Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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).