There is a growing body of evidence supporting the use of Pennebaker’s ‘Expressive Writing’ paradigm as an adjunct to psychological therapy or as a self-help therapeutic intervention. Research, thus far, has predominantly focused on measuring, explaining and analysing the effects of ‘Expressive Writing’ as a therapeutic intervention through randomised controlled trials, paying little attention to the subjective experience of the individuals and the types of narratives people write. This doctoral research approaches ‘Expressive Writing’ from a narrative perspective, which argues that individuals construct their sense of self and create meaning of their own lives through the use of narratives. The aim of this thesis is to explore how people construct their sense of self through ‘Expressive Writing’. Following an adapted version of Pennebaker’s ‘Expressive Writing’ guidelines, six participants were asked to spend 50 to 60 minutes writing about an emotional life-changing event and then share their stories, and their experience of writing about their stories, in an hour-long interview. The study used qualitative methods of inquiry, namely narrative analyses to explore the process of the construction of sense of self in both the written and oral narratives. The emerged findings point to the natural tendency of people to write in a narrative form using culturally available narratives and highlight the dialogical nature of the intervention. Findings are discussed in terms of implications for Counselling Psychology practice, their contribution to theory, and suggestions for future research. Overall, this thesis suggests that Expressive Writing could be a valuable addition to Counselling Psychology practice, when used in line with the ethos and values of Counselling Psychology.
In the current study, the aim was to explore whether certain types of emotions that
emerge in participants‟ personal narratives of past traumatic events are associated with subsequent improvement in emotional well-being following expressive writing. The sample was archival data consisting of 255 undergraduate students. Participants‟ narrative material was coded for the presence of key emotions. Participants‟ psychological well-being was assessed at baseline, and at 17 and 31 days post- intervention. Participants were observed to evidence different key emotional states that were differentially associated with symptom distress. No relationship was observed between expressions of different emotions and participants‟ subsequent emotional development. Findings suggest that participants do not always adhere to writing instructions; personal narratives are revealing of symptom distress; and repeated writing, emotional or non-emotional, may enhance emotional well-being in general.
Psychol Health. 2015;30(3):284-300. doi: 10.1080/08870446.2014.971798. Epub 2014 Oct 27.
Lepore SJ1, Revenson TA, Roberts KJ, Pranikoff JR, Davey A.
This randomised trial tested (i) whether a home-based expressive writing (EW) intervention improves quality of life in patients with colorectal cancer (CRC) and (ii) whether the intervention is more beneficial for men or for people who feel constrained in disclosing cancer-related concerns and feelings.
Patients treated for CRC were randomised to an EW (n = 101) or control writing (CW; n = 92) group. Assessments were completed at 1 month pre- and post-intervention. Sex and perceived social constraints on disclosure were evaluated as moderators.
MAIN OUTCOME MEASURES:
Primary outcomes were depressive symptoms, sleep problems and quality of life indicators.
Eighty-one per cent of participants completed all writing assignments. Consistent with hypotheses, relative to the CW group, participants in the EW group expressed more negative emotion in writing and rated their writings as more meaningful, personal and emotionally revealing. There were no significant main effects of EW or moderating effects of sex or social constraints on outcomes.
Although EW is feasible to use with persons who have CRC, it was not effective as a stand-alone psychotherapeutic intervention. Neither was it more effective for men nor for people who felt they could not freely disclose cancer-related concerns and feelings.
Psychooncology. 2015 Nov;24(11):1349-59. doi: 10.1002/pon.3802. Epub 2015 Apr 14.
Zachariae R1, O’Toole MS2.
This study aimed to evaluate the effectiveness of expressive writing intervention (EWI) for improving psychological and physical health in cancer patients and survivors.
We searched databases and existing reviews for randomized controlled studies published between 1986 and 2014 that evaluated the effects of EWI on psychological and physical health outcomes. We computed and combined effect sizes and examined the role of methodological characteristics.
From 223 unique citations, we identified 16 independent randomized controlled trials published from 1999 to 2014, examining the effect of EWI on a range of psychological and physical health outcomes. No statistically significant effects were found for any of the individual or combined psychological (Hedges’s g: 0.04; 95% CI, -0.06 to 0.14; p = 0.42), physical (0.08; 95% CI, -0.05 to 0.20; p = 0.22), or quality-of-life outcomes (0.09; 95% CI, -0.05 to 0.24; p = 0.22). The results were unaffected by differences in study characteristics, for example, type of control condition, study setting, cancer type, and overall study quality ratings. Results from a subset of studies indicated a possible moderating effect of social constraints, suggesting that participants experiencing low levels of emotional support may be more likely to benefit from EWI.
Our results do not support the general effectiveness of EWI in cancer patients and survivors. However, given the practical and inexpensive intervention, it is possible that even small effects in subgroups of patients could be clinically relevant, and future studies are recommended to test the effects of potential moderators, including pre-intervention distress levels and context-dependent factors such as emotional support.
Research into the change processes underlying the benefits of expressive writing is still incomplete. To fill this gap, we investigated the linguistic markers of change in cognitive and emotional processing among women with breast cancer, highlighting the differences and peculiarities during different treatment phases. A total of 60 writings were collected from 20 women: 10 receiving chemotherapy and 10 receiving biological therapy. We performed a series of repeated measures ANOVA for the most meaningful LIWC linguistic categories, including positive/negative emotions and cognitive processes, to assess change over three sessions. Results demonstrated a significant increase in the positive emotions category for the entire group of women, with particular relevance for the biological therapy group of women, and a marginally significant (p = .07) greater use of words indicating cognitive processes for women receiving biological therapy. For the negative emotions category time was significant for the whole group of women, showing a peak of use in the second session of writing. Peculiar differences in the linguistic markers of processing trauma were observed between the two groups. Although the writing intervention is a support for both groups of women, it seems to be beneficial when there is a large time gap since the administration of chemotherapy and, thus, when the patient can revisit the experience. The relationship of the illness with life can be rearticulated, and the writing becomes a space for resignifying the traumatic cancer experience.
Qual Health Res. 2015 Mar;25(3):348-59. doi: 10.1177/1049732314551059. Epub 2014 Sep 22.
Freda MF1, Martino ML2.
There is literary evidence stating that expressive writing affects health outcomes. Nevertheless, the processes underlying its benefits remain unclear. In our previous article, we described the benefits of writing; in this article, we investigate the meaning-making processes underlying the traumatic experiences of parents of children with leukemia in off-therapy. We collected the writings of 23 parents and grouped them according to the parents’ psychological outcome (low/good/high) with respect to anxiety, as assessed during a follow-up. We qualitatively analyzed the texts written by parents with good psychological outcomes to highlight their main meaning-making processes, that is, how they put into words the shattering experience, reordered the events, connected their emotions and the events, reevaluated the event, and reconstructed the time process. We found that parents with low/high outcomes articulated these processes differently. Furthermore, we discussed the uses and functions of written narration for each group.