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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if expressive writing can enhance mood and quality of life for caregivers of cancer patients. Participants will join group writing sessions via video call to share thoughts and feelings about their caregiving experiences. Researchers are investigating whether more emotional or personal writing, or certain group dynamics, lead to greater benefits. This trial may suit those caring for adults with specific cancers who have access to a device for video calls. Participants will be divided into two groups to compare the effects of the expressive writing intervention with those who wait before starting. As an unphased trial, this study offers a unique opportunity to explore new ways to support caregivers and improve their well-being.

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 prior data suggests that this expressive writing intervention is safe for caregivers?

Research shows that expressive writing is generally safe for participants. Studies have found that this type of writing can improve emotional well-being, especially for those dealing with stress and trauma. For instance, one study discovered that expressive writing reduced feelings of anxiety and depression during the COVID-19 pandemic. Another study showed its benefits for people with post-traumatic stress disorder, leading to a noticeable decrease in symptoms. Although these studies examined different groups, they provide evidence that expressive writing is well-tolerated and can positively affect mood. Importantly, no major reports of harm or negative effects have been linked to expressive writing, making it a safe option for participants in clinical trials. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the expressive writing intervention for caregivers because it offers a novel approach to managing emotional distress. Unlike traditional therapies that often involve face-to-face counseling or medication, this method empowers caregivers to process their emotions through structured writing sessions. Conducted via videoconference, the intervention is accessible and convenient, allowing participants to engage from the comfort of their homes. Additionally, the use of erasable Rocketbooks ensures privacy, which might make participants more willing to express their deepest thoughts and feelings. This unique combination of accessibility, privacy, and self-reflection has the potential to provide significant emotional relief for caregivers.

What evidence suggests that this expressive writing intervention is effective for improving mood and quality of life in caregivers of persons with cancer?

Research shows that writing about thoughts and feelings can help reduce stress, especially for people with cancer. Studies have found that this kind of writing can improve both mental and physical health in cancer patients. Expressing emotions through writing helps people feel better and enhances their quality of life. Some research also suggests that online writing can be effective, which supports using formats like video calls. This trial will evaluate the effectiveness of an expressive writing intervention for caregivers, with participants in the active intervention arm attending group-based writing sessions. However, results can vary for each person, and more research is needed to determine if these benefits apply to caregivers. ^{2 6 7 8 9}

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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]

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 (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]

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]

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 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]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7683413/

Effectiveness of Expressive Writing in the Reduction ... This study aims to assess the effectiveness of EW interventions in the reduction of psychological distress in the general population during ...

2. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6680178/

The effect of expressive writing intervention on ... This study aimed to evaluate the effectiveness of expressive writing intervention (EWI) for improving psychological and physical health in cancer patients ...

3. frontiersin.org frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2022.1042274/full

Effectiveness of online expressive writing in reducing ... This study aimed to assess the effectiveness of EW interventions in reducing the psychological distress of the asymptomatic COVID-19 patients in ...

4. bmcpalliatcare.biomedcentral.com bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-019-0449-y

Expressive writing as a therapeutic intervention for people ... Although the trial results suggest there is no benefit in expressive writing for people with advanced disease, the current evidence is limited.

5. onlinelibrary.wiley.com onlinelibrary.wiley.com/doi/full/10.1002/nop2.1897

Efficacy of expressive writing versus positive writing in ... The results showed that for the general population, PW was more positive on mood than EW and could offer more changes in cognitive mechanisms.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3830620/

Effects of Expressive Writing on Psychological and ... The current study assessed main effects and moderators (including emotional expressiveness, emotional processing and ambivalence over emotional expression)

7. frontiersin.org frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2020.587282/full

Effectiveness of Expressive Writing in the Reduction ... We aim to assess the applicability and effectiveness of an online format of EW in the reduction of psychological distress in context of the COVID-19 pandemic.

8. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0165178119314970

Effects of expressive writing intervention for women's PTSD ... Expressive writing (EW) as a psychological intervention could significantly alleviate the severity of post-traumatic stress disorder.

9. researchgate.net researchgate.net/publication/334897892_Expressive_writing_as_a_therapeutic_intervention_for_people_with_advanced_disease_a_systematic_review

(PDF) Expressive writing as a therapeutic intervention for ... The primary goal is to foster emotional processing, promote insight, and facilitate cognitive restructuring, thereby improving psychological well-being and ...