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Abstract
Scopo: Il distress emozionale rappresenta uno dei sintomi maggiormente riportati nel paziente oncologico in terapia, aumentando il rischio di sviluppare una patologia depressiva. Attraverso l'analisi della letteratura si vuole valutare se l'utilizzo della scrittura espressiva sui malati oncologici nel loro percorso di cura rispetto all'uso della scrittura neutra riduce il distress emozionale. Metodo: La ricerca bibliografica è stata condotta utilizzando le banche dati CINHAL, PubMed, Cochrane Library e PsycInfo. Risultati: I risultati della ricerca, condotta su 7 studi clinici randomizzati e controllati, di cui 3 studi pilota, hanno evidenziato in seguito a sessioni di scrittura espressiva (gruppo sperimentale) versus scrittura neutra (gruppo di controllo) una riduzione significativa nel gruppo sperimentale del distress negli stadi iniziali della malattia oncologica ( p = 0,0183); nei pazienti con una diagnosi metastatica assegnati al gruppo di scrittura espressiva vi è stata una rilevanza statisticamente significativa nella riduzione dei disturbi dell'umore (p = 0,03). Sono state determinate differenze di gruppo statisticamente significative anche rispetto ad alcune misure sulla qualití del sonno (p = 0,04). La scrittura espressiva non ha prodotto significative riduzioni di stress psicologico e miglioramenti della salute fisica (p>0,20) nei pazienti con diagnosi metastatica di lunga durata e, nell'ambito delle cure palliative non vi sono stati risultati di fattibilití per una scarsa aderenza nel follow-up. Conclusioni: Dai risultati si evidenzia come le strategie di scrittura espressiva migliorano la gestione della malattia, riducono i sintomi fisici e psicologici correlati al tumore riducendo il distress emozionale, nei pazienti ad uno stadio iniziale della patologia.
Parole chiave: scrittura espressiva, cancro, distress, stress psicologico
ABSTRACT
Aim: The emotional distress represents one of the symptoms most frequently reported in the cancer patient in therapy, increasing the risk of developing a disease depressive. Through the analysis of the literature we want to assess whether the use of expressive writing on cancer patients in their care pathway compared to the use of writing neutral reduces emotional distress. Methods: The bibliographic search was conducted using the databases CINAHL, PubMed, Cochrane Library and PsycInfo. Results: The results of research conducted on 7 randomized controlled trials, including 3 pilot studies have shown after expressive writing sessions (experimental group) versus neutral writing (control group) a significant reduction in distress in the experimental group early stages of cancer (p = 0,0183); in patients with a diagnosis of metastatic assigned to the group expressive writing there was a statistically significant relevance in the reduction of mood disorders (p = 0,03).Were determined statistically significant group differences also with respect to some measure on the quality of sleep (p = 0,04). The expressive writing did not produce significant reductions in psychological distress and improvements in physical health (p > 0,20) in patients diagnosed with metastatic disease of long duration and, in the palliative care there have been results of feasibility for poor adherence at follow-up. Conclusions: From the results it is evident that the strategies of expressive writing improves the management of the disease, reduce the physical and psychological symptoms related to the tumor while reducing the emotional distress in patients at an early stage of the disease.
Key words: expressive writing, cancer patients, distress, stress-psychological
Dettagli dell'articolo
Riferimenti
- Annunziata, M.A., & Muzzatti, B. (2011). Le dimensioni psicosociali del cancro. Noos, 17, 73-86.
- Ballenger, J.C., Davidson, J.R.T., Lecrubier, Y., Nutt, D.J., Jones, R.D., & Berard, R.M.F. (2001). International consensus group on depression and anxiety. Consensus statement on depression, anxiety and oncology. Journal of Clinical Psychiatry, 62 (8), 64-67.
- Bruera, E., Willey, J., Cohen, M., & Palmer, J.L. (2008). Expressive writing in patients receiving palliative care : a feasibility study. Journal of Palliative Medicine, 11 (1), 15-19.
- Bultz, B.D., & Carlson, L.E. (2006). Emotional distress: the sixth vital sign-future directions in cancer care. Psycho-Oncology, 15( 2), 93-95.
- De Moor, C., Sterner, J., Hall, M., Warneke, C., Gilani, Z., & Amato, R.(2002). A piloty study of the effects of expressive writing on psychological and behavioral adjustment in patients enrolled in a Phase II Trial Vaccine Therapy for metastatic renal cell carcinoma. Journal of Health Psychology, 21 (6), 615-619.
- Gidron, Y., Peri ,T., Connonlly, J.F., & Shalev, A.Y. (1996). Written disclosure in posttraumatic stress disorder: Is it beneficial for the patient? The Journal of Nervous and Mental Disease, 184, 505-507.
- Gil, F., Grassi, L., Travado, L., Tomamichel, M., & Gonzalez, J.R. (2005). Use of distress and depression patients. Thermometers to measure psychosocial morbidity among southern European cancer patients. Supportive Care in Cancer, 13, 600-606.
- Lepore, S.J., & Smyth, J.M. (1997). Expressive writing moderates the relation between intrusive thoughts and depressive symptoms. Journal of Personality and Social Psychology, 73, 1030-1037.
- Low, A.C., Stanton, A.L., Bower, J.E., & Gyllenhammer, L. (2012). A Randomized Controlled Trial of emotionally expressive writing for women with metastatic breast cancer. Journal of Health Psychology, 29 (4), 460-466.
- Lowery, A.E., & Holland, J.C. (2011). Screening cancer patients for distress: guidelines for routine
- implementation. Journal of Community Oncology, 8, 502-505.
- Morgan, N.P., Graves, K.D., Poggi, E.A., & Cheson, B.D.(2008). Implementing an expressive Writing Study in a Cancer Clinic. The Oncologist, 13, 196-204.
- Mosher, C.E., Duhamel, K.N., Lam, J., Dickler, M., Li, Y., Massie, M.J., et al. (2012).Randomised trial of expressive writing for distressed metastatic breast cancer patients. Journal of Health Psychology, 27, 88-100.
- Pennebaker, J.W. (1997). Writing About Emotional Experiences as a Therapeutic Process. Psychological Science, 8 (3), 162-166.
- Pennebaker, J.W., & Beall, S.K. (1986). Confronting a traumatic event: toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95 (3), 274-281.
- Pennebaker, J.W., Kiecolt-Glaser, J.K., & Glaser, R (1988). Disclosure of traumas and immune function. Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56 (2), 239-245.
- Smith, A.B., Rush, R., Wright, P., Stark, D., Velikova, G., & Sharpe, M. (2009).Validation of an item bank for detecting and assessing psychological distress in cancer patients. Psycho-Oncology, 18, 195-199.
- Smyth, J.M. (1998). Written emotional expression: effect sizes, outcome types and moderating variables. Journal of Consulting and Clinical Psychology, 66 (1), 174-184.
- Stanton, A.L., Danoff-Burg ,S., Sworowski, L.A., Collins, C.A., Branstetter, A.D., Kirk, S.B., et al.(2002). Randomized Controlled Trial of written emotional expression and benefit finding in breast cancer patients. Journal of Clinical Oncology, 20, 4160-4168.
- Zakowski, S.G., Ramati, A., Morton, C., & Johnson, P. (2004).Written emotional disclosure buffers the effects of social constraints on distress among cancer patients. Journal of Health Psychology, 23 (6), 555-563.
Riferimenti
Annunziata, M.A., & Muzzatti, B. (2011). Le dimensioni psicosociali del cancro. Noos, 17, 73-86.
Ballenger, J.C., Davidson, J.R.T., Lecrubier, Y., Nutt, D.J., Jones, R.D., & Berard, R.M.F. (2001). International consensus group on depression and anxiety. Consensus statement on depression, anxiety and oncology. Journal of Clinical Psychiatry, 62 (8), 64-67.
Bruera, E., Willey, J., Cohen, M., & Palmer, J.L. (2008). Expressive writing in patients receiving palliative care : a feasibility study. Journal of Palliative Medicine, 11 (1), 15-19.
Bultz, B.D., & Carlson, L.E. (2006). Emotional distress: the sixth vital sign-future directions in cancer care. Psycho-Oncology, 15( 2), 93-95.
De Moor, C., Sterner, J., Hall, M., Warneke, C., Gilani, Z., & Amato, R.(2002). A piloty study of the effects of expressive writing on psychological and behavioral adjustment in patients enrolled in a Phase II Trial Vaccine Therapy for metastatic renal cell carcinoma. Journal of Health Psychology, 21 (6), 615-619.
Gidron, Y., Peri ,T., Connonlly, J.F., & Shalev, A.Y. (1996). Written disclosure in posttraumatic stress disorder: Is it beneficial for the patient? The Journal of Nervous and Mental Disease, 184, 505-507.
Gil, F., Grassi, L., Travado, L., Tomamichel, M., & Gonzalez, J.R. (2005). Use of distress and depression patients. Thermometers to measure psychosocial morbidity among southern European cancer patients. Supportive Care in Cancer, 13, 600-606.
Lepore, S.J., & Smyth, J.M. (1997). Expressive writing moderates the relation between intrusive thoughts and depressive symptoms. Journal of Personality and Social Psychology, 73, 1030-1037.
Low, A.C., Stanton, A.L., Bower, J.E., & Gyllenhammer, L. (2012). A Randomized Controlled Trial of emotionally expressive writing for women with metastatic breast cancer. Journal of Health Psychology, 29 (4), 460-466.
Lowery, A.E., & Holland, J.C. (2011). Screening cancer patients for distress: guidelines for routine
implementation. Journal of Community Oncology, 8, 502-505.
Morgan, N.P., Graves, K.D., Poggi, E.A., & Cheson, B.D.(2008). Implementing an expressive Writing Study in a Cancer Clinic. The Oncologist, 13, 196-204.
Mosher, C.E., Duhamel, K.N., Lam, J., Dickler, M., Li, Y., Massie, M.J., et al. (2012).Randomised trial of expressive writing for distressed metastatic breast cancer patients. Journal of Health Psychology, 27, 88-100.
Pennebaker, J.W. (1997). Writing About Emotional Experiences as a Therapeutic Process. Psychological Science, 8 (3), 162-166.
Pennebaker, J.W., & Beall, S.K. (1986). Confronting a traumatic event: toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95 (3), 274-281.
Pennebaker, J.W., Kiecolt-Glaser, J.K., & Glaser, R (1988). Disclosure of traumas and immune function. Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56 (2), 239-245.
Smith, A.B., Rush, R., Wright, P., Stark, D., Velikova, G., & Sharpe, M. (2009).Validation of an item bank for detecting and assessing psychological distress in cancer patients. Psycho-Oncology, 18, 195-199.
Smyth, J.M. (1998). Written emotional expression: effect sizes, outcome types and moderating variables. Journal of Consulting and Clinical Psychology, 66 (1), 174-184.
Stanton, A.L., Danoff-Burg ,S., Sworowski, L.A., Collins, C.A., Branstetter, A.D., Kirk, S.B., et al.(2002). Randomized Controlled Trial of written emotional expression and benefit finding in breast cancer patients. Journal of Clinical Oncology, 20, 4160-4168.
Zakowski, S.G., Ramati, A., Morton, C., & Johnson, P. (2004).Written emotional disclosure buffers the effects of social constraints on distress among cancer patients. Journal of Health Psychology, 23 (6), 555-563.