Expressive writing interventions in cancer patients: a systematic review

Abstract

Decades of research have suggested that expressive writing produces physical and psychological benefits in controlled laboratory experiments among healthy college students. This work has been extended to clinical and medical populations, including cancer patients. Although expressive writing could be a promising and inexpensive intervention for this population, the effects have not been systematically examined in oncology samples. A systematic review using PRISMA guidelines was conducted for experimental trials of cancer patients who participated in an expressive writing intervention. PsycINFO and PubMed/Medline were searched for peer-reviewed studies. Thirteen articles met the inclusion/exclusion criteria. Although the majority of the intervention effects were null, there were several main effects for expressive writing on sleep, pain, and general physical and psychological symptoms. Several moderators were identified, suggesting that expressive writing may be more or less beneficial based on individual characteristics such as social constraints. The reviewed studies were limited due to representativeness of the samples, performance, detection and patient-reported outcomes biases, and heterogeneity of the intervention protocol and writing prompts. Future studies with rigorous designs are needed to determine whether expressive writing is therapeutically effective in cancer patients.

Keywords:

• expressive writing
• cancer
• adjustment
• coping
• emotional disclosure
• oncology

Acknowledgements

We are grateful to Linda C. Gallo, PhD for helpful comments on an earlier version of this paper. We thank Scott C. Roesch, PhD and Sharon Danoff-Burg, PhD for providing additional guidance and clarification. We thank three anonymous reviewers for their constructive comments which contributed to improving the final version of this paper.

Supplemental material

Supplemental material for this article can be accessed here: http://dx.doi.org/10.1080/17437199.2014.882007

Notes

1. Although including grey literature may attenuate publication bias, given that published studies generally have larger treatment effects than unpublished studies (Hopewell, McDonald, Clarke, & Egger, 2007), grey literature can also introduce bias due to poorer methodological quality (Egger, Juni, Barlett, Holenstein, & Sterne, 2003) and comprehensiveness of locatable grey literature (Sterne, Egger, & Moher, 2011). Given that reviews that include grey literature produce similar results to those that do not (Egger et al., 2003), it was decided to restrict the search to published findings.

2. The authors described the neutral writing condition as an experimental group; however, for consistency across studies it was categorized as a control condition for the purpose of this review.

3. Jensen-Johansen and colleagues (2012) performed their manipulation check by evaluating participants’ mood immediately following the EW intervention, rather than assessing the linguistic characteristics of the essays.