Impact of Expressive Writing on Affect, Psychological Distress, and Quality of Life of Breast Cancer Survivors in Pakistan
DOI:
https://doi.org/10.52053/jpap.v6i2.248Keywords:
Anxiety, Cancer, Depression, Expressive Writing, Oncology, Stress, WellbeingAbstract
In this experimental study, effectiveness of expressive writing was assessed on affect, psychological distress and quality of life of survivors of breast cancer in Pakistan. To evaluate this impact, seventy-two breast cancer survivors who fulfilled the inclusion criteria were recruited from oncology clinics of Lahore, Pakistan. Participants completed the baseline assessment including The Positive and Negative Affect Schedule (PANAS), The Depression Anxiety Stress Scale-21 (DASS-21) and WHOQOL BREF.The participants were assigned to experimental and control groups. The expressive writing group had 35 participants (EW) and the control group had 37 participants. After 4 weeks, the same measures were completed by the experimental and control group participants for the post assessment. A debriefing session was also conducted following data analysis. The control group participants were provided with the option to engage in the expressive writing task. The results of the MANOVA suggest that the writing intervention had significant positive effects on the dependent variables including depression, anxiety, stress, affect and quality of life. These results suggest that the expressive writing intervention facilitated the breast cancer survivors to overcome some of the psycho-social costs associated with cancer survivorship.
References
Akhter, N. (2017). Urdu translation and validation of shorter version of Positive Affect and Negative Affect Schedule (PANAS) on Pakistani bank employees. JPMA. The Journal of the Pakistan Medical Association, 67(10), 1517-1523.
Aslam, N., Kamal, A. (2017). Translation, validation and effectiveness of Depression, Anxiety and Stress Scale (DASS-21) in assessing the psychological distress among flood affected individuals. Journal of Pakistan Psychiatric Society, 14(4), 16-20.
Azam, M., Aslam, M., Basharat, J., Mughal, M. A., Nadeem, M. S., & Anwar, F. (2021). An empirical study on quality of life and related factors of Pakistani breast cancer survivors. Scientific Reports, 11(1), 24391.
Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11(5), 338-346.
Banning, M., Hafeez, H., Faisal, S., Hassan, M., & Zafar, A. (2009). The impact of culture and sociological and psychological issues on Muslim patients with breast cancer in Pakistan. Cancer Nursing, 32(4), 317-324.
Bhurgri, Y., Bhurgri, A., Nishter, S., Ahmed, A., Usman, A., Pervez, S., Ahmed, R., Kayani, N., Riaz, A., Bhurgri, H., Bashir, I., & Hassan, S. H. (2006). Pakistan--country profile of cancer and cancer control 1995-2004. JPMA. The Journal of the Pakistan Medical Association, 56(3), 124–130.
Chu, Q., Wu, I. H., & Lu, Q. (2020). Expressive writing intervention for posttraumatic stress disorder among Chinese American breast cancer survivors: the moderating role of social constraints. Quality of Life Research, 29, 891-899.
Ferlay, J., Héry, C., Autier, P., & Sankaranarayanan, R. (2010). Global burden of breast cancer. Breast Cancer Epidemiology, 1-19.
Gallagher, M. W., Long, L. J., Tsai, W., Stanton, A. L., & Lu, Q. (2018). The unexpected impact of expressive writing on posttraumatic stress and growth in Chinese American breast cancer survivors. Journal of Clinical Psychology, 74(10), 1673-1686.
Gil, F., Costa, G., Hilker, I., & Benito, L. (2012). First anxiety, afterwards depression: psychological distress in cancer patients at diagnosis and after medical treatment. Stress and Health, 28(5), 362-367.
Kercher, K. (1992). Assessing subjective well-being in the old-old: The PANAS as a measure of orthogonal dimensions of positive and negative affect. Research on Aging, 14(2), 131-168.
Lodhi, F. S., Raza, O., Montazeri, A., Nedjat, S., Yaseri, M., & Holakouie-Naieni, K. (2017).Psychometric properties of the Urdu version of the World Health Organization's quality of life questionnaire (WHOQOL-BREF). Medical Journal of the Islamic Republic of Iran, 31, 129.
Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335-343.
Low, C. A., Stanton, A. L., Bower, J. E., & Gyllenhammer, L. (2010). A randomized controlled trial of emotionally expressive writing for women with metastatic breast cancer. Health Psychology, 29(4), 460.
Lu, Q., Dong, L., Wu, I. H., You, J., Huang, J., & Hu, Y. (2019). The impact of an expressive writing intervention on quality of life among Chinese breast cancer patients undergoing chemotherapy. Supportive Care in Cancer, 27(1), 165-173.
Lu, Q., Gallagher, M. W., Loh, A., & Young, L. (2018). Expressive writing intervention improves quality of life among Chinese-American breast cancer survivors: a randomized controlled trial. Annals of Behavioral Medicine, 52(11), 952-962.
Lu, Q., & Stanton, A. L. (2010). How benefits of expressive writing vary as a function of writing instructions, ethnicity and ambivalence over emotional expression. Psychology and Health, 25(6), 669-684.
Pennebaker, J. W. (2010). Expressive writing in a clinical setting. The Independent Practitioner, 30, 23-25.
Stanton, A. L., & Bower, J. E. (2015). Psychological Adjustment in Breast Cancer Survivors. Advances in Experimental Medicine and Biology, 862, 231–242. https://doi.org/10.1007/978-3-319-16366-6_15
Teo, I., Krishnan, A., & Lee, G. L. (2019). Psychosocial interventions for advanced cancer patients: A systematic review. Psychooncology, 28(7), 1394-1407.
Warmoth, K., Cheung, B., You, J., Yeung, N. C., & Lu, Q. (2017). Exploring the social needs and challenges of Chinese American immigrant breast cancer survivors: a qualitative study using an expressive writing approach. International Journal of Behavioral Medicine, 24(6),827-835.
WHOQOL Group. (1998). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551-558.
Wong, D. (2018). Practitioner experiences of online treatment (Doctoral dissertation, University of Southampton).
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Sadia Sultan, Elizabeth Maria Schwaiger
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Creative Commons Attribution-Non Commercial 4.0 International (CC BY-NC 4.0) License: This article is distributed under the terms of the Creative Commons Attribution-Non Commercial 4.0 International License (https://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-Commercial use, reproduction
and distribution of the work without further permission provided the original work is attributed as specified on the Journal website at (https://iprpk.com/ojs/index.php/jpap)
