The Write Stuff: Expressive Writing About Cancer Promotes Healing and Well-Being

Loree Luther first picked up a pen to write about her experience with cancer a few weeks after receiving a diagnosis of Hodgkin lymphoma at age 38. At first, she’d been too busy and too traumatized, dealing with doctor appointments, finishing up wedding cakes for clients and trying to explain cancer to her two young children.

“I had a couple of treatments under my belt, and my hair was coming out,” says the 42-year-old San Diego pastry chef. “It was a critical time. I didn’t know yet if the treatment was working.”

So Luther began working through her anxiety by putting it down on paper during an expressive writing workshop for cancer patients and caregivers offered by the cancer center at Scripps Clinic and Scripps Green Hospital in La Jolla, Calif. The experience proved powerful. “Writing was as important to my recovery as any chemotherapy or radiation I received,” Luther says.

Research shows that expressive writing can measurably improve the physical and mental health of many of those who have been traumatized, including those dealing with cancer. The findings have led to the inclusion of expressive writing programs in complementary therapies offered by several cancer centers.

James Pennebaker, PhD, a social psychology researcher at the University of Texas at Austin, discovered the association between expressive writing, trauma and health improvement more than two decades ago.

“Our basic findings have been replicated in the last 25 years in more than 300 related studies from labs around the world,” Pennebaker says. “We’re still not entirely sure why it works, but the result crosses boundaries of age, gender [and] social class.”

In Pennebaker’s experiments and in subsequent studies, people who wrote about intensely emotional experiences four consecutive days for about 15 minutes each time made fewer illness-related trips to the doctor. Their liver and lung function also improved, and they experienced a decrease in high blood pressure.

Luther says working through the assignments in her writing group helped her organize on paper all the diverse thoughts and feelings she was experiencing—hope, anxiety, fear, sadness, relief and joy.

“Writing was a way for me to sort through everything,” Luther says. “There’s only so much you want to dump on family. You don’t want to add to their emotional load sometimes,” she says. “But you can always dump on paper.”

Or on the computer. Or by recording your own stories if you can’t type or write, Pennebaker says. Although science hasn’t nailed down precisely how emotional or reflective writing improves health, he suspects that there are several contributing factors, and Luther identified a key one.

Writing was as important to my recovery as any chemotherapy or radiation I received.

“When something unexpected or jolting occurs, such as the diagnosis of cancer, our brains automatically try to figure it out,” Pennebaker says. “Writing may make that figuring-out process more efficient. If we can construct a story out of it, a simple and coherent story, it may allow us to move through the experience more efficiently.”

Expressive and reflective writing also helps people bring new and broader perspectives to events, which may enable them to change the way they organize their thoughts about trauma, Pennebaker says. Obsessive and repetitive thoughts, such as “How did this happen?” or “What did I do wrong?” or “Why me?” can be stressful, biologically and socially, he says, and can strain relationships and disrupt sleep.

[Read "Expressing One's Thoughts" on ways to begin writing about your cancer.]

When Pennebaker and his colleagues analyzed the texts of people who enjoyed the greatest physical benefits from expressive writing exercises, they spotted several trends. Those whose health improved most tended to use more “causal” or “insight” words over time, words such as “because,” “reason,” “understand” and “realize.”

Carissa Low, PhD, a postdoctoral psychology researcher at the University of Pittsburgh, says that the writing process may also motivate some patients to communicate better with healthcare professionals.

In one set of experiments, a patient who had written about anxiety reported the following: “Talked to my doctor about my anxiety as appointments approached. He told me to consider my cancer as a chronic disease; that he would let me know in advance of my appointment if there was any change in my lab tests, so I wouldn’t need to worry between blood draws and the appointment.”

Other trials have shown that people who participate in expressive writing exercises are more likely to seek professional mental health services.

Recently, researchers have identified some exceptions to the positives of expressive writing, causing Low to caution that expressive writing is not universally beneficial.

“We have found that, for some people, this intervention was somewhat detrimental,” she says. “Women with metastatic breast cancer may not benefit from writing interventions, especially if they’ve lived with the disease for several years and have a strong support network. For some of these women, writing expressively about trauma actually hurts, triggering thoughts that disrupt healthy sleep, for example.”

She and several colleagues recently tested the effectiveness of emotionally expressive writing in a group of women with metastatic breast cancer. Some had received their diagnosis years ago, others in recent months; some had strongly supportive friends and family, others didn’t.

In general, people who had lived with their cancer for years did not benefit, Low says.

“They reported that their sleep suffered—they woke up in the middle of the night or had trouble falling asleep,” Low says. It’s possible these women had already figured out how to make meaning of their cancer experience, she adds. “Asking them to participate in this intervention may have stirred up emotions and thoughts that they had resolved long ago.”

In her study, the writing intervention was also less likely to help people who had a strong support network that accepted and listened to worries and other issues of cancer, but more likely to help those with less emotional support.

“If you don’t have that network,” Low says, “writing may be an opportunity for expression, one that can provide a vehicle for getting these thoughts and worries out of your head.”

Low and Pennebaker agree that people who are newly diagnosed, who may be reeling from the news, may not benefit from writing for a few days to weeks. “Sometimes distancing yourself a little bit can be helpful,” Pennebaker says.

He says writing differs from other experiences known to improve health.

“Exercise and meditation are probably better than writing for maintaining long-term health,” Pennebaker says. “I view writing as more of a course-correction strategy—something that is beneficial when things are going badly.”

That resonates with Luther. She has a strong support network in friends and family, but found great benefit in writing, and also realized, looking back at her life, that she picked up the pen at particular times.

“When things were challenging for me, I took to writing,” Luther says. “Now, it’s almost like getting a massage. [I] feel the release of this tension and stress.”