title: The effects of expression: how providing emotional support online improves cancer patients' coping strategies.
abstract: BACKGROUND
  Emotional support has traditionally been conceived as something a breast cancer patient receives. However, this framework may obscure a more complex process, facilitated by the emerging social media environment, which includes the effects of composing and sending messages to others. Accordingly, this study explores the effects of expression and reception of emotional support messages in online groups and the importance of bonding as a mediator influencing the coping strategies of breast cancer patients.
  
  
  METHODS
  Data were collected as part of two National Cancer Institute-funded randomized clinical trials. Eligible subjects were within 2 months of diagnosis of primary breast cancer or recurrence. Expression and reception of emotionally supportive messages were tracked and coded for 237 breast cancer patients. Analysis resulted from merging 1) computer-aided content analysis of discussion posts, 2) action log analysis of system use, and 3) longitudinal survey data.
  
  
  RESULTS
  As expected, perceived bonding was positively related to all four coping strategies (active coping: β = 0.251, P = .000; positive reframing: β = 0.288, P = .000; planning: β = 0.213, P = .006; humor: β = 0.159, P = .009). More importantly, expression (γ = 0.138, P = .027), but not reception (γ = -0.018, P = .741), of emotional support increases perceived bonding, which in turn mediates the effects on patients' positive coping strategies.
  
  
  CONCLUSIONS
  There is increasing importance for scholars to distinguish the effects of expression from reception to understand the processes involved in producing psychosocial benefits. This study shows that emotional support is more than something cancer patients receive; it is part of an active, complex process that can be facilitated by social media.
authors.affiliation: Department of Community and Leadership Development, University of Kentucky, 504 Garrigus Building, Lexington, KY 40546-0215. kang.namkoong@uky.edu.
authors.forename: Kang
authors.initials: K
authors.lastname: Namkoong
authors.forename: Bryan
authors.initials: B
authors.lastname: McLaughlin
authors.forename: Woohyun
authors.initials: W
authors.lastname: Yoo
authors.forename: Shawnika J
authors.initials: SJ
authors.lastname: Hull
authors.forename: Dhavan V
authors.initials: DV
authors.lastname: Shah
authors.forename: Sojung C
authors.initials: SC
authors.lastname: Kim
authors.forename: Tae Joon
authors.initials: TJ
authors.lastname: Moon
authors.forename: Courtney N
authors.initials: CN
authors.lastname: Johnson
authors.forename: Robert P
authors.initials: RP
authors.lastname: Hawkins
authors.forename: Fiona M
authors.initials: FM
authors.lastname: McTavish
authors.forename: David H
authors.initials: DH
authors.lastname: Gustafson
mesh_terms: D001943:Breast Neoplasms / Q000523:psychology*; D005260:Female; D006801:Humans; D012657:Self-Help Groups; D061108:Social Media; D012944:Social Support