I have many sessions with breast cancer patients during 3 years. CBT and hypnosis was my approach in treatment and was efficient in stress reduction in these patients.for many times,I have request to the patients to writing about their emotions,although,my patients didn't like writing about their illness and related negative emotions.your article is a valuable intervention in this patients.

Hi, Fatemeh Taghizadeh. Thanks for your comment. I'm glad CBT and hypnosis were both effective in reducing stress for your breast cancer patients. Yes, I can see how it might be difficult for people to write about their experience. Perhaps feeling negative emotions in the short term would lead to greater benefits in the long term though. I believe avoiding painful feelings, instead of expressing them, can be quite harmful in the long run. Expressive writing is one simple, essentially cost-free method of allowing cancer patients to receive benefits to their health. Some patients may benefit more from CBT or other treatment options, but these typically have higher costs for the patient. One idea for expressive writing, is to provide a journal prompt(s) (printed paper) for patients and suggest they write freely their thoughts and feelings (~15 minutes) after their diagnosis of cancer and then each week thereafter. They could complete the journal prompt in the lobby following the appointment, at home, or at a place of their choice.

In my opinion and professional experience, expressive writing and other form of creative reframing inner experiences are very usefull and valuable for somatic patients (also cancer patients). These additional techniques help patients in dealing with tension between regular sessions of psychotherapy and provide tools of self-help that give a sense of internal control.

I frequently use creative writing, poetry, and journaling in my Art Therapy groups. I have found it to be an important expressive tool to process through and communicate thoughts and feelings. Often, the expressive writing tasks can access important emotional content that simply speaking about things cannot. Additionally, I have used a portable paper shredder to write and destroy "no-send" letters and letters of anger as a method to let-go of and work toward healing from difficult emotions.

Hi Mike Hoelzer , thanks for sharing. I agree that writing can access important emotional content that simply speaking cannot. That's a great idea--shredding "no send" letters of anger. I know Abraham Lincoln did that as well. The idea is that all emotions have equal importance of being expressed. And, anger is an important stage of the grief cycle, which many cancer patients go through.

I agree, Agata Giza-Zwierzchowska. Writing is a simple tool that can empower patients and enable them to continue progressing psychologically, independent of therapy. Thanks for sharing.

Thank you Sarah fischbuch for your idea.kindly,explain about,that we must write what statements for them on paper print? And the patient answer that?

One of the most expressive pieces of writing on the topic of therapy for cancer patients is Rachel Naomi Remen’s ‘kitchen table wisdom‘ - as an oncologist turned writer it is well worth a look

thank you Claire Diesendorf .what is the approach of the author?Is this book available free download?

Fatemeh Taghizadeh, there are a number of listed writing prompts you could choose online (search via Google). An idea for you is the following: Select prompts for 7 weeks (weekly writing exercise) and after the appointment where the patient is diagnosed with cancer you could explain to your patient the benefits of expressive writing and offer him/her the assignment of completing a writing exercise before the next visit (and be sure to ask about it the next visit). At the end of each visit you could give your patient a piece of paper with the prompt printed on it. You could suggest they purchase a notebook or write in a journal so their responses are all in the same place. Examples below:

Visit #1

Please choose one of the following options:

#1 Take 15 minutes to write freely about a place of refuge. What does it look like? Who is there?

#2 Take 15 minutes to write freely about a topic of your choice.

#3 Take 15 minutes to write freely about what you were like as a child. If that child were to come talk with you now, what would he or she say to you?

Visit #2

Please choose one of the following options:

#1 Take 15 minutes to write freely about a challenge you have overcome in your life.

#2 Take 15 minutes to write freely about a topic of your choice.

#3 Take 15 minutes to write freely about an experience you have had with someone you care about who has passed away (parent, grandparent, child, friend, etc.). How are you still connected to this person?

Visit #3

Please choose one of the following options:

#1 Take 15 minutes to write freely about a place of anger. What happened? How were you affected? What would it be like to let go of the anger? How would you change?

#2 Take 15 minutes to write freely about a topic of your choice.

#3 Take 15 minutes to write freely about what you believe is the purpose of life. Have you achieved that purpose? How can you continue to achieve that purpose?

Visit #4

Please choose one of the following options:

#1 Take 15 minutes to write freely about an experience where you have helped someone else. Why did you help them? How did you feel?

#2 Take 15 minutes to write freely about a topic of your choice.

#3 Take 15 minutes to write freely about what you are afraid of.

Visit #5

Please choose one of the following options:

#1 Take 15 minutes to write freely about a time where you have experienced love. What was the experience like? How can you love more deeply? How can you receive love more deeply?

#2 Take 15 minutes to write freely about a topic of your choice.

#3 Take 15 minutes to write freely about a time where a Higher Power, or someone you love, has helped you.

Visit #6

Please choose one of the following options:

#1 Take 15 minutes to write freely a message to your family, or someone you care about. What do you want to thank them for? What do you want them to know?

#2 Take 15 minutes to write freely about a topic of your choice.

#3 Take 15 minutes to write freely about your pain. What causes the pain? Why is it important to endure pain? Where do you receive strength?

Visit #7

Please choose one of the following options:

#1 Take 15 minutes to write freely about your life. What have you learned?

#2 Take 15 minutes to write freely about a topic of your choice.

#3 Take 15 minutes to write freely about death. Do you believe there is life after death? Do you believe in a Higher Power? What you have written can be a record of your life. Who would benefit from reading what you have written about your life and what you have experienced? How might they benefit?

Thanks, Claire Diesendorf for the suggestion--Rachel Naomi Remen's "Kitchen Table Wisdom." I'd like to check it out!

Than you Sarah fischbuch

Hello Sarah. I think writing is another instrument for use in clinical intervention. I use it sometimes when I thing it could be useful. First, is the best way to have the personal history, the writing obligates someone to make an historical line of his/her life, and elaborate this history for a differente person. Second, it could be a good way to express adversive episodes or unpleasant events, producing extinction over emotional responses related with those events. And third-place, it could be a self-recording method for daily life of social and private interactions that the clinician could't see other way.

Thanks for sharing, Luis Valero. I like the idea of the personal history timeline and sharing it with another person after writing it. I want to do that myself--thanks! I've seen a lot of benefits to the third option you mentioned--recording daily what has happened that day. There's been a lot of research regarding the health benefits of gratitude.

Another idea is, along with a prescribed, regular writing exercise, to suggest to the patient to end the writing exercise by writing 3 things they are grateful for and why.

For example, "I am grateful that it rained today because it reminded me of the city I grew up in and how much I enjoy being surrounded by green trees."

Or, "I am grateful for my friend Edward buying me lunch today because it was unexpected and kind, and I felt special."

Another option would be to prescribe that the patient handwrite (or type if unable to write) a thank you card and send it to someone each week. I love this. The effects of gratitude are phenomenal. Also, I believe sending thank you letters increases our ability to feel connected, leading to a decrease in loneliness and/or depression, which is correlated with most disease.

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OK, those could be good uses for writing assignment.