Jensen-Johansen, M.B., Christensen, S., Valdimarsdottir, H., Zakowski, S., Jensen, A.B., Bovbjerg, D.H., & Zachariae, R. (2012). Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors—Results from a nationwide randomized clinical trial. Psycho-Oncology, 22, 1492–1500.

To examine the effects of an expressive writing intervention on cancer-related distress, symptoms of depression, and mood in women with early-stage breast cancer

Women were randomized to an expressive writing group or a control group. Both groups were instructed to write for 20 minutes once a week over a three-week period. On each writing day, patients were contacted by telephone to initiate the writing session and contacted again after 20 minutes to terminate writing. Patients in the expressive writing group were instructed to write about a distressing event and to explore their deepest emotions and feelings about the experience. Control group patients were asked to write about their daily activities in a detailed and objective manner. Study questionnaires were completed at baseline and at three and nine months postintervention.

• The study reported on a sample of 437 female patients.
• Mean patient age was 53.6 years.
• All patients had breast cancer (stage I or II) and were contacted regarding study participation within three weeks of initial breast surgery.
• The majority (80%) of patients were married or partnered, and 64.5% were retired or unemployed.

• Multisite
• Home setting
• Denmark

Single-blind, randomized controlled trial with an active control group

• Impact of Event Scale
• Beck Depression Inventory
• Profile of Mood States
• Social Constraints Scale
• Toronto Alexithymia Scale

The expressive writing group showed significant changes in negative and positive mood immediately after the writing sessions (d = 0.84–1.04, p < 0.001). When age and baseline measures were included in analysis as covariates, there were no significant effects or group-by-time interactions.

Investigators could not confirm the hypothesis that, compared to patients in an active control group, patients in an expressive writing group experience less cancer-related distress.

• Fifteen percent of the sample initially randomized dropped out or was lost to follow-up.
• Investigators did not report whether patients were actively receiving treatment during the study.
• Baseline outcome data were not reported.

This study does not provide evidence to support expressive writing as an intervention to reduce anxiety and symptoms of depression in women with breast cancer.