“…The diagnosis of Amyotrophic Lateral Sclerosis (ALS) evokes a number of issues related to psychological adaptation, such as adjustment to changes in functional abilities and physical appearance, guilt about being burdensome to caregivers, loss of autonomy, and coping with the certainty of death. However, there has been a paucity of research examining the psychological aspects of this disease, and, to date, few studies have incorporated a psychological intervention for people with ALS (Hunter, Robinson, & Neilson, 1993; Sebring & Moglia, 1987), despite the suggestion that the quality of life of people with ALS is more determined by psychological and existential factors than by physical health (e.g., Roach, Averill, Segerstrom, & Kasarskis, 2009; Robbins, Simmons, Bremer, Walsh, & Fischer, 2001; Simmons, Bremer, Robbins, Walsh, & Fischer, 2000). People with ALS differ from other patient groups for whom expressive disclosure has been used as an intervention (e.g., cancer, rheumatoid arthritis, asthma) in a number of important ways, including faster disease progression, paralysis, loss of independence, inability to communicate, and universal fatality as a prognosis.…”