Effects of Writing About Traumatic Experiences: The Necessity for Narrative Structuring


Effects of Writing About Traumatic Experiences: The Necessity for Narrative Structuring
Joshua Smyth1, Nicole True2, Joy Souto3


Although writing about traumatic events has been shown to produce a variety of health benefits, little is known about how writing produces benefits. The degree to which individuals form narrative structure when writing may predict health improvements. This study manipulated narrative formation during writing to test if narrative structure is necessary for writing to be beneficial. A total of 116 healthy students were randomly assigned to write about control topics or about their thoughts and feelings regarding the most traumatic event of their life in one of two ways: list in an fragmented format or construct a narrative. Individuals asked to form a narrative reported less restriction of activity because of illness and showed higher avoidant thinking than the other groups. The fragmented writing group did not differ from controls on any measure. These data (a) demonstrate that instructions to form a narrative produce a different response to writing than instructions to form fragmented and control writing and (b) suggest narrative formation may be required to achieve health benefits.

Symptom management in older primary care patients: feasibility of an experimental, written self-disclosure protocol.

Ann Intern Med. 2001 May 1;134(9 Pt 2):905-11.

Klapow JC1, Schmidt SM, Taylor LA, Roller P, Li Q, Calhoun JW, Wallander J, Pennebaker J.

Distress-driven symptoms are prevalent among older primary care patients and account for a large percentage of office visits and increased medical costs. An experimental written self-disclosure protocol has been shown to reduce symptoms and use of health care services in healthy adults. Written self-disclosure as a method for reducing symptoms has not been evaluated in the primary care setting.


To evaluate the feasibility of adapting an experimental written self-disclosure protocol for the primary care setting.


Randomized, single-blind feasibility study.


University-based geriatric and internal medicine primary care clinics.


45 patients 66 years of age or older without a psychiatric diagnosis.


Three 20-minute writing sessions focusing on distressing experiences (in the intervention group) or health behaviors (in the control group).


The feasibility outcomes were patient recruitment, protocol logistics, and patient and provider satisfaction. The clinical outcomes were somatic and distress symptoms, health care utilization, and associated costs.


One third of patients screened were recruited; 96% of patients recruited completed the protocol. Clinic contact time was an average of 55 minutes per patient. Patients and providers reported high levels of satisfaction with the protocol. Reductions in symptoms were minimal for both groups. Use of outpatient services and associated costs decreased in both groups, but the reduction was twice as great in the treatment group as in the control group.


Findings support the feasibility of implementing the protocol as a primary care intervention.