The effects of expressive writing following first myocardial infarction: a randomized controlled trial.

Health Psychol. 2011 Sep;30(5):642-50. doi: 10.1037/a0023519.

Willmott L1, Harris P, Gellaitry G, Cooper V, Horne R.

To assess the effects of expressive writing on health care utilization, clinical variables and subjective quality of life following first myocardial infarction (MI).


One-hundred and seventy-nine first MI patients were randomized to Intervention (N = 88) or Control (N = 91) groups. The intervention group wrote about their thoughts and feelings in relation to having had an MI. Controls wrote in a neutral way about daily activities. The main outcome measures were health care utilization, physical status and subjective quality of life (QOL), assessed after one, two, and five months.


One-hundred and fifty-six (87%) completed the study. Five months post-intervention, the intervention group had significantly fewer recorded medical appointments compared to controls. The number of prescribed medicines decreased over time within the intervention group but increased within the control group. The intervention group attended significantly more rehabilitation sessions, reported fewer cardiac related symptoms and had lower diastolic blood pressure five months post-intervention. There was no significant group by time interaction on reported physical health. The group by time interaction on reported mental health approached significance, those in the intervention group reporting greater improvement.


Expressive writing may be a beneficial strategy which could be incorporated into rehabilitation interventions to help individuals adjust after first MI.

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.

‘Narrative expressive writing’ might protect against harmful health effects of divorce-related stress