Cogniţie, Creier, Comportament / Cognition, Brain, Behavior

Copyright © 2008 Romanian Association for Cognitive Science. All rights reserved.
ISSN: 1224-8398
Volume XII, No.1 (March), 115 - 129

EMOTIONAL BENEFITS OF EXPRESSIVE WRITING

IN A SAMPLE OF ROMANIAN FEMALE CANCER
PATIENTS

Éva KÁLLAY* & Adriana BĂBAN

Department of Psychology, Babeş-Bolyai University, Cluj-Napoca, Romania

ABSTRACT

The main purpose of the present study was to investigate the possible positive effects
of the Expressive Writing paradigm on a sample of Romanian female cancer
patients. The major tenet of this paradigm is that if individuals with high levels of
distress express in writing, for three or four consecutive writing sessions, their
deepest thoughts and emotions regarding the activating event and its consequences,
on the follow-up assessment they would experience significantly lower levels of
distress, and improved physical and/or psychological functioning. Our study has
evinced, that the participants of the sample we investigated has experienced at the
follow-up assessment significantly lower levels of distress, and significantly higher
levels of positive meaning in life and benefit finding, however, the results may
depend on the pre-intervention levels of depression. Nevertheless, the Expressive
Writing task has not significantly contributed in our sample to the enhancement of
the levels of positive emotions.

KEYWORDS: Expressive Writing paradigm, distress, meaning in life, benefit finding.

Humans have an innate need to share the emotions they experience. The
expression of emotions might create a link between our internal experiences and
the outside world. Studies investigating the social sharing of emotions have
revealed this human propensity elicited by even insignificant, everyday events
(Rimé, Herbette, & Corsini, 2004; Rimé, Mesquita, Philippot, & Boca, 1991;
Rimé, 1987). These studies have evinced that the inclination to share certain
emotions evoked by even minor events is neither education nor culture dependent.

*
Corresponding author:
E-mail: evakallay@psychology.ro
116 É. Kállay, A. Băban

Asians, North Americans, Europeans, regardless of their levels of education, need

to share with others the fear, anger, sadness, happiness, affection, etc., induced by
all sorts of events (Rimé, Herbette, & Corsini, 2004; Pennebaker, Zech, & Rimé,
2001).
The study of Emotional Expression has a long history, which dates back to
the 1870s with scientific investigations undergone by Charles Darwin who
emphasized the biological utility of emotional expression. His theory contributed
to the development of an evolutionary-expressive approach to emotion, which
suggests that emotions exist because they contribute to survival. Kennedy-Moore
and Watson (1999) regard emotional expression as having four central functions,
the promotion of arousal regulation, self-understanding, the development of coping
skills and finally, to help improve interpersonal relationships.
It has also been noticed that the propensity to socially share emotions is
not accounted for several personality traits. As Pennebaker et al. (2001) have stated
“general personality dimensions such as the “Big Five” have no predictive value
for the social sharing of emotion” (p. 522). However, as expected, alexithymia - a
particular personality dimension, which involves a marked difficulty to use
appropriate language to express and describe feelings, and to differentiate them
from bodily sensations, a striking paucity of fantasies and a utilitarian way of
thinking (Sifneos, 2000), has been repeatedly found to negatively correlate with
emotional sharing (especially regarding negative emotions) (Taylor, Bagby, &
Parker, 1997). Gross (2002) claims that expression plays a crucial part in the way
we process emotions and in reducing distress which results from negative
emotional experience.
Nevertheless, it has also been observed that even if people need to share all
sorts of emotions, guilt, shame, and frustration are less frequently expressed and
socially shared (Rimé, Herbette, & Corsini, 2004; Finkenauer & Rimé, 1998). This
apparently paradoxical phenomenon has to do with attitudes that reflect the
socially, culturally (and sub-culturally) imposed norms regarding the acceptability
and/or unacceptability of sharing certain emotions with other people.
The need to share one’s emotions is even more imperative in the cases
when the individual experiences negative emotions of high intensity. Research has
shown that the need of socially sharing emotions strongly depends on the degree of
destructiveness of the event, namely, the more negative, disruptive the event, the
higher the frequency of sharing it (Pennebaker et al., 2001). The inclination to
share such debilitating emotions has been steadily noticed after oil platform
disasters (Ersland, Weisoeth, & Sund,1989), earthquakes (Pennebaker & Haber,
1993), war (see effects of the Persian Gulf War in Pennebaker & Haber, 1993), and
other more individualized negative events, such as the loss of a loved one
(Schoenberg, Carr, Peretz, Kutscher, & Cherico, 1975), chronic illness (e.g.,
diagnosis with cancer, see Mitchell & Glickman, 1977), or assaults, sexual abuse,
severe, life-threatening illness, divorce, etc. (Janoff-Bulman, 1992). To put it
briefly, research within reactions after confronting traumatic experiences has
evidenced that such events intensify the subject’s need to be with other people and

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 É. Kállay, A. Băban 117

to share with them the events and especially the emotions experienced (Rimé,
Herbette, & Corsini, 2004; Lehman, Wortman, & Williams, 1987; Schoenberg et
al., 1975).
If humans indeed have this propensity, what would the rewards, benefits of
it be? Common sense has instinctually associated emotional disclosure,
verbalization of emotional experiences with significant reduction of the emotional
charge (Pennebaker et al., 2001).
Different forms of emotional expression have constantly been found to
have positive effect on both mental and physical health, as well as on different
forms of social functioning as social integration, better interpersonal relationships,
etc. (e.g., Pennebaker & Graybeal, 2001; Esterling, Antoni, Kumar, &
Schneiderman, 1990; Fawzy, Fawzy, Hyun, Elashoff, Guthrie, Fahey, & Morton,
1993; Baban, 2000).
To emphasize the findings within emotional disclosure, the approach
targeting emotional inhibition has revealed its detrimental effects on both physical
and mental health (e.g., Florin, Freudenberg, & Hollander, 1985; Larson, 1990,
etc.). The suppression of both thoughts and emotions has a negative effect on the
individual’s physical functioning (e.g., deterioration in the functioning of the
immune system, see Petrie, Booth, & Pennebaker, 1998). The refraining from
expressing negative events and the collateral negative emotions has been
associated with poorer physical health and lower psychological functioning
(Finkenauer & Rimé, 1998). Interestingly, not only the suppression of negative
emotions, but also the deprivation of experiencing, or inhibition of expressing
positive emotions has been found to have a similar effect (Zautra, 2003).
In other words, we could say that the disclosure of emotions related
especially to a negative event seems to help the individual to organize the
experiences he/she has confronted with, and make sense (find meaning, sometimes
create meaning) of the event and its possible aftermaths (Park & Blumberg, 2002),
thus attaining a better overall functioning.
The two main research areas and approaches investigating the effects of
emotional disclosure are those effectuated in Rimé’s laboratory, and those by
James Pennebaker and colleagues (Pennebaker et al., 2001). Rimé’s research has
mainly had a double focus: (i) the verbalization of emotionally charged events, and
(ii) the effects of this verbalization on the emotional recovery from such events
[emotional recovery being defined as “the evolution over time of the arousal still
elicited when a given emotional memory is re-accessed” (Pennebaker et al., 2001,
p. 519)]. On the other hand, Pennebaker and colleagues have thoroughly
investigated the effects of disclosing personal events on both physical and
psychological health.
The mechanisms underlying emotional disclosure are not yet fully
understood. Some authors attain that emotional disclosure integrates cognitive and
emotional processes. This in turn would offer the patient the possibility of
increasing at least insight, self-reflection, organization and analysis of the
experience (Smyth & Graybeal, 2001), and not only of venting emotions. Some

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118 É. Kállay, A. Băban

theories sustain that through habituation, the process of cognitive restructuring of

trauma-related thoughts is facilitated, subsequently leading to a perception of
diminished levels of stress (Foa & Kozak, 1986; Lepore, 1997). Other theories
sustain that by disclosing his/her emotions, the individual acquires greater insight
and self-understanding (Pennebaker & Francis, 1996), and cognitive resolution
(Lepore, Ragan, & Jones, 2000). Thus, disclosure would be much more helpful
than the simple expression of emotions.

In this regard, Pennebaker and colleagues have developed a special form of

emotional expression, the method called Expressive Writing (EW). In their first
published study (Pennebaker & Beall, 1986) college students were asked to write
about their most traumatic and/or upsetting experiences on 4 consecutive days, for
15 minutes daily. The control group on the other hand had to write about trivial
topics in the same time-frame conditions. The results revealed that those students
who wrote about their most stressful events reported 4 months later significant
benefits in physical functioning compared to the control group (e.g., less frequent
visits to medical centers). The constantly growing research within this paradigm
over the last 20 years has proven its beneficial effects on emotional and physical
functioning in individuals who had to confront highly stressful events (Baikie &
Wilhelm, 2005).
In the following, we will present the main aspects of Expressive Writing.

Expressive Writing

Briefly stated, this paradigm sustains that after subjects express through
writing their deepest thoughts about a negative event, their level of distress would
decrease, symptoms of depression would remit, and even positive changes in their
overall health would be observable. As Smith’s (1998) meta-analysis evidences,
Expressive Writing has been given an important role in the study and practice of
reactions following exposure to highly stressful negative events.
The standard procedure of this paradigm is as follows: subjects, after being
assessed on their levels of physical and/or psychological functioning, have to
complete the typical 3 or 4 day writing session, in which they daily have to write
about their deepest feelings and thoughts for 15-20 minutes. Some studies have
also suggested that the lengthening of writing sessions may lead to even better
results (Smyth, 1998). After 4 to 6 weeks, the subjects are assessed again on the
initially evaluated dimensions (posttest) to assess the impact of the procedure.
Different studies have used different types of instructions. Usually, the
experimental group is instructed to write either about their deepest thoughts
(trauma fact group), their deepest emotions about the event (trauma emotion
group), or both (trauma-combo group). Usually, the control group is instructed to
write about life-events of minor importance (e.g., describe their home, write about
their shoes, etc.). Data support the idea that the trauma-combo group benefits most
from the Expressive Writing paradigm.

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 É. Kállay, A. Băban 119

Nevertheless, research within this paradigm has started positing questions

whether the method would in all cases lead to emotional and health benefits, who
would benefit most out of it (males, females, individuals with high or low
education), as well as the timing of intervention. Would individuals benefit as
much if they were instructed to write about their deepest thoughts and feelings
immediately after the negative event, or a certain amount of time should have
elapsed between event and intervention?

a. Immediate and long-term effects

As oftentimes observed, the immediate impact of expressive writing is a
momentary increase of distress and negative mood (Baikie & Wilhelm, 2001).
When trying to remember different aspects of the event, or re-experience the
produced emotions in order to conform to the instruction, people tend to re-
experience similar, nevertheless less intense emotions, as those experienced around
the event. Thus, even if in the immediate aftermath of the intervention participants
tend to feel a slightly higher level of distress, the long-term benefits surpass the
short-term emotional inconveniences.

b. Benefits of Expressive Writing

Expressive Writing leads to benefits observable both objectively (e.g.,
significantly reduced number of visits to the doctor, improved immune system
functioning, reduced blood-pressure, etc.), and through self-reports, regarding (i)
improvement of physical health, and (ii) improvement of emotional health (Baikie
& Wilhelm, 2005). Self-reported improvements have been observed in positive
changes in mood/affect (Pennebaker, Kiecolt-Glaser, & Glaser, 1988),
psychological well-being (Park & Blumberg, 2002), reduction of depressive
symptoms in students before exams (Lepore, 1997), etc.
As Baikie and Wilhelm (2005) notice, the most robust and consistent
findings regarding the benefits of Expressive Writing have been observed in
positive changes within different aspects of physical health.

c. Who benefits?
Benefits after sessions of Expressive Writing have been observed in two
main domains: medical and psychological conditions. Regarding medical
conditions, research reveals that asthma patients, those with rheumatoid arthritis
(Broderick, Stone, Smyth, & Kaell, 2004), cancer patients (Stanton & Danoff-
Burg, 2002), showed after participating in the Expressive Writing paradigm
improved physical functioning (for more details see Baikie & Wilhelm, 2005;
Smyth, Stone, Hurewitz, & Kaell, 1999), while patients with HIV showed
improved immune functioning (Petrie, Fontanilla, Thomas, Booth, & Pennebaker,
2004).
From the point of view of psychological functioning, Expressive Writing
has resulted in more or less consistent improvements in posttraumatic reactions
(Schoutrop, Lange, Hanewald, Davidovich, & Salomon, 2002), and other aspects

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120 É. Kállay, A. Băban

of psychological functioning (Deters & Range, 2003). Nevertheless, several studies

have proven that Expressive Writing has detrimental effects on adult survivors of
childhood sexual abuse (Batten, Follette, Rasmussen Hall, & Palm, 2002).
On the overall, the perusing of the literature suggests that the most benefits
from Expressive Writing tend to be more often experienced by participants with
considerable levels of distress.
The Expressive Writing paradigm has previously been quite successfully
applied to a sample of Romanian students (Opre, Coman, Kallay, Rotaru, &
Manier, 2005). This study has shown that the experimental group benefited from
the expressive writing technique, by reducing the students’ psychological distress
scores (BDI, POMS - NAS), and improving their physical and mental health scores
measured by a self reported health scale (SRH). Seeing these encouraging results
we have thought of investigating the effects of Expressive Writing on a sample of
Romanian female cancer patients, where the results may have clinical implications
as well.
As known, the levels of distress after the diagnosis with different forms of
cancer is considerably high (Degi, Kallay, & Vincze, 2006). It is also well known
that the diagnosis with cancer has a huge impact on peoples’ lives. In the period
following the diagnosis, some may succumb, others be negatively affected for a
long period of time, while still other recover, and/or bounce back to their previous
levels of functioning (O’Leary & Ickovics, 1995; Bonanno, 2004). The diagnosis-
induced distress, especially if prolonged and extremely intense, might have serious
detrimental effects on the patients’ psychological and/or physical functioning. One
of the main aspects of human functioning that might contribute to a better
adaptation to the diagnosis and the distress it implies is highly dependent on the
patients’ ability to find benefit in the event (Tedeschi & Calhoun, 2004), and a
positive meaning for life (for more details see Kallay & Miclea, 2006; Kallay &
Miclea, 2007).

OBJECTIVES

Our study is an exploratory investigation, and has two major objectives:

(i) To investigate whether Romanian female cancer patients might benefit

from the Expressive Writing technique, benefits that would be represented
by reduced levels of distress, and higher levels of positive emotions.
(ii) If the Expressive Writing technique would also lead to higher levels of
positive meaning in life, and stress-related growth, that might indicate the
individual’s ability to find some benefits in the threatening life event
(diagnosis with cancer).

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 É. Kállay, A. Băban 121

METHOD

Participants
We have investigated 82 female cancer patients hospitalized at “Ion
Chiricuta” Oncological Institute, Cluj-Napoca, Romania, with ages between 41 and
55 years (mean = 50.09 ), with 4 months to 16 months elapsed between diagnosis
and assessment (mean = 8.12). 78% of the patients were diagnosed with breast
cancer and 20% with cervical cancer, the remaining 2% with pulmonary and
stomach cancer. The patients’ level of education varied between 8 and 18 years.
Even if 82 patients agreed to participate in the study, only 45 patients completed
the four writing sessions and the 4-week follow-up assessment.

Materials
Depression was measured with the Beck Depression Inventory (BDI).
Beck Depression Inventory (Beck, Ward, Mendelson, Mock, & Erbaugh,
(1961) is a 21-item, multiple-choice format inventory, designed to measure the
presence of depression in adults and adolescents. Each of the 21 items assesses a
symptom or attitude specific to depression, inquiring its somatic, cognitive and
behavioral aspects. By its assessments, single scores are produced, which indicate
the intensity of the depressive episode. Scores ranging from 0 to 9, represent
normal levels of depression. Scores situated between 10 and 18 represent mild to
moderate depression; values between 19 and 29 represent moderate to severe
depression, while scores above the value of 30 represent severe depression. The
reliability figures of the BDI are usually above .90.
Internal consistency shows a correlation coefficient of .86 for the test
items. For the assessed population in this study, the value of internal consistency
was .84.

Mood states and emotions were assessed by Profile of Mood States (POMS)
(McNair, Lorr, & Droppleman, 1971).
POMS is a 48-item inventory, that measures general and specific distress
(e.g. anxiety, depression, hostility, confusion), but also contains a positive
mood/emotion subscale.
The test asks participants to answer how they are feeling (a particular
mood state) by specifying a degree ranging from “not at all” (0) to “extremely” (4).
The POMS was shown to be 92% reliable for tension/anxiety; 95% for
depression/dejection; 92% for anger/hostility; 89% for vigor; 94% for fatigue, and
87% for confusion.
Cronbach’s alpha for the subscales of the original POMS varies from .87
to .95, while on the population assessed in our study from .73 to .94. Cronbach’s
alpha for the global POMS has the value of .92.

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122 É. Kállay, A. Băban

The subjective meaning of life was assessed by the Life Regard Index (LRI)
(Battista & Almond, 1973).
LRI is a 28-item self-report questionnaire designed to assess positive and
negative life regard, more specifically the degree to which individuals can envision
their lives within some meaningful perspective or have derived a set of motivating
life goals. Assessed individuals are asked to indicate on a 3-point scale (ranging
from 1 to 3), whether they agree or not with each of the 28 statements.
The LRI was repeatedly found to strongly discriminate between distressed
and non-distressed subjects (Debats, van der Lubbe, & Wezeman, 1993). The
internal validity of the original scale is situated between .79 to .87, and test-retest
reliability with an interval of two weeks r = .94 Cronbach’s alpha for the positive
and negative sub-scales of the LRI on the assessed cancer-diagnosed population
was .87 for positive life regard, and .74 for negative life regard.

Posttraumatic growth has been assessed with: The Stress Related Growth Scale
(SRGS) short version (Park, Cohen, & Murch, 1996).
The SRGS is a 15-item questionnaire, attempting to measure positive
outcomes determined by the struggle with a highly stressful event (in our case the
diagnosis with cancer). Thus, patients are asked to choose among 3 response
choices: 0 = not at all, 1 = somewhat, and 2 = to a great deal, regarding perceived
growth determined by the occurrence of the negative event (e.g., Because of this
stressful event: I learned to be nicer to others: 0-1-2). The scale offers a global
score, with scores ranging from minimum 0 to maximum 30.
The SRGS’s original internal consistency (Cronbach’s alpha) is .96
(Tedeschi, Park, & Calhoun, 1996), and test-retest reliability of .81 (Park et al.,
1996). As the authors of the scale have mentioned (Park et al., 1996), the results of
subsequent studies have revealed that the acceptable internal consistency and test-
retest reliability are not influenced by social desirability. Another study conducted
by the same authors has revealed that the SRGS responses were significantly
related to those provided by relatives and friends (Park et al., 1996). The internal
consistency of this scale on the population assessed in Study 1 has been found to
be .78.

Procedure
After agreeing to participate at the study (the entire procedure has been
thoroughly explained to the participants), all patients were assessed at T1 with all
the above mentioned scales (demographic, BDI, POMS, LRI, SRGS). Afterwards,
four consecutive days, all participants were asked to write daily for 20 minutes
about their deepest thoughts and emotions regarding their illness and its
implications. After 4 weeks from the last day of writing task, all participants were
assessed again on all the dimensions assessed at T1. Even if at T1 the number of
patients who agreed to participate was 82, only 45 patients participated to the end
of the study, thus the percentage of drop-out is quite considerable (almost 55%).

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 É. Kállay, A. Băban 123

RESULTS

In order to investigate the possible changes produced by the Expressive

Writing paradigm, we have conducted a paired samples t-test, thus comparing
scores at T1 with those at T2 (significant differences are presented in Table 1).

Table 1
Significant differences at paired samples t-test comparing scores at T1 and T2

N=45 SCALES Pre-test Mean St. dev. t Sig.

Post-test
BDI T1 12.22 6.7820 3.15 .00
T2 9.55 5.6228
LRI positive T1 35.33 4.8336 -3.60 .00
T2 36.93 4.6534
SRGS T1 20.68 7.5613 - 2.67 .01
T2 21.97 6.6691
POMS depression T1 18.42 10.4457 3.02 .00
T2 14.51 8.9560
POMS fury T1 5.04 3.5926 2.60 .01
T2 3.68 3.5150

Another issue we have been interested in is that of who would benefit most
from this paradigm, regarding especially initial levels of depression. In the
literature, the results are quite inconsistent – some studies suggest that individuals
with moderate levels of distress benefit more, while other studies indicate that in
some cases even those who experience really high levels of distress might
significantly benefit from this paradigm.

Consequently, we have separated our participants in two groups, based on

their initial (T1) levels of depression measured on BDI. Thus, in group 1 (Gr 1)
entered those participants who had levels of depression lower that the score of 18
(scores between 0-9 represent normal levels, while between 10-18 mild), and in
group 2 (Gr 2) those participants who had scores higher than 18 (which represents
moderate and severe). Next, we have conducted a paired samples t-test for
investigating changes from T1 to T2 split on these two groups (see significant
results in Table 2).

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124 É. Kállay, A. Băban

Table 2
Significant differences at paired samples t-test at T2 for patients with lower (Gr 1) and
higher (Gr 2) than mild scores (18) on BDI at T1.

GR 1 SCALES Pre-test Mean St. dev. t Sig.

N=35 Post-test
LRI positive T1 36.31 4.65 - 2.71 .03
T2 37.42 4.72
POMS depression T1 15.62 10.18 2.70 .01
T2 11.28 7.01
POMS fury T1 4.25 3.60 2.89 .00
T2 2.48 2.95
POMS fatigue T1 7.48 2.72 2.14 .03
T2 6.68 2.36
GR 2 SCALES Pre-test Mean St. dev. T Sig.
N=10 Post-test
BDI T1 22.909 2.92 22.93 .00
T2 13.20 2.39
LRI positive T1 31.90 3.92 - 4.94 .00
T2 35.20 4.15
SRGS T1 19.60 6.41 - 2.94 .01
T2 22.20 5.15

In the following step, we wanted to investigate whether the differences

between these groups on their scores at T2 are significant (results are presented in
Table 3).

Table 3
Independent samples t-test for scores at T2 between normal/mild and severe T1
levels of depression

SCALES Group Mean St. dev. t Sig.

(N)
BDI at T2 1 (35) 8.51 5.86 - 2.45 .01
2 (10) 13.20 2.39
LRI negative at T2 1 (35) 21.60 5.99 - 2.90 .00
2 (10) 27.60 4.81
POMS positive at T2 1 (35) 23.48 5.11 4.65 .00
2 (10) 14.80 5.55
POMS anxiety at T2 1 (35) 10.17 4.22 - 3.14 .00
2 (10) 14.60 2.54
POIMS depression at T2 1 (35) 11.28 7.01 - 6.10 .00
2 (10) 25.80 4.93
POMS fury at T2 1 (35) 2.48 2.95 - 5.57 .00
2 (10) 7.90 1.44
POMS confusion at T2 1 (35) 5.25 1.73 - 3.50 .02
2 (10) 7.50 1.95

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 É. Kállay, A. Băban 125

DISCUSSIONS AND CONCLUSIONS

As the results presented in Tables 1 show, after participating at the

expressive writing task, participants’ level of depression has significantly lowered
t = 3.15 at p < .01, as well as their levels of depressive states measured with POMS
t = 3.03 at p < .01, and fury t = 2.60 at p < .01. By the same token, participants
have significantly found more positive meaning in life t = - 3.60 at p < .01, and
significantly more benefit in the event t = - 2.60 at p < .01. Nevertheless, we have
not found, as expected any significant positive change in activation of positive
emotions. The expressive writing task has not significantly improved patients’
levels of positive emotions. However, the fact that the technique has significantly
lowered the patients’ levels of depression and depressive mood is in itself an
encouraging result. On the other hand, the fact that the patients tend to significantly
find and/or search for more positive meaning in life, and benefits in the afterwards
of the event, might in the long run contribute to the enhancement of positive
emotions.
The second, a posteriory part of our statistical investigation intended to
inquire whether there might be differences in the way patients, depending on their
initial levels of distress measured with BDI, would benefit from the Expressive
Writing paradigm.
Consequently, we have found that those with relatively low initial levels of
depression, after participating at the Expressive Writing technique find
significantly higher levels of positive meaning in life (t = -2.71 at p < .05, and
experience significantly lower levels of depressive mood on POMS (t = 2.70 at
p < .01), fury (t = 2.89 at p < .01), and fatigue (t = 2.14 at p < .05). In the
meanwhile, those who initially had higher levels of depression, benefit from the
Expressive Writing paradigm by significantly reduced levels of depression on BDI
(t = 22.93 at p < .01), significantly higher levels of positive meaning in life (t = -
4.94 at p < .01), and benefit in the event (t = - 2.94 at p < .01). The results have
also shown that the differences between these two groups are also significant on
their levels of depression (t = -2.45 at p < .01), in the sense that even if the
Expressive Writing has reduced their level of depression, those with initially higher
levels of depression still have significantly higher levels at T2. Thus, the
Expressive Writing task reduced the initially experienced levels of depression, but
does not even these levels between the groups. In the same fashion, the levels of
different manifestations of negative mood measured on POMS (anxiety,
depression, fury and confusion), have the same fate (see Table 3). Consequently,
we may say that in our case the Expressive Writing technique reduces negative
reactions to the diagnosis with cancer, it does not even the scores. However, these
last findings presented in Tables 2 and 3 represent only possible directions for
future research, since the number of participants in group 2 is really low (N = 10).
This aspect is one of the main limitations of this study.
Other limitations of this exploratory study are that we did not have a
control group, and the study was conducted only on female cancer patients. We

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126 É. Kállay, A. Băban

propose that future studies would investigate these very important aspects (gender
differences in the effectiveness of Expressive Writing paradigm, and experimental
vs. control groups) as well.
A very important aspect we would like to highlight refers to the fact that
the Expressive Writing task has significantly lowered the levels of depression in
cancer patients, which might contribute at least to the enhancement of quality of
life. In the same manner, this task has activated in patients the search for higher,
more positive meanings in life, aspect that might contribute to the activation and
elevation of the levels of positive emotions.
Since this type of intervention is relatively simple, and implies low costs
(the task may also be given to patients as home assignment, not only effectuated in
highly controlled laboratory environments) (Baikie & Wilhem, 2001), we
encourage its thorough, more detailed investigation in other areas of chronic illness
in our geographic area. If future research could be completed with data regarding
physical functioning, the data would offer a more complex image regarding the
effects of Expressive Writing.

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