The Effectiveness of Writing Therapy on Anxiety and Depression in Patients with Leukemia

The effectiveness of writing therapy in patients with leukemia


  • Hawra'a Fadhel Abbas AL-Baghdady
  • Ali Abdulhussain Fadhil
  • Ali Obaid Hajray
  • Abed J. Kadhim
  • Saad Ghazi Talib
  • Zainab Hussein Adhab
  • Sara Salah Mahdi
  • Shaker Holh Sabit
  • Rana Ahmed Ragab
  • Doaa A. Hamad


Background: The diagnosis of cancer, followed by lengthy treatment, poses a significant threat to patients' mental health. The current study aimed to examine the effectiveness of writing therapy on depression and anxiety of patients with leukemia.

Methods: This study involved two groups in a randomized clinical trial. The statistical population of the current study comprised 384 patients of Baghdad Medical City, Iraq, who met the inclusion criteria, in 2019. A simple random sampling method was used to select a statistical sample of 110 individuals, who were then divided into experimental and control groups (55 members in each group). Data collection tools included Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI). Multivariate analysis of covariance (MANCOVA) was used in SPSS software for data analysis.

Results: The writing therapy intervention approach reduced the anxiety (F = 67.864, P < 0.001) and depression (F = 54.218, P < 0.001) of patients with leukemia. In addition, none of the demographic variables of the study's participants had a significant relationship with the findings.

Conclusion: Implementing the writing therapy intervention can improve the psychological symptoms of patients with leukemia.


Appelhans, B. M., Whited, M. C., Schneider, K. L., Ma, Y., Oleski, J. L., Merriam, P. A. et al. (2012). Depression severity, diet quality, and physical activity in women with obesity and depression. J Acad Nutr Diet., 112(5), 693-698. doi:S2212-2672(12)00158-X [pii];10.1016/j.jand.2012.02.006 [doi]. Retrieved from PM:22709773

Arnau, R. C., Meagher, M. W., Norris, M. P., & Bramson, R. (2001). Psychometric evaluation of the Beck Depression Inventory-II with primary care medical patients. Health Psychol, 20(2), 112-119. doi:10.1037//0278-6133.20.2.112 [doi]. Retrieved from PM:11315728

Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. J Consult.Clin Psychol, 56(6), 893-897. doi:10.1037//0022-006x.56.6.893 [doi]. Retrieved from PM:3204199

Beck, A. T., Steer, R. A., & Garbin, M. G. (1988). Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clin Psychol Rev, 8(1), 77-100.

Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Arch Gen.Psychiatry, 4, 561-571. doi:10.1001/archpsyc. 1961.01710120031004 [doi]. Retrieved from PM:13688369

Bonifacci, P., Candria, L., & Contento, S. (2007). Reading and writing: what is the relationship with anxiety and depression? Read Writ, 21(6), 609.

Christiansen, D. M. (2022). Martino, M. L., Elklit, A., & Freda, M. F. (2022). Sex differences in the outcome of expressive writing in parents of children with leukaemia. Clinical Psychology in Europe, 4(1), e5533.

Cvetkovic, J., & Nenadovic, M. (2016). Depression in breast cancer patients. Psychiatry Res, 240, 343-347. doi:S0165-1781(16)30519-4 [pii];10.1016/j.psychres.2016.04.048 [doi]. Retrieved from PM:27138829

Ding, T., Wang, X., Fu, A., Xu, L., & Lin, J. (2019). Anxiety and depression predict unfavorable survival in acute myeloid leukemia patients. Medicine (Baltimore.), 98(43), e17314. doi:10.1097/MD.0000000000017314 [doi];00005792-201910250-00005 [pii]. Retrieved from PM:31651837

Ennis, N., & Cartagena, G. (2020). Therapeutic writing as a tool to facilitate therapeutic process in the context of living with HIV: A case study examining partner loss. Psychotherapy.(Chic.), 57(1), 68-74. doi:2019-62898-001 [pii];10.1037/pst0000259 [doi]. Retrieved from PM:31647262

Esterling, B. A., L'Abate, L., Murray, E. J., & Pennebaker, J. W. (1999). Empirical foundations for writing in prevention and psychotherapy: mental and physical health outcomes. Clin Psychol Rev, 19(1), 79-96. doi:S0272735898000154 [pii];10.1016/s0272-7358(98)00015-4 [doi]. Retrieved from PM:9987585

Fischer, J., Knop, S., Danhof, S., Einsele, H., Keller, D., & L+¦ffler, C. (2022). The influence of baseline characteristics, treatment and depression on health-related quality of life in patients with multiple myeloma: A prospective observational study. Research Square, 2022. doi: 10.21203/

Gu, M., Hao, X., Cong, L., & Sun, J. (2019). The prevalence, risk factors, and prognostic value of anxiety and depression in refractory or relapsed acute myeloid leukemia patients of North China. Medicine (Baltimore.), 98(50), e18196. doi:10.1097/MD.0000000000018196 [doi];00005792-201912130-00016 [pii]. Retrieved from PM:31852076

Hamid, N., Talebian, L., Mehrabizadeh Honarmand, M., & Yavari, A. (2011). The effects of logotherapy on depression, anxiety and quality of life of cancer patients in Ahvaz Big Oil Haspital. Psychological Achievements, 18(2), 199-224.

Jensen-Johansen, M. B., Christensen, S., Valdimarsdottir, H., Zakowski, S., Jensen, A. B., Bovbjerg, D. H. et al. (2013). Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors - results from a nationwide randomized clinical trial. Psychooncology., 22(7), 1492-1500. doi:10.1002/pon.3193 [doi]. Retrieved from PM:22991162

Jones, J. K., Evans, J. F., & Barfield, R. C. (2021). The Utility of Verbal Therapy for Pediatric Cancer Patients and Survivors: Expressive Writing, Video Narratives, and Bibliotherapy Exercises. Front Pediatr., 9, 579003. doi:10.3389/fped.2021.579003 [doi]. Retrieved from PM:33614548

Kunin-Batson, A. S., Lu, X., Balsamo, L., Graber, K., Devidas, M., Hunger, S. P. et al. (2016). Prevalence and predictors of anxiety and depression after completion of chemotherapy for childhood acute lymphoblastic leukemia: A prospective longitudinal study. Cancer, 122(10), 1608-1617. doi:10.1002/cncr.29946 [doi]. Retrieved from PM:27028090

Li, Z., Peng, L., Li, Y., Zhang, J., & Jiang, Q. (2022). Lower tumor burden is associated with better cognitive function in patients with chronic phase chronic myeloid leukemia. Leuk.Lymphoma., 1-12. doi:10.1080/10428194.2022.2070912 [doi]. Retrieved from PM:35543618

Lu, Y. Y., Lu, X. M., Shao, C. Y., Wang, C. C., Xu, T. T., & Zhang, B. L. (2022). Empathetic nursing with mindful cognitive therapy for fatigue, depression, and negative emotions in leukemia patients undergoing long-term chemotherapy. World.J Clin Cases., 10(6), 1826-1833. doi:10.12998/wjcc.v10.i6.1826 [doi]. Retrieved from PM:35317141

Matsuo, K., Duval, C. J., Youssefzadeh, A. C., Mandelbaum, R. S., Ouzounian, J. G., & Wright, J. D. (2022). Prevalence of anxiety and depressive disorders in pregnant women with malignancy. Int J Gynaecol.Obstet. doi:10.1002/ijgo.14335 [doi]. Retrieved from PM:35816388

Mosher, C. E., Duhamel, K. N., Lam, J., Dickler, M., Li, Y., Massie, M. J. et al. (2012). Randomised trial of expressive writing for distressed metastatic breast cancer patients. Psychol Health, 27(1), 88-100. doi:938653648 [pii];10.1080/08870446.2010.551212 [doi]. Retrieved from PM:21678181

Nissen, E. R., O'Connor, M., Kaldo, V., Hojris, I., Borre, M., Zachariae, R. et al. (2020). Internet-delivered mindfulness-based cognitive therapy for anxiety and depression in cancer survivors: A randomized controlled trial. Psychooncology., 29(1), 68-75. doi:10.1002/pon.5237 [doi]. Retrieved from PM:31600414

Osborn, R. L., Demoncada, A. C., & Feuerstein, M. (2006). Psychosocial interventions for depression, anxiety, and quality of life in cancer survivors: meta-analyses. Int J Psychiatry Med, 36(1), 13-34. doi:10.2190/EUFN-RV1K-Y3TR-FK0L [doi]. Retrieved from PM:16927576

Pennebaker, J. W. (1980). Perceptual and environmental determinants of coughing. Basic and Applied Social Psychology, 1(1), 83-91.

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. Psychosom.Med, 66(2), 272-275. doi:10.1097/01.psy.0000116782.49850.d3 [doi]. Retrieved from PM:15039514

Petrykey, K., Lippe, S., Robaey, P., Sultan, S., Laniel, J., Drouin, S. et al. (2019). Influence of genetic factors on long-term treatment related neurocognitive complications, and on anxiety and depression in survivors of childhood acute lymphoblastic leukemia: The Petale study. PLoS.One., 14(6), e0217314. doi:10.1371/journal.pone.0217314 [doi];PONE-D-19-03382 [pii]. Retrieved from PM:31181069

Qian, J., Zhou, X., Sun, X., Wu, M., Sun, S., & Yu, X. (2020). Effects of expressive writing intervention for women's PTSD, depression, anxiety and stress related to pregnancy: A meta-analysis of randomized controlled trials. Psychiatry Res, 288, 112933. doi:S0165-1781(19)31497-0 [pii];10.1016/j.psychres.2020.112933 [doi]. Retrieved from PM:32315889

Quinto, R. M., Iani, L., De, V. F., Russo, F., Porcelli, P., & Abeni, D. (2022). Does Guided Written Disclosure Reduce Distress and Improve Psychological Functioning in Patients with Skin Diseases? Int J Environ.Res Public Health, 19(5). doi:ijerph19052943 [pii];10.3390/ijerph19052943 [doi]. Retrieved from PM:35270635

Ramanda, S., Rita, M., & Diah, L. (2022). The effect of music therapy on children with cancer patients. Proceedings of the 4th International Conference on Arts and Design Education (ICADE 2021); (pp. 270-281). Amsterdam, Netherlands: Atlantis Press.

Reinhold, M., Bürkner, P. C., & Holling, H. (2018). Effects of expressive writing on depressive symptomsA metaanalysis. Clin Psychol, 25(1), e12224.

Sarman, A., & Gunay, U. (2022). The effect of calligraphy as an art therapy intervention containing religious motifs, on the anxiety and depression in adolescent psychiatric patients. J Relig.Health. doi:10.1007/s10943-021-01479-0 [doi];10.1007/s10943-021-01479-0 [pii]. Retrieved from PM:35059964

Shen, L., Yang, L., Zhang, J., & Zhang, M. (2018). Benefits of expressive writing in reducing test anxiety: A randomized controlled trial in Chinese samples. PLoS.One., 13(2), e0191779. doi:10.1371/journal.pone.0191779 [doi];PONE-D-16-08261 [pii]. Retrieved from PM:29401473

Sherman, K. A., Przezdziecki, A., Alcorso, J., Kilby, C. J., Elder, E., Boyages, J. et al. (2018). Reducing body image-related distress in women with breast cancer using a structured online writing exercise: Results from the my changed body randomized controlled trial. J Clin Oncol., 36(19), 1930-1940. doi:10.1200/JCO.2017.76.3318 [doi]. Retrieved from PM:29688834

Smyth, J. M., Johnson, J. A., Auer, B. J., Lehman, E., Talamo, G., & Sciamanna, C. N. (2018). Online positive affect journaling in the improvement of mental distress and well-being in general medical patients with elevated anxiety symptoms: A preliminary randomized controlled trial. JMIR.Ment.Health, 5(4), e11290. doi:v5i4e11290 [pii];10.2196/11290 [doi]. Retrieved from PM:30530460

Talebiazar, N., Choobianzali, B., Hassanpour, A., Goli, R., Shakorzadeh, S., & Ghalandari, M. (2022). The effect of hypnotherapy on the hospital anxiety in three children with cancer: A case report. Int J Surg Case Rep., 93, 106961. doi:S2210-2612(22)00207-3 [pii];10.1016/j.ijscr.2022.106961 [doi]. Retrieved from PM:35477214

Taylor, M. R., Hillard, C. J., Drobyski, W. R., Szabo, A., Johnson, B. D., Zhu, F. et al. (2022). The effect of tocilizumab on patient reported outcomes and inflammatory biomarkers in hematopoietic cell transplantation. Brain Behav Immun.Health, 23, 100480. doi:10.1016/j.bbih.2022.100480 [doi];S2666-3546(22)00070-9 [pii]. Retrieved from PM:35757656

Thune-Boyle, I. C., Stygall, J. A., Keshtgar, M. R., & Newman, S. P. (2006). Do religious/spiritual coping strategies affect illness adjustment in patients with cancer? A systematic review of the literature. Soc Sci Med, 63(1), 151-164. doi:S0277-9536(05)00666-0 [pii];10.1016/j.socscimed.2005.11.055 [doi]. Retrieved from PM:16427173

Wallert, J., Gustafson, E., Held, C., Madison, G., Norlund, F., von, E. L. et al. (2018). Predicting adherence to internet-delivered psychotherapy for symptoms of depression and anxiety after myocardial infarction: machine learning insights from the U-CARE heart randomized controlled trial. J Med Internet.Res, 20(10), e10754. doi:v20i10e10754 [pii];10.2196/10754 [doi]. Retrieved from PM:30305255

Wang, C., Chen, J., Wang, Y., Xu, W., Xie, M., Wu, Y. et al. (2021). Effects of family participatory dignity therapy on the psychological well-being and family function of patients with haematologic malignancies and their family caregivers: A randomised controlled trial. Int J Nurs.Stud, 118, 103922. doi:S0020-7489(21)00062-6 [pii];10.1016/j.ijnurstu.2021.103922 [doi]. Retrieved from PM:33812296




How to Cite

Fadhel Abbas AL-Baghdady, H., Fadhil, A. A. ., Hajray, A. O. ., Kadhim, A. J. ., Talib, S. G. ., Adhab, Z. H. ., Mahdi, S. S. ., Sabit, S. H. ., Ragab, R. A. ., & Hamad, D. A. . (2022). The Effectiveness of Writing Therapy on Anxiety and Depression in Patients with Leukemia: The effectiveness of writing therapy in patients with leukemia. International Journal of Body, Mind and Culture, 9(sp). Retrieved from



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