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Writing as Therapy? A Brief Look at “Expressive Writing”

by Matthew Lopatto

Writing as Therapy? A Brief Look at “Expressive Writing” and its Benefits

Expressive writing is an intervention for people that are dealing with difficult and stressful experiences in their lives. Dr. James Pennebaker devised this type of therapy in 1986, and expressive writing has become increasingly popular in psychological research over the last couple of decades. While expressive writing can come in many different forms, the instructions normally ask a person to write for somewhere between 10 and 30 minutes on consecutive days about traumatic or upsetting experiences (Baikie & Wilhelm, 2005). When subjects begin writing, they are asked to explore their deepest thoughts and emotions related to stressors (Baikie & Wilhelm, 2005). Depending on the study, writing instructions can limit subjects to discuss one specific stressor, or allow the writer to discuss any number of stressors in their life. The control group(s) may also vary, but typically control groups are writing about neutral topics in a non-emotional way (e.g., reporting the activities they did yesterday). The implementation of expressive writing is easy, with low to no cost. Although some expressive writing experiments are conducted in a laboratory or clinic, there are times when it is done in subjects’ homes (Henry et al., 2010). Regardless of setting, the writer is supposed to be in a quiet place, where there are no distractions. An example of the expressive writing paradigm is presented below:

“For the next 4 days, I would like you to write your very deepest thoughts and feelings about the most traumatic experience of your entire life or an extremely important emotional issue that has affected you and your life. In your writing, I’d like you to really let go and explore your deepest emotions and thoughts. You might tie your topic to your relationships with others, including parents, lovers, friends or relatives; to your past, your present or your future; or to who you have been, who you would like to be or who you are now. You may write about the same general issues or experiences on all days of writing or about different topics each day. All of your writing will be completely confidential.”

While this writing task may seem simple, there are numerous health benefits for people who participate in expressive writing. Participants in previous studies have shown significant improvements in physical health conditions, such as blood pressure (Davidson et al., 2002), lung function (Smyth et al., 1999), and immune system function (Esterling et al., 1994; Petrie et al., 2004). Adults have shown fewer absent days from work (Smyth et al., 2001), greater chance of reemployment after job loss (Spera et al., 1994), and significant improvements in working memory (Klein & Boals, 2001). Physical symptoms and visits to doctors have decreased after taking part in expressive writing (Cameron & Nicholls, 1998). Additionally, self-reported mood (Pennebaker et al., 1988), psychological well-being (Pennebaker et al., 1988), and depressive symptoms (Lepore, 1997) have improved.

Students at Queens College would be happy to know that expressive writing can help when it comes to taking standardized tests for graduate school. A study done by Dalton & Glenwick (2009) found that 76 undergraduates who wrote about their thoughts on three consecutive days relating to their upcoming graduate exams (GRE, LSAT, GMAT) performed 19 percentile points better than subjects who wrote about non-emotional topics. Subjects who did not partake in all three writing sessions performed worse on these standardized exams than participants who completed all three. Also, the more expressive writing a student participated in, the lesser their anxiety was before the test.

What Must Happen During Writing to Obtain Better Health Outcomes?

How does what is written affect measured health outcomes? Many studies have attempted to answer this question. Research has found that high levels of overall emotional expression during expressive writing has been linked with successful health outcomes. Austenfeld et al. (2006) reported that subjects who participated in expressive writing about their experience in medical school had better health outcomes than the control group who just wrote about their goals. Those high in emotional expression while writing experienced a greater decrease in depressive symptoms than those low in emotional expression. Another study by Kraft, Lumley, D’Souza, and Dooley (2008) looked at how emotional expression during writing relates to the health of undergraduate women who suffer from migraines. They compared the outcomes of an expressive writing group to the outcomes of the control group, who only participated in relaxation exercises. They found that higher emotional expression predicted a decrease in headache frequency for the expressive writing group. The common theme throughout the psychological literature seems to be that greater emotional expression is related to improved health. Putting these emotions in writing can help someone create a narrative about what they are experiencing to work through their stressors.

Without a doubt, humans have to deal with a wide variety of emotional traumas throughout their lives. Unfortunately, they don’t always have the money or time to seek professional help to deal with them. Expressive writing is around to ease the pain of daily life and can be done quickly in someone’s spare time, free of cost. The downsides are limited, while the upside, a mind closer to peace, is tremendous. There is little reason why people shouldn’t try expressive writing!

References

Austenfeld, J., Paolo, A., & Stanton, A. (2006). Effects of Writing About Emotions Versus Goals on Psychological and Physical Health Among Third‐Year Medical Students. Journal of Personality Psychology.

Baikie, K., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment1, 338-346.

Cameron, L., & Nicholls, G. (1998). Expression of stressful experiences through writing: Effects of a self-regulation manipulation for pessimists and optimists. Health Psychology, 17, 84–89.

Dalton, J., & Glenwick, D. (2009). Effects of expressive writing on standardized graduate entrance exam performance and physical health functioning. The Journal of Psychology.

Davidson, K., Schwartz, A. R., Sheffield, D. (2002). Expressive writing and blood pressure. In The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-being, 313, 17–30.

D’Souza, P., Lumley, M., Kraft, C., & Dooley, J. (2008). Relaxation training and written emotional disclosure for tension or migraine headaches: A randomized, controlled trial. Annals of Behavioral Medicine.

Esterling, B., Antoni, M., Fletcher, M. (1994). Emotional disclosure through writing or speaking modulates latent Epstein–Barr virus antibody titers. Journal of Consulting and Clinical Psychology, 62, 130–140.

Henry, E et. al. (2010). The feasibility and effectiveness of expressive writing for rural and urban breast cancer survivors. Oncology Nursing Forum37, 749-757.

Klein, K. & Boals, A. (2001). Expressive writing can increase working memory capacity. Journal of Experimental Psychology: General, 130, 520–533.

Lepore, S., Greenberg, M., Bruno, M. (2002). Expressive writing and health: self-regulation of emotion-related experience, physiology, and behavior. In The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-being, 99–117).

Pennebaker, J. & Beall, S. (1986). Confronting a traumatic event. Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274–281.

Pennebaker, J. Kiecolt-Glaser, J. Glaser, Ronald. (1988). Journal of Consulting and Clinical Psychology, 56(2), 239-245.

Petrie, K., Fontanilla, I., Thomas, M. (2004). Effect of written emotional expression on immune function in patients with Human Immunodeficiency Virus infection. A randomized trial. Psychosomatic Medicine, 66, 272–275.

Petrie, K., Fontanilla, I., Thomas, M. (2004). Effect of written emotional expression on immune function in patients with Human Immunodeficiency Virus infection. A randomized trial. Psychosomatic Medicine, 66, 272–275.

Rubin, D., Boals, A., & Klein, K. (2010). Autobiographical memories for very negative events: The effects of thinking about and rating memories. Cognitive Therapy Research34, 35-48.

Smyth, J., Stone, A., Hurewitz, A. (1999). Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis. A randomized trial. JAMA, 281, 1304–1309.

Smyth, J., True, N. & Souto, J. (2001). Effects of writing about traumatic experiences. The necessity for narrative structuring. Journal of Social and Clinical Psychology, 20, 161–172.

Spera, S., Morin, D., Buhrfeind, E., & Pennebaker, J. (1994). Expressive writing and coping with job loss. Academy of Management Journal37.

Date: October 10, 2018

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