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Expressive writing intervention for posttraumatic stress disorder among Chinese American breast cancer survivors: the moderating role of social constraints

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Abstract

Purpose

Posttraumatic stress disorder (PTSD) is a significant condition among breast cancer survivors (BCSs). However, few intervention studies for cancer-related PTSD were conducted among Asian cancer survivors. We evaluated a culturally sensitive expressive writing intervention, which combined cognitive reappraisal and emotional disclosure, in reducing PTSD among Chinese American BCSs. We also tested social constraints (defined as social conditions when individuals feel misunderstood or alienated when they desire to disclose their thoughts and feelings) as a moderator.

Methods

Chinese American BCSs (n = 136) were randomly assigned to three groups with assigned writing topics for 3 weeks: a self-regulation group, which wrote about the deepest feelings related to cancer in week 1, cognitive reappraisal about stress and coping in week 2, and benefit finding in week 3; an enhanced self-regulation group, with the same instructions, except weeks 1 and 2 were reversed; and a cancer-fact group, which wrote about cancer experiences objectively for 3 weeks. PTSD symptoms were measured at baseline and 1-, 3-, and 6-month follow-ups. Social constraints were measured at baseline.

Results

Both the self-regulation and enhanced self-regulation groups showed reduced PTSD symptoms compared to the cancer-fact group. For reexperiencing and hyperarousal symptoms, expressive writing was more effective for BCSs who experienced high vs. low levels of social constraints; the opposite was found for avoidance symptoms.

Conclusion

Findings demonstrated the effectiveness of expressive writing intervention in reducing PTSD for this minority population, and that the moderating role of survivors’ social network varies among different PTSD symptom clusters.

ClinicalTrials.gov Identifier: NCT02946619.

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Funding

This study was funded by the American Cancer Society (MRSGT-10-011-01-CPPB: PI Qian Lu).

Author information

Authors and Affiliations

  1. School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China

    Qiao Chu

  2. Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA

    Ivan H. C. Wu & Qian Lu

  3. Department of Psychology, University of Houston, Houston, TX, USA

    Qian Lu

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  1. Qiao Chu
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  2. Ivan H. C. Wu
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  3. Qian Lu
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Contributions

All authors contributed to the study conception and design of this secondary data analysis and QL contributed to the original study design. Data analysis was performed by QC and IW. The first draft of the manuscript was written by QC and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Qian Lu.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of The University of Texas MD Anderson Cancer Center (Protocol Number: PA18-0590) and University of Houston (Protocol Number: 16493-EX) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Data analysis of the present study was performed when Dr. Qiao Chu was a postdoctoral fellow at The University of Texas MD Anderson Cancer Center.

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Chu, Q., Wu, I.H.C. & Lu, Q. Expressive writing intervention for posttraumatic stress disorder among Chinese American breast cancer survivors: the moderating role of social constraints. Qual Life Res 29, 891–899 (2020). https://doi.org/10.1007/s11136-019-02385-5

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