Download 10.1080@08893670903198383

This article was downloaded by: [Korea University]
On: 28 December 2014, At: 18:55
Publisher: Routledge
Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered
office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
Journal of Poetry Therapy: The
Interdisciplinary Journal of Practice,
Theory, Research and Education
Publication details, including instructions for authors and
subscription information:
http://www.tandfonline.com/loi/tjpt20
Evaluating the use of poetry to improve
well-being and emotional resilience in
cancer patients
a
b
c
Ingrid Tegnér , John Fox , Robin Philipp & Pamela Thorne
c
a
Institute of Poetry Therapy of Maryland , P.O. Box 83026,
Gaithersburg, MD, 20883, USA
b
The Institute for Transpersonal Psychology, The Institute for
Poetic Medicine , P.O. Box 60189, Palo Alto, CA, 94306, USA
c
Centre for Health in Employment and the Environment (CHEE) ,
Bristol Royal Infirmary , Bristol, BS2 8HW, UK
Published online: 04 Sep 2009.
To cite this article: Ingrid Tegnér , John Fox , Robin Philipp & Pamela Thorne (2009) Evaluating the
use of poetry to improve well-being and emotional resilience in cancer patients, Journal of Poetry
Therapy: The Interdisciplinary Journal of Practice, Theory, Research and Education, 22:3, 121-131,
DOI: 10.1080/08893670903198383
To link to this article: http://dx.doi.org/10.1080/08893670903198383
PLEASE SCROLL DOWN FOR ARTICLE
Taylor & Francis makes every effort to ensure the accuracy of all the information (the
“Content”) contained in the publications on our platform. However, Taylor & Francis,
our agents, and our licensors make no representations or warranties whatsoever as to
the accuracy, completeness, or suitability for any purpose of the Content. Any opinions
and views expressed in this publication are the opinions and views of the authors,
and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content
should not be relied upon and should be independently verified with primary sources
of information. Taylor and Francis shall not be liable for any losses, actions, claims,
proceedings, demands, costs, expenses, damages, and other liabilities whatsoever
or howsoever caused arising directly or indirectly in connection with, in relation to or
arising out of the use of the Content.
Downloaded by [Korea University] at 18:55 28 December 2014
This article may be used for research, teaching, and private study purposes. Any
substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,
systematic supply, or distribution in any form to anyone is expressly forbidden. Terms &
Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions
Journal of Poetry Therapy
(September 2009), Vol. 22, No. 3, pp. 121131
Downloaded by [Korea University] at 18:55 28 December 2014
Evaluating the use of poetry to
improve well-being and emotional
resilience in cancer patients
Ingrid Tegnér,*,1 John Fox,2 Robin Philipp3 &
Pamela Thorne3
1
Institute of Poetry Therapy of Maryland, P.O. Box 83026, Gaithersburg, MD 20883,
USA, 2 The Institute for Transpersonal Psychology, The Institute for Poetic Medicine,
P.O. Box 60189, Palo Alto, CA 94306, USA, and 3 Centre for Health in Employment
and the Environment (CHEE), Bristol Royal Infirmary, Bristol BS2 8HW, UK
The purpose of this pilot study was to evaluate the use of a group poetry therapy intervention with
cancer patients utilizing a support center. It was hypothesized that the intervention would increase
their emotional resilience and psychological well-being by encouraging the expression of emotions.
Design and method. Twelve female patients have participated in the study. In a crossover design,
half experienced a series of six weekly poetry groups while the rest acted as controls in a ‘‘waiting’’
period before experiencing the same intervention. Outcome measures. Participants completed a selfreport questionnaire pre and posttest, which contained four short scales: the Hospital Anxiety and
Depression Scale (HADS); the Mini-Mental Adjustment to Cancer Scale (Mini-Mac); the
Courtauld Emotional Control Scale (CECS); and the Post-traumatic Growth Inventory. Results.
The hypothesis received partial support. There was a significant decrease in suppression of emotions as
measured by the CECS and in anxiety as measured by HADS in those who experienced the poetry
intervention. There were no changes on these measures in the control group. Conclusions. It was
concluded in this pilot study that a poetry therapy intervention may improve emotional resilience and
anxiety levels in cancer patients; however, larger randomized control group trials are needed.
Keywords Cancer; coping; emotional control; emotional resilience; poetry therapy; posttraumatic
growth; well-being
Introduction
Diagnosis of a life-threatening disease is indisputably distressing and high levels of
psychiatric morbidity are commonly found amongst cancer patients (Blake-Mortimer,
Gore-Felton, Kimerling, Turner-Cobb, & Spiegel, 1999; Sheard & Maguire, 1999).
*Corresponding author. Tel: 1 301-610-6016. Fax: 1 301-610-0165. Email: ingridtegner@
gmail.com
ISSN 0889-3675 print # 2009 National Association for Poetry Therapy
DOI: 10.1080/08893670903198383
Downloaded by [Korea University] at 18:55 28 December 2014
122 I. Tegnér et al.
Subsequent treatment has been associated with sexual problems, nausea, fatigue, pain,
body image problems, and fear of the future (Walker, 2000) and the need has been
stressed for cognitive-emotional processing in both intra and interpersonal environments, to ensure psychosocial adjustment (Cordova, Ruzek, Benoit, & Brunet, 2003;
Lepore & Helgeson, 1998). It is well-documented that psychosocial interventions can
alleviate distress and therefore improve quality of life for cancer patients (BlakeMortimer et al., 1999; Cunningham, 2002; Walker et al., 1999). Poetry therapy is
particularly suited to this purpose. One way in which the discussion of poetry and
reflective/creative writing has been found to benefit cancer patients is by helping
individuals to express their emotions (Fox, 1997; Philipp & Robertson, 1996). The
terms poetry therapy, applied poetry facilitation, journal therapy, bibliotherapy, biblio/
poetry therapy, word arts therapy, and poetry/journal therapy reflect the interactive use
of various forms of literature and/or writing to promote personal growth and emotional
healing. There is a growing abundance of qualitative and anecdotal evidence to
support the efficacy of this form of intervention in improving health and well-being of
both the practitioners (Bolton, 1999; Johns, 2000) and patients (Philipp, 2002;
Robinson, 2004). Many voices have endorsed the use of words as a particularly
beneficial art form (Pennebaker, 1997; Philipp & Robertson, 1996) and a number of
excellent books have been published on the topic (e.g., Bolton, Howlett, Lago, &
Wright, 2004; Fox, 1997; Hunt & Sampson, 1998; Hynes & Hynes Berry, 1994;
Mazza, 2003). The practice of promoting health through arts has gained pace and
credibility in the last decade since the Nuffield Trust Windsor Conferences (Philipp,
Baum, Mawson, & Calman, 1999). However, this is not an area which has lent itself
easily to quantitative evaluation. What we have not yet seen is a large-scale study to
evaluate this type of intervention, using the gold standard method of randomized
controlled trials (Greenhalgh, 1999; Walker, 2000).
There is some evidence to suggest that negative affect may predict treatment
response and survival (Blake-Mortimer et al., 1999; Walker, Ratcliffe, & Dawson,
2000; Watson, Haviland, Greer, Davidson, & Bliss, 1999), but research focusing on
the role of psychosocial factors in the onset and progression of cancer has been
controversial (Walker, Heys, & Eremin, 1999). The suggestion that a depressed mental
state or melancholic temperament can predispose to cancer was first made by the
ancient Greek physician Galen, but the more recent concept of a ‘‘cancer-prone
personality’’ (Temoshok, 1987) has been seen by some as apportioning blame to
people for becoming ill (Brennan, 2004). The different ways in which individuals cope
with the stress of having cancer has received considerable attention, with studies
suggesting that coping style influences survival and recurrence, but a recent review of
this research concluded that the evidence for such an association, which is biologically
plausible, is inconclusive (Petticrew, Bell, & Hunter, 2002). In defense of the theory it
has been pointed out that, rather than suggesting patient responsibility for the illness or
its progression, these findings place the onus on the medical profession to identify
those at risk and provide adequate psychological care as an adjuvant to treatment in
oncology services (Watson, Davidson-Homewood, Haviland, & Bliss, 2003). This is in
keeping with the expressed aim of the UK’s National Health Service (NHS), as well as
some American medical practitioners, to provide holistic health care.
Downloaded by [Korea University] at 18:55 28 December 2014
Use of poetry to improve well-being and emotional resilience 123
The coping strategy of suppressing negative emotions has been linked to higher
mood disturbance (Cordova et al., 2003; Stanton et al., 2000; Watson et al., 1991),
but several studies have shown that it can be changed by therapeutic intervention,
thus potentially improving quality of life (Giese-Davis et al., 2002; Meyer & Mark,
1995; Walker et al., 1999). There have been calls for prospective, randomized,
controlled trials to systematically assess the effects of interventions, which are
designed to alter coping strategies (Walker, 2000; Walker, Heys, & Eremin, 1999).
A number of formal studies have demonstrated that writing about emotional
issues, compared to a neutral writing task, leads to an improvement in health and
well-being in a healthy population (Pennebaker, 1997; Pennebaker, Colder, & Sharp,
1990). A more recent study reported improved symptoms in asthma and rheumatoid
arthritis sufferers after a similar short writing exercise (Smyth, Stone, Hurewitz, &
Kaell, 1999).
This study brings together evidence of the healing benefits of writing activities
and that from the psychosocial/medical literature on the specific ways in which
psychosocial intervention can help cancer patients. It is hypothesized that an intervention of poetry therapy will increase the emotional resilience of cancer patients by
encouraging expression of emotion, and in particular negative emotions, thus
improving psychological well-being as measured by lower mood disturbance.
Method
Design and participants
In this preliminary feasibility study, cancer patients were randomly allocated to an
intervention group or a delayed intervention group. A crossover design was used to
compare those receiving an intervention of poetry therapy alongside their usual
treatment with those receiving only their usual treatment for an equivalent period of
time.
Twelve female cancer patients aged 50 or more, attending a cancer support
center in Northern Virginia, consented to take part in the study. All were at different
stages of their illness. Clinical data were not collected.
Procedure
Baseline assessment of all participants included demographic information and
completion of a self-report questionnaire. The intervention group then took part
in a one-and-a-half hour poetry therapy session each week for a period of six weeks
before repeating the self-report measures. The delayed intervention group, who
acted as ‘‘controls’’ during this period, receiving no intervention, also repeated the
assessment measures at this point. They were then offered the same series of poetry
workshops followed by post-test assessment. Both intervention and control groups
continued their usual treatment.
124 I. Tegnér et al.
Downloaded by [Korea University] at 18:55 28 December 2014
Outcome measures
The self-completion questionnaire used at each assessment point contained the
following short, well-validated psychometric tests which have been widely used in
cancer studies, and which are sensitive to change over time:
Hospital Anxiety and Depression Scale (HADS). This screening tool assesses
anxiety and depression as two dimensions and has been validated in cancer patients
(Zigmond & Snaith, 1983).
Mini-Mental Adjustment to Cancer (Mini-Mac) Scale. This 29-item short form
of the MAC scale assesses people’s cognitive and behavioral responses to diagnosis
and treatment of cancer in five dimensions: helplessnesshopelessness; anxious
preoccupation; fighting spirit; cognitive avoidance; and fatalism (Watson et al., 1994).
Courtauld Emotional Control Scale (CECS). A brief, self-completion scale
designed to measure the extent to which people consciously control their reactions
when they feel angry, anxious, or depressed. Three sub-scales (21 questions in all)
sum to a total ‘‘control of emotion’’ score. This widely used scale was originally
designed for use with cancer patients (Watson & Greer, 1983).
Post-traumatic Growth Scale (PTGI). A 21-item scale which assesses positive
outcomes reported by people who have experienced traumatic events. The five
factors included are: new possibilities; relating to others; personal strength; spiritual
change; and appreciation of life (Tedeschi & Calhoun, 1996).
The intervention
The poetry therapy sessions were led by the first author, an experienced certified
poetry therapist (CPT), who is familiar with group work in clinical settings. [See
www.poetrytherapy.org, http://www.nfbpt.com/, and http://www.lapidus.org.uk/ for
information regarding professional and credentialing matters]
The sessions were held in a private and comfortable room with the participants
seated so that they were able to make eye contact with one another. Both groups used
the same literature, a different poem for each of Sessions 16 (Appendix 1). The
poems were chosen both for their accessibility and imagery and for the developmental
phase of the group.
The underlying goal of each session was to create a safe space for the
participants to share their thoughts and feelings. The facilitator planned a further
goal for each session, based on participants’ needs.
Group rules were established by the group, including respecting confidentiality
and making every effort to attend each week.
Each session started with a warm-up activity associated with the poem to be
used. This would involve saying one’s name and responding to a simple prompt, such
as, name one thing you have noticed today. This is in order for everyone to put their
voices into the room and to begin to make connections with the other participants as
well as a foreshadowing of some element contained in the poem.
The poem chosen for the session was read aloud at least twice, once by one or all
of the participants, followed by a discussion. Participants are encouraged to share
Use of poetry to improve well-being and emotional resilience 125
Downloaded by [Korea University] at 18:55 28 December 2014
what the poem means to them and any associations they may have with a word, an
image, or a phrase.
After the discussion, participants were invited to write for a period of approximately five minutes, using a given ‘‘prompt’’ arising from the discussion or the
poem itself. No one is ever required to share their writing, they may discuss the process
of writing if they wish or decline altogether. Usually the participants shared what they
wrote and the rest of the group would listen and accept what was shared. The act of
being heard is a crucial part of this process. Further writing and sharing took place
if time allowed.
Each session ended with a brief closing ritual, reinforcing the experience that
had occurred and marking the transition back into daily life.
Results
The intervention and delayed intervention (control) groups were compared at baseline
using MannWhitney tests and no differences were seen on any of the measures.
One participant in the delayed intervention group completed the ‘‘control’’
period and post-assessment, but then dropped out before taking part in the poetry
workshops. Eleven people therefore experienced the intervention and there were six
‘‘controls’’ (delayed intervention group).
Between pre and posttest measures there was a significant change in the median
value of the total CECS for the participants who experienced the poetry workshops,
the median value decreased from 47 to 41. The median score on the anger sub-scale of
CECS also decreased significantly from 17 to 15 ( p B0.05, Wilcoxon Signed Ranks
test). A further significant change was shown for this group on the anxiety scale of the
HADS, where the median value decreased from six to four ( p B0.05, Wilcoxon
Signed Ranks test). Scores on the other measures for those receiving the poetry
therapy intervention were also changed in the hypothesized direction, but these
changes were not statistically significant.
In the delayed intervention group, who served as controls and received no
intervention during the six-week period following baseline assessment, a significant
decrease from 19 to 18 was found in the median value of the Anxious Pre-occupation
factor of the Mini-MAC between pre and post-test ( p B0.05, Wilcoxon Signed
Ranks test), but there was little change in any of the other measures for this group
(see Tables 1 and 2).
Discussion of results
We hypothesized that a poetry therapy group, which encourages the expression of
emotions, would increase emotional resilience, represented by:
. reduced emotional control (CECS);
. improved adjustment to having cancer, measured by the mini-MAC; and
. increased psychological growth (PTGI).
126 I. Tegnér et al.
Downloaded by [Korea University] at 18:55 28 December 2014
TABLE 1. Change in scores after six-week poetry therapy intervention (Wilcoxon signed ranks test).
Experimental group (n 9)
Median (pre-test)
Median (post-test)
Significance (two-tailed)
Mini-Mac
Fatalism
Fighting spirit
Hopelessness/helplessness
Anxious preoccupation
Cognitive avoidance
17.00
13.00
9.00
19.00
9.00
16.00
13.00
10.00
19.00
9.00
0.305
0.180
0.783
0.952
0.111
Courtauld Emotional Control Scale
Anger
17.00
Anxiety
16.00
Depressed mood
15.00
Total CECS score
47.00
15.00
16.00
13.00
41.00
0.034
0.147
0.192
0.050
Post-traumatic Growth Inventory
Relating to others
New possibilities
Personal strengths
Spiritual change
Appreciation of life
Total PTGI score
23.00
17.00
12.00
6.50
12.00
63.00
26.00
20.00
13.00
6.00
12.00
83.00
0.674
0.210
0.128
0.257
0.765
0.260
Hospital Anxiety and Depression Scale
Anxiety
6.00
Depression
3.00
Total HADS score
11.00
4.00
2.00
6.00
0.035
0.492
0.109
Support for this hypothesis was given by the statistically significant drop in total
CECS scores and Anger sub-scale scores seen after the series of workshops, while
little change was seen in the control group after the no intervention period.
There were no statistically significant changes in the adjustment to cancer
measures, with the exception of anxious pre-occupation, which rather surprisingly
decreased significantly in the control group after the no intervention period. This may
be an artifact associated with small numbers in the study, or possibly due to an
unexpected placebo effect.
There was no significant change in scores on the PTGI, though these did
increase more in the intervention group than in the control group. This particular
measure was felt by the poetry therapists involved to tap especially relevant aspects of
well-being, reflecting the kind of benefits which they habitually hear expressed by
those experiencing their poetry sessions. Change over time has been shown with this
instrument (Lieberman et al., 2003; Manne et al., 2004), but we have no knowledge
of its use with such a relatively short (six weeks) intervention. The changes observed,
though not statistically significant, encourage us to use this measure in proposed
larger trials, which will include a six-month follow-up, by that time further change
may have occurred.
It was also hypothesized that the poetry therapy intervention would increase wellbeing, reducing anxiety and negative affect as shown by lower HADS scores. Again
Use of poetry to improve well-being and emotional resilience 127
TABLE 2. Change in scores over six week no intervention period (Wilcoxon signed ranks test).
Control group (n 6)
Median (pre-test)
Median (post-test)
Significance (two-tailed)
15.50
13.00
11.00
19.00
7.50
15.50
13.00
9.50
18.00
8.50
1.000
1.000
0.564
0.039
0.336
Courtauld Emotional Control Scale
Anger
18.00
Anxiety
17.50
Depressed mood
18.00
Total CECS score
53.50
17.00
18.50
17.50
53.00
0.705
0.140
1.000
0.596
Post-traumatic Growth Inventory
Relating to others
New possibilities
Personal strengths
Spiritual change
Appreciation of life
Total PTGI score
24.50
17.00
14.50
7.50
11.00
73.50
22.50
18.50
12.50
6.50
12.00
69.50
0.833
0.343
0.214
0.461
0.414
0.917
Hospital Anxiety and Depression Scale
Anxiety
8.50
Depression
3.00
Total HADS score
12.50
6.50
3.00
10.50
0.180
0.285
0.109
Downloaded by [Korea University] at 18:55 28 December 2014
Mini-Mac
Fatalism
Fighting spirit
Hopelessness/helplessness
Anxious preoccupation
Cognitive avoidance
this was supported in part, with significantly reduced anxiety in the intervention group
which was not seen in the controls.
General discussion
The sample sizes in this feasibility study were very small, and it is therefore not
possible to draw definitive conclusions from the statistical results. It is, however,
encouraging that a nonparametric statistical test showed a significant decrease in
suppression of emotions (CECS) and experience of anxiety (HADS-A) in the group
which received poetry therapy, but not in the control group, although both were
comparable on these measures at baseline assessment.
The finding that suppression of anger, in particular, was reduced in the group who
experienced poetry therapy was interesting. This suggests that maybe discussing their
common situation within the framework created by the poem followed by reflective
writing gives people a means of expressing their anger, a commonly found reaction to
having cancer, which was not available to them before. Longo (1996) suggested that
different sounds express different emotions, the sharpness of firm consonants giving
tension which conveys anger, stress, or struggle. There are many intriguing studies to
be done on this theme, but they are beyond the scope of the present investigation,
which seeks only to demonstrate objectively the efficacy of a poetry intervention.
Downloaded by [Korea University] at 18:55 28 December 2014
128 I. Tegnér et al.
The trend toward change in the hypothesized direction on the other measures
used here suggests that they are appropriate for picking up the kind of changes which
this particular intervention hopes to achieve. A recent longitudinal study has shown
that posttraumatic growth continues over a period of 18 months in breast cancer
patients who express their feelings (Manne et al., 2004).
By chance rather than intention, the participants in this pilot study were all female.
They were also a self-selected group in that they were attending a cancer support
center, where other complementary programs were offered. Most had done some
writing previously. These potential biases would need to be avoided in a larger study.
A more comparable population could be found by inviting participation from those
whose curative treatment has just ended. This has been shown to be a particularly
vulnerable time in the ‘‘cancer journey’’ (Luzzatto & Gabriel, 2000; Turton & Cooke,
2000).
The cancer patients who took part in this study spontaneously expressed their
enjoyment of the poetry therapy group and would have liked to continue. Further
trials to evaluate the intervention will include a qualitative element to further
examine the acceptability of poetry therapy to a wider spectrum of cancer patients.
Facilitating a poetry group of six sessions requires a high level of skill in both
preparation and implementation. The literature to be used is chosen for its
accessibility and imagery, as well as the developmental stage the group has reached:
certain poems work well in the beginning phase, allowing groups member to get to
know one another in a nonthreatening way. Other poems work well with groups that
have developed cohesion and can delve into deeper issues. The poems chosen for the
ending phase contain elements of closure. All the poems chosen contain the element of
hope. The poems must also be appropriate particularly for each group’s needs, which
are assessed and reassessed as the sessions progress and different issues are evoked.
Conclusion
The results of this small, feasibility study suggest that emotional resilience can be
improved by the use of a poetry therapy intervention and that this can also improve
anxiety levels. The repeated self-report questionnaire was found to be acceptable by
the cancer patients who took part, who also verbally expressed their enjoyment of the
poetry therapy intervention.
Poetry therapy sessions are noninvasive and enjoyable, and have been shown to be
therapeutic. The use of poetry to heal offers people a sense of meaning and community
that is rare within the highly clinical treatment environment. In a supportive, group
atmosphere, participants are provided with a means of creatively expressing their
feelings, which they can incorporate into their daily lives and continue beyond the end
of their study participation.
Larger, randomized, controlled trials are being designed; these will include
further independent variables, including clinical data, and a qualitative element will
be added to the outcome measures.
Use of poetry to improve well-being and emotional resilience 129
Acknowledgements
We are indebted to Mr Tony Hughes, Medical Statistician, CHEE, Bristol Royal
Infirmary, England, for undertaking the statistical analysis of the study data. This
study was supported, in part, from a Poetry Alive grant from the National Association
for Poetry Therapy Foundation (NAPTF).
Downloaded by [Korea University] at 18:55 28 December 2014
References
Blake-Mortimer, J., Gore-Felton, C., Kimerling, R., Turner-Cobb, J. M., & Spiegel, D. (1999).
Improving the quality and quantity of life among patients with cancer: A review of the effectiveness
of group psychotherapy. European Journal of Cancer 35(11), 15811586.
Bolton, G. (1999). Stories at work: Reflective writing for practitioners. The Lancet 354, 243245.
Bolton, G., Howlett, S., Lago, C., & Wright, J. K. (Eds.) (2004). Writing cures. An introductory handbook
of writing in counselling and therapy. Hove, UK: Brunner-Routledge.
Brennan, J. (2004). Cancer in context. A practical guide to supportive care. Oxford: OUP.
Cordova, M. J., Giese-Davis, J., Golant, M., Kronnenwetter, C., Chang, V., McFarlin, S., & Spiegel, D.
(2003). Mood disturbance in community cancer support groups. The role of emotional suppression
and fighting spirit. Journal of Psychosomatic Research 55(5), 461467.
Cordova, M. J., Ruzek, J. I., Benoit, M., & Brunet, A. (2003). Promotion of emotional disclosure
following illness and injury: A brief intervention for medical patients and their families. Cognitive
and Behavioral Practice 10, 358371.
Cunningham, A. J. (2002). Group psychological therapy: An integral part of care for cancer patients.
Integrative Cancer Therapies 1(1), 6775.
Fox, J. (1997). Poetic medicine. The healing art of poem-making. New York: Jeremy P Tarcher/Putnam.
Giese-Davis, J., Koopman, C., Butler, L. D., Classen, C., Cordova, M., Fobair, P., Benson, J., Kraemer,
H. C., & Spiegel, D. (2002). Change in emotion-regulation strategy for women with metastatic
breast cancer following supportive-expressive group therapy. Journal of Consulting & Clinical
Psychology 70(4), 916925.
Greenhalgh, T. (1999). Writing as therapy. Editorial. British Medical Journal 319, 271272.
Hunt, C., & Sampson, F. (Eds.) (1998). The self on the page: Theory and practice of creative writing in
personal development. London: Jessica Kingsley.
Hynes, A. A. M., & Hynes Berry, M. (1994). Biblio/poetry therapy: The interactive process: A handbook. St.
Cloud, MN: North Star Press.
Johns, C. (2000). Becoming a reflective practitioner: A reflective and holistic approach to clinical nursing,
practice development and clinical supervision. London: Blackwell Science.
Lapidus. www.lapidus.org.uk7 (accessed August 11, 2009).
Lepore, S. J., & Helgeson, V. S. (1998). Social constraints, intrusive thoughts, and mental health after
prostate cancer. Journal of Social and Clinical Psychology 17(1), 89106.
Lieberman, M. A., Golant, M., Giese-Davis, J., Winzlenberg, A., Benjamin, H., Humphreys, K.,
Kronenwetter, C., Russo, S., & Spiegel, D. (2003). Electronic support groups for breast carcinoma.
A clinical trial of effectiveness. Cancer 97(4), 920925.
Longo, P. J. (1996). Poetry as therapy. www.spcsb.org/advoc/poetrytx.html (accessed November 12, 2008).
Luzzatto, P., & Gabriel, B. (2000). The creative journey: A model for short-term group art therapy with
posttreatment cancer patients. Art Therapy: Journal of the American Art Therapy Association 17(4),
265269.
Manne, S., Ostroff, J., Winkel, G., Goldstein, L., Fox, K., & Grana, G. (2004). Posttraumatic growth
after breast cancer: Patient, partner and couple perspectives. Psychosomatic Medicine 66, 442454.
Mazza, N. (2003). Poetry therapy: Theory & practice. New York and London: Brunner-Routledge.
Meyer, T. J., & Mark, M. M. (1995). Effects of psychosocial interventions with adult cancer patients:
A meta-analysis of randomized experiments. Health Psychology 14(2), 101108.
National Association for Poetry Therapy. www.poetrytherapy.org (accessed August 11, 2009).
National Coalition of Creative Arts Therapies Associations. www.nccata.org (accessed August 11, 2009).
Downloaded by [Korea University] at 18:55 28 December 2014
130 I. Tegnér et al.
National Federation for Biblio/Poetry Therapy (2007). Guide to training requirements for certification and
registration in poetry therapy. NFB/PT.
National Federation for Biblio/Poetry Therapy (NFBPT). www.nfbpt.com (accessed August 11, 2009).
Pennebaker, J. W. (1997). Writing about emotional experiences as a therapeutic process. Psychological
Science 8(3), 162166.
Pennebaker, J. W., Colder, M., & Sharp, L. K. (1990). Accelerating the coping process. Journal of
Personality and Social Psychology 58(3), 528537.
Petticrew, M., Bell, R., & Hunter, D. (2002). Influence of psychological coping on survival and
recurrence in people with cancer: Systematic review. British Medical Journal 325, 10661069.
Philipp, R. (2002). Arts, health and well-being. London: Nuffield Trust.
Philipp, R., Baum, M., Mawson, A., & Calman, K. (Eds.) (1999). Humanities in medicine: Beyond the
millennium. Report Series No.10; London: Nuffield Trust.
Philipp, R., & Robertson, I. (1996). Poetry helps healing. Letter. The Lancet 347, 332333.
Robinson, A. (2004). A personal exploration of the power of poetry in palliative care, loss and
bereavement. International Journal of Palliative Nursing 10(1), 3238.
Sheard, T., & Maguire, P. (1999). The effect of psychological interventions on anxiety and depression in
cancer patients: Results of two meta-analyses. British Journal of Cancer 80(11), 17701780.
Smyth, J. M., Stone, A. A., Hurewitz, A., & Kaell, A. (1999). Effects of writing about stressful
experiences on symptom reduction in patients with asthma or rheumatoid arthritis: A randomized
trial. Journal of the American Medical Association 281(14), 13041309.
Stanton, A. L., Danoff-Burg, S., Cameron, C. L., Bishop, M., Collins, C. A., Kirk, S. B., Sworowski,
L. A., & Twillman, R. (2000). Emotionally expressive coping predicts psychological and physical
adjustment to breast cancer. Journal of Consulting and Clinical Psychology 68(5), 875882.
Tedeschi, R. G., & Calhoun, L. G. (1996). The posttraumatic growth inventory: Measuring the positive
legacy of trauma. Journal of Traumatic Stress 9(3), 455472.
Temoshok, L. (1987). Personality, coping style, emotion and cancer: Towards an integrative model.
Cancer Surveys 6, 545567.
Turton, P., & Cooke, H. (2000). Meeting the needs of people with cancer for support and selfmanagement. Complementary Therapies in Nursing and Midwifery 6, 130137.
Walker, L. G. (2000). Surviving cancer: Does the fighting spirit matter? Inaugural lecture, University of
Hull. Monday November 6, 2000. http://www.lgwalker.com/ (retrieved October 28, 2008).
Walker, L. G., Heys, S. D., & Eremin, O. (1999). Surviving cancer: Do psychosocial factors count?
Editorial. Journal of Psychosomatic Research 47(6), 497503.
Walker, L. G., Ratcliffe, M. A., & Dawson, A. A. (2000). Relaxation and hypnotherapy: Long term
effects on the survival of patients with lymphoma. Abstracts of the 1999 British Psychosocial
Oncology Society Annual Conference. Psycho-Oncology 9, 355364.
Walker, L. G., Walker, M. B., Ogston, K., Heys, S. D., Ah-See, A. K., Miller, I. D., Hutcheon, A. W.,
Sarkar, T. K., & Eremin, O. (1999). Psychological, clinical and pathological effects of relaxation
training and guided imagery during primary chemotherapy. British Journal of Cancer 80(1/2), 262268.
Watson, M., Davidson-Homewood, J., Haviland, J., & Bliss, J. (2003). Psychological coping and cancer.
Letter. British Medical Journal 326, 598.
Watson, M., & Greer, S. (1983). Development of a questionnaire measure of emotional control. Journal
of Psychosomatic Research 27, 299305.
Watson, M., Greer, S., Rowden, L., Gorman, C., Robertson, B., Bliss, J. M., & Tunmore, R. (1991).
Relationships between emotional control, adjustment to cancer and depression and anxiety in breast
cancer patients. Psychological Medicine 21, 5157.
Watson, M., Haviland, J. S., Greer, S., Davidson, J., & Bliss, J. M. (1999). Influence of psychological
response on survival in breast cancer: A population-based cohort study. The Lancet 354(9187),
13311336.
Watson, M., Law, M., dos Santos, M., Greer, S., Baruch, J., & Bliss, J. (1994). The mini-MAC: Further
development of the Mental Adjustment to Cancer Scale. Journal of Psychosocial Oncology 12, 3346.
Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica
Scandinavica 67, 361370.
Use of poetry to improve well-being and emotional resilience 131
Appendix 1
The poems used for the six-week series were as follows:
1.
2.
3.
4.
Downloaded by [Korea University] at 18:55 28 December 2014
5.
6.
Snowdrops by Louise Gluck (from Wild Iris by Louise Gluck, 1993, Ecco, p. 6.).
Yes, It Hurts by Karin Boye (from Half Sun Half Sleep, translated by May
Swenson, 1967, Scribner).
Possibilities by Wislawa Szymborska (from Poems New and Collected by Wislawa
Syzmborska, 1998, Harcourt, Orlando, FL., p. 214.
In Blackwater Woods by Mary Oliver (from New and Selected Poems by Mary
Oliver, 1992, Beacon Press, Boston, p. 177).
The Seven of Pentacles by Marge Piercy (from Circles on the Water: Selected Poems
by Marge Piercy, 1994, Alfred A. Knopf, New York, p. 128).
i thank You God for most this amazing by e e cummings (from Selected Poems by e e
cummings, Edited by Richard S. Kennedy, 1994, Liveright, New York, p. 167).