PhD in Nursing Science Program

Liz McDowell

Analysis of Written Emotional Disclosure and Control Group Essay Organization in Breast Cancer Survivors with Stage II Lymphedema


Dissertation under the direction of Professor Kenneth A Wallston


While many researchers have found written emotional disclosure to be beneficial for psychological health, physical health, and overall functioning in certain populations, no one has definitively ascertained how or why this intervention results in positive changes. Because some researchers have suggested that the benefits of written emotional disclosure are related to the formation of coherent and cohesive essays, this dissertation research examined the essay organization (i.e., the coherence and cohesion) of written emotional disclosure and control narratives previously collected in a randomized clinical trial from participants who were living with breast cancer treatment-related lymphedema (LE) to determine the correlation of essay organization, or the development of this organization over time, and health benefits. Essay organization was measured utilizing the Global Ratings of Essays about Trauma (GREAT) coding system.

Several significant findings were generated from this study. There was some limited support for the hypotheses that the averaged ratings for organization and the positive progression of essay organization scores over time are positively correlated with changes in mental and physical health outcomes and social behavior outcomes such that higher organization scores and a progression from lower organization scores to higher organization scores predict improvements in depressed mood, psychological symptoms, physical symptoms and social behaviors. In addition, asking participants to write with emotion about living with lymphedema did not prompt more organized narratives than instructions to write about neutral topics.  Both the intervention and control groups wrote similarly organized essays, but the intervention group showed better health and social outcomes. 

Additional research using the GREAT coding system is needed to continue to assess its psychometric properties. In addition, conducting analyses where the dependent variable is organization scores, and the predictors are personal attributes or characteristics of the writers is needed.  This would help us predict which individuals would write more organized essays, thus helping to determine for whom the writing intervention works best.