Clinical Implications of Writing Therapy

• Since the foundation research conducted in the 1980’s by James W. Pennebaker, there have been further studies demonstrating that expressive writing may act as an agent to increase long term health. ^[1] Expressive writing (EW) is characterized as a form of writing that allows individuals to process and work through trauma in a way at enables healing ^[2]. Further research conducted since then validates these initial findings of expressive writing in promoting health.
• A review paper by Baikie and Wilhelm examines how there have been several meta-analysis conducted across literature in the field assessing if expressive writing causes significant results. Based on this review, as well as a meta-analysis conduced in 2004, significant results as a result of expressive writing have been obtained ^{[3] [4]}
  • (Already cited on the page) General review of health benefits of expressive writing, following Pennebaker's prompts and guidance. ^[3]
• Pennebaker ^{[5] [6] [7]}
• Palliative Care, Systematic Review, Health outcomes ^{[4] [8] [9]}
• Economic/Implementation considerations. ^{[10] [11]}

Condensed version for posting:

Since the foundation research conducted in the 1980’s by James W. Pennebaker, there have been further studies demonstrating that expressive writing may act as an agent to increase long term health. ^[12] Expressive writing can result in physiological, psychological, and biological outcomes, and is part of the emerging field of the medical humanities. ^[13] There are experiments demonstrating quantitative physiological readout such as changes in immune counts, blood pressure, as well as qualitative readouts relating to psychiatric symptoms. ^{[14] [15] [16]} Research implementing expressive writing interventions in clinical settings indicates that there are potential benefits in incorporating writing therapy into treatment plans. ^[17] However, the specifics of such expressive writing procedures or protocols, and the populations most likely to benefit from it are not entirely clear.

Posted Version Edits:

Additional research since the 1980s has demonstrated that that expressive writing may act as an agent to increase long-term health. ^[18] Expressive writing can result in physiological, psychological, and biological outcomes, and is part of the emerging medical humanities field. ^[19] Experiments demonstrate quantitative physiological readout such as changes in immune counts, blood pressure, in addition to qualitative readouts relating to psychiatric symptoms. ^{[20] [21] [22]} Past attempts at implementing expressive writing interventions in clinical settings indicate that there are potential benefits for treatment plans. ^[23] However, the specifics of such expressive writing procedures or protocols, and the populations most likely to benefit are not entirely clear.

Potential Benefits for Cancer Patients

• Recent research has explored how narrative medicine and expressive writing, independently, may play a therapeutic role in chronic diseases such as cancer. ^[24]
• Comparisons in practice have been made between expressive writing and psychotherapy(LeRoy et al., 2018). A similar thinking style has already been incorporated into the medical field by designations such as integrative, holistic, humanistic or complementary medicine. These involve including spirituality, meditation, wellness and other supplemental care practices into treatment. Expressive writing is self-administered with minimal prompting, and LeRoy et al. (2018) propose it as a more cost effective potential alternative to psychotherapy, examine the benefits and drawbacks. ^[10]

• Narrative medicine/ expressive writing is useful in the clinical setting. It can potentially be used to increase patient's sense of well being. There is a lot of variation across "narrative medicine" studies. Need more concise studies in the future. Provides a review and context of current narrative medicine research. Examines methodology and outcome - it will be useful in evaluating knowledge gaps and the current state of narrative medicine practice. While it focuses on NM, it also addresses EW. ^[25]

• Examines stress and and stress management (SM) on: immune function, inflammation. Additionally, it reviews management techniques: physical, mindfulness, cognitive-behavioral. Finally, it examines long term clinical implications of stress. ^[26]
• Experimental non-significant initial results are comparable to outcomes of several similar studies, as well as systematic reviews and meta-analyses, conducted recently examining the effectiveness of expressive writing in reducing negative physical and psychological symptoms experienced by cancer patients. ^{[27] [28] [10] [25] [29]} These results suggest that expressive writing is likely not generally applicable as a therapeutic interventions. However, analysis of sub-groups and moderating variables suggest that particular symptoms, or situations, may benefit more than others from EWI.
• A review by Antoni and Dhabhar (2019) examined how psychosocial stress negatively impacts the immune response of patients with cancer. ^[26] It is important to acknowledge that even if a EWI cannot directly impact cancer prognosis, it may play an important role in mediating factors such as chronic stress.

Condensed version for posting:

Illness and disease is experienced on multiple different fronts: biological, psychological, and social. Cancer especially, becomes a part of the patient’s daily life, invading the very identity of the person diagnosed with the disease. Recent research has explored how narrative medicine and expressive writing, independently, may play a therapeutic role in chronic diseases such as cancer. ^[24] Comparisons in practice have been made between expressive writing and psychotherapy. ^[10] A similar thinking style has already been incorporated into the medical field by designations such as integrative, holistic, humanistic or complementary medicine. These involve including spirituality, meditation, wellness and other supplemental care practices into treatment. Expressive writing is self-administered with minimal prompting, and with further research and refinement it may be used as a more cost effective potential alternative to psychotherapy, examine the benefits and drawbacks. ^[10]

Posted Version Edits:

Illness and disease is experienced on multiple different fronts: biological, psychological, and social. Recent research has explored how narrative medicine and expressive writing, independently, may play a therapeutic role in chronic diseases such as cancer. ^[30] Comparisons in practice have been made between expressive writing and psychotherapy. ^[31] Similarly, practices such as: integrative, holistic, humanistic or complementary medicine have already been incorporated into the field. Expressive writing is self-administered with minimal prompting. With further research and refinement, it may be used as a more cost effective alternative to psychotherapy. ^[31]

Recent experiments, systematic reviews, and meta-analyses examining the effects of expressive writing on ameliorating negative cancer symptoms yielded primarily non-significant initial results. ^{[32] [33] [34] [35]} However, analysis of sub-groups and moderating variables suggest that particular symptoms, or situations, may benefit some more than others with the implementation of an expressive writing intervention. For example, a review by Antoni and Dhabhar (2019) examined how psychosocial stress negatively impacts the immune response of patients with cancer. ^[36] Even if an expressive writing intervention cannot directly impact cancer prognosis, it may play an important role in mediating factors such as chronic stress, trauma, depression, and anxiety.