The focus of this article is on a creative writing group developed for women with chronic pelvic pain. The authors address whether their experiences have anything to say about how creative writing sits within the current Western health paradigm and its approach to people who suffer from medically unexplained symptoms.
J Trauma Dissociation. 2005;6(3):83-104.
In the current study we sought, first, to distinguish associations with health arising from types of trauma as indicated by betrayal trauma theory (Freyd, 1996, 2001), and, second, to investigate the impact of disclosing a trauma history in survey form and/or writing essays about betrayal traumas. We recruited 99 community adults reporting at least 12 months of chronic medical illness or pain, 80 of whom completed all four sessions of this six-month longitudinal intervention study. Participants were randomly assigned to write about betrayal traumas or neutral events, and they were randomly assigned to complete an extensive trauma survey or a long personality inventory, producing four groups of participants. All 99 participants were assessed at their initial visit for trauma history using the Brief Betrayal Trauma Survey (BBTS) and physical and mental symptoms. The BBTS assesses exposure to both traumas high in betrayal (such as abuse by a close other) and traumas low in betrayal but high in life-threat (such as an automobile accident). Exposure to traumas with high betrayal was significantly correlated with number of physical illness, anxiety, dissociation, and depression symptoms. Amount of exposure to other types of traumas (low betrayal traumas) did not predict symptoms over and above exposure to betrayal trauma. While neither the survey manipulation nor the writing intervention led to main effects on change in symptoms over time, there were interactions between betrayal trauma history and condition such that participants with many betrayal traumas fared better in the control conditions while participants with fewer betrayal traumas had better outcomes if they were placed in the trauma writing and/or survey conditions. We discuss ongoing and future research aimed at evaluating the role of increased structure in writing assignments as beneficial for those with severe histories of betrayal trauma.
Transl Behav Med. 2012 Mar;2(1):73-81. doi: 10.1007/s13142-011-0085-4.
Life stress and the avoidance of negative emotions may contribute to chronic pain. The technique of written or spoken emotional disclosure can reverse emotional avoidance and improve health, and 18 randomized studies have tested it among people with chronic pain. We review these studies to provide guidance for the clinical use of this technique. The benefits of emotional disclosure for chronic pain are quite modest overall. Studies in rheumatoid arthritis show very limited effects, but two studies in fibromyalgia suggest that disclosure may be beneficial. Effects in other populations (headaches, cancer pain, pelvic pain, abdominal pain) are mixed. Moderator findings suggest that some patients are more likely to benefit than others. Emotional disclosure has been tested in well-controlled efficacy trials, leaving many unanswered questions related to translating this technique to practice. Issues needing further study include determining disclosure’s effects outside of randomized controlled trials, identifying the optimal pain populations and specific individuals to target for disclosure, presenting a valid rationale for disclosure, selecting the location and method of disclosure, and choosing between cognitive-behavioral or emotional disclosure techniques.
Psychosom Med. 2004 Mar-Apr;66(2):174-83.
Although written emotional disclosure has potential as a stress management intervention for people with health problems, the main (group) effects of disclosure in medical populations are limited. This study sought to identify individual difference moderators of the effects of written disclosure among women with chronic pelvic pain.
In a prospective, randomized trial, 48 women with chronic pelvic pain completed 3 individual difference measures and then wrote for 3 days about stressful consequences of their pain (disclosure) or positive events (control). Health status was assessed at baseline and 2 months after writing.
Main effect group comparisons indicated that disclosure writing resulted in significantly lower evaluative pain intensity ratings than control writing at follow-up, but there were no main effects on other outcome variables (sensory or affective pain, disability, affect). Three baseline individual difference measures, however, significantly moderated group effects. Compared with control writing, disclosure led to less disability among women with higher baseline ambivalence over emotional expression or higher catastrophizing, and to increased positive affect among women with higher baseline negative affect. Ambivalence, but not catastrophizing, was independent of negative affect in its moderation effect.
Although the main effects of writing about the stress of pelvic pain are limited, women with higher baseline ambivalence about emotional expression or negative affect appear to respond more positively to this intervention.
Chronic pain represents a wide-spread and costly problem that is often not treated effectively with traditional biomedical approaches (Turk et al., 2011). The literature emphasizes the importance of using psychological interventions that encourage self-management of pain. This study tested the effectiveness of two brief, online writing interventions that can be used by chronic pain patients in a wide-spread and cost-effective way (Kerns et al., 2001). Writing interventions have been found to produce beneficial psychological and physical outcomes for those with pain (e.g., Frattaroli, 2006,). This study added to the literature by using positive variations of the expressive writing paradigm that focused on self-compassion and self-efficacy, and testing the moderator variable of pain catastrophizing. Ninety-three participants with chronic pain were recruited from chronic pain forums and completed the writing intervention. Participants were randomized to either self-compassion or self-efficacy writing and wrote for 20 minutes once a week for three consecutive weeks. Participants completed baseline and post-intervention measures of pain severity, illness intrusiveness, pain acceptance, pain catastrophizing, depression symptoms, life satisfaction, self-compassion, and chronic pain self-efficacy. Results indicate that participants in both writing conditions reported significantly less pain, less depression, and greater self-compassion after the writing. Moreover, participants reported feeling more positive after each writing session. One significant difference emerged between the two types of writing: participants in the self-compassion condition reported less intrusive pain, whereas those in the self-efficacy condition reported more intrusive pain after the writing. In conclusion, although both types of writing have beneficial effects on psychological and physical health for those with chronic pain, the self-compassion writing may be even more favorable than the self-efficacy writing.
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Volume 21, 2006 – Issue 5
An intriguing question within the expressive writing literature is whether writing interventions that focus on positive aspects of adverse experiences can produce health benefits, particularly among individuals with serious physical illness. Seventy-five adults with lupus or rheumatoid arthritis were randomly assigned to one of three 4-session writing interventions: benefit finding (BF), standard expressive writing (EW), or a control group. Follow-up questionnaires were completed one and three months later. At three months, fatigue was lower in the BF and EW groups than in the control group. BF appeared effective in reducing pain levels for participants with high trait anxiety, whereas EW appeared effective for participants with low trait anxiety. No significant group effects were found for psychological functioning or disability. Results are discussed with regard to the literature on BF and EW among medical patients.
Medical conditions that might benefit from expressive writing programmes
Lung functioning in asthma
Disease severity in rheumatoid arthritis
Pain and physical health in cancer
Immune response in HIV infection
Hospitalisations for cystic fibrosis
Pain intensity in women with chronic pelvic pain
Sleep-onset latency in poor sleepers