Acculturation Moderates the Effects of Expressive Writing on Post-Traumatic Stress Symptoms Among Chinese American Breast Cancer Survivors

  • Qiao ChuEmail author
  • Celia Ching Yee Wong
  • Qian LuEmail author



Previous research indicated that the benefits of expressive writing on cancer patients’ physical and psychological well-being may vary across cultures. However, it remains unknown whether the within-ethnicity cultural orientation would also moderate the efficacy of expressive writing. Immigrants are a special population who differ widely in extent of endorsing the home culture and the host culture. We examined the role of acculturation in moderating the effect of expressive writing among Chinese American breast cancer survivors in reducing different post-traumatic stress disorder (PTSD) symptom clusters: re-experiencing, avoidance, and arousal.


Ninety-six Chinese American breast cancer survivors were randomly assigned to three groups to write about cancer-related topics: a self-regulation group to write about deepest feelings, stress coping, and finding benefits; an emotional disclosure group to write about deepest feelings; and a cancer-fact group to write about cancer experience objectively. The only examined moderator, acculturation, was assessed at baseline. PTSD symptoms were assessed at baseline and 1-, 3-, and 6-month follow-ups.


Acculturation moderated the effect of expressive writing at 3- and 6-month follow-ups. Among participants with low acculturation, PTSD symptoms were less severe in the self-regulation and cancer-fact groups compared with the emotional disclosure group; in contrast, no group differences in PTSD were found among highly acculturated participants.


Our findings highlight the important role of sub-ethnic cultural orientation in the efficacy of psychosocial interventions targeting immigrant populations.

Trial Registration Identifier: NCT03546673


Acculturation Asian/Chinese breast cancer survivors Expressive writing PTSD 


Funding Information

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

Compliance with Ethical Standards

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 institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© International Society of Behavioral Medicine 2019

Authors and Affiliations

  1. 1.Department of Health Disparities ResearchThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of PsychologyUniversity of HoustonHoustonUSA

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