Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

The aim of this randomized clinical trial was to examine the efficacy of Pennebaker’s expressive writing intervention (EWI) in improving the perceived quality of life (QoL) and in reducing psychiatric symptoms among patients who received a cancer diagnosis.

Methods

Seventy-one consecutively recruited patients who received a cancer diagnosis for the first time in their life were randomized into two groups: an EWI group (EWG: n = 35) and a control group (CG n = 36). At the baseline, anamnestic information was collected for all patients, and the patients completed a series of self-reported measures assessing psychiatric symptoms, alexithymia, and health-related QoL. A modified Pennebaker’s EWI adapted to cancer diagnosis was also administered to the EWG. Six months later, 32 patients (EWG: n = 17, CG: n = 15) participated in the follow-up and filled out the same questionnaires.

Results

The Pennebaker’s EWI was effective in decreasing global psychopathology (d =  -.55). Small but significant effects were also observed for alexithymia levels and health-related QoL, with the EWG showing a reduction in alexithymia levels (d =  -.31) and an increase in the mental component of QoL (d = .31) compared to the CG.

Conclusions

Our findings indicate that the Pennebaker’s EWI is effective in reducing the negative impact of cancer diagnosis on patients’ mental health.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Casellas-Grau A, Ochoa C, Ruini C (2017) Psychological and clinical correlates of posttraumatic growth in Cancer. A systematic and critical review. Psychooncology 26(12):2007–2018. https://doi.org/10.1002/pon.4426

    Article  PubMed  Google Scholar 

  2. Hermelink K, Bühner M, Sckopke P, Neufeld F, Kaste J, Voigt V, Münzel K, Wuerstlein R, Ditsch N, Hellerhoff K, Rjosk-Dendorfer D, Braun M, Von Koch FE, Härtl K, Hasmüller S, Bauerfeind I, Debus G, Herschbach P, Mahner S, Harbeck N (2017) Chemotherapy and post-traumatic stress in the causation of cognitive dysfunction in breast cancer patients. J Natl Cancer Inst 109(10). https://doi.org/10.1093/jnci/djx057

  3. Cardoso G, Graca J, Klut C, Papolia A (2016) Depression and anxiety symptoms following cancer diagnosis: a cross-sectional study. Psychol Health Med 21(5):562–570. https://doi.org/10.1080/13548506.2015.1125006

    Article  PubMed  Google Scholar 

  4. Lo C, Zimmermann C, Rydall A, Walsh A, Jones JM, Moore MJ, Shepherd FA, Gagliese L, Rodin G (2010) Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer. J Clin Oncol 28(18):3084–3089. https://doi.org/10.1200/JCO.2009.26.9712

    Article  PubMed  Google Scholar 

  5. Bottomley A, Gaafa R, Manegold C, Burgers S, Coens C, Legrand C, Vincent M, Giaccone G, Van Meerbeeck J (2006) Short-term treatment-related symptoms and quality of life: results from an international randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma: an EORTC lung-cancer group and National Cancer Institute, Canada, intergroup study. J Clin Oncol 24(9):1435–1442. https://doi.org/10.1200/JCO.2005.03.3027

    Article  CAS  PubMed  Google Scholar 

  6. Hollen PJ, Gralla RJ, Liepa AM, Symanowski JT, Rusthoven JJ (2004) Adapting the lung cancer symptom scale (LCSS) to mesothelioma: using the LCSS Meso conceptual model for validation. Cancer 101(3):587–595. https://doi.org/10.1002/cncr.20315

    Article  PubMed  Google Scholar 

  7. Rodin G, Yuen D, Mischitelle A, Minden MD, Brandwein J, Schimmer A, Marmar C, Gagliese L, Lo C, Rydall A, Zimmermann C (2013) Traumatic stress in acute leukemia. Psychooncology 22(2):299–307. https://doi.org/10.1002/pon.2092

    Article  PubMed  Google Scholar 

  8. Taylor S, Harley C, Campbell LJ, Bingham L, Podmore EJ, Newsham AC, Selby PJ, Brown JM, Velikova G (2011) Discussion of emotional and social impact of cancer during outpatient oncology consultations. Psychooncology 20(3):242–251. https://doi.org/10.1002/pon.1730

    Article  PubMed  Google Scholar 

  9. Moore S, Darlison L, Tod AM (2010) Living with mesothelioma. A literature review. Eur J Cancer Care 19(4):458–468. https://doi.org/10.1111/j.1365-2354.2009.01162.x

    Article  CAS  Google Scholar 

  10. Taylor GJ, Bagby RM, Parker JDA (1997) Disorder of affect regulation. Alexithymia in medical and psychiatric illness. University Press Cambridge, Cambridge

    Book  Google Scholar 

  11. Wise TN, Mann LS, Mitchell JD, Hryvniak M, Hill B (1990) Secondary alexithymia: an empirical validation. Compr Psychiatry 31(4):284–288. https://doi.org/10.1016/0010-440X(90)90035-Q

    Article  CAS  PubMed  Google Scholar 

  12. Schimmenti A, Caretti V (2018) Attachment, trauma, and alexithymia. In: Luminet O, Taylor GJ, Bagby RM (eds) Alexithymia: advances in research, theory, and clinical practice. Cambridge University Press, Cambridge, pp 127–141

    Chapter  Google Scholar 

  13. Messina A, Beadle JN, Paradiso S (2014) Towards a classification of alexithymia: primary, secondary and organic. J Psychopathol 20:38–49

    Google Scholar 

  14. Holland JC, Breitbart WS, Butow PN, Jacobsen PB, Loscalzo MJ, McCorkle R (2015) Psycho-oncology, Third edn. Oxford Medicine, Oxford

    Google Scholar 

  15. Osborn RL, Demoncada AC, Feuerstein M (2006) Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med 36(1):13–34. https://doi.org/10.2190/EUFN-RV1K-Y3TR-FK0L

    Article  PubMed  Google Scholar 

  16. Frattaroli J (2006) Experimental disclosure and its moderators: a meta-analysis. Psychol Bull 132(6):823–865. https://doi.org/10.1037/0033-2909.132.6.823

    Article  PubMed  Google Scholar 

  17. Frisina PG, Borod JC, Lepore SJ (2004) A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations. J Nerv Ment Dis 192(9):629–634. https://doi.org/10.1097/01.nmd.0000138317.30764.63

    Article  PubMed  Google Scholar 

  18. Merz EL, Fox RS, Malcarne VL (2014) Expressive writing interventions in cancer patients: a systematic review. Health Psychol Rev 8(3):339–361. https://doi.org/10.1080/17437199.2014.882007

    Article  PubMed  Google Scholar 

  19. Smyth JM (1998) Written emotional expression: effect size, outcome types, and moderating variables. J Consult Clin Psychol 66(1):174–184. https://doi.org/10.1037/0022-006X.66.1.174

    Article  CAS  PubMed  Google Scholar 

  20. Jensen-Johansen MB, Christensen S, Valdimarsdottir H, Zakowski S, Jensen AB, Bovbjerg DH, Zachariae R (2013) Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors. Results from a nationwide randomized clinical trial. Psychooncology 22(7):1492–1500. https://doi.org/10.1002/pon.3193

    Article  CAS  PubMed  Google Scholar 

  21. Mosher CE, Duhamel KN, Lam J, Dickler M, Li Y, Massie MJ, Norton L (2012) Randomised trial of expressive writing for distressed metastatic breast cancer patients. Psychol Health 27(1):88–100. https://doi.org/10.1080/08870446.2010.551212

    Article  PubMed  Google Scholar 

  22. Zachariae R, O'Toole MS (2015) The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients- a systematic review and meta-analysis. Psychooncology 24(11):1349–1359. https://doi.org/10.1002/pon.3802

    Article  PubMed  PubMed Central  Google Scholar 

  23. Craft MA, Davis GC, Paulson R (2013) Expressive writing in early breast cancer survivors. J Adv Nurs 69(2):305–315. https://doi.org/10.1111/j.1365-2648.2012.06008.x

    Article  PubMed  Google Scholar 

  24. Henry EA, Schlegel RJ, Talley AE, Molix LA, Bettencourt BA (2010) The feasibility and effectiveness of expressive writing for rural and urban breast cancer survivors. Oncol Nurs Forum 37(6):749–757. https://doi.org/10.1188/10.ONF.749-757

    Article  PubMed  Google Scholar 

  25. Jensen-Johansen MB, O'Toole MS, Christensen S, Valdimarsdottir H, Zakowski S, Bovbjerg DH, Jensen AB, Zachariae R (2018) Expressive writing intervention and self-reported physical health out-comes–results from a nationwide randomized controlled trial with breast cancer patients. PLoS One 13(2):1–17. https://doi.org/10.1371/journal.pone.0192729

    Article  CAS  Google Scholar 

  26. Solano L, Donati V, Pecci F, Persichetti S, Colaci A (2003) Postoperative course after papilloma resection: effects of written disclosure of the experience in subjects with different alexithymia levels. Psychosom Med 65(3):477–484. https://doi.org/10.1097/01.PSY.0000035781.74170.F1

    Article  PubMed  Google Scholar 

  27. Bunevicius A (2018) Personality traits, patient-centered health status and prognosis of brain tumor patients. J Neuro-Oncol 137(3):593–600. https://doi.org/10.1007/s11060-018-2751-6

    Article  Google Scholar 

  28. Granieri A, La Marca L, Mannino G, Giunta S, Guglielmucci F, Schimmenti A (2017) The relationship between defense patterns and DSM-5 maladattive domains. Front Psychol 8:1–12. https://doi.org/10.3389/fpsyg.2017.01926

    Article  Google Scholar 

  29. Pennebaker JW (1997) Opening up: the healing power of expressing emotions. Guilford Press, New York

    Google Scholar 

  30. Pennebaker JW (1985) Traumatic experience and psychosomatic disease: exploring the roles of behavior, obsession and confiding. Can Psychol 26(2):82–95. https://doi.org/10.1037/h0080025

    Article  Google Scholar 

  31. Pennebaker JW, Beall SK (1986) Confronting a traumatic event: toward an understanding of inhibition and disease. J Abnorm Psychol 95(3):274–281

    Article  CAS  PubMed  Google Scholar 

  32. Pennebaker JW (2010) Expressive writing in a clinical setting. Indep Pract 30:23–25

    Google Scholar 

  33. Derogatis LR (1994) SCL-90-R symptom Checklist-90-R administration, scoring and procedures manual. Pearson, Minneapolis

    Google Scholar 

  34. Prinz U, Nutzinger DO, Schulz H, Petermann F, Braukhaus C, Andreas S (2013) Comparative psychometric analyses of the SCL-90-R and its short versions in patients with affective disorders. BMC Psychiatry 13(104):1–9. https://doi.org/10.1186/1471-244X-13-104

    Article  Google Scholar 

  35. Ware JE Jr, Sherbourne CD (1992) The MOS 36-itemshort-form health suvery (SF-36): I. Conceptual framework and item selection. Med Care 30(6):473–483

    Article  Google Scholar 

  36. McHornery CA, Ware JE, Raczek AE (1993) The MOS 36-item short-form from health survery (SF-36): II. Psychometric and clinical test of validity in measuring physical and mental health constructs. Med Care 31(3):247–263

    Article  Google Scholar 

  37. Bagby RM, Parker JDA, Taylor GJ (1994) The twenty-item Toronto alexithymia scale-I. Item selection and cross-validation of the factor structure. J Psychosom Res 38(1):23–32

    Article  CAS  PubMed  Google Scholar 

  38. Bagby RM, Taylor GJ, Parker JDA (1994) The twenty-item Toronto alexithymia scale-II. Convergent, discriminant, and concurrent validity. J Psychosom Res 38(1):33–40

    Article  CAS  Google Scholar 

  39. Morris SB (2008) Estimating effect sizes from pretest-posttest-control group designs. Organ Res Methods 11(2):364–386. https://doi.org/10.1177/1094428106291059

    Article  Google Scholar 

  40. Cohen J (1988) Statistical power analysis for the behavioral sciences, Second edn. Lawrence Earlbaum, Hillsdale

    Google Scholar 

  41. Thompson B (2007) Effect sizes, confidence intervals, and confidence intervals for effect sizes. Psychol Sch 44(5):423–432. https://doi.org/10.1002/pits.20234

    Article  Google Scholar 

  42. Pennebaker JW, Smyth JM (2016) Opening up by writing it down: how expressive writing improves health and eases emotional pain. Guilford Press, New York

    Google Scholar 

  43. Bucci W (1997) Psychoanalysis and cognitive science. A multiple code theory. Guilford Press, New York

    Google Scholar 

  44. Schimmenti A (2017) The trauma factor: examining the relationships among different types of trauma, dissociation, and psychopathology. J Trauma Dissociation. https://doi.org/10.1080/15299732.2017.1402400

  45. Low CA, Stanton AL, Bower JE, Gyllenhammer L (2010) A randomized controlled trial of emotionally expressive writing for women with metastatic breast cancer. Health Psychol 29(4):460–466. https://doi.org/10.1037/a0020153

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Human and Social Sciences, UKE-Kore University of Enna, Enna, Italy

    Luana La Marca, Erika Maniscalco & Adriano Schimmenti

  2. Department of Hematology and Oncology, Hospital Vincenzo Cervello, Palermo, Italy

    Francesco Fabbiano & Francesco Verderame

Authors
  1. Luana La Marca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Erika Maniscalco
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Fabbiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco Verderame
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Adriano Schimmenti
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luana La Marca.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

La Marca, L., Maniscalco, E., Fabbiano, F. et al. Efficacy of Pennebaker’s expressive writing intervention in reducing psychiatric symptoms among patients with first-time cancer diagnosis: a randomized clinical trial. Support Care Cancer 27, 1801–1809 (2019). https://doi.org/10.1007/s00520-018-4438-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-018-4438-0

Keywords

Search

Navigation