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Title page for ETD etd-03212012-151752

Type of Document Dissertation
Author McDowell, Liz
Author's Email Address liz.mcdowell@vanderbilt.edu
URN etd-03212012-151752
Title Analysis of Written Emotional Disclosure and Control Group Essay Organization in Breast Cancer Survivors with Stage II Lymphedema
Degree PhD
Department Nursing Science
Advisory Committee
Advisor Name Title
Kenneth A. Wallston Committee Chair
Amy-Jill Levine Committee Member
Lois Wagner Committee Member
Sheila H. Ridner Committee Member
Vaughn G. Sinclair Committee Member
  • lymphedema
  • written emotional disclosure
  • GREAT code
  • breast cancer
Date of Defense 2012-03-19
Availability unrestricted
While 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 of written emotional disclosure and control narratives previously collected in a randomized clinical trial to determine the correlation of essay organization, or the development of this organization over time, and health benefits. These essays were written by participants living with breast cancer treatment-related lymphedema (LE). Essay organization was measured utilizing the Global Ratings of Essays about Trauma (GREAT) coding system.

There was some support for the hypotheses that participants writing more organized essays and/or showing a progression of narrative organization over time would experience better mental and physical health outcomes and social behavior outcomes. However, the support was not consistent throughout the writing groups or the follow-up points. There appears to be stronger support for the formation of an organized narrative over writing sessions affecting health outcomes positively, however such conclusions must be made cautiously. The participants in both the intervention and control groups wrote essays that were similar in organization even though the writing instructions were different. And the averaged word counts of the essays were significantly and positively correlated with the averaged organization scores of the essays.

Additional research using the GREAT coding system is needed to continue to assess its psychometric properties. Similar research studies should be replicated with varying populations under varying conditions to test the importance of essay organization. Researchers need to revisit writing instructions, perhaps providing instructions in how to create a coherent narrative. In addition, researchers should conduct analyses where the dependent variable is organization scores, and the predictors are personal attributes or characteristics of the writers. This would help predict which individuals would write more organized essays, thus helping to determine for whom the writing intervention works best.

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