Expressive writing or journaling involves a patient writing about his or her emotional experiences. It is a basic writing paradigm that has been studied by Pennebaker (2004). This process encourages a patient to express whatever is on his or her mind, letting hopes and fears flow out. This allows the patient to better understand what may be bothering them or triggering stress.
Early after my initial cancer diagnosis, I found it difficult to sleep. My mind was like a video camera with constant thoughts interfering with my ability to rest. Finally, one night, I decided to get up and actually put my thoughts on paper. It was like an emotional catharsis. As I wrote, my feelings were expressed and slowly, I could develop a plan to deal with the issues of "watchful waiting," repeat CT scans, and the impact of the diagnosis on myself, family, friends, and my ability to work. My journaling has continued and provides a source of comfort and stress management.
Participants report expressive writing or journaling as valuable and meaningful.
Some studies found that cancer patients reported benefits such as better physical health, reduced pain, and reduced need to use healthcare services. (Rosenberg, 2002).
A study by Morgan (2008) supports the feasibility of conducting expressive writing with patients in a clinic setting. Adult leukemia and lymphoma patients (N=71) completed a baseline survey, a 20-minute writing task, a post writing survey, and a three-week follow-up. At the three-week follow-up, 54 percent of those completing all parts of the study reported writing changed their thoughts and 38 percent reported writing changed their feelings about their illness. Many of the changes expressed in the writing were positive and related to feelings about family, spirituality, work, and the future. Evidence at this time indicates that expressive writing or journaling may help cancer patients cope with stress, relieve anxiety, and experience improvement in sleep.
Given its simplicity, expressive writing or journaling is a therapeutic tool that may be used in diverse clinical settings or as a means of self-help. It can assist the patient to process and clarify thoughts and feelings. There is no magic formula or format. It should be flexible and fit the needs of the patient.
Suggestions may include the following:
- Writing should be carried out in a comfortable, private, and personal space free from distractions.
- Writing is private, confidential, and anonymous.
- "For patient eyes only" -- Just express thoughts, do not worry about spelling, grammar, or punctuation.
- Write about what happened and how you feel about it.
- It is acceptable to write about the unfairness of the cancer diagnosis, along with the anger, denial, and sadness that go along with it.
- Consider including positive entries and affirmations as well.
- Prompts may include listing the benefits of illness and how it has caused you to reconsider relationships, work, or religion. Write about people who have provided physical, emotional, or spiritual support.
There is no doubt that cancer is life changing, but addressing those life changes through writing can do a world of good. Research indicates that expressive writing or journaling provides an opportunity for patients to express cancer-related concerns and can influence the patient's adjustment to associated stressors. (Zachariae, 2011).
Expressive writing or journaling requires limited involvement of other individuals, is relatively low cost and portable, and has a tremendous potential for self-help. Nurses, as patient advocates, are in an ideal position to encourage this intervention for our patients. Let's give it a try. It will be most interesting to hear of your patients' success stories on this blog.
References:
- Morgan, NP, Graves KD, Poggi EA, (2008) Oncologist. Feb:13(2):196-204.
- Pennebaker, JW (2004) Theories, therapies and taxpayers. On the complexities of the expressive writing paradigm. Clinical Psychology: Science and Practice, 11, 138-142.
- Rosenberg, H, Rosenberg, SD, Ernoff, M.S.,(2002) Expressive disclosure and health outcomes in prostate cancer population. International Journal of Psychiatry in Medicine, 32, 37-53.
- Zachariae, R, Jensen-Johansen, MB (2011) Written Emotional Disclosure, in Handbook of Psychotherapy in Cancer Care, Wiley and sons, Chichester, UK. Doi:10.1002/9780470975176.ch9.
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