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To better understand the process and effect of social support exchanges within computer-mediated social support (CMSS) groups for breast cancer patients, this study examines (1) the dynamic interplay between emotional support giving and receiving and (2) the relative effects of emotional support giving and receiving on patients' psychosocial health outcomes.Data was collected from 177 patients who participated in online cancer support groups within the Comprehensive Health Enhancement Support System (CHESS) during the 4-month intervention. Data included (1) pretest and/or post-test survey scores of demographic, disease-related, and psychosocial factors, (2) automatically collected CHESS usage data, and (3) computer-aided content analysis of social support messages posts.Hierarchical regression analyses revealed that those who receive higher levels of support from others have fewer breast cancer-related concerns (β= − 0.15,p<0.05), while those who give higher levels of support to others reframe their own problems in a positive light and adopt more positive strategies for coping (β= 0.16,p<0.05). In addition to these positive effects, partial correlation analysis indicated that these two supportive behaviors are reciprocal.We concluded that supportive exchanges of receiving and giving play positive, but different, roles in predicting psychosocial health outcomes. Moreover, emotional support giving and receiving tend to reinforce each other. Our findings help practitioners, health-care providers, and health system designers make sense of diverse social support processes among cancer patients participating within CMSS groups.