Expressive Writing Intervention for Emotional Distress in Caregivers

Overseen By Shelby Langer, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Arizona State University

Disqualifiers: Caregiver for pediatric cancer patient

Compensation: Varies

Number of Visits: 4

Duration: 4 weeks

100 Participants Needed

Trial Summary

What is the purpose of this trial?

The goal of this clinical trial is to test the effects of an expressive writing intervention for caregivers of persons with cancer. The main questions the study aims to answer are: 1. Does participation in a group-based, videoconference-delivered expressive writing intervention improve mood and quality of life for caregivers of persons with cancer? 2. Is greater improvement associated with writing that is more emotionally expressive or personally revealing, or with group-based sessions characterized by certain linguistic features such as greater emotionality? 3. Is benefit greater for certain subgroups of caregivers, such as those who are younger or who identify as female in gender? Participants will be asked to join four videoconference-delivered, group-based expressive writing sessions. This will be done in groups of 4-8 caregivers and led by a trained facilitator. During each session, participants will write about their deepest thoughts and feelings about their loved one's cancer and their experiences as a caregiver. They will then discuss as a group any reactions to the writing process. Participants will be randomly assigned to either active intervention (receiving the intervention as soon as a group is formed) or waitlist control. Researchers will compare active and waitlist control participants on to pre- to post-intervention changes in mood and quality of life.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on writing and emotional expression, so it's unlikely that medication changes are required.

What data supports the effectiveness of the treatment Expressive Writing Intervention for emotional distress in caregivers?

Research shows that expressive writing interventions can improve mood and reduce psychiatric symptoms in cancer patients, suggesting it may also help caregivers manage emotional distress. ^{1 2 3 4 5}

How is expressive writing intervention different from other treatments for emotional distress in caregivers?

Expressive writing intervention is unique because it allows caregivers to express their emotions through writing, providing a private and reflective space that can improve mental health and coping strategies, unlike traditional support groups where some may feel uncomfortable speaking. ^{1 2 6 7 8}

Eligibility Criteria

This trial is for adults over 18 who speak English and are informal caregivers to an adult with stage II-IV breast, ovarian, prostate, colon, rectal, or lung cancer diagnosed in the last 2 years. They must have WIFI and a device for video calls and surveys. It's not for those caring for children with cancer.

Inclusion Criteria

I am a caregiver for an adult with advanced cancer diagnosed in the last 2 years.

I can speak and understand English.

I have a device with WIFI for surveys and video sessions.

Exclusion Criteria

Caregiver for pediatric cancer patient

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants attend four group-based expressive writing sessions delivered via videoconference over 4 weeks

4 weeks

4 visits (virtual)

Follow-up

Participants are monitored for changes in mood, quality of life, and psychological distress after the intervention

2 weeks

Treatment Details

Interventions

• Expressive writing intervention

Trial Overview The study tests if group-based expressive writing via videoconference can improve mood and quality of life in caregivers of cancer patients. Participants write about their feelings on caregiving then discuss it in groups led by a trained facilitator. Some will start immediately; others will wait to see which method works better.

Participant Groups

Group I: Active intervention Experimental Treatment 1 Intervention

Participants will attend four group-based expressive writing sessions led by a trained facilitator. All sessions will be delivered via videoconference. Sessions will occur weekly over the course of 4 consecutive weeks and will not exceed 60 minutes in length. Each session will include a 15- to 20-minute writing stint whereby participants are asked to write about their deepest thoughts and feelings regarding their loved one's cancer and their role as caregiver. All participants will be given a Rocketbook for this purpose, a spiral notebook that has the look and feel of a standard paper notebook but uses a pen with erasable ink. The writing stint will be followed by a group discussion; participants will be invited to share what they wrote about (if so desired) and their reactions to the writing process. Each session will end with a debriefing and erasure of the writing content just created. This will ensure privacy of the material and may be perceived as cleansing.

Group II: Waitlist control Placebo Group 1 Intervention

Procedures are exactly the same as for the experimental arm but delayed.

Who Is Running the Clinical Trial?

Arizona State University

Lead Sponsor

Trials

311

Recruited

109,000+

Cancer Support Community Arizona

Collaborator

Trials

1

Recruited

100+

Findings from Research

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]

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 (EW) significantly reduces negative somatic symptoms in breast cancer patients within a 3-month follow-up period, based on a meta-analysis of 11 randomized controlled trials involving 1,178 participants.

However, EW does not show a significant impact on psychological health outcomes at any follow-up time, indicating that while it may help with physical symptoms, its benefits may be limited and short-lived.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Expressive Writing Intervention on Health Outcomes in Breast Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Zhou, C., Wu, Y., An, S., et al.[2023]

In a randomized clinical trial with 71 cancer patients, Pennebaker's expressive writing intervention (EWI) significantly reduced global psychiatric symptoms, indicating its efficacy in improving mental health after a cancer diagnosis.

The EWI also led to a reduction in alexithymia levels and an improvement in the mental component of quality of life, suggesting that this intervention can enhance emotional processing and overall well-being in cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of Pennebaker's expressive writing intervention in reducing psychiatric symptoms among patients with first-time cancer diagnosis: a randomized clinical trial. La Marca, L., Maniscalco, E., Fabbiano, F., et al.[2021]

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 pilot project showed that incorporating narrative writing into support groups for caregivers of older adults significantly improved their physical and mental health, providing an additional coping strategy for stress.

Therapeutic writing can be an effective tool for emotional expression, and nurses can play a key role in developing interventions that utilize this method to support caregivers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A different kind of caregiving support group. Dellasega, C., Haagen, B.[2022]

The BRiC pilot trial found that a 2-week benefit finding writing intervention did not significantly improve primary outcomes (benefit finding) or secondary outcomes (quality of life, depression, and anxiety) among caregivers compared to a control group.

Despite no significant effects on outcomes, the intervention was generally feasible, but many caregivers in the control group were less likely to recommend it, indicating that future interventions may need to be tailored to specific caregiver preferences, especially for those who enjoy writing.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Building Resources in Caregivers: Feasibility of a Brief Writing Intervention to Increase Benefit Finding in Caregivers. Gallagher, S., O'Sullivan, L., Hughes, Z., et al.[2021]

Expressive writing, even in just two sessions, effectively helps healthcare professionals in palliative care manage compassion fatigue and improve their emotional well-being, confirming previous research findings.

Participants who engaged in expressive writing reported enhanced clarity in problem-solving and improved interactions with others, leading to increased work satisfaction and reduced burnout risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Expressive writing. A tool to help health workers of palliative care. Tonarelli, A., Cosentino, C., Tomasoni, C., et al.[2020]

References

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

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

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

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

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

Effect of Expressive Writing Intervention on Health Outcomes in Breast Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. [2023]

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

Efficacy of Pennebaker's expressive writing intervention in reducing psychiatric symptoms among patients with first-time cancer diagnosis: a randomized clinical trial. [2021]

5. 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]

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

A different kind of caregiving support group. [2022]

7. England pubmed.ncbi.nlm.nih.gov

Building Resources in Caregivers: Feasibility of a Brief Writing Intervention to Increase Benefit Finding in Caregivers. [2021]

8. Italy pubmed.ncbi.nlm.nih.gov

Expressive writing. A tool to help health workers of palliative care. [2020]