Expressive writing/journaling is the art of putting thoughts and feelings on paper. Writing about negative emotional experiences may improve physical and psychological health, and writing about deep feeling regarding personal stressors can enhance well-being and health. Expressive writing as a form of emotional disclosure has been examined in fatigue and depression and may have relevance for pain, sleep-wake disturbances, anxiety, and caregiver strain and burden. Individuals may be counseled to write specifically about thoughts and feelings, or some other aspect of their experience.
de Moor, C., Sterner, J., Hall, M., Warneke, C., Gilani, Z., Amato, R., & Cohen, L. (2002). A pilot study of the effects of expressive writing on psychological and behavioral adjustment in patients enrolled in a phase II trial of vaccine therapy for metastatic renal cell carcinoma. Health Psychology, 21(6), 615–619.
An expressive writing intervention involved four writing sessions. Patients were randomized to an expressive writing (EW) group in which they were instructed to write their deepest thoughts and feelings about their cancer or to a neutral writing (NW) group in which they were instructed to write about a different health behavior at each session. Writing instructions were developed from the Pennebaker and Beall model. Repeated measures at baseline, end of intervention, and 4, 6, 8, and 10 weeks later.
It is implied that the setting is outpatient, in which patients are participating in a phase II clinical trial using vaccine therapy.
There was 86% and 81% adherence with each group. No differences in the POMS fatigue subscale were found; the POMS vigor subscale was significantly higher in the EW group.
Lu, Q., Zheng, D., Young, L., Kagawa-Singer, M., & Loh, A. (2012). A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors. Health Psychology, 31, 548–551.
To test the feasibility, cultural sensitivity, and effect of an expressive writing intervention.
Patients completed baseline assessments by mail and received three envelopes that were to be opened according to labels for study week. They were asked to write about their deepest feelings about having cancer and about the strategies they used for coping. They were to write for 20 minutes each week. After the last writing assignment and three and six months later they completed study questionnaires by mail. Focus group interviews were also conducted.
The study used a quasiexperimental, pre-/post repeated measures design.
At three months, the change in fatigue showed a partial eta2 of 0.066, and eta2 for posttraumatic stress was 0.208. There was 100% compliance in completing writing assignments. Patients commented that the activity was meaningful for Chinese women.
Findings suggested that expressive writing is a feasible and acceptable intervention for Chinese American women.
Expressive writing appeared to be an acceptable intervention for these women. The study design and sample size did not allow for any firm conclusions about effects to be drawn.
Mosher, C. E., Duhamel, K. N., Lam, J., Dickler, M., Li, Y., Massie, M. J., & Norton, L. (2012). Randomised trial of expressive writing for distressed metastatic breast cancer patients. Psychology and Health, 27, 88–100.
To examine the health effects—on existential and psychological well-being, fatigue, and sleep—of writing about the deepest cancer-related thoughts and feelings in patients with advanced breast cancer.
The study was a randomized trial, with interviewers blinded in regard to the group they were interviewing.
In this sample, expressive writing—compared to neutral writing—did not result in better existential and psychological well-being, reduced fatigue, or enhanced sleep quality. Although both writing groups showed little change in their distress over time, during the study, patients in the expressive writing group reported more than double the rate of mental health service use than did patients in the neutral writing group.
Expressive writing may have increased patients’ awareness of their distress and challenging circumstances, prompting the patients to seek mental health services. Further research is needed.
Expressive writing may increase use of psychological support services by distressed patients, without increasing symptom severity. Expressive writing may help keep patients in touch with their emotions, whether negative or positive. When patients are in touch with their emotions, they may be more likely to reach out for help, if they recognize negative emotions that they are not resolving on their own. However, this intervention did not result in differences in patient symptoms or outcomes.