How Does Insightful and Emotional Disclosure Bring Potential Health Benefits?: Study Based on Online Support Groups for Women with Breast Cancer.

J Commun. 2011 Jun;61(3):432-464.

Shim M1, Cappella JN2, Han JY3.



Despite much research on the beneficial effects of written disclosure, relatively little attention has been paid to specifying the mechanism underlying the effects. Building upon the two theoretical models (the cognitive adaptation model and the emotional exposure-habituation model), this research focused on two aspects of disclosure content—insights and emotions—and examined how women with breast cancer benefit from written disclosure in online support groups. Using survey data collected at baseline and after four months and messages posted in bulletin-board-type online groups in between, we analyzed how the content of disclosive messages predicted health outcomes. Disclosure of insights led to greater improvements in health self-efficacy, emotional well-being, and functional well-being, which was mediated by lowered breast cancer concerns. Disclosure of negative emotions did not have main effects on health outcomes; instead, it weakened the unfavorable association between concerns at baseline and functional well-being at follow-up. Our findings support both theoretical models, but in regard to different aspects of disclosure content.

The Effects of Expressive Writing on Adjustment to HIV

Inna D. Rivkin; Julie Gustafson; Ilene Weingarten; Dorothy Chin


AIDS and Behavior. 2006;10(1):13-26.

Previous research suggests that writing about stressful experiences results in better health and psychological well-being. In the present study, a multi-ethnic sample of 79 HIV-positive women and men participated in a structured interview, and wrote about either their deepest thoughts and feelings about living with HIV (expressive writing) or their activities in the last 24 hr (control). Sixty-two participants returned for the 2-month follow-up and 50 returned for the 6-month follow-up interview. Oral fluid samples of beta2-microglobulin were taken at the baseline and follow-up assessments to examine the immunological effects of writing. No effects of writing condition were found, but expressive writing participants who included increasing insight/causation and social words in their writing had better immune function and reported more positive changes at follow-up. Results suggest that cognitive processing and changes in social interactions may be critical to the benefits of writing.

Does altering the writing instructions influence outcome associated with written disclosure?

Behav Ther. 2007 Jun;38(2):155-68. Epub 2007 Jan 18.

Sloan DM1, Marx BP, Epstein EM, Lexington JM.

This study examined the effect of changing the instructional set for written disclosure on psychological and physical health reports among traumatized college students with current posttraumatic stress symptoms. Eighty-two participants were randomly assigned to one of three writing conditions that focused on emotional expression (EE), insight and cognitive assimilation, or to a control condition. Participants assigned to the EE condition reported significant improvements in psychological and physical health 1 month following the writing sessions relative to the other two conditions. The EE participants also reported and displayed significantly greater initial psychophysiological reactivity and subsequent habituation compared with the other two conditions. These findings suggest the importance of emphasizing emotional expression during written disclosure and underscore the importance of examining how modifying the written disclosure protocol can affect outcome.

How writing works: self-directed change

writing authentically about one’s own lived experience helps construct a coherent, consistent narrative and assists in finding meaning in life’s challenges and difficulties (Pennebaker 1986, 1989, 2004; Smyth 1998; Frattaroli 2008; Poon and Danoff-Burg 2011). My own research indicates that expressive writing also offers clarity and insight, promotes emotional management through safe, effective catharsis, accelerates resolution of difficulties, and helps manage stress (Adams 2006a). In my therapy practice, I have found again and again that the journal represents an important resource for self-directed change—the process of growing oneself out of negative, painful, destructive patterns, beliefs, and circumstances.

Kathleen Adams

from “Your Brain on Ink”

(pp. 25-26).