Self-expressive writing as a therapeutic intervention for veterans and family members

Pages 201-221 | Published online: 23 Oct 2013

This qualitative case study reflects the voices and experiences of five veterans who engaged in a self-expressive writing session over a period of eight weeks. The purpose was to explore whether or not self-expressive writing could be used as a therapeutic intervention. Findings indicated that the intervention helped participants express emotions, increase their awareness of personal issues, helped separate problems from self, and foster a sense of empowerment. This study reveals the potential usefulness of physically expressing problems and interacting with them deliberately over time. Such interventions may be useful components of therapy and help those populations who have limited access to therapy services or who are reluctant to be present for therapy.

From therapy to poetry and back again: One writer’s journey

Pages 115-125 | Published online: 10 May 2013

This reflective piece suggests three phases from therapeutic writing to full-fledged poetry to an audience’s reading and discussion, illustrated with specific examples and commentary. The author, a social scientist, an adult educator and a published poet, begins with the role of writing in her own processing of the painful experience of a family member’s severe mental illness and suicide, showing us her earliest therapeutic writing. She then illuminates a second phase, in which she gives us an inside look at the rewriting process that led to two poems suitable for public display. She considers how the resulting poems might be used for both therapeutic and educational purposes, offering discussion prompts and questions related to the poems.

Creative writing in recovery from severe mental illness.

Int J Ment Health Nurs. 2013 Oct;22(5):444-52. doi: 10.1111/j.1447-0349.2012.00891.x. Epub 2012 Dec 5.


There is evidence that creative writing forms an important part of the recovery experience of people affected by severe mental illness. In this paper, we consider theoretical models that explain how creative writing might contribute to recovery, and we discuss the potential for creative writing in psychosocial rehabilitation. We argue that the rehabilitation benefits of creative writing might be optimized through focus on process and technique in writing, rather than content, and that consequently, the involvement of professional writers might be important. We describe a pilot workshop that deployed these principles and was well-received by participants. Finally, we make recommendations regarding the role of creative writing in psychosocial rehabilitation for people recovering from severe mental illness and suggest that the development of an evidence base regarding the effectiveness of creative writing is a priority.

Expressive disclosure to improve well-being in patients with amyotrophic lateral sclerosis: a randomised, controlled trial.

Psychol Health. 2013;28(6):701-13. doi: 10.1080/08870446.2012.754891. Epub 2013 Jan 7.

Averill AJ1, Kasarskis EJ, Segerstrom SC.

Amyotrophic lateral sclerosis (ALS) is a terminal neurological disease associated with progressive paralysis, loss of communicative ability and functional decline. Expressive disclosure may help people with ALS, particularly those who are emotionally or socially inhibited, meet psychological challenges associated with the disease. People with ALS (N = 48) were randomised to expressive disclosure about their disease or no disclosure. Psychological well-being (affect, depression and quality of life) was assessed pre-intervention and also three and six months later. Results of multi-level models indicated that the group that disclosed thoughts and feelings about ALS had higher well-being than the control group at three months post-intervention, but not six months. Ambivalence over emotional expression (AEE) moderated three-month post-intervention well-being. Those low in AEE had higher well-being than those high in AEE regardless of condition. Those high in AEE, who disclosed, had increased well-being from pre-intervention, whereas controls had decreased well-being from pre-intervention. Expressive disclosure may be helpful for people with ALS, but only those who have difficulty expressing emotions. In addition, the intervention had only temporary effects; the dynamic challenges of ALS progression may mean that the effect of processing thoughts and feelings about the disease in one stage may not generalise to later stages.

Effects of Guided Written Disclosure Protocol on mood states and psychological symptoms among parents of off-therapy acute lymphoblastic leukemia children.

J Health Psychol. 2013 Jun;18(6):727-36. doi: 10.1177/1359105312462434. Epub 2012 Nov 23.

Martino ML1, Freda MF, Camera F.

This study assesses the effects of Guided Written Disclosure Protocol on psychological distress in mothers and fathers of off-therapy acute lymphoblastic leukemia children. An experimental group participated in the writing intervention with a control group subject only to test-taking standards. The Symptom Questionnaire and Profile of Mood States were administered at baseline, post-intervention, and follow-up. Guided Written Disclosure Protocol had significant effects on the progressive reduction of anxiety, depression, somatic symptoms, hostility, tension-anxiety, and fatigue-inertia within the experimental group. However, the control group distress levels tended to worsen over time. The mediating role of emotional processing was highlighted.

Writing therapy after traumatic events: therapeutic approaches and mechanisms of change

Psychother Psychosom Med Psychol. 2013 Sep;63(9-10):391-7. doi: 10.1055/s-0033-1349078. Epub 2013 Oct 11.

Knaevelsrud C1, Böttche M.

The (written) disclosure of information, thoughts and emotions of individually significant tops is associated with positive effects on well-being and the psychological health. The applicability of expressive writing as a psychotherapeutic intervention for stress reactions after stressful/traumatic life events were also intensely discussed in the clinical context. However, structural and content-related variation of the initial writing paradigm resulted in significantly different effects on general psychological health and posttraumatic stress symptoms.This overview provides current findings to application and efficacy of expressive writing respectively writing therapy for posttraumatic stress disorder. Mechanisms of expressive writing (inhibition, habituation, construction of a coherent narrative, emotion regulation, social integration) are analyzed with regard to their relevance concerning PTSD. Finally, potentials for application in the clinical practice are discussed.

Expressive writing as a brief intervention for reducing drinking intentions.

Addict Behav. 2013 Dec;38(12):2913-7. doi: 10.1016/j.addbeh.2013.08.025. Epub 2013 Sep 4.

Young CM1, Rodriguez LM, Neighbors C.

The present study examined the effectiveness of expressive writing in reducing drinking behavior. We expected that students prompted to write about negative drinking experiences would show greater decreases in future drinking intentions compared to the neutral and the positive writing conditions. We also expected that decreases in drinking intentions following the writing prompts might differ based on current drinking and AUDIT scores. Participants included 200 (76% female) undergraduates who completed measures of their current drinking behavior. They were then randomly assigned to either write about: a time when they had a lot to drink that was a good time (Positive); a time when they had a lot to drink that was a bad time (Negative); or their first day of college (Neutral), followed by measures assessing intended drinking over the next three months. Results revealed that participants intended to drink significantly fewer drinks per week and engage in marginally fewer heavy drinking occasions after writing about a negative drinking occasion when compared to control. Interactions provided mixed findings suggesting that writing about a positive event was associated with higher drinking intentions for heavier drinkers. Writing about a negative event was associated with higher intentions among heavier drinkers, but lower intentions among those with higher AUDIT scores. This research builds on previous expressive writing interventions by applying this technique to undergraduate drinkers. Preliminary results provide some support for this innovative strategy but also suggest the need for further refinement, especially with heavier drinkers.

Written exposure therapy for veterans diagnosed with PTSD: a pilot study.

J Trauma Stress. 2013 Dec;26(6):776-9. doi: 10.1002/jts.21858. Epub 2013 Nov 6.

Sloan DM1, Lee DJ, Litwack SD, Sawyer AT, Marx BP.

There is a need to identify alternative treatment options for posttraumatic stress disorder (PTSD), especially among veterans where PTSD tends to be more difficult to treat and dropout rates are especially high. One potential alternative is written exposure therapy, a brief intervention shown to treat PTSD among civilians effectively. This study investigated the feasibility and tolerability of written exposure therapy in an uncontrolled trial with a sample of 7 male veterans diagnosed with PTSD. Findings indicated that written exposure therapy was well tolerated and well received. Only 1 of the 7 veterans dropped out of treatment, no adverse events occurred during the course of treatment, and veterans provided high treatment satisfaction ratings. Clinically significant improvements in PTSD symptom severity were observed for 4 veterans at posttreatment and 6 veterans at the 3-month follow up. Moreover, 5 of the 7 veterans no longer met diagnostic criteria for PTSD 3 months following treatment. These findings suggest that written exposure therapy holds promise as a brief, well tolerated treatment for veterans with PTSD. However, additional research using randomized controlled trial methodology is needed to confirm its efficacy.

Expressive Writing Can Impede Emotional Recovery Following Marital Separation.

Clin Psychol Sci. 2013 Mar 18;1(2):120-134.

Sbarra DA1, Boals A2, Mason AE1, Larson GM1, Mehl MR1.

Marital separation and divorce are common life events that increases risk for poor health outcomes, yet few intervention studies explore how to mitigate this increased risk. This study implemented an expressive writing (EW; see Pennebaker, 1997) intervention for adults who experienced a recent marital separation. Ninety participants (32 men) were randomly assigned to and completed one of three experimental writing tasks: traditional EW, a novel (narrative-based) type of EW or control writing. Up to nine months after this writing, participants judged to be actively engaged in a search for meaning concerning their separation reported significantly worse emotional outcomes when assigned to either EW condition relative to control writing. Within the control condition, those participants actively engaged in a search for meaning reported the lowest levels of separation-related disturbance. We discuss these results in terms of the factors that may limit and promote psychological recovery following marital separation.

Sudden Gains During Patient-Directed Expressive Writing Treatment Predicts Depression Reduction in Women with History of Childhood Sexual Abuse: Results from a Randomized Clinical Trial.

Cognit Ther Res. 2013 Aug 1;37(4):690-696.

Lorenz TA1, Pulverman CS1, Meston CM1.

Sudden gains are large reductions in symptoms measured in a single between-session interval and are positively associated with long-term treatment outcomes. To date, sudden gains have mostly been observed in therapist-directed psychotherapies. There are currently mixed findings surrounding the mechanisms underlying sudden gains, with some support for a cognitive mechanism and some support for therapist characteristics such as the therapeutic alliance. In this study of 77 female survivors of childhood sexual abuse, sudden gains in trauma symptoms were found in a randomized clinical trial of a patient-directed expressive writing intervention. Women in the active treatment condition (who wrote about their beliefs related to sexuality or trauma) exhibiting sudden gains in trauma symptoms showed larger improvements in depression than those in the control condition (who merely wrote about their daily needs). The extension of sudden gains from psychotherapy to a client-directed treatment refines our understanding of the mechanisms underlying these gains, and supports the hypothesis that cognitive change is a likely mechanism underlying sudden gains.