Acculturation Moderates the Effects of Expressive Writing on Post-Traumatic Stress Symptoms Among Chinese American Breast Cancer Survivors.

Abstract

Previous research indicated that the benefits of expressive writing on cancer patients' physical and psychological well-being may vary across cultures. However, it remains unknown whether the within-ethnicity cultural orientation would also moderate the efficacy of expressive writing. Immigrants are a special population who differ widely in extent of endorsing the home culture and the host culture. We examined the role of acculturation in moderating the effect of expressive writing among Chinese American breast cancer survivors in reducing different post-traumatic stress disorder (PTSD) symptom clusters: re-experiencing, avoidance, and arousal. Ninety-six Chinese American breast cancer survivors were randomly assigned to three groups to write about cancer-related topics: a self-regulation group to write about deepest feelings, stress coping, and finding benefits; an emotional disclosure group to write about deepest feelings; and a cancer-fact group to write about cancer experience objectively. The only examined moderator, acculturation, was assessed at baseline. PTSD symptoms were assessed at baseline and 1-, 3-, and 6-month follow-ups. Acculturation moderated the effect of expressive writing at 3- and 6-month follow-ups. Among participants with low acculturation, PTSD symptoms were less severe in the self-regulation and cancer-fact groups compared with the emotional disclosure group; in contrast, no group differences in PTSD were found among highly acculturated participants. Our findings highlight the important role of sub-ethnic cultural orientation in the efficacy of psychosocial interventions targeting immigrant populations. ClinicalTrials.gov Identifier: NCT03546673.