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Symposia

Cognitive Science/ Cognitive Processes

How adaptive mental time travel can reduce anxiety and improve well-being: Novel CBT approaches to revisiting the past and reimagining the future

2 - (SYM 68) Writing Content Predicts Outcomes in Written Exposure to Worst-case Future Scenarios in Advanced Cancer

Sunday, November 23, 2025
2:27 PM - 2:48 PM CST
Location: Celestin D&E, Level 3
Keywords: Anxiety, Cognitive Processes, Translational Research
Recommended Readings: Moscovitch, D. A., Moscovitch, M., & Sheldon, S. (2023). Neurocognitive Model of Schema-Congruent and -Incongruent Learning in Clinical Disorders: Application to Social Anxiety and Beyond. Perspectives on Psychological Science, 18(6), 1412-1435. https://doi.org/10.1177/17456916221141351,   Craske, M. G., Dunn, B. D., Meuret, A. E., Rizvi, S. J., & Taylor, C. T. (2024). Positive affect and reward processing in the treatment of depression, anxiety, and trauma. Nature Reviews Psychology, 3(10), 665–685. https://doi.org/10.1038/s44159-024-00355-4,   Benito, K., Pittig, A., Abramowitz, J., Arch, J. J., Chavira, D., de Kleine, R., De Nadai, A. S., Hermans, D., Hofmann, S. G., Hoyer, J., Huppert, J. D., Kircanski, K., McEvoy, P. M., Meyer, H., Monfils, M.-H., Papini, S., Rief, W., Rosenfield, D., Storch, E. A., … Smits, J. A. J. (2024). Mechanisms of Change in Exposure Therapy for Anxiety and Related Disorders: A Research Agenda. Clinical Psychological Science, 0(0). https://doi.org/10.1177/21677026241240727,   ,  
Abstract Body

Background: Living with late-stage cancer can trigger intense fear of the future including imagined worst-case scenarios (WCS), fear of future cancer progression, and cancer-related trauma symptoms. This study evaluated the mechanisms of a novel intervention (‘EASE’) to reduce fear of progression (FoP) and cancer-related trauma symptoms by writing in specific ways about these future WCS.  EASE is novel, brief, easy to learn, and delivered by telehealth; it consists of 3 written exposure sessions followed by 2 written coping sessions. EASE embodies this year’s conference theme by “bridging the divide” and reducing barriers to supporting distressed adults with life-threatening disease – a population that has been generally overlooked by cognitive behavioral interventions.

Methods: EASE was evaluated among 29 adults with stage 3 or 4 cancer and elevated cancer-related trauma symptoms or fear of cancer progression (FoP). Participant writing was collected at each of the five weekly intervention sessions (three written exposure sessions followed by two written coping sessions) and analyzed using LIWC-22 linguistic analysis software.

Results: EASE was associated with large and significant reductions in cancer-related trauma symptoms and fear of progression (FoP).  During the 3 written exposure sessions, greater use of positive emotion words (trauma: p< 0.001, ηp2=0.64; FoP: p=0.011, ηp2=0.34) and negative emotion words (FoP: p=0.007, ηp2=0.38) predicted worse trauma and/or FoP at post-intervention, whereas greater use of death-related words was the most robust predictor of improved FoP (p=0.023, ηp2=0.22). During the two written coping sessions, more positive tone predicted improved FoP (p=0.009, ηp2=0.31) and more negative tone predicted worse FoP (p=0.026, ηp2=0.22).



Conclusion: EASE writing instructions and content mattered, and exposure and coping writing sessions functioned somewhat distinctly. For the exposure-based sessions, writing about death/dying, and less emotionally, without ‘sugarcoating’ (using fewer positive emotions), led to greater reductions in cancer-related trauma or FoP. For the coping-based writing sessions, maintaining a more positive tone, as instructed, predicted greater improvements in FoP. These findings provide partial support for hypothesized EASE mechanisms.