Writing Content Predicts Outcomes in Written Exposure to Worst-Case Scenarios for Advanced Cancer

Background: A novel written exposure-based coping intervention (EASE) for distressed adults with advanced cancer focused on their cancer-related worst-case scenario and showed promise for reducing cancer-related trauma symptoms and fear of cancer progression (FoP). This study examines potential mechanisms of change, specifically linguistic features of participants' writing. Methods: Adults (N = 28) with advanced solid tumor (n = 23) or high-risk blood cancer (n = 5) reporting elevated trauma or FoP participated. Writing was collected during five weekly intervention sessions (three exposure, two coping) and analyzed using linguistic software (LIWC-22). Outcomes were assessed pre-intervention and one-week post-intervention. Results: More positive (trauma: ηp² = 0.64, p < 0.001; FoP: ηp² = 0.34, p = 0.011) and negative (FoP: ηp² = 0.38, p = 0.007) emotion words during exposure writing sessions predicted worse outcomes, while more death-related words predicted reduced FoP (ηp² = 0.22, p = 0.023). Positive tone in coping writing sessions predicted reduced FoP (ηp² = 0.31, p = 0.009), while negative tone predicted worse FoP (ηp² = 0.22, p = 0.026). Conclusions: Findings offer preliminary support for several proposed mechanisms of this novel written exposure intervention.