbi.nlm.nih.gov

Effects of Structured Expressive Writing on Quality of Life and Perceived Self-Care Self-Efficacy of Breast Cancer Patients Undergoing Chemotherapy in Central China: A Randomized Controlled Trial. [2023]

3. England pubmed.ncbi.nlm.nih.gov

The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients--a systematic review and meta-analysis. [2022]

4. Germany pubmed.ncbi.nlm.nih.gov

The impact of an expressive writing intervention on quality of life among Chinese breast cancer patients undergoing chemotherapy. [2022]

5. England pubmed.ncbi.nlm.nih.gov

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. [2009]

6. Italy pubmed.ncbi.nlm.nih.gov

[The use of expressive writing in the course of care for cancer patients to reduce emotional distress: analysis of the literature]. [2018]

7. United States pubmed.ncbi.nlm.nih.gov

Efficacy of expressive writing versus positive writing in different populations: Systematic review and meta-analysis. [2023]

8. England pubmed.ncbi.nlm.nih.gov

Can emotional expressivity and writing content predict beneficial effects of expressive writing among breast cancer patients receiving chemotherapy? A secondary analysis of randomized controlled trial data from China. [2023]

9. England pubmed.ncbi.nlm.nih.gov

Efficacy of expressive helping in adult hematologic cancer patients undergoing stem cell transplant: protocol for the Writing for Insight, Strength, and Ease (WISE) study's two-arm randomized controlled trial. [2021]