Expressive writing in psychotherapy: A tool to promote and track therapeutic change.

Cummings, J. A., Hayes, A. M., Saint, D. S., & Park, J. (2014). Expressive writing in psychotherapy: A tool to promote and track therapeutic change. Professional Psychology: Research and Practice, 45(5), 378-386.

http://dx.doi.org/10.1037/a0037682

 

Expressive writing (EW) can be a useful supplement to psychotherapy, regardless of therapeutic orientation. In an open trial of exposure-based cognitive therapy for depression, 43 participants used EW before each session, producing 928 EW samples. Using examples from these, we discuss how EW can be used to both promote and track therapeutic change. Specifically, we review the impact of EW on therapeutic growth, via self-monitoring, increased awareness, and exposure/emotional processing. We then discuss how EW can be used to track important predictors of change such as symptoms, therapeutic alliance, social support, avoidance, and hopelessness. We conclude by discussing potential limitations to the use of EW in therapy and by recommending specific strategies for incorporating EW into clinical practice.

http://psycnet.apa.org/record/2014-35404-001

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Computer-based Written Emotional Disclosure: The Effects of Advance or Real-time Guidance and Moderation by Big 5 Personality Traits

Published online 2013 Dec 23. doi:  10.1080/10615806.2013.868887

Jonathan A. Beyer, Mark A. Lumley, Deborah A. Latsch, Lindsay M.S. Oberleitner, Jennifer N. Carty, and Alison M. Radcliffe

Standard written emotional disclosure (WED) about stress, which is private and unguided, yields small health benefits. The effect of providing individualized guidance to writers may enhance WED, but has not been tested. This trial of computer-based WED compared two novel therapist-guided forms of WED—advance guidance (before sessions) or real-time guidance (during sessions, through instant messaging)—to both standard WED and control writing; it also tested Big 5 personality traits as moderators of guided WED. Young adult participants (n = 163) with unresolved stressful experiences were randomized to conditions, had three, 30-min computer-based writing sessions, and were reassessed 6 weeks later. Contrary to hypotheses, real-time guidance WED had poorer outcomes than the other conditions on several measures, and advance guidance WED also showed some poorer outcomes. Moderator analyses revealed that participants with low baseline agreeableness, low extraversion, or high conscientiousness had relatively poor responses to guidance. We conclude that providing guidance for WED, especially in real-time, may interfere with emotional processing of unresolved stress, particularly for people whose personalities have poor fit with this interactive form of WED.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4067474/

Linguistic Markers of Processing Trauma Experience in Women’s Written Narratives During Different Breast Cancer Phases: Implications for Clinical Interventions

Eur J Psychol. 2015 Nov; 11(4): 651–663.
Published online 2015 Nov 27. doi:  10.5964/ejop.v11i4.991
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.

Linguistic Markers of Processing Trauma Experience in Women’s Written Narratives During Different Breast Cancer Phases: Implications for Clinical Interventions.

Eur J Psychol. 2015 Nov 27;11(4):651-63. doi: 10.5964/ejop.v11i4.991. eCollection 2015 Nov.

Martino ML1, Onorato R1, Freda MF1.

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.

https://www.ncbi.nlm.nih.gov/pubmed/27247683

The moderating role of autonomy and control on the benefits of written emotion expression.

Pers Soc Psychol Bull. 2009 Mar;35(3):351-64. doi: 10.1177/0146167208328165.

Weinstein N1, Hodgins HS.

Two studies examined the hypothesis that relative to control motivation, autonomy motivation is associated with effective written expression and regulation, leading to positive emotional, physical, and cognitive outcomes over time. Participants viewed a Hiroshima-Nagasaki documentary in each of two sessions. Study 1 showed that dispositionally autonomous participants, particularly those who expressed, had positive well-being, energy, and memory after the second viewing. Study 2 explored benefits of situational motivation by priming autonomy and control. Results showed that dispositionally controlled individuals received the same benefits as autonomous individuals only when primed with autonomy and encouraged to express. Coding of writing content revealed that the benefits of autonomy were mediated by nondefensive and effective emotional processing, as reflected in greater use of self-referencing and cognitive mechanism words and lower use of concrete words. Results support the expectation that autonomy relates to effective expression and emotion regulation, leading to positive functioning over time.

https://www.ncbi.nlm.nih.gov/pubmed/19223457

Effects of writing about emotions versus goals on psychological and physical health among third-year medical students.

J Pers. 2006 Feb;74(1):267-86.

Austenfeld JL1, Paolo AM, Stanton AL.

A randomized, controlled trial compared writing about emotional topics (EMO) to writing about goals as the “best possible self” (BPS; after King, 2001) and evaluated emotional approach coping, i.e., efforts to cope through processing and expressing emotion, as a moderator of writing effects on psychological and physical health in 64 third-year medical students. In participants with higher baseline hostility, the EMO condition was associated with less hostility at 3 months compared to the BPS and control conditions. Emotional processing (EP) and emotional expression (EE) moderated the effect of experimental condition on depressive symptoms at 3 months; high EP/EE participants reported fewer depressive symptoms in the EMO condition, whereas low EP/EE individuals reported fewer depressive symptoms in the BPS condition compared to the EMO and control conditions. A moderating effect of EP on physical health was also identified, such that low EP individuals who wrote about goals (BPS) had fewer health care visits at 3 months compared to low EP participants in the EMO and control conditions.

https://www.ncbi.nlm.nih.gov/pubmed/16451232

Health effects of written emotional disclosure in adolescents with asthma: a randomized, controlled trial.

J Pediatr Psychol. 2006 Jul;31(6):557-68. Epub 2005 Jul 13.

Warner LJ1, Lumley MA, Casey RJ, Pierantoni W, Salazar R, Zoratti EM, Enberg R, Simon MR.

To test the effects of written emotional disclosure on the health of adolescents with asthma and to examine how language in disclosures predicts outcomes.

METHODS:

We randomized 50 adolescents with asthma to write for 3 days at home about stressful events (disclosure) or control topics. At baseline and 2 months after writing, we assessed symptoms, affect, disability, internalizing behavior problems, and lung function; parents independently rated internalizing behavior and disability.

RESULTS:

Compared with control writing, disclosure writing led to improved positive affect and internalizing problems. Disclosure also decreased asthma symptoms and functional disability among adolescents with baseline elevations of these difficulties. Lung function was not changed. Disclosures with more negative emotion, insight, and causal words–and increased causal or insight words over days–predicted improved health.

CONCLUSIONS:

Written emotional disclosure improves emotional and behavioral functioning among adolescents with asthma, particularly those whose writings suggest emotional processing and cognitive restructuring.

https://www.ncbi.nlm.nih.gov/pubmed/16014820