Implementing an Expressive Writing Study in a Cancer Clinic


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 settings. 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 resulted 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.




Health psychology and writing: an introduction.

J Health Psychol. 2009 Mar;14(2):158-60. doi: 10.1177/1359105308100199.

Murray M1.

There has been substantial empirical research on the health benefits of expressive writing. However, there has been less psychological research on the broader nature of writing and its relationship with health. The aim of this special section is to promote a more extensive engagement between health psychology and writing. It includes three articles on the value of investigating more established forms of writing, the nature of creative writing and the value of an intensive analysis of written accounts of illness. This article introduces this special section.

Neural activity during affect labeling predicts expressive writing effects on well-being: GLM and SVM approaches.

Soc Cogn Affect Neurosci. 2017 Sep 1;12(9):1437-1447. doi: 10.1093/scan/nsx084.

Memarian N1, Torre JB1, Haltom KE1, Stanton AL1,2,3, Lieberman MD1,2.

Affect labeling (putting feelings into words) is a form of incidental emotion regulation that could underpin some benefits of expressive writing (i.e. writing about negative experiences). Here, we show that neural responses during affect labeling predicted changes in psychological and physical well-being outcome measures 3 months later. Furthermore, neural activity of specific frontal regions and amygdala predicted those outcomes as a function of expressive writing. Using supervised learning (support vector machines regression), improvements in four measures of psychological and physical health (physical symptoms, depression, anxiety and life satisfaction) after an expressive writing intervention were predicted with an average of 0.85% prediction error [root mean square error (RMSE) %]. The predictions were significantly more accurate with machine learning than with the conventional generalized linear model method (average RMSE: 1.3%). Consistent with affect labeling research, right ventrolateral prefrontal cortex (RVLPFC) and amygdalae were top predictors of improvement in the four outcomes. Moreover, RVLPFC and left amygdala predicted benefits due to expressive writing in satisfaction with life and depression outcome measures, respectively. This study demonstrates the substantial merit of supervised machine learning for real-world outcome prediction in social and affective neuroscience.


Emotional and physical health benefits of expressive writing

Karen A. Baikie, Kay Wilhelm

Medical conditions that might benefit from expressive writing programmes

  • Lung functioning in asthma

  • Disease severity in rheumatoid arthritis

  • Pain and physical health in cancer

  • Immune response in HIV infection

  • Hospitalisations for cystic fibrosis

  • Pain intensity in women with chronic pelvic pain

  • Sleep-onset latency in poor sleepers

  • Post-operative course