de Moor, J. S., Moyé, L., Low, M. D., Rivera, E., Singletary, S. E., Fouladi, R. T., & Cohen, L. (2008). Expressive writing as a presurgical stress management intervention for breast cancer patients. Journal of the Society for Integrative Oncology, 6, 59–66.

To evaluate whether expressive writing (EW) was an effective stress management intervention for patients with breast cancer.

Women were assigned to write about their cancer experience (EW group; n = 24) or neutral topics (neutral writing [NW] group; n = 25). Women were asked to write for 20 minutes a day for a total of four writing sessions that were completed over a seven-day period. Patients were reassessed approximately three days before and two weeks after surgery.

• The sample was comprised of 49 women.
• Patients were older than 18 years; mean age was 56.89 years (standard deviation = 10.79 years).
• Women were recruited two or more months from neoadjuvant chemotherapy.
• Of the patients, 58% were white, 13% were black, 13% were Latina, and 16% were other; 52% were college graduates or had some graduate training; 44% had an annual income of greater than $50,000, 79% were married/cohabitating; and 49% had stage II and 54% had stage III.

• Cancer outpatient clinic
• MD Anderson Cancer Center, Texas

Patients were undergoing the active treatment phase of care.

The study was a randomized, controlled trial.

• Brief Symptom Inventory 18 (BSI 18)
• Perceived Stress Scale (PSS)
• Pittsburgh Sleep Quality Index (PSQI)
• Social Constraints Scale (SCS)
• Brief Pain Inventory (BPI)
• Impact of Events Scale (IES)
• Emotional Approach Coping Scale (EACS)
• Linguistic Inquiry and Word Count (LIWC)

The EW intervention did not significantly decrease women’s distress, perceived stress, sleep disturbance, or pain. There was some evidence that the EW group used more sleep medication at the presurgical assessment than the NW group. Social constraints moderated the effect of the intervention. Among women with high social constraints, the EW group reported lower average daily pain than the NW group. Among women with low social constraints, the EW group reported higher average daily pain than the NW group.

EW was not as broadly effective as a stress management intervention for women with breast cancer.

• The study had a small sample size and lacked statistical power.
• There was high attrition and inconsistent adherence.

These data do not support the use of EW as a presurgical mind-body complementary medicine program for this population.