Autobiographical Memory Writing Intervention with Cancer Survivors: a Study Protocol

Authors

  • Maria Luisa Martino Department of Humanities, Federico II University, Naples, Italy
  • Adele Nerini Oncology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Italy
  • Ermelinda Quarata Oncology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Italy
  • Matilde Cesaro Free University of Autobiography, Anghiari, Italy
  • Michela Conte Oncology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Italy
  • Gaetano Facchini Oncology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Italy
  • Chiara Barraco Oncology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Italy
  • Andrea D'Arienzo Oncology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Italy
  • Antonella Nicastro Oncology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Italy
  • Maria Francesca Freda Department of Humanities, Federico II University, Naples, Italy
  • Ida Bolognini Oncology Unit, Santa Maria Delle Grazie Hospital, Pozzuoli, Italy

DOI:

https://doi.org/10.13129/2282-1619/mjcp-5473

Keywords:

Autobiographical writing, Cancer survivors, Clinical Psychology, Narrative identity, Psycho-oncology, Psychological well-being, Study protocol

Abstract

A cancer diagnosis and its subsequent treatment can disrupt a person's sense of identity, temporal continuity, and personal meaning. Psychological distress often persists beyond the active treatment phase. Although cancer survivorship is increasingly recognised as a long-term psychosocial condition, there are limited structured interventions that specifically address this phase. Although narrative and writing-based approaches have shown potential in promoting meaning-making and identity reconstruction, existing paradigms mainly rely on expressive writing protocols. Interventions targeting autobiographical memory and narrative identity remain under-explored. This innovative protocol outlines the design and planned evaluation of the Autobiographical Memory Writing Intervention (AMWI): a four-month, co-conducted intervention for cancer survivors, delivered by a psycho-oncologist and a narrative coach. The programme consists of eight fortnightly sessions: the first and final sessions are dedicated to psychometric and qualitative assessment, and the six intermediate sessions constitute the autobiographical intervention. During these sessions, participants engage in guided autobiographical activities based on structured writing prompts and shared clinical meta-reflection. They progressively move from exploring personal identity to reconstructing cancer-related narratives. A quasi-experimental mixed-methods design will be implemented in two phases: first, a feasibility and micro-pilot phase with pre- and post-assessments; then, a controlled phase including a comparison group of survivors who decline the intervention but agree to complete assessments, with a three-month follow-up. Primary outcomes include psychological distress, depressive symptoms, anxiety, and trauma-related symptoms, while secondary outcomes include autobiographical memory processes and perceived social support. Narrative materials will be analysed qualitatively and integrated with quantitative findings. The expected outcomes are related to improvements in psychological well-being resulting from integrating one’s personal cancer story into one’s autobiographical identity. The evaluation of the clinical efficacy of AMWI will involve extending current clinical approaches targeted at cancer survivorship to offer a more comprehensive alternative using different devices of semiotic mediation and multilayered discursive channels to empower clinical implications.  

References

1. Birren, J. E., & Deutchman, D. E. (1991). Guiding autobiography groups for older adults: Exploring the fabric of life. Johns Hopkins University Press.

2. Bottesi, G., Ghisi, M., Altoè, G., Conforti, E., Melli, G., & Sica, C. (2015). The Italian version of the Depression Anxiety Stress Scales-21: Factor structure and psychometric properties on community and clinical samples. Comprehensive psychiatry, 60, 170–181.

https://doi.org/10.1016/j.comppsych.2015.04.005

3. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. https://doi.org/10.1191/1478088706qp063oa

4. Bray, F., Ferlay, J., Soerjomataram, I., Siegel, R. L., Torre, L. A., & Jemal, A. (2018). Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 68(6), 394–424. https://doi.org/10.3322/caac.21492

5. Burney, S. (2019). Psychological issues in cancer survivorship. Climacteric, 22(6), 584-588.

https://doi.org/10.1080/13697137.2019.1606795

6. Charon, R. (2017). The principles and practice of narrative medicine. Oxford University Press.

7. Conway, M. A., & Pleydell-Pearce, C. W. (2000). The construction of autobiographical memories in the self-memory system. Psychological Review, 107(2), 261–288.

https://doi.org/10.1037/0033-295X.107.2.261

8. De Vincenzo, F., Cosentino, C., Quinto, R. M., Di Leo, S., Contardi, A., Guidotti, S., Iani, L., & Pruneti, C. (2022). Psychological adjustment and heart rate variability in ovarian cancer survivors. Mediterranean Journal of Clinical Psychology, 10(1), 1-18.

https://doi.org/10.13129/2282-1619/mjcp-3318

9. Denzin, N. K., & Lincoln, Y. S. (Eds.). (1994). Handbook of qualitative research. Sage Publications, Inc.

10. Devlin, E. J., Denson, L. A., & Whitford, H. S. (2017). Cancer treatment side effects: a meta-analysis of the relationship between response expectancies and experience. Journal of Pain and Symptom Management, 54(2), 245-258. https://doi.org/10.1016/j.jpainsymman.2017.03.017

11. Fioretti, C., & Smorti, A. (2017). Narrating positive versus negative memories of illness: Does narrating influence the emotional tone of memories? European Journal of Cancer Care, 26(3), e12524.

https://doi.org/10.1111/ecc.12524

12. Fitzmaurice, C., Allen, C., Barber, R. M., Barregard, L., Bhutta, Z. A., Brenner, H., Dicker, D. J., Chimed-Orchir, O., Dandona, R., Dandona, L., Fleming, T., Forouzanfar, M. H., Hancock, J., Hay, R. J., Hunter-Merrill, R., Huynh, C., Hosgood, H. D., Johnson, C. O., Jonas, J. B., … Naghavi, M. (2017). Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-years for 32 Cancer Groups, 1990 to 2015: A Systematic Analysis for the Global Burden of Disease Study. JAMA oncology, 3(4), 524–548.

https://doi.org/10.1001/jamaoncol.2016.5688

13. Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132(6), 823–865. https://doi.org/10.1037/0033-2909.132.6.823

14. Freda, M. F., Lemmo, D., Auriemma, E., De Luca Picione, R., & Martino, M. L. (2023). From sense to meaning: Narrative Function Coding System for the experience of illness. Qualitative Research Journal, 23(1), 41-61. https://doi.org/10.1108/QRJ-06-2022-0081

15. Gil, F., Grassi, L., Travado, L., Tomamichel, M., & Gonzalez, J. R. (2005). Use of distress and depression thermometers to measure psychosocial morbidity among southern European cancer patients. Supportive care in cancer, 13(8), 600-606. https://doi.org/10.1007/s00520-005-0780-0

16. Kaptein, A. A., 2021. Writing cancer. Support. Care Cancer 29 (8), 4375–4380.

https://doi.org/10.1007/s00520-020-05920-0

17. Lai, J., Song, H., Wang, Y., Ren, Y., Li, S., Xiao, F., Liao, S., Xie, T., & Zhuang, W. (2023). Efficacy of expressive writing versus positive writing in different populations: Systematic review and meta‐analysis. Nursing Open, 10(9), 5961-5974. https://doi.org/10.1002/nop2.1897

18. Lancia, F. (2004). Strumenti per l'analisi dei testi. Introduzione all'uso di T-LAB. Milano: Franco Angeli.

19. Lee, Y., & Kim, E. (2026). Effect Size of Factors Influencing Colorectal Cancer Survivors' Quality of Life: A Systematic Review and Meta‐Analysis. Cancer Medicine, 15(5), e71841.

https://doi.org/10.1002/cam4.71841

20. Mahvi, D. A., Liu, R., Grinstaff, M. W., Colson, Y. L., & Raut, C. P. (2018). Local cancer recurrence: the realities, challenges, and opportunities for new therapies. CA: a Cancer Journal for Clinicians, 68(6), 488-505. https://doi.org/10.3322/caac.21498

21. Martino, M. L., Nerini, A., Quarata, E., Facchini, G., Barraco, C., D'Arienzo, A., Nicastro, A., Cesaro, M., Freda, M. F., & Bolognini, I. (2026). Writing interventions with cancer survivors: which paradigms for which effects? A systematic review. European Journal of Oncology Nursing, 80, 103045. https://doi.org/10.1016/j.ejon.2025.103045

22. Martino, M. L., Lemmo, D., & Gargiulo, A (2021). A review of psychological impact of breast cancer in women below 50 years old. Health Care for Women International, 42(7-9), 1066-1085.

https://doi.org/10.1080/07399332.2021.1901901

23. Martino, M. L., Lemmo, D., Moylan, J., Stevenson, C., Bonalume, L., Freda, M. F., & Singer, J. A. (2023). The role and function of autobiographical memory narratives during the emotional processing of breast cancer treatment: an empirically-derived memory coding system. International Journal of Environmental Research and Public Health, 20(2), 1492. https://doi.org/10.3390/ijerph20021492

24. Martino, M. L., Sebri, V., Singer, J., Madow, K., Giudice, A. V., Mazzoni, D., Freda, M. F., & Pravettoni, G. (2024). Specificity and integration of meaning in self-defining memories of breast cancer survivors: clinical reflections to promote a narrative identity integration. Frontiers in Psychology, 15, 1433266. https://doi.org/10.3389/fpsyg.2024.1433266

25. McAdams, D. P. (2008). Personal narratives and the life story. In: John, O.P., Robins, R.W., Pervin, L.A. (Eds.), Handbook of Personality: Theory and Research. The Guilford Press, New York, pp. 242–262.

26. McAdams, D. P., Bauer, J. J., Sakaeda, A. R., Anyidoho, N. A., Machado, M. A., Magrino- Failla, K., White, K. W., Pals, J. L. (2006). Continuity and change in the life story: A longitudinal study of autobiographical memories in emerging adulthood. Journal of personality, 74(5), 1371-1400.

https://doi.org/10.1111/j.1467-6494.2006.00412.x.

27. Merz, E. L., Fox, R. S., & Malcarne, V. L. (2014). Expressive writing interventions in cancer patients: a systematic review. Health Psychology Review, 8(3), 339-361.

https://doi.org/10.1080/17437199.2014.882007

28. Miniati, M., Miccoli, M., Ciacchini, R., Orrù, G., & Conversano, C. (2020). Defensive responses to stressful life events associated with cancer diagnosis. Mediterranean Journal of Clinical Psychology, 8(1).

https://doi.org/10.6092/2282-1619/mjcp-2384

29. Neimeyer, R. A. (2019). Meaning reconstruction in bereavement: Development of a research program. Death Studies, 43(2), 79–91. https://doi.org/10.1080/07481187.2018.1456620

30. Nieto, M., Navarro-Bravo, B., Moreno, B., Ocana, A., Serrano, J. P., Boix Gras, C., Ricarte, J., Fernández-Aguilar, L., Ros, L., & Latorre, J. M. (2019). Functioning of autobiographical memory specificity and self-defining memories in people with cancer diagnosis. PeerJ, 7, e8126.

https://doi.org/10.7717/peerj.8126

31. Park, C. L. (2022). Meaning making following trauma. Frontiers in Psychology, 13, 844891.

https://doi.org/10.3389/fpsyg.2022.844891

32. Pennebaker, J. W. (1997). Writing about emotional experiences as a therapeutic process. Psychological Science, 8(3), 162–166. https://doi.org/10.1111/j.1467-9280.1997.tb00403.x

33. Sansom-Daly, U. M., Wakefield, C. E., Robertson, E. G., McGill, B. C., Wilson, H. L., & Bryant, R. A. (2018). Adolescent and young adult cancer survivors’ memory and future thinking processes place them at risk for poor mental health. Psycho-Oncology, 27(12), 2709–2716.

https://doi.org/10.1002/pon.4856

34. Schellekens, M. P., Zwanenburg, L. C., & van der Lee, M. L. (2024). Resilience in the face of cancer: on the importance of defining and studying resilience as a dynamic process of adaptation. Current Oncology, 31(7), 4003-4014. https://doi.org/10.3390/curroncol31070297

35. Singer, J. A., & Blagov, P. S. (2000). Classification system and scoring manual for self-defining autobiographical memories. Unpublished manuscript, Connecticut College.

36. Smyth, J. M. (1998). Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66(1), 174–184. https://doi.org/10.1037/0022-006X.66.1.174

37. Tedeschi, R. G., & Calhoun, L. G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 1–18. https://doi.org/10.1207/s15327965pli1501_01

38. Thomsen, D. K., Cowan, H. R., & McAdams, D. P. (2025). Mental illness and personal recovery: A narrative identity framework. Clinical Psychology Review, 116, 102546.

https://doi.org/10.1016/j.cpr.2025.102546

39. Weiss, D. S. (2007). The impact of event scale: revised. In Cross-cultural assessment of psychological trauma and PTSD (pp. 219-238). Boston, MA: Springer US.

https://doi.org/10.1007/978-0-387-70990-1_10

40. Williams, J. M. G., Barnhofer, T., Crane, C., Hermans, D., Raes, F., Watkins, E., & Dalgleish, T. (2007). Autobiographical memory specificity and emotional disorder. Psychological Bulletin, 133(1), 122–148. https://doi.org/10.1037/0033-2909.133.1.122

41. Zainal, N. Z., Booth, S., & Huppert, F. A. (2013). The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: a meta-analysis. Psycho-oncology, 22(7), 1457–1465.

https://doi.org/10.1002/pon.3171

42. Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30–41.

https://doi.org/10.1207/s15327752jpa5201_2

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Published

15-08-2026

Issue

Vol. 14 No. 2 (2026)

Section

Health Psychology

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