Deconstructing therapeutic mechanisms in cancer support groups: do we express more emotion when we tell stories or talk directly to each other?
Studies indicate that story-telling and emotional expression may be important therapeutic mechanisms. This study examined how they work together over 1 year of supportive-expressive group therapy (SET). Participants were 41 women randomized to SET. We coded emotional expression and story types (story vs. non-story) at the initial session, 4, 8, and 12 months. Women engaged in more storytelling in their initial than later sessions. In later sessions, women expressed significantly more emotion, specifically compassion and high-arousal positive affect. Direct communication (non-story) allowed more positive but also more defensive expression as women supported and challenged each other. Greater hostility in non-story and greater constrained anger during story were associated with increasing depression. Greater high-arousal positive affect in non-story and greater primary negative affect in story were associated with increasing social network size. These results inform clinicians about cues they might use to improve the effectiveness of cancer support groups.
KeywordsMetastatic breast cancer Emotional expression Storytelling Supportive-expressive group therapy Narratives
We thank the principal investigator for the parent study, David Spiegel, and acknowledge The John D. and Catherine T. MacArthur Foundation Mind/Body Network, and National Institute of Mental Health Grant MH47226 and MH47226-11 with additional funding from The National Cancer Institute and the Fetzer Institute, Kalamazoo, Mich. Breast Cancer Research Program of California #9IB-0191, and the Kozmetsky Global Collaboratory also supported analysis. Preparation of this article was supported by the Alberta Innovates—Health Solutions Fellowship and the Psychosocial Oncology Research Training Post-doctoral Fellowship awarded to Dr. Rie Tamagawa. Salary support for Janine Giese-Davis is from the Enbridge Chair for Psychosocial Oncology Research held by Linda E. Carlson. This project started as an undergraduate honors project conducted by Caroline J. Perry under the mentorship of J. Giese-Davis, and was awarded Stanford University’s Firestone Medal and a citation at the Annual meeting of the Society for Behavioral Medicine, Washington, D.C., April 2002. The Emotion Coding Labs—Stanford and Calgary completed the project. We presented the current study at the Canadian Association of Psychosocial Oncology (CAPO), Vancouver, BC. April 25-28, 2012. We also gratefully acknowledge Helena C. Kraemer, biostatistician; coders Jennifer Boyce-McNeille, Diana Edwards, Sanjay Chakrapani, Barbara Symons, Casey Alt, Caryn Bernstein, David Weibel, Wendy Ellis, Suzanne Twirbutt, and Maya Yutsis; and the therapists and women who participated in this study.
Conflict of interest
All authors, Rie Tamagawa, Yong Li, Theo Gravity, Karen Altree Piemme, Sue DiMiceli, Kate Collie, and Janine Giese-Davis, declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
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