by Jeremy R. Geffen, MD, FACP
The cancer journey is, for most people, a turbulent upheaval in their lives and -- at the very least -- an emotional roller coaster ride. In addition to sorting through a complex maze of conventional and unconventional treatment options, patients and families must navigate a stormy sea of ever-changing thoughts, feelings and emotions -- some of which may not even be in their conscious awareness. All of this often occurs at a time when important decisions have to be made in the midst of daunting challenges and tremendous uncertainty.
The emotional dimensions of dealing with cancer can impact every aspect of the journey, in both desirable and undesirable ways. This doesn’t mean, however, that patients and loved ones must necessarily be buffeted uncontrollably by whatever emotions happen to be arising in the moment. A growing body of scientific evidence suggests they can take an active role in transforming their emotional experience, and improving their physical health as well. One surprisingly simple yet powerful way of doing this is by expressing emotions in writing.
Throughout human history, writing in a journal has been a widely practiced activity of daily life. Instinctively, people discovered that they felt better after simply writing about the events in their lives and their innermost thoughts, feelings, and impressions. This remains true today—yet it is only in the past 20 years that the health-related benefits of written emotional expression have been scientifically documented.
A growing number of studies in the medical literature have now clearly demonstrated numerous measurable benefits of writing about events in one’s life.[1],[2],[3] A classic, 1988 study by James Pennebaker and his colleagues showed improved immune function among 50 healthy undergraduate students after written disclosure of traumatic events.[4] Improved immune responses to hepatitis B vaccination,[5] modulation of Epstein-Barr virus antibody titers,[6] and increased CD4+ lymphocyte counts[7] have also been confirmed as benefits of written emotional expression in other populations.
From a more clinical perspective, a well-known 1999 study published in the Journal of the American Medical Association demonstrated significantly reduced symptoms among asthma and rheumatoid arthritis patients who wrote about stressful events in their lives for twenty minutes a day over a period of several days.[8] Similar benefits from written emotional expression were found in subsequent studies involving patients with fibromyalgia[9] and chronic pelvic pain.[10] Reduced hospitalizations were also seen among patients with cystic fibrosis who participated in a brief process of written emotional expression.[11]
Although the medical issues of cancer are unique, and obviously different from those of asthma, arthritis, fibromyalgia, chronic pelvic pain, or cystic fibrosis, there is no doubt that putting thoughts and feelings into writing can have significant benefits for patients dealing with cancer. A 2002 article published in the Journal of Clinical Oncology reported that women with breast cancer who wrote about their deepest thoughts and feelings concerning their disease experienced fewer physical symptoms and required fewer medical appointments than those who did not.[12] Another 2002 study, published in the International Journal of Psychiatry Medicine, showed that written emotional disclosure by men with prostate cancer improved physical symptoms and healthcare utilization.[13]
Most recently, a study published in the February 2008 edition of The Oncologist, provides further evidence that writing about one’s deepest thoughts and feelings can not only change the way people with cancer think and feel about their disease, but also improve their physical quality of life.[14] The study, entitled “Implementing an Expressive Writing Study in a Cancer Clinic,” was conducted over seven years at the Lombardi Cancer Center at Georgetown University and involved 71 adult patients with leukemia and lymphoma. Nearly half (49.1%) of patients who engaged in expressive writing for 20 minutes a week reported that the process immediately changed the way they thought about their illness. Furthermore the reported changes were significantly associated with better physical quality of life.
Writing about one’s thoughts, feelings, and emotions -- in a journal or otherwise -- provides an outlet for completely honest, unfiltered self-expression that is available to anyone, at all times and at no cost. I encourage all of my patients -- and their loved ones -- to purchase a hardbound journal and spend some time each day writing in it. Even five or ten minutes a day is helpful. This simple practice can reveal thoughts, feelings, and experiences that may have been buried in the unconscious which, once discovered, can be an important source of healing, and even deep inspiration. It can also provide a reference to draw upon during difficult moments and a place to record important milestones and victories.
Finally, the process of written self-expression can be a precious opportunity for anyone -- including family members, loved ones, colleagues, and friends, as well as patients -- to not only contact and transform their innermost emotions, but also to experience the silent witness of all the events of one’s life. For many, this provides a vital and rejuvenating respite from the unceasing chatter of the critical, judging mind, which can powerfully enhance and transform the healing journey.[15]
References:
[1] Frisina PG, Borod JC, Lepore SJ. A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations. J Nerv Ment Dis. 2004;192(9):629–634.
[2] Frattaroli J. Experimental disclosure and its moderators: A meta-analysis. Psychol Bull. 2006;132(6):823–865.
[3] Baikie KA, Wilhelm K. Emotional and physical health benefits of expressive writing. Adv Psychiatr Treat. 2005;11:338-346.
[4] Pennebaker JW, Kiecolt-Glaser JK, Glaser R. Disclosure of traumas and immune function: health implications for psychotherapy. J Consult Clin Psychol. 1988; 56: 239–45.
[5] Petrie KJ, Booth RJ, Pennebaker JW, et al. Disclosure of trauma and immune response to a hepatitis B vaccination program. J Consult Clin Psychol. 1995; 63(5):787–792.
[6] Esterling B, Antoni M, Fletcher M, et al. Emotional disclosure through writing or speaking modulates Epstein-Barr virus antibody titers. J Consult Clin Psychol. 1994;62(1):130-140.
[7] Petrie KJ, Fontanilla I, Thomas MG, et al. Effect of written emotional expression on immune function in patients with Human Immunodeficiency Virus infection: A randomized trial. Psychosom Med. 2004;66(2): 272-275
[8] Smyth JM, Stone AA, Hurewitz A, Kaell A. Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: A randomized trial. J Amer Med Assoc. 1999;281:1304–1309.
[9] Broderick JE, Junghaenel DU, Schwartz JE. Written emotional expression produces health benefits in fibromyalgia patients. Psychosom Med. 2005;67(2):326-334.
[10] Norman SA, Lumley MA, Dooley JA, Diamond MP. For whom does it work? Moderators of the effects of written emotional disclosure in a randomized trial among women with chronic pelvic pain. Psychosom Med. 2004;66(2):174-183.
[11] Taylor, LA, Wallander,JL, Anderson D, et al. Improving health care utilization, improving chronic disease utilization, health status, and adjustment in adolescents and young adults with cystic fibrosis. A preliminary report. J Clin Psychol Med Settings. 2003;10(1):9–16.
[12] Stanton AL, Danoff-Burg S, Sworowski LA, et al. Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients. J Clin Oncol. 2002;20:4160–4168.
[13] Rosenberg H, Rosenberg S, Ernstoff M, et al. Expressive disclosure and health outcomes in a prostate cancer population. Int J Psychiatry Med. 2002;32(1):37–53.
[14] Morgan NP , Graves KD, Poggi EA, Cheson BD. Implementing an expressive writing study in a cancer clinic. Oncologist. 2008;13(2):196-204.
[15] Geffen JR. The Journey Through Cancer: Healing and Transforming the Whole Person. NY: Three Rivers Press. 2006.
Additional articles by Jeremy R. Geffen, MD, FACP: