Using Expressive Writing to Explore Thoughts and Beliefs about Cancer and Treatment among Chinese American Immigrant Breast Cancer Survivors

Psychooncology. Author manuscript; available in PMC 2017 Nov 1.
Published in final edited form as:
Psychooncology. 2016 Nov; 25(11): 1371–1374.

Published online 2015 Sep 25. doi:  10.1002/pon.3991

Qian Lu, Ph.D., M.D.,1 Nelson C. Y. Yeung, M.Phil.,1 Jin You, Ph.D.,2 and Jiajie Dai, M.S.1

A pilot study of expressive writing intervention among Chinese-speaking breast cancer survivors.

Health Psychol. 2012 Sep;31(5):548-51. doi: 10.1037/a0026834. Epub 2012 Jan 9.

Lu Q1, Zheng D, Young L, Kagawa-Singer M, Loh A.

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 populations. This pilot study aimed to test the cultural sensitivity, feasibility, and potential health benefits of an expressive writing intervention among Chinese-speaking breast cancer survivors.


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.


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.


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 populations. Future studies employing randomized, controlled trial designs are warranted.

Writing Can Heal: Effects of Self-Compassion Writing Among Hong Kong Chinese College Students

(full text)

Asian American Journal of Psychology © 2016 American Psychological Association 2016, Vol. 7, No. 1, 74–82 1948-1985/16/$12.00

Self-compassion has been repeatedly shown to be associated with mental and physical well-being. Recent studies showed that self-compassion writing can promote mental well-being, but this has not been examined among Chinese populations. The present study examined the effectiveness of self-compassion writing among Chinese students. One hundred and twelve university students were recruited and randomly assigned into 1 of the following 2 writing conditions: self-compassion writing and control writing. Participants were asked to write according to the instruction for 3 times in a week and report their levels of positive and negative affect immediately after writing. Self-reported depressive symptoms and physical symptoms, as well as self-compassion (i.e., self-kindness, common humanity, and mindfulness) and emotion regulation capacities (i.e., attention, clarity, and repair) were assessed at baseline and 2 follow-ups (1-month, 3-month). Results showed the self-compassion writing group reported more negative affect across the 3 days of writing than the control group. No significant group differences were found in depressive symptoms, self-compassion components, or emotion regulation capacities, but the self-compassion writing group reported a significant drop in physical symptoms at the 1- and 3-month follow-up whereas the control writing group reported no significant change in physical symptoms across time. The findings suggested that self-compassion writing may benefit physical health, but further studies should be conducted to examine its underlying mechanism.

How benefits of expressive writing vary as a function of writing instructions, ethnicity and ambivalence over emotional expression



Psychology & Health

Volume 25, 2010 – Issue 6


Pages 669-684


Written emotional disclosure has been reported to confer a variety of benefits on physical and psychological well-being. However, variable findings suggest that outcomes may vary systematically as a function of specific parameters of the experimental design. This study aims to investigate the unique and combined effects of disclosure instructions focusing on emotional expression and instructions facilitating cognitive reappraisal and to examine how ambivalence over emotional expression and ethnicity moderate the effects of these writing instructions. Seventy-one Asian and 59 Caucasian undergraduates (N = 130) with at least minimal physical or depressive symptoms were randomly assigned to one of the four writing conditions: emotional disclosure (ED), cognitive reappraisal (COG), the combination of ED and COG, or a control condition. Self-reported physical symptoms, positive affect (PA) and negative affect were assessed at baseline and three follow-ups spanning 4 months. Mixed linear models revealed that COG writing reduced physical symptoms, ED buffered a decrease in PA over time, and the combination of ED and COG (i.e. self-regulation; SR) was most effective. Asians and highly ambivalent participants benefited most from expressive writing. Findings contribute to the development of a SR moderator model and carry implications for designing expressive disclosure studies, particularly for ethnic minorities.