Writing and Healing and Breast Cancer

Is there a benefit to writing for women with breast cancer?
What kind of writing is most beneficial?
(And might the answers to these questions be extrapolated to other groups?)

To look at the first two questions, Annette Stanton, a psychologist at the University of Kansas, and Sharon Danoff-Burg, psychologist at State University of New York in Albany, conducted a study several years ago now in which they divided a group of women with breast cancer into three groups:

1. A group instructed to write a detailed account of the facts of their breast cancer and its treatment
2. A group instructed to write their deepest thoughts and feelings about their experience with breast cancer.  This is often called expressive writing.
3. A group instructed to write only about their positive thoughts and feelings in connection to their experience of cancer

All of the women completed four twenty-minute writing sessions.  And here are some things they learned from this group of women:

• Women who wrote about facts and women who did expressive writing reported more distress immediately after writing when compared with women who wrote only about positive feelings.
• At one and three months after writing, women in all three groups reported overall more positive quality of life, less distress, and “high vigor” compared with similar cancer patients who hadn’t written.
• Three months after writing, women who did expressive writing, and the women who wrote about positive thoughts and feelings reported a significant decrease in physical symptoms and they also had fewer visits to the doctor for cancer-related illness than women who wrote only about facts—or women who didn’t write at all.  Writing about thoughts and feelings led to significant physical benefit.

Thus, along with expressive writing, writing about positive thoughts and feelings—writing about the good part—was shown to be beneficial for women with breast cancer.  Interestingly, though, and, I think, wisely, the authors, in the wake of these finding, advise caution in asking (or, worse, prescribing) persons who are facing adversity to find a positive benefit.  They write:

Indeed, exhorting individuals to ‘look on the bright side’ or to focus on a specific advantage in their misfortune is likely to be interpreted as minimizing or not understanding their plight.

And they go on to name three reasons they think asking for a positive benefit was effective in this particular study:

• They did not suggest any woman find a particular benefit—but, instead, let women have complete control over any benefit they named and explored.
• The women were asked to write only after the primary treatment for their cancer had been completed.
• They had evidence that these women had already had opportunities to process negative emotions in other settings.

This is an interesting, and potentially significant, study.  And, granting, first, that all research in this field is still preliminary and that more research needs to be done, I’m taking from this study five useful bits:

• First, that women with breast cancer (And all women with cancer?  All people with cancer?  All people with illness?) have the potential to gain significant benefit from writing—whether they’re writing about all their thoughts and feelings or whether they’re writing about positive thoughts and feelings that have begun to emerge.
• Second, that there may be value, at some point, in focusing solely on the good part.
• Third, that writing about the good part, in general, probably causes less distress and feels more pleasant than writing about the difficult parts; thus it can offer a bit of reprieve—a break—
• Fourth, that this focusing on the good part is probably best done late rather than early—and, in particular, after it’s become possible to vent at least some of one’s negative thoughts and feelings.
• Finally, that always, always, each person gets to choose on any given day, whether to write (or speak) about the bad part or the good part—or both.  (Remembering that both—expressing the difficult stuff and the good stuff—has the potential to contribute to healing.)

• An abstract of the study can be found at PubMed.

• A summary of this study by Stanton and Danoff-Berg, with commentary by the authors, can be found in Chapter 3 of The Writing Cure.