Expressive writing in newly diagnosed breast cancer patients
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The purpose of this study was (a) to determine whether the positive benefits of expressive writing reported in other groups (i.e., improved psychological well-being and physical health related outcomes) are seen in newly diagnosed breast cancer patients and (b) to compare three specific writing assignments to determine which may provide the most benefit for reducing physical symptoms and psychological distress associated with breast cancer. Specifically it was proposed that women who do expressive writing about their diagnosis of breast cancer or about critical events in their lives will have less depression and anxiety and improved overall physical health as reflected by improved scores on the following measures: (a) Beck Depression Inventory (BDI-II) (b) State Trait Anxiety Inventory (STAI) and (c) Functional Assessment of Cancer Therapy-Breast cancer version (FACT-B). This study was a longitudinal randomized controlled trial using a pretest-posttest control group design. Participants were randomized into one of four groups: three writing groups and one control group that did not write. Study instruments were administered at entry (T1), one month post intervention (T2), and six months post intervention (T3). One hundred seventeen newly diagnosed breast cancer women were recruited from multiple sites in central Oklahoma, and 68 of these completed the writing assignments and tests. MANCOVA, ANOVA, and t-tests were used to evaluate differences among the groups. Writing about breast cancer as the traumatic event was statistically significant for improvement in functional quality of life as measured by the FACT-B and depression as measured by the BDI-II. Simply writing about exercise, diet, sleep, and medications related to the breast cancer experience (attentional control group) was also beneficial. The group that wrote about a self-selected worst traumatic event was only significant on difference scores for anxiety. All three writing groups reported a decreased use of antidepressants that was significantly different than that of the control group. Expressive writing was found to be a useful mechanism to deal with breast cancer and had an effect on physical functioning, depression and anxiety. Although barriers exist to its use, women find it helpful and can identify factors that would assist in its implementation.