Expressive Writing & Adjustment to Colorectal Cancer

描述（由申请人提供）： 表达性书写是一种理论驱动的行为医学干预，旨在通过增加对创伤事件的认知和情感处理来增强健康和幸福感。许多研究表明，在相对健康的非临床人群中，表达性书写在高度受控的实验室条件下对健康有益。一些试点研究提供了暗示性证据，表明表达性写作对癌症的适应有好处，但大多数研究的设计都不太理想。拟议的研究旨在：（1）确定对最近接受CRC治疗的个体应用简短、廉价的表达性书写干预的可行性;（2）确定影响可行性的人口统计学和心理社会因素;（3）确定表达性书写对改善一系列健康相关生活质量结局的潜在功效（例如，抑郁症状、身体功能和症状、社会情感成长）;以及（4）确定可能影响写作干预功效的人口统计学和社会心理因素。我们将使用三组，前后设计，其中183名女性和男性最近接受治疗的第I-III期结肠癌或直肠癌将被随机分配到三个条件之一：表达性写作，控制写作，或没有写作。数据将通过结构化的，面对面的采访前不久进行的写作干预，并再次在一个和三个月后的干预。主要成果包括可行性指标（例如，累积率和保留率、程序的可接受性和对书面说明的遵守）和生活质量变量（一般和癌症特异性、心理抑郁和社会情感成长）。调节变量包括社会心理变量（例如，社会约束、侵入性思想）以及社会人口和医疗因素。主持人的分析将集中在探索谁从表达性写作中受益以及为什么受益。例如，我们预测表达性书写将对以下CRC患者最有益：（a）社会支持不足，或者在与他人讨论癌症时感到受限，（B）对癌症有侵入性想法，因为书写的安全情感表达应该缓冲这种对生活质量的负面影响。可行性和有效性数据将用于为未来随机对照试验的开发提供信息。

DESCRIPTION (provided by applicant): Expressive writing is a theory-driven behavioral medicine intervention that is designed to enhance health and well-being through increased cognitive and emotional processing of traumatic events. Many studies have shown the health benefits of expressive writing in relatively healthy, non-clinical populations writing under highly controlled laboratory conditions. A few pilot studies have provided suggestive evidence of benefits of expressive writing on adjustment to cancer, but most of these studies have had less than ideal designs. The proposed study aims to: (1) Determine the feasibility of applying a brief, inexpensive expressive writing intervention to individuals recently treated for CRC; (2) Identify demographic and psychosocial factors that influence feasibility; (3) Determine the potential efficacy of expressive writing for improving a range of healthrelated quality of life outcomes (e.g., depressive symptoms, physical functioning and symptoms, social-emotional growth); and (4) Identify demographic and psychosocial factors that may influence the efficacy of the writing intervention. We will use a three-group, pre-post design, in which 183 women and men recently treated for Stage l-lll colon or rectal cancer will be randomly assigned to one of three conditions: expressive writing, control writing, or no writing. Data will be collected through structured, face-to-face interviews conducted shortly before the writing intervention and again at one and three months after the intervention. Primary outcomes include feasibility indicators (e.g., accrual and retention rates, acceptability of procedures, and adherence to writing instructions) and quality of life variables (general and cancer-specific, psychological depression, and social-emotional growth). Moderator variables include psychosocial variables (e.g., social constraints, intrusive thoughts) as well as socio-demographic and medical factors. Moderator analyses will focus on exploring who benefits from expressive writing and why. For instance, we predict that expressive writing will be most beneficial for people with CRC who: (a) have inadequate social support, or who feel constrained in discussing their cancer with others, and (b) have intrusive thoughts about their cancer, because the safe emotional expression of writing should buffer them from the negative effects of such unbidden thoughts on quality of life outcomes. Feasibility and efficacy data will be used to inform the development of a future randomized controlled trial.