Coping with cancer through the healing art of expressive writing

Amid all the challenges and emotional turmoil of illness, diagnosis, and treatment, there was yet another challenge: the almost universal request to be positive. Despite the genuine concern and tremendous support I received from family and friends, they were deeply uncomfortable, and I understood. I was uncomfortable, too! Introverted and deeply shy, I became even more inhibited about sharing my experience after my cancer diagnosis. Yet, I felt intense emotions. Terror, grief, and anger knocked against my ribs; they demanded release. But, how?

I was fortunate that, during my experience with cancer, I discovered a lifeline that allowed me to navigate overwhelming emotions and find my voice: expressive writing.

Finding solace in expressive writing

When I was a teenager, I wrote in journals, unleashing the angst I felt as a young girl in a highly dysfunctional family by using looping cursive penmanship and addressing each entry to “Dear Diary.” Through that process, I became a friend to myself.

In 2008, I needed a friend to whom I could vent my worst fears, my ugliest feelings, and my sharpest anger. Who else but the blank page – or in my case, the blank screen – would blink back with acceptance of all this dark matter and suggest, with its calm repose, that I could offer more if I’d like?

I wrote in a password-protected document on my laptop, which I filled with unpolished prose. My writing was unpretty, but this document was for my eyes only. I needed the release of unedited feeling. Though I didn’t know the facts at the time, I intuited correctly: writing about feelings is a way to heal.

The research on expressive writing for cancer

Soon after I began to work at LBBC, I learned that expressive writing is a complementary therapy for cancer treatment. I discovered a significant body of research supports the healing potential of journaling for people experiencing trauma, high stress, or deeply emotional events. James W. Pennebaker, PhD, social psychologist and professor of psychology at the University of Texas at Austin, was among the first to study the effects of expressive writing on health. Expressive writing has significant positive effects on physical health outcomes for people with cancer, among others with serious or chronic illnesses, his studies found. In people with HIV, Dr. Pennebaker detected that CD4 lymphocyte counts that measure immune function increased in patients who specifically wrote about emotions, a positive impact not experienced by those who wrote about other topics. This resulted in fewer doctor’s visits for the expressive writing group.

Other studies show writing helps individuals heal from trauma and improve their emotional and psychological well-being, leading to less stress, anxiety, and depression. A 2012 study of people with early-stage breast cancer found that expressive writing significantly improved quality of life. Indeed, research suggests that the benefits of expressive writing are “substantial,” in terms of improving the psychological well-being of healthy individuals. Furthermore, it is a less involved, time-consuming, and expensive alternative to other psychological interventions. In fact, researchers have remarked that if a drug could offer comparable results to expressive writing, it would be considered a "major" medical breakthrough.

How expressive writing helped

Cancer affects everything. The dynamics of love, family, and work relationships are tested; major decisions must be deliberated, from treatment decisions, finances, childcare to work schedules, and more; and there is significant loss.

During treatment, I relied on journaling to center myself and feel grounded for the rest of the day. I began waking up at 5:30 a.m. to write before my son would wake. I soon found that writing was the best method I had to process not only my feelings but also my experiences. During journaling, I puzzled out the dynamics of my relationships, and I found confidence in the decisions I made, sometimes surprising myself with the course I had chosen or the revelation I’d made.

Within the pages I wrote while I underwent treatment, I explored my tangled feelings, and I began to navigate boundaries for the first time. I asked for time off from work to recover during the week after chemotherapy, and later, I carefully considered advocating for a lowered dose of radiation. As a 41-year-old woman, I was learning to take care of my needs. This, in turn, made me better able to care for others, chiefly my son, but I began to set my expectations with family and friends, too.

How to do it

During my time at Living Beyond Breast Cancer, I've encountered many people diagnosed with breast cancer who have used expressive writing as a tool to cope with the emotional and physical challenges of the experience. Here are some tips we have shared to get started:

What you'll need

• A journal, notebook, sketchbook, or paper with a pen, pencil, or marker; or a laptop, computer, phone, or tablet with writing software.
• A comfortable space offering no interruptions.

Optional

• Music that enhances concentration.
• A Tibetan bell or incense to create a serene environment.

Directions

• Open your journal and write for a full 15-30 minutes without stopping.
• Write about anything you want; just focus on your thoughts and feelings related to your experiences with cancer. Explore what has been difficult and how your life has changed.
• Don't worry about grammar or spelling. The most important thing is to express yourself freely.

Tips

• If you find yourself stuck, try free-writing: write whatever comes to mind without stopping to edit or correct yourself. You can start the entry with, "I don't know what to write about," and then describe your feelings or the environment around you.
• To make it easier to start each journal entry, leave the last sentence of every entry half-written and begin a new entry by finishing your last sentence or thought.
• Another technique to overcome writer's block, or if you want an alternative, is to record yourself on your phone. I enjoy going for a walk, which frees my thoughts in a way that sitting or staring at a screen sometimes restricts. I open a new note in my iPhone app, hit the Microphone icon, and record the date and place to begin. Soon, I start talking-writing after a few minutes of movement. Studies have found this practice of talking about emotions is as effective as writing about them. I often practice R-A-I-N with this method when I need to sort out my emotions. It always amazes me how much better I feel afterward. During my next writing session, I transcribe the iPhone note into my journal, which usually prompts another entry.
• If you journal with a word-processing program, consider using a password so you can truly feel uninhibited.
• Many people enjoy Julia Cameron's ritual of "morning pages," in which they write whatever thoughts come to mind for three to five pages when they first wake up.
• Writing every day is not necessary.

Key points

• Writing about stressful or traumatic experiences may cause distress. So, limit writing sessions about a particular experience to three to five sessions and about 15 to 20 minutes each, spread over the course of a few days. Writing more than that can lead to rumination, which is repetitive dwelling on negative thoughts or emotions.
• While it’s important to feel uninhibited in writing, the key is to find meaning in your experience to create resilience and personal growth. After your writing session, take some time to think about what you’ve written. Be kind to yourself.
• If you find it difficult to cope with your emotions, consider talking to a therapist or counselor.

Learn more

• Opening Up by Writing It Down: How Expressive Writing Improves Health and Eases Emotional Pain Third Edition by James W. Pennebaker and Joshua M. Smyth
• The Artist’s Way by Julia Cameron
• Blogs written by people who have been impacted by breast cancer:
  • Overexpressed by Jenny Burkholder
  • For the Breast of Us's Blog
  • No half measures: Living out loud by Abigail Johnston
  • LBBC’s Blogs

Final thoughts

My experience of cancer prompted a personal journey of expressive writing, and that, along with counseling offered by my cancer center, gifted me the opportunity to enact real changes in my life. Over time, I became the mother I wanted to be but hadn't known how to imagine within myself. I eventually became more interested in different kinds of writing and embarked on a different career after my diagnosis. And I continue to evolve and change.

One thing remains constant: I’ve made it a priority to always respectfully hold space for anyone diagnosed with cancer to share what they feel. I’m deeply grateful to honor the stories of individuals impacted by breast cancer in my role here at Living Beyond Breast Cancer. I hope you’ll try the practice of expressive writing and uncover healing, self-acceptance, and personal transformation. Your words have the power to uplift and heal; embrace their beauty and strength.