Writing Content Predicts Outcomes in Written Exposure to Worst-Case Scenarios for Advanced Cancer.

Abstract

<b><i>Background:</i></b> A novel written exposure-based coping intervention (EASE) for distressed adults with advanced cancer focused on their cancer-related worst-case scenario and showed promise for reducing cancer-related trauma symptoms and fear of cancer progression (FoP). This study examines potential mechanisms of change, specifically linguistic features of participants' writing. <b><i>Methods:</i></b> Adults (<i>N</i> = 28) with advanced solid tumor (<i>n</i> = 23) or high-risk blood cancer (<i>n</i> = 5) reporting elevated trauma or FoP participated. Writing was collected during five weekly intervention sessions (three exposure, two coping) and analyzed using linguistic software (LIWC-22). Outcomes were assessed pre-intervention and one-week post-intervention. <b><i>Results:</i></b> More positive (trauma: <i>ηp</i>² = 0.64, <i>p</i> < 0.001; FoP: <i>ηp</i>² = 0.34, <i>p =</i> 0.011) and negative (FoP: <i>ηp</i>² = 0.38, <i>p =</i> 0.007) emotion words during exposure writing sessions predicted worse outcomes, while more death-related words predicted reduced FoP (<i>ηp</i>² = 0.22, <i>p</i> = 0.023). Positive tone in coping writing sessions predicted reduced FoP (<i>ηp</i>² = 0.31, <i>p</i> = 0.009), while negative tone predicted worse FoP (<i>ηp</i>² = 0.22, <i>p</i> = 0.026). <b><i>Conclusions:</i></b> Findings offer preliminary support for several proposed mechanisms of this novel written exposure intervention.