The use of expressive writing in the course of care for cancer patients to reduce emotional distress: analysis of the literature

Prof Inferm. 2015 Jan-Mar;68(1):29-36. doi: 10.7429/pi.2015.681029.

[Article in Italian; Abstract available in Italian from the publisher]

The emotional distress represents one of the symptoms most frequently reported in the cancer patient in therapy, increasing the risk of developing a disease depressive. Through the analysis of the literature we want to assess whether the use of expressive writing on cancer patients in their care pathway compared to the use of writing neutral reduces emotional distress.


The bibliographic search was conducted using the databases CINAHL, PubMed, Cochrane Library and PsycInfo.


The results of research conducted on 7 randomized controlled trials, including 3 pilot studies have shown after expressive writing sessions (experimental group) versus neutral writing (control group) a significant reduction in distress in the experimental group early stages of cancer (p = 0,0183); in patients with a diagnosis of metastatic assigned to the group expressive writing there was a statistically significant relevance in the reduction of mood disorders (p = 0,03).Were determined statistically significant group differences also with respect to some measure on the quality of sleep (p = 0,04). The expressive writing did not produce significant reductions in psychological distress and improvements in physical health (p > 0,20) in patients diagnosed with metastatic disease of long duration and, in the palliative care there have been results of feasibility for poor adherence at follow-up.


From the results it is evident that the strategies of expressive writing improves the management of the disease, reduce the physical and psychological symptoms related to the tumor while reducing the emotional distress in patients at an early stage of the disease.

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 Psychol. 2002 Nov;21(6):615-9.

de Moor C1, Sterner J, Hall M, Warneke C, Gilani Z, Amato R, Cohen L.

Forty-two patients with metastatic renal cell carcinoma who were participating in a Phase II clinical trial were randomly assigned to an expressive writing (EW) or neutral writing (NW) group. Patients in the EW group wrote about their cancer, and patients in the NW group wrote about health behaviors. No statistically significant group differences were found in symptoms of distress, perceived stress, or mood disturbance, except for the Vigor subscale of the Profile of Mood States. However, patients in the EW group reported significantly less sleep disturbance, better sleep quality and sleep duration, and less daytime dysfunction compared with patients in the NW group. The results suggest that EW may have sleep-related health benefits in terminally ill cancer patients.

Expressive writing in women with advanced breast cancer.

Oncol Nurs Forum. 2007 Sep;34(5):1019-24.

Laccetti M1.

To explore the relationships between patterns of affective word use (words with positive or negative connotations) in expressive writing conducted over four consecutive days and quality of life (QOL) three months after the writing exercise in women with metastatic breast cancer.


Descriptive, correlational.


Six clinical sites in New England.


68 women with metastatic breast cancer.


Patterns of positive and negative affective word use and QOL.


Usage patterns of affective words in expressive writing were identified through the Linguistic Inquiry and Word Count (LIWC). Relationships between patterns of affective word use and QOL were explored. QOL was measured at baseline and three months after the writing exercise by the Functional Assessment of Cancer Therapy-Breast. Correlations between patterns of word use and QOL were investigated using general linear regression.


A significant relationship was found between positive-affect word use and emotional well-being. Manual scoring of 10 expressive writing texts to validate LIWC data identified a significant difference between LIWC and manual counts for negative language. Contextual evaluation suggested marked ambivalence in how the women wrote about cancer.


A positive relationship between affective language in disclosure and QOL was demonstrated, illustrating a cognitive process occurring in expressive writing.


The findings suggest that expressive writing is a positive, helpful intervention for patients with cancer attempting to reintegrate the experience in life. Nurses should gain deeper understanding of underlying cognitive processes of disclosure to identify the most effective manner in which to use such interventions.