The Efficacy of Journal Writing in Assisting Survivors of Sexual Trauma towards Post- Traumatic Growth

Narrative Engagement: The Importance of Assessing Individual Investment in Expressive Writing

Lindsey T. Roberts, Sherry Hamby, John Grych, Victoria Banyard. Narrative Engagement: The Importance of Assessing Individual Investment in Expressive Writing. American Journal of Social Sciences. Vol. 3, No. 4, 2015, pp. 96-103.


The positive benefits of narrative and expressive writing have been demonstrated in numerous experimental studies, but these experimental efforts have not focused on understanding authors’ perceptions of the writing experience. This study presents a new brief measure of narrative engagement that assesses authors’ investment and motivation for expressive writing. The Narrative Engagement Index was developed based on theory and an extensive review of participants’ reflections on a narrative-based writing intervention, and could be tailored to suit many written narrative exercises. For the present study, it was used to assess narrative engagement for the Laws of Life Essay program. Participants (n=717) were drawn from a rural, low-income Southern region, and a subset (n=55) were asked to bring “someone who knew them well” in order to provide reliability and validity data from a close informant. To our knowledge, it is the first study to include a close informant in the study of the correlates of narrative. Positive, significant correlations were found for measures of related constructs, including expressive writing items that are widely used in experimental studies of narrative, meaning making, and posttraumatic growth. Close informants perceived writers with higher levels of narrative engagement to have higher levels of current well-being than less engaged writers. The Narrative Engagement Index has good psychometric qualities and complements existing measures of narrative by assessing the author’s investment in the writing process.

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Adapting narrative exposure therapy for Chinese earthquake survivors: a pilot randomised controlled feasibility study.

BMC Psychiatry. 2014 Oct 3;14:262. doi: 10.1186/s12888-014-0262-3.

Zang Y1,2, Hunt N3, Cox T4,5.

Narrative exposure therapy (NET) is a brief, manualised treatment for Posttraumatic Stress Disorder (PTSD). It has been shown to have therapeutic benefits for a wide range of individuals and settings. This study, following our previous work applying the original NET in earthquake survivors, aimed to revise NET to be adaptable for treating PTSD after a natural disaster.


A randomised waiting-list controlled study was conducted with 30 adult participants with PTSD who were randomly allocated to NET (n = 10), revised NET (NET-R; n = 10) or a waiting list condition (WL; n = 10). Participants in NET and NET-R received treatment immediately; those in the WL condition received NET-R treatment after a waiting period. All groups were assessed on PTSD, general distress, anxiety, depression, social support, coping and posttraumatic change before and after treatment and three-month follow-up.


Compared with WL, both NET and NET-R groups showed significant reductions in PTSD and related symptoms. Significant increases were found in posttraumatic growth, active coping and perceived social support. The WL group showed similar improvements after treatment. Further reductions on PTSD symptoms were found at three months, showing that NET-R is as effective as the original NET in treating post-earthquake traumatic symptoms in adult Chinese earthquake survivors.


NET-R is a feasible and cost-effective intervention for Chinese earthquake survivors. Further studies are needed to replicate these findings in other survivor populations, and with larger samples and over longer periods. This study highlighted the value of oral narrative approach, which is well-accepted and useful in the context of single natural disaster and lower- income area.

Cognitive-behavioural emotion writing tasks: a controlled trial of multiple processes.

J Behav Ther Exp Psychiatry. 2008 Dec;39(4):558-66. doi: 10.1016/j.jbtep.2007.11.008. Epub 2008 Feb 6.

Guastella AJ1, Dadds MR.

We report on a controlled trial of three structured writing paradigms that engage the writer with cognitive-behavioural emotion-processes: exposure, devaluation, and benefit-finding. University students (N=198) wrote once a week for three weeks about their most upsetting experience. The long-term effects of these structured writing procedures were compared to an unstructured emotion writing condition and control. Outcomes indicated that exposure writing sped the reduction of intrusive and avoidant symptoms, while benefit-finding writing increased reports of positive growth. Results suggest the use of these paradigms to study emotion-processing mechanisms and, potentially, in practice to enhance coping in process-specific ways.

Expressive writing and post-traumatic stress disorder: effects on trauma symptoms, mood states, and cortisol reactivity.

Br J Health Psychol. 2008 Feb;13(Pt 1):85-93. doi: 10.1348/135910707X250866.

Smyth JM1, Hockemeyer JR, Tulloch H.

This study investigates the boundary conditions (feasibility, safety, and efficacy) of an expressive writing intervention for individuals with post-traumatic stress disorder [PTSD].


Randomized trial with baseline and 3-month follow-up measures of PTSD severity and symptoms, mood states, post-traumatic growth, and (post-only) cortisol reactivity to trauma-related stress.


Volunteers with a verified diagnosis of PTSD (N=25) were randomly assigned to an experimental group (writing about their traumatic experience) or control group (writing about time management).


Expressive writing was acceptable to patients with PTSD and appeared safe to utilize. No changes in PTSD diagnosis or symptoms were observed, but significant improvements in mood and post-traumatic growth were observed in the expressive writing group. Finally, expressive writing greatly attenuated neuroendocrine (cortisol) responses to trauma-related memories.


The present study provides insight into several boundary conditions of expressive writing. Writing did not decrease PTSD-related symptom severity. Although patients continue to exhibit the core features of PTSD, their capacity to regulate those responses appears improved following expressive writing. Dysphoric mood decreased after writing and when exposed to traumatic memories, participants’ physiological response is reduced and their recovery enhanced.


The relevance of the study is determined by the current situation in Ukraine and the special attention of experts to the field of mental health and posttraumatic stress disorders. Special focus on the disorder, together with the achievement of the important goal (to find the ways of treating it) can lead to stigmatisation and discrimination of people suffering from posttraumatic stress disorders (PTSD). To avoid this, the other phenomenon – the posttraumatic growth (PTG) should be put in focus. The current understanding of the PTG as a situation in which personal development, at least in some areas, has exceeded its previous level, the one a person had had before the crisis. The following tools for measuring the posttraumatic growth are used: The Changes in Outlook Questionnaire, The Posttraumatic Growth Inventory, The Stress-Related Growth Scale, The Thriving Scale, The Perceived Benefit Scales. Besides, the attention is paid to its relations with socio-demographic characteristics, personality changes, cognitive processes, the level of PTSD, the impact of posttraumatic growth on overcoming posttraumatic stress. The model of psychotherapeutic intervention facilitating posttraumatic growth and affecting the intensity of the treatment of PTSD (model by L. Calhoun, R. Tedeschi and THRIVE-model by S. Joseph) has been described. It includes the following components: taking stock (making sure a client is safe and helping him/her to overcome PTSD, for example, by means of exposure techniques); harvesting hope (to learn to have plans for the future, for example, by means of inspiring stories of people, who have experienced the same situations); re-authoring (rewriting one’s experience by means of creating stories, expressive writing technique); identifying change (observing one’s PTG with the help of the questioning or surveys); valuing change (development of confidence in new priorities); expressing change in action (searching for ways of transferring PTG in real world, for example, by means of writing week schedules).

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Expressive Writing Intervention for Teens Whose Parents Have Cancer

The role of emotional expression was explored in the writings of adolescent children of parents with cancer. Participants ages 12-18 (n=40) were assigned randomly to write in 3 sessions about their thoughts and feelings regarding their parents’ cancer (experimental condition) or their time management (fact control condition). Physical health (i.e., doctor visits, school absences, physical symptoms) and psychological health variables (i.e., internalizing and externalizing behavior, depression, anxiety, positive emotion, negative emotion, post traumatic growth) were assessed as a function of writing condition and participants’ temporal orientation (i.e., the time period on which a person bases the majority of his or her perceptions of reality). Results from analysis of covariance indicated experimental condition was related to decreases in negative affect, self reported depression symptoms, parent-reported anxiety symptoms, and parent- reported internalizing problems in the adolescent participants and increases in post traumatic growth reported by the adolescent participants. Past temporal orientation was related to increased conduct problems reported by parents, increased physical symptoms, and decreased school absences. Conduct problems scores reported by parent were related to increased positive affect, increased anxiety, and decreased illness-related doctor visits. Adolescent Atypicality scores were related to increased parent-reported anxiety in the child, physical symptoms, and school absences. Problem solving coping was related to decreased anxiety, and behavioral avoidance coping was related to increased depression as reported by parent and increased internalizing problems as reported by parent. Given the significant results for the experimental condition, the findings are discussed in light of future possible research on the use of emotional expressive writing in adolescents as well as use of emotional writing tasks as interventions for adolescent children of cancer patients.

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