Jensen-Johansen Mikael B, O'Toole Mia S, Christensen Søren, Valdimarsdottir Heiddis, Zakowski Sandra, Bovbjerg Dana H, Jensen Anders B, Zachariae Robert
VIA University College, Aarhus, Denmark.
Unit for Psychooncology and Health Psychology, Department of Oncology, Aarhus University Hospital, and Department of Psychology and Behavioural Science, University of Aarhus, Aarhus, Denmark.
PLoS One. 2018 Feb 23;13(2):e0192729. doi: 10.1371/journal.pone.0192729. eCollection 2018.
The objective was to examine the effect of Expressive Writing Intervention (EWI) on self-reported physical symptoms and healthcare utilization in a nationwide randomized controlled trial with Danish women treated for primary breast cancer, and to explore participant characteristics related to emotion regulation as possible moderators of the effect. Women who had recently completed treatment for primary breast cancer (n = 507) were randomly assigned to three 20 min. home-based writing exercises, one week apart, focusing on emotional disclosure (EWI) of a distressing experience (their cancer or a non-cancer topic) or a non-disclosing topic (control). Outcomes were self-reported physical symptoms and healthcare utilization (visits and telephone contacts with GP) 3 and 9 months post-intervention. Potential moderators were repressive coping, alexithymia, rumination, social constraints, and writing topic. Results revealed no group by time interaction effects for any outcomes. Moderation analyses showed that 1) low alexithymic women in the EWI group showed larger decreases in GP telephone calls over time than both high alexithymic women and controls and 2) women in the EWI group writing about their own cancer, but not women writing about other topics, showed a larger decrease than controls. The results from this large randomized trial are concordant with previous findings showing that EWI is unlikely to be a generally applicable intervention to improve health-related outcomes in cancer patients and cancer survivors. However, written disclosure might have a beneficial impact for individuals who write about their own cancer, as well as for those low in alexithymia.
目的是在一项针对丹麦原发性乳腺癌女性患者的全国性随机对照试验中，研究表达性写作干预（EWI）对自我报告的身体症状和医疗保健利用情况的影响，并探索与情绪调节相关的参与者特征，作为该效应可能的调节因素。最近完成原发性乳腺癌治疗的女性（n = 507）被随机分配到三个20分钟的家庭写作练习组，每组间隔一周，重点是对痛苦经历（她们的癌症或非癌症话题）或非披露性话题（对照组）进行情感披露（EWI）。结果指标为干预后3个月和9个月时自我报告的身体症状和医疗保健利用情况（与全科医生的就诊和电话联系）。潜在的调节因素包括压抑应对、述情障碍、沉思、社会限制和写作话题。结果显示，在任何结果指标上均未发现组间与时间的交互作用。调节分析表明：1）EWI组中述情障碍程度低的女性随着时间的推移，与全科医生的电话联系减少幅度大于述情障碍程度高的女性和对照组；2）EWI组中撰写自己癌症经历的女性，而非撰写其他话题的女性，与对照组相比减少幅度更大。这项大型随机试验的结果与之前的研究结果一致，表明EWI不太可能是一种普遍适用于改善癌症患者和癌症幸存者健康相关结果的干预措施。然而，书面披露可能对那些撰写自己癌症经历的个体以及述情障碍程度低的个体有有益影响。
