Results from a systematic writing program in grief process: part 2.

Patient Prefer Adherence. 2011 Jan 6;5:15-21. doi: 10.2147/PPA.S15155.

Furnes B1, Dysvik E.

This paper, the second of two, reports the results of a systematic writing program used as a tool in the grief process. The study was based on a specifically developed program, which has been described and discussed previously in Part 1.


The study had a qualitative research design, with a hermeneutic phenomenological approach. The research tool of the study, a writing program, was developed and implemented. A purposive sample was used, consisting of 13 bereaved adults.


From an analysis of all of the texts written during the program, we drew four conclusions. Writing yields new thoughts and increases knowledge. Writing is stressful as well as a relief. Writing awakens and preserves memories. The value of writing is related to the forms, ways, and situations of writing.


We have discussed handling grief with a unique process. Our findings reveal a great breadth and variation in the experiences associated with different writing forms, ways of writing, and writing situations. This implies that flexibility and individualization are important when implementing grief management programs like this. We believe that a structured writing program can be helpful in promoting thought activity and as a tool to gain increased coherence and understanding of the grief process. This writing program may be a valuable guide for program development and future research.

Efficacy of Narrative Writing as an Intervention for PTSD: Does the Evidence Support Its Use?

Published online 2015 May 14. doi:  10.1007/s10879-014-9292-x

Denise M. Sloan,corresponding author Alice T. Sawyer, Sara E. Lowmaster, Jeremy Wernick, and Brian P. Marx

Although a number of effective psychotherapies for posttraumatic stress disorder (PTSD) are available, there is a need to develop alternative treatments for those who may not respond optimally to these treatments or who may not have access to clinicians who can competently deliver them. Narrative writing, which involves repeated recounting about a traumatic event in writing, is one treatment that deserves further examination as a potential alternative. In this paper, we describe the most commonly used narrative writing treatment protocols for those with either a diagnosis of PTSD or probable PTSD and discuss the available efficacy data for each of these protocols. We conclude with recommendations for using narrative writing to treat those with PTSD and offer recommendations for future work in this area.

Emotional disclosure interventions for chronic pain: from the laboratory to the clinic.

Transl Behav Med. 2012 Mar;2(1):73-81. doi: 10.1007/s13142-011-0085-4.

Lumley MA1, Sklar ER, Carty JN.

Life stress and the avoidance of negative emotions may contribute to chronic pain. The technique of written or spoken emotional disclosure can reverse emotional avoidance and improve health, and 18 randomized studies have tested it among people with chronic pain. We review these studies to provide guidance for the clinical use of this technique. The benefits of emotional disclosure for chronic pain are quite modest overall. Studies in rheumatoid arthritis show very limited effects, but two studies in fibromyalgia suggest that disclosure may be beneficial. Effects in other populations (headaches, cancer pain, pelvic pain, abdominal pain) are mixed. Moderator findings suggest that some patients are more likely to benefit than others. Emotional disclosure has been tested in well-controlled efficacy trials, leaving many unanswered questions related to translating this technique to practice. Issues needing further study include determining disclosure’s effects outside of randomized controlled trials, identifying the optimal pain populations and specific individuals to target for disclosure, presenting a valid rationale for disclosure, selecting the location and method of disclosure, and choosing between cognitive-behavioral or emotional disclosure techniques.

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A closer examination of the structured written disclosure procedure.

J Consult Clin Psychol. 2004 Apr;72(2):165-75.

Sloan DM1, Marx BP.

The current study examined psychological and physical health outcomes of the written disclosure paradigm and the hypothesis that the principles of therapeutic exposure account for the beneficial effects of the paradigm. Participants were randomly assigned to either a written disclosure condition or a control condition. Reactivity to the writing sessions was examined using both subjective and physiological measures. Measures of psychological and physical health were completed before and 1 month after the sessions. Participants assigned to the disclosure condition reported fewer psychological and physical symptoms at follow-up compared with control participants, though reductions were clinically significant for only 1 outcome measure. Physiological activation to the 1st disclosure session was associated with reduced psychological symptoms at follow-up for disclosure participants. Subjective reports of emotional responding corresponded with physiological reactivity. Implications of these findings are discussed.

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.

Finding happiness in negative emotions: An experimental test of a novel expressive writing paradigm

The Journal of Positive Psychology

Dedicated to furthering research and promoting good practice

Volume 6, 2011 – Issue 3


Using an experimental writing design, this study pitted a novel emotion regulation strategy, integrating psychological acceptance and positive reappraisal, against two established strategies for increasing psychological well-being: emotional disclosure (Pennebaker, 1997Pennebaker, JW. 1997. Writing about emotional experiences as a therapeutic process. Psychological Science, 8: 162166. [Crossref], [Web of Science ®][Google Scholar]) and positive reappraisal (DeNeve & Cooper, 1998; Gross & John, 2003). 315 undergraduate students wrote on four consecutive days about the biggest problem in their lives and were randomly assigned to use one of the three strategies: (1) emotional disclosure, (2) positive reappraisal, or (3) acceptance + positive reappraisal. Results indicated that the integrative condition led to optimal emotional well-being outcomes at post-intervention, including: greater happiness and positive emotions, marginally fewer negative emotions, and greater overall psychological acceptance. Findings indicate that accepting one’s negative emotions and then trying to seek out positives might be an optimal strategy for building happiness.

The effect of meaningfulness and integrative processing in expressive writing on positive and negative affect and life satisfaction

Cognition and Emotion

Volume 26, 2012 – Issue 1


Meaningfulness and integrative processing of expressive writing may influence the effect of expressive writing. Participants completed measures of positive affect, negative affect and life satisfaction before and after an expressive writing intervention. Participants were randomly assigned to one of four expressive writing instruction conditions, which combined higher and lower levels of meaning and integrative processing instructions. Meaningfulness and integrative processing instructions had significant effects in increasing positive affect and there was a significant interaction between meaningfulness instructions and integrative processing instructions; participants in the high meaningfulness and high integrative processing instruction condition showed the greatest increase in positive affect. Meaningfulness had a significant effect in decreasing negative affect. The intervention did not influence life satisfaction. Both meaningfulness and integrative processing instructions led to more self-reported personal meaningfulness of the writing and more cognitive, emotional, behavioural and situational changes. More self-reported meaningfulness of the writing and more cognitive, emotional, behavioural and situational changes made as a result of the writing were in turn associated with greater increases in positive affect. The results of the study affirm the importance of meaningfulness and processing in expressive writing and potentially provide information regarding how to increase the effectiveness of expressive writing.