Expressive writing improves health outcomes for breast cancer survivors

Writing down fears, emotions, and the benefits of a cancer diagnosis may improve health outcomes for Asian American survivors of breast cancer, according to a new study.

"The key to developing an expressive writing intervention is the writing instruction. Otherwise, writing is just like a journal recording facts and events. Writing a journal can be therapeutic, but oftentimes we don't get the empirical evidence to determine whether it's effective or not," said Qian Lu, MD, PhD, assistant professor and director of the Culture and Health Research Center at the University of Houston.

"In my research study, I found long-term physical and psychological health benefits when research participants wrote about their deepest fears and the benefits of a breast cancer diagnosis," she said.

The study was published in Health Psychology (2014; doi:10.1037/a0026834).  The goal of her research is to reduce the psychological burden among minority patients, particularly among breast cancer survivors.

"Cancer patients, like war veterans in Iraq, can experience posttraumatic stress symptoms. Many times when patients receive a cancer diagnosis, they face a lot of emotional trauma. There is a sense of loss, depression, [and] anxiety about going into treatment and how they are going to face the future," said Lu. "They have a lot of emotional events going on in their life."

In her research, Lu found little attention paid to Asian American breast cancer survivor's psychological needs. Previous studies largely focused on non-Hispanic white samples, and she found a need to research this understudied population. Some of the challenges she noted with this population were feeling stigmatized, shame associated with cancer, cultural beliefs of bearing the burden alone to avoid disrupting harmony, suppressing emotions, and a lack of trained mental health professionals with cultural and linguistic competency.

"We thought of a very interesting way to help this problem. It's actually fairly basic. It's to express emotions using writing," she said. "What's so interesting is that it has been proven as a scientific paradigm."

According to Lu, previous research found that writing about emotionally difficult events for just 20 to 30 minutes at a time over 3 or 4 days increased the immune function. The release offered by writing had a direct impact on the body's capacity to withstand stress and fight off infection and disease.

"The findings from the study suggest participants perceived the writing task to be easy, revealed their emotions, and disclosed their experiences in writing that they had not previously told others. Participants reported that they wrote down whatever they thought and felt, and perceived the intervention to be appropriate and valuable," said Lu.

Lu added that health outcomes associated with the expressive writing intervention include a decrease in fatigue, intrusive thoughts, and reducing posttraumatic stress after 3 months. She also noted a decrease in fatigue, posttraumatic stress, and greater qualify of life and positive affect after 6 months.

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