Although expressive writing has positive effects on health, little is known about the underlying psychological mechanisms for these effects. The present study assessed self-affirmation, cognitive processing, and discovery of meaning as potential mediators of the effects of expressive writing on physical health in early-stage breast cancer survivors. A content analysis of the essays showed that self-affirmation writing was associated with fewer physical symptoms at a 3-month follow-up assessment, with self-affirmation writing fully mediating the effects of the emotional expression and benefit-finding writing conditions on reduced physical symptoms. Cognitive processing and discovery of meaning writing were not associated with any physical health outcomes. Consistent with evidence showing that self-affirmation plays an important role in buffering stress, the present study provides the first evidence for self-affirmation as a viable mechanism underlying the health benefits of expressive writing.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173-1182.
2.
Blanton, H., Cooper, J., Skurnik, I., & Aronson, J. (1997). When bad things happen to good feedback: Exacerbating the need for self-justification with self-affirmations. Personality and Social Psychology Bulletin, 23, 684-692.
3.
Bonnano, G. A., Rennicke, C., & Dekel, S. (2005). Self-enhancement among high-exposure survivors of the September 11th terrorist attack: Resilience or social maladjustment. Journal of Personality and Social Psychology, 88, 984-998.
4.
Bower, J. E., Kemeny, M. E., Taylor, S. E., & Fahey, J. L. (1998). Cognitive processing, discovery of meaning, CD4 decline, and AIDS related mortality among bereaved HIV-seropositive men. Journal of Clinical and Consulting Psychology, 66(6), 979-986.
5.
Bower, J. E., Kemeny, M. E., Taylor, S. E., & Fahey, J. L. (2003). Finding positive meaning and its association with natural killer cell cytotoxicity among participants in a bereavement-related disclosure intervention. Annals of Behavioral Medicine, 25, 146-155.
6.
Bower, J. E., Meyerowitz, B. E., Desmond, K. A., Bernaards, C. A., Rowland, J. H., & Ganz, P. A. (2005). Perceptions of positive meaning and vulnerability following breast cancer: predictors and outcomes among long-term breast cancer survivors. Annals of Behavioral Medicine, 29, 236-245.
7.
Broderick, J. E., Junghaenel, D. U., & Schwartz, J. E. (2005). Written emotional expression produces health benefits in fibromyalgia patients. Psychosomatic Medicine, 67, 326-334.
8.
Burton, C. M., & King, L. A. (2004). The health benefits of writing about intensely positive experiences. Journal of Research in Personality, 38, 150-163.
9.
Cameron, L. D., & Nicholls, G. (1998). Expression of stressful experiences through writing: Effects of a self-regulation manipulation for pessimists and optimists. Health Psychology, 17, 84-92.
10.
Cohen, J., Cohen, P., West, S. G., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences (3rd ed.). Mahwah, NJ: Lawrence Erlbaum.
11.
Cohen, S., Hamrick, N., Rodriguez, M. S., Feldman, P. J., Rabin, B. S., & Manuck, S. B. (2002). Reactivity and vulnerability to stress-associated risk for upper respiratory illness. Psychosomatic Medicine, 64, 302-310.
12.
Creswell, J. D., Welch, W. T., Taylor, S. E., Sherman, D. K., Gruenewald, T. L., & Mann, T. (2005). Affirmation of personal values buffers neuroendocrine and psychological stress responses. Psychological Science, 16, 846-851.
13.
Diener, E., & Diener, M. (1995). Cross-cultural correlates of life satisfaction and self-esteem. Journal of Personality & Social Psychology, 68, 653-663.
14.
Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction With Life Scale. Journal of Personality Assessment, 49, 71-75.
15.
Donnelly, D. A., & Murray, E. J. (1991). Cognitive and emotional changes in written essays and therapy interviews. Journal of Social and Clinical Psychology, 10, 334-350.
16.
Epstein, E. M., Sloan, D. M., & Marx, B. P. (2005). Getting to the heart of the matter: Written disclosure, gender, and heart rate. Psychosomatic Medicine, 67, 413-419.
17.
Esterling, B. A., Antoni, M. H., Fletcher, M. A., Margulies, S., & Schneiderman, N. (1994). Emotional disclosure through writing or speaking modulates latent epstein-barr virus antibody titers. Journal of Consulting and Clinical Psychology, 62, 130-140.
18.
Francis, M. E., & Pennebaker, J. W. (1993). LIWC: Linguistic Inquiry and Word Count. Dallas, TX: Southern Methodist University.
19.
Frisina, P. G., Borod, J. C., & Lepore, S. (2004). A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations. The Journal of Nervous and Mental Disease, 192, 629-634.
20.
Greenberg, M. A. (1995). Cognitive processing of traumas: The role of intrusive thoughts and reappraisals. Journal of Applied Social Psychology, 25, 1262-1296.
21.
Hawkley, L. C., Burleson, M. H., Berntson, G. G., & Cacioppo, J. T. (2003). Loneliness in everyday life: Cardiovascular activity, psychosocial context, and health behaviors. Journal of Personality and Social Psychology, 85, 105-120.
22.
Hobfoll, S. E. (1989). Conservation of resources: A new attempt at conceptualizing stress. American Psychologist, 44, 513-524.
23.
Holahan, C. I., & Moos, R. H. (1990). Life stressors, resistance factors, and improved psychological functioning: An extension of the stress resistance paradigm. Journal of Personality and Social Psychology, 58, 909-917.
24.
Howell, D. C. (2001). Statistical methods for psychology (5th ed.). Belmont, CA: Wadsworth.
25.
Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. New York: Free Press.
26.
Keough, K. A. (1998). Reducing stress and illness by affirming the self. Unpublished dissertation, Stanford University.
27.
King, L. A. (2001). The health benefits of writing about life goals. Personality and Social Psychology Bulletin, 27, 798-807.
28.
King, L. A., & Miner, K. N. (2000). Writing about the perceived benefits of traumatic events: Implications for physical health. Personality and Social Psychology Bulletin, 26, 220-230.
29.
Lange, A., Richard, R., Gest, A., de Vries, M., & Lodder, L. (1998). The effects of positive self-instruction: A controlled trial. Cognitive Therapy and Research, 22, 225-236.
30.
Linville, P. W. (1987). Self-complexity as a cognitive buffer against stress-related illness and depression. Journal of Personality and Social Psychology, 52, 663-676.
31.
Low, C. A., Stanton, A. L., & Danoff-Burg, S. (2006). Expressive disclosure and benefit-finding among breast cancer patients: Mechanisms for positive health effects. Health Psychology, 25, 181-189.
32.
Lucas, R. E., Diener, E., & Suh, E. (1996). Discriminant validity of well-being measures. Journal of Personality & Social Psychology, 71, 616-628.
33.
MacKinnon, D. P., Lockwood, C. M., & Hoffman, J. M. (1998). A new method to test for mediation. Paper presented at the Society for Prevention Research, Park City, UT.
34.
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83-104.
35.
Mann, T. (2001). Effects of future writing and optimism on health behaviors in HIV-infected women. Annals of Behavioral Medicine, 23, 26-33.
36.
McNair, D. M., Lorr, M., & Droppelman, L. F. (1971). EITS manual for the Profile of Mood States. San Diego, CA: Educational and Industrial Testing Service.
37.
Norman, S. A., Lumley, M. A., Dooley, J. A., & Diamond, M. P. (2004). For whom does it work? Moderators of the effects of written emotional disclosure in a randomized trial among women with chronic pelvic pain. Psychosomatic Medicine, 66, 174-183.
38.
O’Cleirigh, C., Ironson, G., Antoni, M. H., Fletcher, M. A., McGuffey, L., Balbin, E., et al. (2003). Emotional expression and depth processing of trauma and their relation to long-term survival in patients with HIV/AIDS. Journal of Psychosomatic Research, 54, 225-235.
39.
Pennebaker, J. W. (1982). The psychology of physical symptoms. New York: Springer-Verlag.
40.
Pennebaker, J. W., Mayne, T. J., & Francis, M. E. (1997). Linguistic predictors of adaptive bereavement. Journal of Personality and Social Psychology, 72, 863-871.
41.
Petrie, K. J., Fontanilla, I., Thomas, M. G., Booth, R. J., & Pennebaker, J. W. (2004). Effect of written emotional expression on immune function in patients with human immunodeficiency virus infection: A randomized trial. Psychosomatic Medicine, 66, 272-275.
42.
Ryff, C. D., & Singer, B. (1998). The contours of positive human health. Psychological Inquiry, 9, 1-28.
43.
Seery, M., Blascovich, J., Weisbuch, M., & Vick, S. B. (2004). The relationship between self-esteem level, self-esteem stability, and cardiovascular reactions to performance feedback. Journal of Personality and Social Psychology, 87, 133-145.
44.
Sherman, D. K., & Cohen, G. (2002). Accepting threatening information: Self-affirmation and the reduction of defensive biases. Current Directions in Psychological Science, 11, 119-123.
45.
Sherman, D. K., & Cohen, G. L. (2006). The psychology of self-defense: Self-affirmation theory. In M. P. Zanna (Ed.), Advances in experimental social psychology (Vol. 38, pp. 183-242). San Diego, CA: Academic Press.
46.
Sherman, D. K., Nelson, L. D., & Steele, C. M. (2000). Do messages about health risks threaten the self? Increasing the acceptance of threatening health messages via self-affirmation. Personality and Social Psychology Bulletin, 26, 1046-1058.
47.
Smith, C. P. (2000). Content analysis and narrative analysis. In H. T. Reis & C. M. Judd (Eds.), Handbook of research methods in social and personality psychology (pp. 313-335). New York: Cambridge University Press.
48.
Smyth, J. M. (1998). Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66, 174-184.
49.
Sobel, M. E. (1982). Asymptotic intervals for indirect effects in structural equations models. In S. Leinhart (Ed.), Sociological methodology (pp. 290-312). San Francisco, CA: Jossey-Bass.
50.
Stanton, A. L., Danoff-Burg, S., Sworowski, L. A., Collins, C. A., Branstetter, A. D., Rodriguez-Hanley, A., et al. (2002). Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients. Journal of Clinical Oncology, 20, 4160-4168.
51.
Steele, C. M. (1988). The psychology of self-affirmation: Sustaining the integrity of the self. In L. Berkowitz (Ed.), Advances in experimental social psychology, Vol. 21: Social psychological studies of the self. Perspectives and programs (pp. 261-302). San Diego, CA: Academic Press.
52.
Stone, A. A., Smyth, J. M., Kaell, A., & Hurewitz, A. (2000). Structured writing about stressful events: Exploring potential psychological mediators of positive health effects. Health Psychology, 19, 619-624.
53.
Suedfeld, P., Tetlock, P. E., & Streufert, S. (1992). Conceptual/integrative complexity. In C. P. Smith (Ed.), Motivation and personality: Handbook of thematic content analysis (pp. 393-400). New York: Cambridge University Press.
54.
Taylor, S. E. (1983). Adjustment to threatening events: A theory of cognitive adaptation. American Psychologist, 38, 1161-1173.
55.
Taylor, S. E., & Brown, J. D. (1988). Illusion and well-being: A social psychological perspective on mental health. Psychological Bulletin, 103, 193-210.
56.
Taylor, S. E., Kemeny, M. E., Reed, G. M., Bower, J. E., & Gruenewald, T. L. (2000). Psychological resources, positive illusions, and health. American Psychologist, 55, 99-109.
57.
Taylor, S. E., Lerner, J. S., Sherman, D. K., Sage, R. M., & McDowell, N. K. (2003a). Are self-enhancing cognitions associated with healthy or unhealthy biological profiles?Journal of Personality and Social Psychology, 85, 605-615.
58.
Taylor, S. E., Lerner, J. S., Sherman, D. K., Sage, R. M., & McDowell, N. K. (2003b). Portrait of the self-enhancer: Well adjusted and well liked or maladjusted and friendless? Journal of Personality and Social Psychology, 84, 165-176.
59.
Tedeschi, R. G., & Calhoun, L. G. (1995). Trauma and transformation: Growing in the aftermath of suffering. Thousand Oaks, CA: Sage.
60.
Ullrich, P. M., & Lutgendorf, S. K. (2002). Journaling about stressful events: Effects of cognitive processing and emotional expression. Annals of Behavioral Medicine, 24, 244-250.
61.
Westling, E., & Mann, T. (2005). Effects of cognitive processing and discovery of meaning on medication adherence in HIV-positive adults. Unpublished manuscript, University of California, Los Angeles.
