human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The current study examined psychological and physical health outcomes of the written disclosure paradigm and the hypothesis that the principles of therapeutic exposure account for the beneficial effects of the paradigm . Participants were r and omly assigned to either a  written disclosure condition  or a control condition .  Reactivity to the writing sessions was examined using both subjective and physiological measures . Measures of psychological and physical health were completed before and 1 month after the sessions . Participants assigned to the disclosure condition reported fewer psychological and physical symptoms at follow-up compared with control participants , though reductions were clinical ly significant for only 1 outcome measure . Physiological activation to the 1st disclosure session was associated with reduced psychological symptoms at follow-up for disclosure participants . Subjective reports of emotional responding corresponded with physiological reactivity . Implication s of these findings are discussed Background : Expressive emotional writing has demonstrated efficacy for improving health status in a wide variety of healthy persons and recently in patients with chronic disease . Purpose : This study was a r and omized , controlled effectiveness trial with 4 arms : 2 active treatment writing groups , 1 inactive writing group , and 1 attention control group . It represents the first attempt to translate the expressive writing intervention into a low-cost , community-based intervention in the form of a videotaped program . Methods : Feasibility of the approach and patient adherence were examined in a community rheumatology practice with rheumatoid arthritis patients ( N = 373 ) . Results : The videotape format was able to convey the intervention instructions accurately and produced the expected and differential ratings of stressfulness and emotional provocation across the 3 writing programs . Seventy-nine percent of eligible patients agreed to take the program home ; 49 % of these patients reported that they followed the protocol . Physician Disease Activity Rating and the Physical Component Summary of the SF36v2 Health Survey were assessed pre and post program . Conclusions : Intent-to-treat analyses found no effect of the treatment . Pretreatment differences among the protocol -adherent patients complicated treatment outcome interpretation . The st and ard writing instructions did not yield an effect ; a modified set of instructions to extract meaning from the traumatic event yielded equivocal results . Contrasts between efficacy and effectiveness trials and the challenge of achieving significant outcomes in effectiveness trials are discussed Background Coronary heart disease ( CHD ) is typically associated with many cardiovascular risk factors ( e.g. , elevated blood pressure ) , low health-related quality of life , depression , anxiety and psychological stress . Expressive writing ( EW ) has shown beneficial effects on such variables in both people from the community and in patients with a variety of chronic illnesses . However , no study to date has evaluated the physical and psychological effects of the expressive writing procedure on coronary patients referred to cardiac rehabilitation ( CR ) . Methods The clinical effectiveness of a 2-week disease-related expressive writing procedure ( writing about one 's deepest thoughts and feelings regarding the experience with heart disease ) compared with the st and ard writing task ( writing about one 's deepest thoughts and feelings about the most traumatic or negative event experienced in the life ) , a neutral writing condition ( writing about the facts regarding heart disease and its treatment ) and an empty control condition will be evaluated in a r and omized controlled clinical trial ( RCT ) with repeated follow-up measurements at 3 , 6 and 12 months after discharge from CR . The primary outcome is health-related quality of life ( SF-12 ) . Secondary outcome measures are depression ( BDI-II ) , anxiety ( BAI ) and post-traumatic growth ( PTGI ) . Furthermore , the study will explore the moderating effects of coping styles , type D personality , perceived emotional support and participants ' evaluative ratings of the writing interventions on the main experimental effects in order to identify sub-groups of patients showing different results . Discussion The WRITTEN-HEART study aims to explore and exp and the frontiers of the expressive writing research enterprise by investigating the feasibility , safety and clinical efficacy of brief and cost-effective  expressive writing interventions in patients with CHD referred to CR.Trial registration Clinical Trials.gov PURPOSE To compare the efficacy of the following two empirically supported group interventions to help distressed survivors of breast cancer cope : mindfulness-based cancer recovery ( MBCR ) and supportive-expressive group therapy ( SET ) . PATIENTS AND METHODS This multisite , r and omized controlled trial assigned 271 distressed survivors of stage I to III breast cancer to MBCR , SET , or a 1-day stress management control condition . MBCR focused on training in mindfulness meditation and gentle yoga , whereas SET focused on emotional expression and group support . Both intervention groups included 18 hours of professional contact . Measures were collected at baseline and after intervention by assessors blind to study condition . Primary outcome measures were mood and diurnal salivary cortisol slopes . Secondary outcomes were stress symptoms , quality of life , and social support . RESULTS Using linear mixed-effects models , in intent-to-treat analyses , cortisol slopes were maintained over time in both SET ( P = .002 ) and MBCR ( P = .011 ) groups relative to the control group , whose cortisol slopes became flatter . Women in MBCR improved more over time on stress symptoms compared with women in both the SET ( P = .009 ) and control ( P = .024 ) groups . Per- protocol analyses showed greater improvements in the MBCR group in quality of life compared with the control group ( P = .005 ) and in social support compared with the SET group ( P = .012 ) . CONCLUSION In the largest trial to date , MBCR was superior for improving stress levels , quality of life and social support [ CORRECTED ] for distressed survivors of breast cancer . Both SET and MBCR also result ed in more normative diurnal cortisol profiles than the control condition . The clinical implication s of this finding require further investigation This study examined the effects of emotional disclosure of stressful events on the pain , physical and affective dysfunction  ,  and joint condition of patients with rheumatoid arthritis ( RA ) . Patients were r and omly assigned to talk privately about stressful events ( disclosure group , n = 36 ) or about trivial topics ( control group ,  n = 36 ) for 4 consecutive days . Disclosure result ed in immediate increases in negative mood . At 2 weeks the 2 groups did not differ on any health measure , but at 3 months disclosure patients had less affective disturbance and better physical functioning in daily activities . There was no main effect of disclosure on pain or joint condition , but among the disclosure patients , those who experienced larger increases in negative mood after talking demonstrated improvements in the condition of their joints . This study concludes that , among RA patients , verbal disclosure and emotional processing of stressful life events induces an immediate negative mood followed by improved psychological functioning OBJECTIVE Little attention has been focused on Asian American breast cancer survivor 's psychological needs . No outcome -based psychosocial interventions have been reported to target at this population . Expressive writing interventions have been previously shown to improve health outcomes among non-Hispanic White breast cancer population s. This pilot study aim ed to test the cultural sensitivity , feasibility , and potential health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors . METHODS Participants ( N = 19 ) were asked to write about their deepest thoughts and feelings , their coping efforts , and positive thoughts and feelings regarding their experience with breast cancer each week for 3 weeks . Health outcomes were assessed at baseline , 3 , and 6 months after the intervention . A Community-Based Participatory Research Approach ( CBPR ) is used . RESULTS Expressive writing was associated with medium and large effect sizes ( η(p)² = 0.066∼0.208 ) in improving multiple health outcomes ( quality of life , fatigue , posttraumatic stress , intrusive thoughts , and positive affect ) at follow-ups . Participants perceived the study to be valuable . The study yielded high compliance and completion rates . CONCLUSION Expressive writing is associated with long-term improvement of health outcomes among Chinese breast cancer survivors and has the potential to be utilized as a support strategy for minority cancer survivors . In addition , CBPR is valuable in improving feasibility and cultural sensitivity of the intervention in understudied population s. Future studies employing r and omized , controlled trial design s are warranted The aims of the present study were to examine whether written emotional disclosure would reduce distress among cancer patients and whether it would buffer the effects of high levels of social constraint ( negative social responses to patients ' expressions of emotion regarding their cancer ) on distress . Cancer patients ( N=104 ) were r and omly assigned to write about their emotions regarding their cancer 20 min a day for 3 days or to write about a nonemotional topic . They completed question naires at baseline and 6 months postintervention . Results showed that written disclosure buffered the effects of social constraints on stress at the 6-month follow-up and that avoidance partly mediated these effects . The present data reinforce the notion that interventions should be tailored to patients ' needs AIMS This article is the report of a study aim ed at determining whether or not expressive writing improves the quality -of-life of early breast cancer survivors . An additional aim is the investigation of whether or not the type of writing prompt makes a difference in results . BACKGROUND The risk of distress can extend well beyond the time of a breast cancer diagnosis . Emotional expression may assist in dealing with this . DESIGN R and omized controlled study . METHODS Participants ( n = 120 ) were r and omized into one of four groups : a control group ( no writing ) or one of three expressive writing groups : breast cancer trauma , any self-selected trauma and facts related to breast cancer . Participants wrote 20 minutes a day for 4 consecutive days . Their quality -of-life was measured , using the ' Functional Assessment of Cancer Therapy-Breast Cancer Version ' , at baseline and at 1 month and 6 months after writing . Paired t-tests , multivariate analysis of variance and multiple regression were used to analyse the data of the 97 participants who completed the journaling assignment and at least the first assessment , collected in 2006 . Intention-to-treat analysis was used . RESULTS / FINDINGS Expressive writing about one 's breast cancer , breast cancer trauma and facts related to breast cancer , significantly improved the quality -of-life outcome . CONCLUSION Expressive writing , focusing the instructions on writing about one 's living and dealing with a diagnosis of breast cancer , is recommended for early breast cancer survivors as a feasible and easily implemented treatment approach to improve quality -of-life Objective : Nonpharmacologic treatments for asthma may act as useful adjuncts to pharmacotherapy but should be recommended to patients only after several well-controlled studies provide evidence of efficacy . Research demonstrating that written emotional expression can improve pulmonary function in patients with asthma consists of one impressive yet unreplicated study ( 1 ) . Our main objective was to test and extend previous research finding that written emotional expression improves pulmonary function in patients with asthma compared with writing on neutral topics . Methods : We conducted a r and omized , controlled trial of outpatient asthmatics recruited from hospitals and the community . Of the 137 adult patients with asthma who were r and omized , 117 began and 114 completed the study . Patients were r and omly assigned to write for 20 minutes , once per week , for 3 weeks about stressful experiences ( n = 41 ) , positive experiences ( n = 37 ) , or neutral experiences ( n = 36 ; control group ) . At baseline , postintervention , and 2-month follow up , patients were assessed by spirometry . Results : The mean change from baseline to 2-month follow up in percentage of predicted forced expiratory volume in 1 second ( FEV1 ) was 4.2 % in the stress-writing group , 1.3 % in the positive-writing group , and 3.0 % in the control group . In forced vital capacity ( FVC ) , there was 3.1 % improvement in the stress-writing group , 3.6 % in the positive-writing group , and 2.4 % in the control group . These changes were not statistically or clinical ly significant . Conclusions : The present study reduces confidence in the ability of written emotional expression to benefit the disease status of asthma patients . FEV1 = forced expiratory volume in 1 second ; FVC = forced vital capacity ; VAPAHCS = Veteran Affairs Palo Alto Health Care System ; PTSD = posttraumatic stress disorder ; COPD = chronic obstructive pulmonary disease CONTEXT Nonpharmacological treatments with little patient cost or risk are useful supplements to pharmacotherapy in the treatment of patients with chronic illness . Research has demonstrated that writing about emotionally traumatic experiences has a surprisingly beneficial effect on symptom reports , well-being , and health care use in healthy individuals . OBJECTIVE To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using st and ardized quantitative outcome measures . DESIGN R and omized controlled trial conducted between October 1996 and December 1997 . SETTING Outpatient community residents drawn from private and institutional practice . PATIENTS Volunteer sample of 112 patients with asthma ( n = 61 ) or rheumatoid arthritis ( n = 51 ) received the intervention ; 107 completed the study , 58 in the asthma group and 49 in the rheumatoid arthritis group . INTERVENTION Patients were assigned to write either about the most stressful event of their lives ( n = 71 ; 39 asthma , 32 rheumatoid arthritis ) or about emotionally neutral topics ( n = 41 ; 22 asthma , 19 rheumatoid arthritis ) ( the control intervention ) . MAIN OUTCOME MEASURES Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were clinical ly examined by a rheumatologist . Assessment s were conducted at baseline and at 2 weeks and 2 months and 4 months 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The current study examined psychological and physical health outcomes of the written disclosure paradigm and the hypothesis that the principles of therapeutic exposure account for the beneficial effects of the paradigm . Participants were r and omly assigned to either a  written disclosure condition  or a control condition .  Reactivity to the writing sessions was examined using both subjective and physiological measures . Measures of psychological and physical health were completed before and 1 month after the sessions . Participants assigned to the disclosure condition reported fewer psychological and physical symptoms at follow-up compared with control participants , though reductions were clinical ly significant for only 1 outcome measure . Physiological activation to the 1st disclosure session was associated with reduced psychological symptoms at follow-up for disclosure participants . Subjective reports of emotional responding corresponded with physiological reactivity . Implication s of these findings are discussed Background : Expressive emotional writing has demonstrated efficacy for improving health status in a wide variety of healthy persons and recently in patients with chronic disease . Purpose : This study was a r and omized , controlled effectiveness trial with 4 arms : 2 active treatment writing groups , 1 inactive writing group , and 1 attention control group . It represents the first attempt to translate the expressive writing intervention into a low-cost , community-based intervention in the form of a videotaped program . Methods : Feasibility of the approach and patient adherence were examined in a community rheumatology practice with rheumatoid arthritis patients ( N = 373 ) . Results : The videotape format was able to convey the intervention instructions accurately and produced the expected and differential ratings of stressfulness and emotional provocation across the 3 writing programs . Seventy-nine percent of eligible patients agreed to take the program home ; 49 % of these patients reported that they followed the protocol . Physician Disease Activity Rating and the Physical Component Summary of the SF36v2 Health Survey were assessed pre and post program . Conclusions : Intent-to-treat analyses found no effect of the treatment . Pretreatment differences among the protocol -adherent patients complicated treatment outcome interpretation . The st and ard writing instructions did not yield an effect ; a modified set of instructions to extract meaning from the traumatic event yielded equivocal results . Contrasts between efficacy and effectiveness trials and the challenge of achieving significant outcomes in effectiveness trials are discussed Background Coronary heart disease ( CHD ) is typically associated with many cardiovascular risk factors ( e.g. , elevated blood pressure ) , low health-related quality of life , depression , anxiety and psychological stress . Expressive writing ( EW ) has shown beneficial effects on such variables in both people from the community and in patients with a variety of chronic illnesses . However , no study to date has evaluated the physical and psychological effects of the expressive writing procedure on coronary patients referred to cardiac rehabilitation ( CR ) . Methods The clinical effectiveness of a 2-week disease-related expressive writing procedure ( writing about one 's deepest thoughts and feelings regarding the experience with heart disease ) compared with the st and ard writing task ( writing about one 's deepest thoughts and feelings about the most traumatic or negative event experienced in the life ) , a neutral writing condition ( writing about the facts regarding heart disease and its treatment ) and an empty control condition will be evaluated in a r and omized controlled clinical trial ( RCT ) with repeated follow-up measurements at 3 , 6 and 12 months after discharge from CR . The primary outcome is health-related quality of life ( SF-12 ) . Secondary outcome measures are depression ( BDI-II ) , anxiety ( BAI ) and post-traumatic growth ( PTGI ) . Furthermore , the study will explore the moderating effects of coping styles , type D personality , perceived emotional support and participants ' evaluative ratings of the writing interventions on the main experimental effects in order to identify sub-groups of patients showing different results . Discussion The WRITTEN-HEART study aims to explore and exp and the frontiers of the expressive writing research enterprise by investigating the feasibility , safety and clinical efficacy of brief and cost-effective  expressive writing interventions in patients with CHD referred to CR.Trial registration Clinical Trials.gov PURPOSE To compare the efficacy of the following two empirically supported group interventions to help distressed survivors of breast cancer cope : mindfulness-based cancer recovery ( MBCR ) and supportive-expressive group therapy ( SET ) . PATIENTS AND METHODS This multisite , r and omized controlled trial assigned 271 distressed survivors of stage I to III breast cancer to MBCR , SET , or a 1-day stress management control condition . MBCR focused on training in mindfulness meditation and gentle yoga , whereas SET focused on emotional expression and group support . Both intervention groups included 18 hours of professional contact . Measures were collected at baseline and after intervention by assessors blind to study condition . Primary outcome measures were mood and diurnal salivary cortisol slopes . Secondary outcomes were stress symptoms , quality of life , and social support . RESULTS Using linear mixed-effects models , in intent-to-treat analyses , cortisol slopes were maintained over time in both SET ( P = .002 ) and MBCR ( P = .011 ) groups relative to the control group , whose cortisol slopes became flatter . Women in MBCR improved more over time on stress symptoms compared with women in both the SET ( P = .009 ) and control ( P = .024 ) groups . Per- protocol analyses showed greater improvements in the MBCR group in quality of life compared with the control group ( P = .005 ) and in social support compared with the SET group ( P = .012 ) . CONCLUSION In the largest trial to date , MBCR was superior for improving stress levels , quality of life and social support [ CORRECTED ] for distressed survivors of breast cancer . Both SET and MBCR also result ed in more normative diurnal cortisol profiles than the control condition . The clinical implication s of this finding require further investigation This study examined the effects of emotional disclosure of stressful events on the pain , physical and affective dysfunction  ,  and joint condition of patients with rheumatoid arthritis ( RA ) . Patients were r and omly assigned to talk privately about stressful events ( disclosure group , n = 36 ) or about trivial topics ( control group ,  n = 36 ) for 4 consecutive days . Disclosure result ed in immediate increases in negative mood . At 2 weeks the 2 groups did not differ on any health measure , but at 3 months disclosure patients had less affective disturbance and better physical functioning in daily activities . There was no main effect of disclosure on pain or joint condition , but among the disclosure patients , those who experienced larger increases in negative mood after talking demonstrated improvements in the condition of their joints . This study concludes that , among RA patients , verbal disclosure and emotional processing of stressful life events induces an immediate negative mood followed by improved psychological functioning OBJECTIVE Little attention has been focused on Asian American breast cancer survivor 's psychological needs . No outcome -based psychosocial interventions have been reported to target at this population . Expressive writing interventions have been previously shown to improve health outcomes among non-Hispanic White breast cancer population s. This pilot study aim ed to test the cultural sensitivity , feasibility , and potential health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors . METHODS Participants ( N = 19 ) were asked to write about their deepest thoughts and feelings , their coping efforts , and positive thoughts and feelings regarding their experience with breast cancer each week for 3 weeks . Health outcomes were assessed at baseline , 3 , and 6 months after the intervention . A Community-Based Participatory Research Approach ( CBPR ) is used . RESULTS Expressive writing was associated with medium and large effect sizes ( η(p)² = 0.066∼0.208 ) in improving multiple health outcomes ( quality of life , fatigue , posttraumatic stress , intrusive thoughts , and positive affect ) at follow-ups . Participants perceived the study to be valuable . The study yielded high compliance and completion rates . CONCLUSION Expressive writing is associated with long-term improvement of health outcomes among Chinese breast cancer survivors and has the potential to be utilized as a support strategy for minority cancer survivors . In addition , CBPR is valuable in improving feasibility and cultural sensitivity of the intervention in understudied population s. Future studies employing r and omized , controlled trial design s are warranted The aims of the present study were to examine whether written emotional disclosure would reduce distress among cancer patients and whether it would buffer the effects of high levels of social constraint ( negative social responses to patients ' expressions of emotion regarding their cancer ) on distress . Cancer patients ( N=104 ) were r and omly assigned to write about their emotions regarding their cancer 20 min a day for 3 days or to write about a nonemotional topic . They completed question naires at baseline and 6 months postintervention . Results showed that written disclosure buffered the effects of social constraints on stress at the 6-month follow-up and that avoidance partly mediated these effects . The present data reinforce the notion that interventions should be tailored to patients ' needs AIMS This article is the report of a study aim ed at determining whether or not expressive writing improves the quality -of-life of early breast cancer survivors . An additional aim is the investigation of whether or not the type of writing prompt makes a difference in results . BACKGROUND The risk of distress can extend well beyond the time of a breast cancer diagnosis . Emotional expression may assist in dealing with this . DESIGN R and omized controlled study . METHODS Participants ( n = 120 ) were r and omized into one of four groups : a control group ( no writing ) or one of three expressive writing groups : breast cancer trauma , any self-selected trauma and facts related to breast cancer . Participants wrote 20 minutes a day for 4 consecutive days . Their quality -of-life was measured , using the ' Functional Assessment of Cancer Therapy-Breast Cancer Version ' , at baseline and at 1 month and 6 months after writing . Paired t-tests , multivariate analysis of variance and multiple regression were used to analyse the data of the 97 participants who completed the journaling assignment and at least the first assessment , collected in 2006 . Intention-to-treat analysis was used . RESULTS / FINDINGS Expressive writing about one 's breast cancer , breast cancer trauma and facts related to breast cancer , significantly improved the quality -of-life outcome . CONCLUSION Expressive writing , focusing the instructions on writing about one 's living and dealing with a diagnosis of breast cancer , is recommended for early breast cancer survivors as a feasible and easily implemented treatment approach to improve quality -of-life Objective : Nonpharmacologic treatments for asthma may act as useful adjuncts to pharmacotherapy but should be recommended to patients only after several well-controlled studies provide evidence of efficacy . Research demonstrating that written emotional expression can improve pulmonary function in patients with asthma consists of one impressive yet unreplicated study ( 1 ) . Our main objective was to test and extend previous research finding that written emotional expression improves pulmonary function in patients with asthma compared with writing on neutral topics . Methods : We conducted a r and omized , controlled trial of outpatient asthmatics recruited from hospitals and the community . Of the 137 adult patients with asthma who were r and omized , 117 began and 114 completed the study . Patients were r and omly assigned to write for 20 minutes , once per week , for 3 weeks about stressful experiences ( n = 41 ) , positive experiences ( n = 37 ) , or neutral experiences ( n = 36 ; control group ) . At baseline , postintervention , and 2-month follow up , patients were assessed by spirometry . Results : The mean change from baseline to 2-month follow up in percentage of predicted forced expiratory volume in 1 second ( FEV1 ) was 4.2 % in the stress-writing group , 1.3 % in the positive-writing group , and 3.0 % in the control group . In forced vital capacity ( FVC ) , there was 3.1 % improvement in the stress-writing group , 3.6 % in the positive-writing group , and 2.4 % in the control group . These changes were not statistically or clinical ly significant . Conclusions : The present study reduces confidence in the ability of written emotional expression to benefit the disease status of asthma patients . FEV1 = forced expiratory volume in 1 second ; FVC = forced vital capacity ; VAPAHCS = Veteran Affairs Palo Alto Health Care System ; PTSD = posttraumatic stress disorder ; COPD = chronic obstructive pulmonary disease CONTEXT Nonpharmacological treatments with little patient cost or risk are useful supplements to pharmacotherapy in the treatment of patients with chronic illness . Research has demonstrated that writing about emotionally traumatic experiences has a surprisingly beneficial effect on symptom reports , well-being , and health care use in healthy individuals . OBJECTIVE To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using st and ardized quantitative outcome measures . DESIGN R and omized controlled trial conducted between October 1996 and December 1997 . SETTING Outpatient community residents drawn from private and institutional practice . PATIENTS Volunteer sample of 112 patients with asthma ( n = 61 ) or rheumatoid arthritis ( n = 51 ) received the intervention ; 107 completed the study , 58 in the asthma group and 49 in the rheumatoid arthritis group . INTERVENTION Patients were assigned to write either about the most stressful event of their lives ( n = 71 ; 39 asthma , 32 rheumatoid arthritis ) or about emotionally neutral topics ( n = 41 ; 22 asthma , 19 rheumatoid arthritis ) ( the control intervention ) . MAIN OUTCOME MEASURES Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were clinical ly examined by a rheumatologist . Assessment s were conducted at baseline and at 2 weeks and 2 months and 4 months 
    Output:
    