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Expressive writing may help breast cancer survivors

Writing down fears, emotions and the benefits of a cancer diagnosis may improve health outcomes for Asian-American breast cancer survivors, according to a study conducted by a researcher at the University of Houston (UH).

"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, assistant professor and director of the Culture and Health Research Center at UH.

"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.

Lu and colleagues published a study titled, "A Pilot Study of Expressive Writing Intervention Among Chinese-Speaking Breast Cancer Survivors," in Health Psychology. 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 post-traumatic stress symptoms. Many times when cancer patients get diagnosed, they face lots of emotional trauma. There's a sense of loss, depression, 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 three or four 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.

"I based my study for Chinese-speaking breast cancer survivors on Pennebaker's research paradigm, and we have conducted a series of studies to modify the paradigm for Asian-Americans" said Lu.

Rather than going to a hospital, Lu worked with a community-based partner to recruit participants. Lu's research team asked participants to complete a standardized health assessment and then they were asked to write 20 minutes each week for three weeks. Three sealed envelopes were mailed simultaneously to the participants with each envelope containing different writing instructions for the corresponding week. Questionnaires assessing health outcomes were mailed to participants at three and six months after the completion of the writing assignments. Semi-structured phone interviews were conducted after the 6-month follow-up.

"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 of fatigue, intrusive thoughts, and reducing posttraumatic stress after three months. She also noted a decrease of fatigue, posttraumatic stress, and the increase of qualify of life and positive affect after six months.

Lu notes this research study contributes to the growing literature of expressive writing by illustrating the feasibility and potential benefits among Chinese-speaking breast cancer survivors using a community-based participatory research approach and a mixed method design. The results of the intervention demonstrate that writing was associated with health benefits at long-term follow-ups and how to adapt and utilize expressive writing intervention for minorities.


Contact: Melissa Carroll
University of Houston

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