Expressive writing in patients receiving palliative care: a feasibility study. Linguistic predictors of adaptive bereavement. The pilot study. The feasibility and effectiveness of an expressive writing intervention for rheumatoid arthritis via home-based videotaped instructions The WRITTEN-HEART study (expressive writing for heart healing): rationale and design of a randomized controlled clinical trial of expressive writing in coronary patients referred to residential cardiac rehabilitation A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors. Written emotional disclosure buffers the effects of social constraints on distress among cancer patients. Expressive Disclosure and Health Outcomes in a Prostate Cancer Population Expressive writing in early breast cancer survivors. Does Writing Affect Asthma? A Randomized Trial Implementing an expressive writing study in a cancer clinic. Effect of Internet peer-support groups on psychosocial adjustment to cancer: a randomised study Does emotional expression make a difference in reactions to breast cancer? Expressive disclosure and benefit finding among breast cancer patients: mechanisms for positive health effects. Does narrative writing instruction enhance the benefits of expressive writing? Emotional disclosure through patient narrative may improve pain and well-being: results of a randomized controlled trial in patients with cancer pain. Narrowing the gap: the effects of an expressive writing intervention on perceptions of actual and ideal emotional support in women who have completed treatment for early stage breast cancer. Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors - results from a nationwide randomized clinical trial. Who benefits from emotional expression? An examination of personality differences among gynaecological cancer patients participating in a randomized controlled emotional disclosure intervention trial. [Development and effectiveness of expressive writing program for women with breast cancer in Korea].
BACKGROUND Patients with advanced cancer receiving palliative care often experience severe physical and psychosocial symptoms . However , there are limited re sources for psychological and emotional support . Expressive writing has shown decreased anxiety level in young and healthy people suffering from a number of stressors . OBJECTIVE The purpose of this study was to determine the feasibility of expressive writing in patients receiving palliative care and the most suitable outcomes of expressive writing in this patient population . DESIGN In this pilot study , patients were r and omly assigned to either the expressive writing group ( EW ) or the neutral writing group ( NW ) . Anxiety level before and after the writing session was compared between the two groups . Writing material s were content analyzed using st and ard qualitative research methods . RESULTS A total of 24 patients ( 12 in EW and 12 in NW ) were enrolled in the study between October 2006 and January 2007 . Although the majority of patients ( 83%-100 % ) were able to complete all baseline assessment s , poor adherence was observed during the follow-ups . Only 8 % of patients completed the 2-week study . There was no significant difference in the State-Trait Anxiety Inventory ( STAI ) State-Anxiety scores at baseline , before and after each writing session between the EW and NW groups . DISCUSSION Our rapid accrual suggests that palliative care patients are interested in participating in studies such as expressive writing . The high level of adherence to the baseline assessment s indicates that these assessment s were not particularly difficult for our patients to complete . Future studies may need to include patients with better performance status , better patient education , means of emotional expression ( i.e. , audio recording , telephone interview ) and improved adherence . CONCLUSION We conclude that clinical trials of expressive writing in the palliative care setting are not feasible unless they undergo major modification in methods compared to those previous reported in other patient population . Our findings will hopefully assist research ers considering similar studies The words people use in  disclosing a trauma  were hypothesized to predict improvements in mental and physical health in 2 studies . The first study reanalyzed data from 6 previous experiments in which language variables served as predictors of health . Results from 177 participants in previous writing studies showed that increased use of words associated with insightful and causal thinking was linked to improved physical but not mental health . Higher use of positive relative to negative emotion words was also associated with better health . An empirical measure that was derived from these data correlated with subsequent distress ratings . The second study tested these models on interview transcripts of 30 men who had lost their partners to AIDS . Cognitive change and empirical models predicted postbereavement distress at 1 year . Implication s of using computer-based text analyses in the study of narratives are discussed This pilot aims to better underst and the market for childcare in Saudi Arabia – both the supply and dem and sides – and to design a r and omized controlled experiment to test whether access to affordable day care ( in the form of subsidies , for example ) would incentivize Saudi mothers to search actively for employment and to remain employed once they are hired . In addition , the study seeks to underst and the degree to which employment early on in one ’s life impacts employment in later stages . The pilot will provide information on the groups of women the experiment should target , appropriate levels for the childcare subsidy , and the quality and current geographic locations of daycare sites . Expected Impact Determine the effects of facilitating childcare access on Saudi women ’s employment . PRINCIPAL INVESTIGATORS  Boston University Patricia Cortes  Harvard University Claudia Goldin  Swarthmore College Jennifer 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 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 Objective : This pilot study explored the feasibility and the efficacy of a brief , well-defined psychosocial intervention ( expressive disclosure ) in improving behavioral , medical , immunological , and emotional health outcomes in men with diagnosed prostate cancer . Method : Thirty prostate cancer patients receiving outpatient oncology care were r and omized into  experimental ( disclosure ) and control ( non-disclosure ) groups . All had been previously treated by surgery or radiation within the last 4 years and were being monitored without further intervention for change in PSA levels .  Psychological and physical health surveys were administered and peripheral blood for PSA levels and immune assays was obtained upon study enrollment and again at 3 and 6 months post enrollment . Multivariate analyses were used to examine how the expressive disclosure impacted the hypothesized domains of functioning : physical and psychological symptoms ; health care utilization ; and immunocompetence . Results : Compared to controls , patients in the expressive disclosure condition showed improvements in the domains of physical symptoms and health care utilization , but not in psychological variables nor in disease relevant aspects of immunocompetence . Conclusions : Study results support the feasibility of an expressive disclosure intervention for men with prostate cancer . The intervention was well accepted by this population , and participation/adherence was quite high . Results provide only limited support for the hypothesis that a written emotional disclosure task can positively impact health outcomes in a cancer population . However , this pilot study may have lacked adequate power to detect possible intervention benefits . Further studies with larger sample s are needed to better assess the intervention 's impact on psychological well-being and immunocompetence 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 Patients at a comprehensive cancer center have participated in a weekly writing program for 7 years . Anecdotal evidence following writing in this clinical setting appeared congruent with the results of expressive writing studies conducted in laboratory setting s. To move expressive writing research beyond the laboratory , we evaluated the feasibility of engaging a clinical population in a structured expressive writing task while they waited for an appointment in a cancer clinic . Adult leukemia and lymphoma patients ( n = 71 ) completed a baseline assessment , 20-minute writing task , postwriting assessment , and 3-week follow-up ; 88 % completed the writing task and 56 % completed the follow-up . Participants reported positive responses to the writing , and immediately postwriting about half ( 49.1 % ) reported that writing result ed in changes in their thoughts about their illness , while 53.8 % reported changes in their thoughts at the 3-week follow-up . Reports of changes in thoughts about illness immediately postwriting were significantly associated with better physical quality of life at follow-up , controlling for baseline quality of life . Initial qualitative analyses of the texts identified themes related to experiences of positive change/transformation following a cancer diagnosis . Findings support the feasibility of conducting expressive writing with a clinical population in a nonlaboratory setting . Cancer patients were receptive to expressive writing and reported changes in the way they thought about their illness following writing . These preliminary findings indicate that a single , brief writing exercise is related to cancer patients ' reports of improved quality of life Background : We conducted a r and omised study to investigate whether providing a self-guided Internet support group to cancer patients affected mood disturbance and adjustment to cancer . Methods : Baseline and 1- , 6- and 12-month assessment s were conducted from 2004 to 2006 at a national rehabilitation centre in Denmark . A total of 58 rehabilitation course weeks including 921 survivors of various cancers were r and omly assigned to a control or an intervention group by cluster r and omisation . The intervention was a lecture on the use of the Internet for support and information followed by participation in an Internet support group . Outcome measures included self-reported mood disturbance , adjustment to cancer and self-rated health . Differences in scores were compared between the control group and the intervention group . Results : The effect of the intervention on mood disturbance and adjustment to cancer showed a transient difference at the 6-month follow-up , where the intervention group reported less reduction in anxious preoccupation ( P=0.04 ) , helplessness ( P=0.002 ) , confusion ( P=0.001 ) and depression ( P=0.04 ) . Otherwise no significant effects were observed . Conclusion : We conclude that use of Internet-based support groups in cancer patients still needs to confirm long-lasting psychological effects PURPOSE / OBJECTIVES To examine the feasibility of using an emotional expression intervention with patients with cancer and test the hypothesis that emotional expression improves psychosocial adjustment . DESIGN Sequentially r and omized pretest/post-test design with repeated measures . SETTING Two radiation therapy ( RT ) facilities . SAMPLE Women completing RT for stage I or II breast cancer , who spoke and read English , were independent in self-care , and provided written consent . Subjects ( N = 44 ) were middle-aged ( mean = 53.6 years ) , Caucasian , married , and well educated . METHODS Following a baseline interview , subjects were sequentially r and omized to an attentional control group , a single dose , or a three-dose emotional expression writing group . Interventions were administered at the time of completion of RT . Follow-up telephone interviews were completed at 1 , 4 - 6 , 16 , and 28 weeks post-RT . MAIN RESEARCH VARIABLES Positive and negative affect , intrusiveness of thoughts , use of avoidant coping , side effect severity , trait negative affectivity , content of written essay , and themes derived from content analysis . FINDINGS A high level of acceptance and completion of emotional expression existed , but no effect of the intervention on psychosocial adjustment was evident . Process measures in the three-dose group changed as expected . No relationship existed between content changes and outcome measures . CONCLUSIONS Emotional expression is feasible for patients with cancer , but the efficacy of the intervention in improving mood and decreasing cognitive intrusion and avoidance was not supported . Emotional expression processes were consistent with those seen in other sample s and may influence outcomes that were not addressed in this study . IMPLICATION S FOR NURSING PRACTICE More extensive testing is needed , including additional outcome variables . Essays reveal concerns around communication , recurrence , and health behavior changes that should be considered in practice A r and omized trial ( n = 60 ; A. L. Stanton , S. Danoff-Burg , L. A. Sworowski , et al. , 2002 ) revealed that 4 sessions of written expressive disclosure or benefit finding produced lower physical symptom reports and medical appointments for cancer-related morbidities at 3-month follow-up among breast cancer patients relative to a fact-control condition . The goal of this article is to investigate mechanisms underlying these effects . Within-session heart rate habituation mediated effects of expressive disclosure on physical symptoms , and greater use of negative emotion words in essays predicted a decline in physical symptoms . Postwriting mood and use of positive emotion and cognitive mechanism words in essays were not significant mediators , although greater cognitive mechanism word use was related to greater heart rate habituation and negative emotion word use Abstract We examined whether instructing participants to write in a narrative fashion about stressful life events would produce superior physical and psychological health benefits relative to st and ard expressive writing instructions that do not specify the essay 's structure . Undergraduates ( N=101 ) were r and omly assigned to engage in two , 20-minute narrative writing , st and ard expressive writing , or control writing tasks . Follow-up data were obtained one month later . The essays of the narrative writing group evidence d higher levels of narrative structure than did those of the expressive writing group . Greater narrative structure was associated with mental health gains , and self-rated emotionality of the essays was associated with lesser perceived stress at follow-up . In addition , the narrative and expressive writing groups reported lower levels of perceived stress and depressive symptoms relative to controls but did not differ from each other with regard to these outcomes . Health care utilization at follow-up did not vary by group assignment . Findings suggest that both emotional expression and narrative structure may be key factors underlying expressive writing 's mental health benefits . Results also suggest that , among college students , instruction in narrative formation does not increase the positive effects of expressive writing relative to st and ard expressive writing instructions Narrative medicine is based upon physicians ' awareness of patients ' narration of their suffering , their hopes , and how illness has affected them . It offers a model for improving health outcomes . To determine whether incorporating a narrative approach in patients with cancer decreases pain intensity and improves their global sense of well-being , we performed a r and omized , single-blind controlled trial in adult patients with cancer and average pain intensity levels of at least 5/10 . Two hundred thirty-four patients were r and omized into three groups : ( 1 ) narrative ( n=79 ) , in which patients wrote a story about how cancer affected their lives for at least 20 minutes once a week for three weeks ; ( 2 ) question naire ( n=77 ) , in which patients filled out the McGill Pain Question naire ; and ( 3 ) control ( n=78 ) , in which patients came weekly to medical visits during which they received usual customary care . Patients rated their pain on a 0 - 10 scale and their well-being on a seven-point Likert scale weekly for eight weeks . Two raters independently evaluated the emotional content of the narratives . Pain intensity and sense of well-being were similar in all groups before and after treatment . Subgroup analyses showed that patients whose narratives had high emotional disclosure had significantly less pain and reported higher well-being scores than patients whose narratives were less emotional . Further study is needed to demonstrate whether the implementation of narrative medicine is associated with health benefits in this and other context OBJECTIVE To assess the effects of an expressive writing ( EW ) intervention on perceptions of emotional support in women completing treatment for early stage breast cancer . METHODS Women were recruited to the study during their final week of treatment . Of 260 eligible patients , 104 ( 40 % ) agreed to participate , and 93 were r and omised . Women in the writing group wrote for 20 min on four consecutive days . The control group received normal care . Women 's perceptions of emotional support , quality of life ( QOL ) , mood , and healthcare utilisation were assessed at baseline , 1 month , 3 months and 6 months . Interviews were conducted to explore women 's experience of writing . RESULTS Eighty participants completed all follow-ups . There was a significant effect of group on women 's perceptions of social support with those in the intervention group being more satisfied with the emotional support they received ( p<0.05 ) . Satisfaction with emotional support was negatively correlated with depression/dejection ( p<0.05 ) and anger/hostility ( p<0.05 ) and positively correlated with social and family well-being ( p<0.001 ) 6 months post intervention . There were no significant effects of the intervention on mood , QOL or healthcare utilisation . Most participants found writing valuable and did not report any long-term negative effects . CONCLUSION EW was associated with a higher level of satisfaction with emotional support compared with controls . Given the existing evidence supporting the importance of social support in adjustment to breast cancer , it seems feasible to suggest that EW may be a cost effective accessible treatment that could be incorporated into the ongoing care of women OBJECTIVE To examine the effects of an expressive writing intervention ( EWI ) on cancer-related distress , depressive symptoms , and mood in women treated for early stage breast cancer . METHODS A nationwide sample of 507 Danish women who had recently completed treatment for primary breast cancer were r and omly assigned to three 20-min home-based writing exercises , one week apart , focusing on either emotional disclosure ( EWI group ) or a non-emotional topic ( control group ) .  Cancer-related distress [ Impact of Event Scale ( IES ) ] , depressive symptoms ( Beck Depression Inventory-Short Form ) , and negative ( 37-item Profile of Moods State ) and positive mood ( Passive Positive Mood Scale ) were assessed at baseline and at 3 and 9 months post-intervention . Choice of writing topic ( cancer versus other ) , alexithymia ( 20-item Toronto Alexithymia Scale ) , and social constraints ( Social Constraints Scale ) were included as possible moderators . RESULTS Significant ( p<0.01 ) group differences in mood change from before to immediately after each session suggested successful manipulation . Reductions over time in psychological symptoms were seen in both groups ( p<0.05 ) , but no time × group interactions were found . Choice of writing topic moderated effects on IES , with women writing about other themes showing greater reductions in cancer-related avoidance than women writing about their cancer . Fewer depressive symptoms and higher levels of positive mood were seen 3 months post-intervention in women writing about their cancer when compared with the control group . Difficulties describing feelings and externally oriented thinking ( 20-item Toronto Alexithymia Scale ) moderated effects on positive mood and IES-total , while no moderating effects were found of social constraints . CONCLUSIONS In concordance with the majority of previous results with cancer patients , no main effects of EWI were found for cancer-related distress , depressive symptoms , and mood . Moderator analyses suggested that choice of writing topic and ability to process emotional experiences should be studied further The present study examined the role of neuroticism and extraversion in the effects of written emotional disclosure in patients diagnosed with gynaecological cancer . It was hypothesized that high levels of neuroticism would be associated with an increase in distress after emotional disclosure as mediated by heightened negative affect and avoidance post-disclosure . Conversely , we expected high extraversion to be associated with decreased distress as mediated by heightened positive moods and a decrease in avoidance . Eighty-eight participants were r and omly assigned to participate in an expressive writing task versus a control writing task .  Distress and avoidance were assessed at baseline and 6 months post-writing . Negative and positive mood were assessed immediately following writing . Multiple regression confirmed that neuroticism but not extraversion moderates the effects of  emotional disclosure  on distress , however no significant mediating relationships were found PURPOSE To develop a expressive writing program for women with breast cancer and to identify its effects on stress physical symptom , cancer symptom , anxiety , depression , and QOL . METHODS A non-equivalent control pre-post design was used . Participants were recruited from self-help groups in six hospitals and were assigned to the experimental  group ( 29 ) or control group ( 29 ) . Data were collected before , after , and at four weeks after the intervention program . Changes in the variables were evaluated to test effects of the developed program , using χ²-test , Fisher 's exact test , repeated measures ANOVA , and paired t-test . RESULTS The expressive writing program was developed for women with breast cancer based on Pennebaker 's expressive writing . Significant differences were found between the two groups for stress related to physical symptoms ( p<.00 ) and quality of life ( p=.024 ) . No significant differences were found in cancer symptoms , anxiety , or depression between the two groups . CONCLUSION The results indicate that the expressive writing program design ed to express cancer-related deep thoughts and emotions helps in decreasing physical symptoms and improving QOL . Further studies are needed to identify the effect on emotions such as anxiety and depression for women with breast cancer with above average levels of anxiety and depression
Decades of research have suggested that expressive writing produces physical and psychological benefits in controlled laboratory experiments among healthy college students .
This work has been extended to clinical and medical population s , including cancer patients .