The physical and psychological health benefits of positive emotional writing: Investigating the moderating role of Type D (distressed) personality

Expressive writing as an intervention to decrease distress in pediatric critical care nurses

Differential efficacy of written emotional disclosure for subgroups of fibromyalgia patients.

Br J Health Psychol. Author manuscript; available in PMC 2009 Oct 8.
Published in final edited form as:


To identify differential health benefits of written emotional disclosure (ED).


Pain-coping style and demographic characteristics were examined as potential moderators of ED treatment efficacy in a randomized controlled trial with female fibromyalgia patients.


Of three pain-coping styles, only patients classified as interpersonally distressed (ID) experienced significant treatment effects on psychological well-being, pain, and fatigue. Treatment effects on psychological well-being were also significantly greater for patients with a high level of education.


Patients with an ID-coping style and/or high education appear to benefit most from ED.


Cogniţie, Creier, Comportament / Cognition, Brain, Behavior
Copyright © 2008 Romanian Association for Cognitive Science. All rights reserved. ISSN: 1224-8398
Volume XII, No.1 (March), 115 – 129


The main purpose of the present study was to investigate the possible positive effects of the Expressive Writing paradigm on a sample of Romanian female cancer patients. The major tenet of this paradigm is that if individuals with high levels of distress express in writing, for three or four consecutive writing sessions, their deepest thoughts and emotions regarding the activating event and its consequences, on the follow-up assessment they would experience significantly lower levels of distress, and improved physical and/or psychological functioning. Our study has evinced, that the participants of the sample we investigated has experienced at the follow-up assessment significantly lower levels of distress, and significantly higher levels of positive meaning in life and benefit finding, however, the results may depend on the pre-intervention levels of depression. Nevertheless, the Expressive Writing task has not significantly contributed in our sample to the enhancement of the levels of positive emotions.


Writing to Heal: What Kinds of Emotions Predict Outcome in Expressive Writing?

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.

The effect of expressive writing intervention for infertile couples: a randomized controlled trial.

Hum Reprod. 2017 Feb;32(2):391-402. doi: 10.1093/humrep/dew320. Epub 2016 Dec 21.

Frederiksen Y1, O’Toole MS2, Mehlsen MY2, Hauge B3, Elbaek HO4, Zachariae R2,5, Ingerslev HJ6,7.

Is expressive writing intervention (EWI) efficacious in reducing distress and improving pregnancy rates for couples going through ART treatment?


Compared to controls, EWI statistically significantly reduced depressive symptoms but not anxiety and infertility-related distress.


ART treatment is considered stressful. So far, various psychological interventions have been tested for their potential in reducing infertility-related distress and the results are generally positive. It remains unclear whether EWI, a brief and potentially cost-effective intervention, could be advantageous.


Between November 2010 and July 2012, a total of 295 participants (163 women, 132 men) were randomly allocated to EWI or a neutral writing control group.


Participants were couples undergoing IVF/ICSI treatment. Single women and couples with Preimplantation Genetic Diagnosis or acute change of procedure from insemination to IVF, were excluded. EWI participants participated in three 20-min home-based writing exercises focusing on emotional disclosure in relation to infertility/fertility treatment (two sessions) and benefit finding (one session). Controls wrote non-emotionally in three 20-min sessions about their daily activities. The participants completed questionnaires at the beginning of treatment (t1), prior to the pregnancy test (t2), and 3 months later (t3). In total, 26.8% (79/295) were lost to follow-up. Mixed linear models were chosen to compare the two groups over time for psychological outcomes (depression, anxiety and infertility-related distress), and a Chi2 test was employed in order to examine group differences in pregnancy rates MAIN RESULTS AND THE ROLE OF CHANCE: One hundred and fifty-three participants received EWI (women = 83; men = 70) and 142 participants were allocated to the neutral writing control group (women = 83; men = 62). Both women and partners in the EWI group exhibited greater reductions in depressive symptoms compared with controls (P = 0.049; [CI 95%: -0.04; -0.01] Cohen’s d = 0.27). The effect of EWI on anxiety did not reach statistical significance. Overall infertility-related distress increased marginally for the partners in the EWI group compared to the partners in the control group (P = 0.06; Cohen’s d = 0.17). However, in relation to the personal subdomain, the increase was statistically significant (P = 0.01; Cohen’s d = 0.24). EWI had no statistically significant effect on pregnancy rates with 42/83 (50.6%) achieving pregnancy in the EWI group compared with 40/80 (49.4%) in the control group (RR = 0.99 [CI 95% = 0.725, 1.341]; P = 0.94).


The results for depressive symptoms corresponded to a small effect size and the remaining results failed to reach statistical significance. This could be due to sample characteristics leading to a possible floor-effect, as we did not exclude participants with low levels of emotional distress at baseline. Furthermore, men showed increased infertility-related distress over time.


EWI is a potentially cost-effective and easy to implement home-based intervention, and even small effects may be relevant. When faced with infertility, EWI could thus be a relevant tool for alleviating depressive symptoms by allowing the expression of feelings about infertility that may be perceived as socially unacceptable. However, the implications do not seem to be applicable for men, who presented with increased infertility-related distress over time.

The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients–a systematic review and meta-analysis.

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.

Self-report and linguistic indicators of emotional expression in narratives as predictors of adjustment to cancer.

J Behav Med. 2006 Aug;29(4):335-45. Epub 2006 Jul 15.

Owen JE1, Giese-Davis J, Cordova M, Kronenwetter C, Golant M, Spiegel D.

Emotional expression and cognitive efforts to adapt to cancer have been linked to better psychological adjustment. However, little is known about the relationship between linguistic indicators of emotional and cognitive coping efforts and corresponding self-report measures of related constructs. In this study, we sought to evaluate the interrelationships between self-reports of emotional suppression and linguistic indicators of emotional and cognitive coping efforts in those living with cancer. Seventy-one individuals attending a community cancer support group completed measures of emotional suppression and mood disturbance and provided a written narrative describing their cancer experience. Self-reports of emotional suppression were associated with more rather than less distress. Although linguistic indicators of both emotional expression and cognitive processing were generally uncorrelated with self-report measures of emotional suppression and mood disturbance, a significant interaction was observed between emotional suppression and use of cognitive words on mood disturbance. Among those using higher levels of emotional suppression, increasing use of cognitive words was associated with greater levels of mood disturbance. These findings have implications for a) the therapeutic use of emotion in psychosocial interventions and b) the use of computer-assisted technologies to conduct content analysis.

Does writing about the bereavement lessen grief following sudden, unintentional death?

Death Stud. 2000 Mar;24(2):115-34.

Range LM1, Kovac SH, Marion MS.

Writing about traumatic events produces improvement in an array of areas including physical and psychological functioning. To see if these improvements extended to improved bereavement recovery after the accidental or homicidal death of a loved one, 64 undergraduates (51 women, 13 men) began, and 44 completed, a writing project. At pretest, they completed measures of depression, anxiety, grief, impact, and non-routine health visits. Then, they were randomly assigned to write about either the bereavement experience (profound condition), or innocuous topics (trivial condition). They wrote for 15 minutes a day for four days, then completed the same measures a second time (posttest). Six weeks later, they were mailed the same measures again (follow-up). A 2 (CONDITION: Profound versus Trivial) x 3 (Time: Pre-, Post-, or Follow-up) MANOVA yielded a significant main effect for time, but no main effect for condition and no interaction. Follow-up ANOVAs indicated that, across conditions, from pretest to follow-up testing participants reported less anxiety and depression, less impact, greater grief recovery, but about the same health center visits. A 2 (CONDITION) x 4 (Writing Day) MANOVA and follow-up tests indicated that those in the profound condition reported less subjective distress from Day 1 to Day 3, compared to those in the trivial condition. Combined with Kovac and Range (1999), present results suggest that writing projects may be more beneficial to those experiencing the unique bereavement of suicidal death, rather than those experiencing the nonintentional death of a loved one by accident or homicide.