Expressive writing is a therapeutic intervention requiring individuals to write about distressing events and their emotional responses to these experiences (Pennebaker & Beall, 1986). The use of expressive writing has improved behavioural, physiological, and psychological outcomes in many populations, including individuals with posttraumatic stress disorder (PTSD; Baikie & Wilhelm, 2005). Greater self-disclosure on such writing tasks has been associated with higher perceived benefits and helpfulness (Brewin & Lennard, 1999). Researchers have investigated how expressive writing protocols can be utilized online to increase levels of self-disclosure when writing about traumatic experiences and, consequently, improve PTSD symptom outcomes. Researchers have not yet assessed for modality-based differences (e.g., typed vs. hand-written expressive writing) for therapeutic efficacy or emotional engagement. The present investigation examined whether 1) typed and hand-written expressive writing equally reduced PTSD symptoms; and 2) emotional engagement affected the efficacy of expressive writing in reducing PTSD symptoms. A community and student sample (n = 29) with clinically significant PTSD symptoms completed the trial. Participants were randomized to one of four conditions with different writing modalities (i.e., typed or hand-written) and paradigms (i.e., control or expressive writing). In one session, participants were administered three 15-minute writing tasks and self-report questionnaires evaluating aspects of emotion (i.e., recognition, expression, trait negative emotionality) and PTSD symptom severity. An optional 7-day follow-up questionnaire re-evaluating PTSD symptom severity was also administered to participants. Each experimental group had non-significant decreases in PTSD symptoms from pre- to post-intervention, these

changes being dependant on pre-intervention symptom severity; however, alexithymia, i

dissociation (i.e., attentional dissociation and dissociative amnesia), negative affect, emotional approach coping, and the presence of a learning disability did affect symptom changes, and when these factors were considered the experimental conditions significantly differed in their effect on symptom outcomes. In conclusion, findings of the current trial suggest that a day-intensive session of expressive writing neither reduces PTSD symptoms nor differs in efficacy based on its method of completion unless emotional engagement with the task is considered. Further investigation into how learning disabilities and emotional predispositions affect engagement with expressive writing is warranted to clarify its efficacy in clinical PTSD populations.

Who does expressive writing work for? Examination of alexithymia, splitting, and repressive coping style as moderators of the expressive writing paradigm.

Br J Health Psychol. 2008 Feb;13(Pt 1):61-6. doi: 10.1348/135910707X250893.

Baikie KA1.

This paper examines the moderating influence of alexithymia, splitting, and repressive coping style in the expressive writing paradigm.


Eighty-eight university students randomized to four weekly 20-minute expressive or neutral writing sessions, with 1-month follow-up.


Expressive writing was more beneficial for individuals scoring higher on alexithymia and splitting, but not repressive coping.


Future research should include personality measures in explorations of expressive writing to further understand the boundary conditions of the expressive writing paradigm.

Effects and linguistic analysis of written traumatic emotional disclosure in an eating-disordered population.

Perm J. 2013 Winter;17(1):16-20. doi: 10.7812/TPP/12-056.

Gamber AM1, Lane-Loney S, Levine MP.

In previous studies, writing about traumatic life events produced positive physical and psychological outcomes in various populations. Specific linguistic trends, such as increasing insight and cognitive words, have paralleled health benefits.


This study explored the effects of written traumatic emotional disclosure on eating disorder behavior and cognitions as well as linguistic dimensions of the disclosure writings completed by eating-disordered patients.


Twenty-nine female patients, aged 16 to 39 years, from the Penn State Hershey Eating Disorders partial-hospitalization program participated. Twenty-five subjects completed a traumatic disclosure or control writing task, and 21 completed all writings and baseline and follow-up questionnaires to assess eating-disorder symptoms, emotional regulation strategies, self-efficacy, and motivation to change eating-disorder behaviors. The handwritten essays were transcribed into a word-processed document and analyzed on numerous dimensions using the Linguistic Inquiry and Word Count software.


Individuals completing the disclosure writing did not differ from those in the control task group on any of the questionnaires at follow-up. However, the disclosure group did use more negative emotion, insight, cognitive, function, and filler words on all writing days along with decrease of tentative words. These changes in word use correlated with previous study findings.


Whereas the expected linguistic trends were evident in the disclosure group writings, no correlating health benefits could be found between the disclosure and control groups. Eating-disordered populations, often alexithymic, may have difficulty engaging with the disclosure task and could potentially benefit from guidance in processing traumatic events and their affective states.

Are alexithymia and emotional characteristics of disclosure associated with blood pressure reactivity and psychological distress following written emotional disclosure?

Br J Health Psychol. 2008 Sep;13(Pt 3):495-512. Epub 2007 Jul 6.

O’Connor DB1, Ashley L.

This study had three aims: 1) to investigate whether cardiovascular responses to laboratory stress and levels of emotional distress were attenuated following written emotional disclosure; 2) to test, in addition to the potential main effects, whether levels of alexithymia moderated the impact of writing; and 3) to examine whether alexithymics who successfully disclosed emotion in their essays would experience positive effects following writing.


Eighty-seven participants wrote about their most stressful life experience or about a non-stressful experience, for 15 minutes, over 3 consecutive days. Two weeks later, blood pressure (BP) responses to laboratory stress and levels of emotional distress were assessed. Emotional characteristics of the disclosure essays were analysed with the Linguistic Inquiry and Word Count programme and alexithymia was assessed at baseline using the Toronto Alexithymia Scale-20.


Analyses found no evidence in support of the main effects of disclosure on cardiovascular responses to stress or on emotional distress. However, alexithymia was found to moderate the impact of writing such that non-alexithymic participants in the experimental condition reported significantly lower emotional distress 2 weeks later. In addition, alexithymic participants who disclosed a greater number of negative when compared with positive emotion words exhibited reduced systolic and diastolic responses to stress. Conversely, non-alexithymic participants who disclosed more positive and less negative emotion words displayed attenuated BP reactivity to stress.


The results of this exploratory study are important as they highlighted, in the absence of main effects, the importance of examining potential moderators of the emotional writing process. These findings may have implications for the development of cardiovascular health interventions.

Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors – results from a nationwide randomized clinical trial.

Psychooncology. 2013 Jul;22(7):1492-500. doi: 10.1002/pon.3193. Epub 2012 Sep 19.

Jensen-Johansen MB1, Christensen S, Valdimarsdottir H, Zakowski S, Jensen AB, Bovbjerg DH, Zachariae R.

To examine the effects of an expressive writing intervention (EWI) on cancer-related distress, depressive symptoms, and mood in women treated for early stage breast cancer.


A nationwide sample of 507 Danish women who had recently completed treatment for primary breast cancer were randomly assigned to three 20-min home-based writing exercises, one week apart, focusing on either emotional disclosure (EWI group) or a non-emotional topic (control group). Cancer-related distress [Impact of Event Scale (IES)], depressive symptoms (Beck Depression Inventory-Short Form), and negative (37-item Profile of Moods State) and positive mood (Passive Positive Mood Scale) were assessed at baseline and at 3 and 9 months post-intervention. Choice of writing topic (cancer versus other), alexithymia (20-item Toronto Alexithymia Scale), and social constraints (Social Constraints Scale) were included as possible moderators.


Significant (p<0.01) group differences in mood change from before to immediately after each session suggested successful manipulation. Reductions over time in psychological symptoms were seen in both groups (p<0.05), but no time × group interactions were found. Choice of writing topic moderated effects on IES, with women writing about other themes showing greater reductions in cancer-related avoidance than women writing about their cancer. Fewer depressive symptoms and higher levels of positive mood were seen 3 months post-intervention in women writing about their cancer when compared with the control group. Difficulties describing feelings and externally oriented thinking (20-item Toronto Alexithymia Scale) moderated effects on positive mood and IES-total, while no moderating effects were found of social constraints.


In concordance with the majority of previous results with cancer patients, no main effects of EWI were found for cancer-related distress, depressive symptoms, and mood. Moderator analyses suggested that choice of writing topic and ability to process emotional experiences should be studied further.