Models of cognitive processing suggest that once a traumatic event is appropriately understood and integrated the stress associated with the event will diminish. Thoughts and feelings surrounding a traumatic experience are often disorganized, yet when disclosed verbally or through writing, they can assume the form of an organized, coherent narrative resulting in improved health outcomes. This is illustrated by recent findings that indicated that a brief written emotional expression exercise was associated with improved physical health, psychological well-being, physiological functioning, and general functioning. This writing exercise was also associated with beneficial changes in immune function. The brief writing intervention is hypothesized to increase cognitive processing and foster adaptation to traumatic events. To date, however, most research examining this intervention has been conducted in healthy populations. The diagnosis and treatment of cancer are traumatic experiences associated with distress and the fear of cancer recurrence, progression, and death. The impact of stress on the immune system may be particularly detrimental to patients with renal cell cancer, as this cancer is immunogenic, meaning that the immune system regulates progression of the disease. Because emotional expression writing interventions have been shown to facilitate adaptation, reduce stress, improve psychological adjustment and QOL, and positively impact immune function, this type of intervention may be beneficial in patients with renal cancer. Pilot data from our laboratory suggest that it is feasible to conduct the emotional expression writing intervention in patients with renal cancer. Results from this study also provide initial evidence that the intervention increases cognitive processing and improves psychological well- being. The proposed study will assess the benefits of this written emotional expression exercise in patients with renal cell carcinoma. Patients in this study will be randomly assigned either to an emotional expression writing group or to a neutral writing group. This research will also evaluate the extent to which psychosocial factors mediate or moderate the effects of the intervention program and predict recovery and adjustment. The effects of the intervention should be evident throughout recovery and across indices of quality of life, mental health, subjective symptoms of stress, and immune function.
