Psychol Health. 2015;30(3):284-300. doi: 10.1080/08870446.2014.971798. Epub 2014 Oct 27.
This randomised trial tested (i) whether a home-based expressive writing (EW) intervention improves quality of life in patients with colorectal cancer (CRC) and (ii) whether the intervention is more beneficial for men or for people who feel constrained in disclosing cancer-related concerns and feelings.
Patients treated for CRC were randomised to an EW (n = 101) or control writing (CW; n = 92) group. Assessments were completed at 1 month pre- and post-intervention. Sex and perceived social constraints on disclosure were evaluated as moderators.
MAIN OUTCOME MEASURES:
Primary outcomes were depressive symptoms, sleep problems and quality of life indicators.
Eighty-one per cent of participants completed all writing assignments. Consistent with hypotheses, relative to the CW group, participants in the EW group expressed more negative emotion in writing and rated their writings as more meaningful, personal and emotionally revealing. There were no significant main effects of EW or moderating effects of sex or social constraints on outcomes.
Although EW is feasible to use with persons who have CRC, it was not effective as a stand-alone psychotherapeutic intervention. Neither was it more effective for men nor for people who felt they could not freely disclose cancer-related concerns and feelings.
J Coll Stud Ret. 2010;12(4):407-428.
Several early studies and subsequent reviews suggested that written emotional disclosure (WED)-writing repeatedly about personal stressful experiences-leads to improved academic performance of college students. Yet a critical review of available studies casts some doubt on this, so we conducted three randomized, controlled experiments of the effects of WED versus control writing on grade point average (GPA) of college students. In all three studies, WED writing was implemented effectively-it contained more negative emotion language and generated more negative mood than did control writing. In Study 1, WED did not influence GPA during either the writing semester or subsequent semester among 96 students with headaches. In Study 2, WED had no effect on GPA compared with either control writing or no writing conditions among 124 students with unresolved stress. In Study 3, WED did not influence GPA or retention among 68 academically at-risk ethnic minority students, although secondary analyses suggested some benefits of WED among students who wrote more than once, particularly men. These three studies challenge the belief that WED improves academic performance of college students, and research should examine subgroups of students who might benefit from WED.
Eur J Psychol. 2015 Nov 27;11(4):651-63. doi: 10.5964/ejop.v11i4.991. eCollection 2015 Nov.
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.
Br J Health Psychol. 2008 Feb;13(Pt 1):31-4. doi: 10.1348/135910707X251234.
This study examined the effects of expressive narrative writing in 607 participants. Compared with a control group, the participants randomly assigned to write about their feelings and thoughts after the Madrid train attack on M11 report less negative emotions related to the recall of the collective trauma at a 2-month follow-up after the attacks. However, no effects were found on positive affect, probably because the study had only one writing session of brief duration. Stronger feelings of joy, use of positive words, and low use of negative words in the narratives predicted low emotional activation at follow-up.
Psychol Sci. 2006 Aug;17(8):660-4.
Writing about emotional experiences is associated with a host of positive outcomes. This study extended the expressive-writing paradigm to the realm of romantic relationships to examine the social effects of writing. For 3 consecutive days, one person from each of 86 dating couples either wrote about his or her deepest thoughts and feelings about the relationship or wrote about his or her daily activities. In the days before and after writing, instant messages were collected from the couples. Participants who wrote about their relationship were significantly more likely to still be dating their romantic partners 3 months later. Linguistic analyses of the instant messages revealed that participants and their partners used significantly more positive and negative emotion words in the days following the expressive-writing manipulation if the participants had written about their relationship than if they had written about their daily activities. Increases in positive emotion words partially mediated the relation between expressive writing and relationship stability.
Psychol Trauma. 2015 Jan;7(1):50-7. doi: 10.1037/a0036462. Epub 2014 Aug 18.
An expressive writing treatment was recently reported to reduce depressive symptoms and improve sexual function and satisfaction in a sample of female survivors of childhood sexual abuse (Meston, Lorenz, & Stephenson, 2013). We conducted a linguistic analysis of this data to determine whether pre- to posttreatment changes in participants’ language use were associated with the improvements in sexuality and depression. Linguistic Inquiry and Word Count (LIWC), a program that counts the use of word categories within a text, was used to evaluate the impact of several word categories, previously associated with changes in mental health (Frattaroli, 2006), and shown to differ between childhood sexual abuse survivors and nonabused women (Lorenz & Meston, 2012), on treatment outcomes. A reduction in the use of the word “I” and an increase in positive emotion words were associated with decreased depression symptoms. A reduction in the use of “I” and negative emotion words were associated with improvement in sexual function and sexual satisfaction. The findings suggest that, because language may serve as an implicit measure of depression and sexual health, monitoring language changes during treatment may provide a reliable indicator of treatment response free of the biases of traditional self-report assessments.
J Pediatr Psychol. 2006 Jul;31(6):557-68. Epub 2005 Jul 13.
To test the effects of written emotional disclosure on the health of adolescents with asthma and to examine how language in disclosures predicts outcomes.
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.
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.
Written emotional disclosure improves emotional and behavioral functioning among adolescents with asthma, particularly those whose writings suggest emotional processing and cognitive restructuring.
Br J Health Psychol. 2008 Sep;13(Pt 3):495-512. Epub 2007 Jul 6.
This study had three aims: 1) to investigate whether cardiovascular responses to laboratory stress and levels of emotional distress were attenuated following written emotional disclosure; 2) to test, in addition to the potential main effects, whether levels of alexithymia moderated the impact of writing; and 3) to examine whether alexithymics who successfully disclosed emotion in their essays would experience positive effects following writing.
DESIGN AND METHODS:
Eighty-seven participants wrote about their most stressful life experience or about a non-stressful experience, for 15 minutes, over 3 consecutive days. Two weeks later, blood pressure (BP) responses to laboratory stress and levels of emotional distress were assessed. Emotional characteristics of the disclosure essays were analysed with the Linguistic Inquiry and Word Count programme and alexithymia was assessed at baseline using the Toronto Alexithymia Scale-20.
Analyses found no evidence in support of the main effects of disclosure on cardiovascular responses to stress or on emotional distress. However, alexithymia was found to moderate the impact of writing such that non-alexithymic participants in the experimental condition reported significantly lower emotional distress 2 weeks later. In addition, alexithymic participants who disclosed a greater number of negative when compared with positive emotion words exhibited reduced systolic and diastolic responses to stress. Conversely, non-alexithymic participants who disclosed more positive and less negative emotion words displayed attenuated BP reactivity to stress.
The results of this exploratory study are important as they highlighted, in the absence of main effects, the importance of examining potential moderators of the emotional writing process. These findings may have implications for the development of cardiovascular health interventions.