Abstract B109: Unlocking health benefits through cognitive processing: Linguistic features from a culturally adapted expressive writing intervention among Chinese American cancer survivors

Background Chinese American cancer survivors (CACS) face unique socio-cultural barriers that may limit the benefits of western culture-centric mental health support. Expressive Writing (EW) interventions are shown to confer health benefits for Caucasian cancer survivors. However, the socio-cognitive mechanisms by which a culturally adapted EW intervention enhances quality of life (QOL) and other health outcomes among CACS remain unclear. This study investigates how linguistic features in participants' writing in a culturally adapted EW intervention relate to health improvements. This study focused on cognitive processing words, which tend to be used when people attempt to work out complex problems or issues in their lives. For example, “think” and “realize” signal active mental engagement to interpret and reflect on experiences. Methods A total of 136 CACS were randomized into one of the three conditions to complete three weekly writing sessions: a self-regulation (SR) condition (writing sequence: emotions-experience-positivity), a culturally adapted enhanced self-regulation (ESR) condition (writing sequence: experience-emotions-positivity), or a control condition (neutral writing). Participants’ QOL and other health outcomes were measured at baseline, and at 1-month, 3-month and 6-month follow-ups. Linguistic features in participants’ writings were analyzed through LIWC-22. Participants were categorized into two groups based on whether their improvement in health was above or below the average. Repeated measures ANOVA were conducted to examine the within- and between-subject differences of the use of cognitive processing words in theses two groups (higher vs. lower health improvement). Results Participants in SR & ESR conditions who exhibited greater improvements in health outcomes used significantly more cognitive processing words in their writings. These outcomes included enhanced health-related quality of life (F(1,77)=4.25, p=.04), improved sleep (F(1,77)=9.15, p=.003), reduced fatigue (F(1,76)=4.17, p=.05), and decreased depression symptoms (trending significant, F(1,76)=3.58, p=.06). Conclusions This study highlights cognitive processing as a crucial socio-cognitive mechanism in the culturally adapted expressive writing intervention among CACS. Increased use of cognitive processing language during writing is significantly associated with better health outcomes, including improved QOL, sleep, and reduced fatigue and depressive symptoms. These findings suggest that interventions that promote deeper cognitive engagement may effectively support health improvements among Chinese survivors. Future research should further explore mechanisms to optimize cognitive processing through tailored interventions, enhancing their health impact across diverse cultural contexts. Citation Format: Yusi Aveva Xu, Jace D. Pierce, Celia C. Wong-Meli, Lenna Dawkins-Moultin, Yisheng Li, James Pennabaker, Qian Lu. Unlocking health benefits through cognitive processing: Linguistic features from a culturally adapted expressive writing intervention among Chinese American cancer survivors [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr B109.