In this article, a model of transformation-through-writing will be introduced that helps to explain how a transformative and dialogical-learning process occurs when narratives or poetry are used for healing. We focus in particular on how a “boundary experience” is processed—or how a painful “first story” can be rewritten to become a more life-giving “second story.” We propose that this occurs stepwise in four cognitive stages: sensing; sifting; focusing; and understanding. These stages are explained and underpinned by research on neurobiology, neuropsychology, and on identity learning. The case study used to illustrate this process, focuses on expressive and reflective writing in emotional recovery from domestic violence. To be effective, therapeutic writing requires a safe and enriching learning environment; we discuss how such an environment supports the dialogical self and what considerations a facilitator might take into account when working with a student or client.
Writing emotionally about upsetting life events (expressive writing) has been shown to speed healing of punch-biopsy wounds compared to writing objectively about daily activities. We aimed to investigate whether a presurgical expressive writing intervention could improve surgical wound healing.
Seventy-six patients undergoing elective laparoscopic bariatric surgery were randomized either to write emotionally about traumatic life events (expressive writing) or to write objectively about how they spent their time (daily activities writing) for 20 min a day for 3 consecutive days beginning 2 weeks prior to surgery. A wound drain was inserted into a laparoscopic port site and wound fluid analyzed for proinflammatory cytokines collected over 24 hr postoperatively. Expanded polytetrafluoroethylene tubes were inserted into separate laparoscopic port sites during surgery and removed after 14 days. Tubes were analyzed for hydroxyproline deposition (the primary outcome), a major component of collagen and marker of healing. Fifty-four patients completed the study.
Patients who wrote about daily activities had significantly more hydroxyproline than did expressive writing patients, t(34) = -2.43, p = .020, 95% confidence interval [-4.61, -0.41], and higher tumor necrosis factor-alpha, t(29) = -2.42, p = .022, 95% confidence interval [-0.42, -0.04]. Perceived stress significantly reduced in both groups after surgery.
Expressive writing prior to bariatric surgery was not effective at increasing hydroxyproline at the wound site 14 days after surgery. However, writing about daily activities did predict such an increase. Future research needs to replicate these findings and investigate generalizability to other surgical groups. (PsycINFO Database Record
(c) 2017 APA, all rights reserved).
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
There is growing evidence that resolution of trauma (or its smaller cousin, stress) requires somatic (body) involvement. The reflection write develops the habit of checking in with the embodied experience of writing, a good gauge of how your nervous system is processing the writing.
When you are present to what emerges on the page by reading what you have just written and writing a few sentences about what you notice, you are developing an observational part of your brain. You are gaining separation from the write itself and taking note of both the process of writing as well as any insights that the writing yielded. What happened in my body as I wrote? Did my handwriting change? Was there a smile on my face or tears in my eyes? Were there any “aha” moments? Paying attention, cultivating curiosity and noticing what emerges as a function of the process of writing is similar to meditation practices that cultivate concentration and invite insight.
The reflection write is the consummate expressive writing tool for focused attention.
The reflection write is an exercise in the process of paying attention, particularly if curiosity and compassion are brought to that process. Reflection supports the process of choosing to fire circuits that over time will change our brains in service of greater healing—and, likely, the authorship of a more integrated, coherent story.
from “Your Brain on Ink”