We are doing this study to see if writing about life experiences helps women adjust to breast cancer that has spread. We will compare two groups. One group will write about their breast cancer experience. The other will write about their daily activities. What we learn from this study may help us to find new ways to help women cope with breast cancer that has spread.

Inclusion Criteria:

• Women with Stage IV breast cancer
• Receiving cancer care at Memorial Sloan-Kettering Cancer Center
• At least 18 years of age
• Can speak, read, and write in English
• In the judgment of consenting professionals able to provide informed consent
• Score of 4 or higher on the distress thermometer (established cutoff score for probable distress; see Jacobsen et al., 2005)

Exclusion Criteria:

• Significant psychiatric or cognitive impairment (dementia/delirium, retardation, psychosis) that in the judgment of the investigators will preclude providing informed consent and participating in the intervention
• Currently engaging in expressive writing (e.g., journal writing that involves expressing one's feelings) on a daily basis
• Currently participating in intervention trials with similar endpoints • Male

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