For years, Harvard researcher Susan Bauer-Wu has worked with people struggling with a dreaded diagnosis, cancer.
Many turn to support groups, psychotherapy or antidepressant drugs to help them cope with the fears and challenges the illness brings.
Her team offers them a pen and paper.
Those are the only tools required for a simple, increasingly popular intervention called "expressive writing" or "journal therapy."
Writing a health boost
The research suggests that by spending 30 minutes each day for four days to write out their innermost thoughts and feelings, patients can significantly boost mental and physical health.
And experts say nearly everyone who tries journal therapy stands to benefit.
"Many people are so surprised at how it really works," said Bauer-Wu, director of the Cantor Center for Nursing and Patient Care Research at the Dana Farber Cancer Institute in Boston. "Even people who were reluctant to do it, who say, 'I'm not a good writer, I can't write well, or I don't like to.' They'll go through the process and have that 'A-ha' moment. They'll tell us, 'Wow, I never realized this about myself, or about this disease, it just came out onto the paper.' "
Expressive writing therapy is just that: Patients are encouraged to express whatever is on their mind, letting their hopes and fears flow out in a natural, unrestrained way. It's akin to keeping a journal, but more focused on the things that might be bothering you or triggering stress.
"We tell them, 'Don't worry about the punctuation, the words, just go with the process,' " Bauer-Wu said. "We also encourage them to build on whatever they have written before."
Writing offers a release
The result, for many patients, is a kind of catharsis - a release and articulation of issues bottled up inside - and also a healthy coming to terms with some of those issues.
"It's about stepping back and thinking about things in a different way, making linkages," explained Dr. Robin Fivush, a professor of psychology at Emory University, in Atlanta. She's conducted her own research on expressive writing.
"It's not just about expressing the emotion, because then you'd just ruminate on it," she said. "If you take a close look at those who benefit from it most, you see a lot of them using what we call 'cognitive processing' words - 'I realize, I understand, now I see that.' "
Helps patients to cope
Insights like these appear to help patients with cancer or other illnesses cope better, studies suggest. "I just read one review article that contained over 140 studies on this subject, and it seems very effective," Fivush said.
Bauer-Wu has conducted three studies of her own, tracking the effects of journal therapy for patients with breast and other cancers. She noted that while the classic program involves 30 minutes per day of writing for four days, cancer patients "may require more than that."
"In my work, we do a four-day intervention, but then repeat it a month later and then a month later again," she said. Patients can write using a pen and paper or computer. Surprisingly, about half of younger, computer-savvy participants in one study opted to handwrite their journal entries. "What's most important is that you find that place each day where you can most freely write," Bauer-Wu said.
"One of the things that's been found in cancer patients across different studies is what we call 'improvements in health-care utilization,' " she said. "Patients end up going to their doctor or calling nurses less frequently. They need fewer sessions with a mental health counselor. Basically, they are having fewer physical symptoms and coping better."
Indeed, there's data that suggest that writing out your emotions eases stress and, in turn, boosts the immune system. "We're not sure how that might work," Fivush said.
Works better for some patients
She added that the therapy does work better for some patients than for others. Preadolescent children, especially, will probably not benefit. "We think that they may not have the cognitive or emotional skills [at that age] to work through things on their own," Fivush said.
According to Bauer-Wu, patients who are solitary and private by nature may benefit the most.
"There's a lot of hype about support groups, but we know that some people just aren't 'talkers,' " the Boston researcher said. "To me, expressive writing is a wonderful alternative for these people. It gives them a way to express their feelings and process what's going on in their minds."
It's important to note that patients who engage in journal therapy don't write with any intended audience in mind. In most cases, according to experts, they don't even have to read back their own journal entries to benefit. "It's the act of writing that seems to be important," Fivush said.
Treatment is cheap
And, as treatments go, expressive-writing therapy is cheap. "Obviously, there's nothing fancy or high-tech that's required, and you don't need to spend money on a therapist," Bauer-Wu pointed out.
"It's right there, it's self-care," she said. "People can heal themselves."
(HealthDay News, February 2007)
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