Review of The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-Being.

The reviewer notes that this book (S. J. Lepore and J. M. Smyth [Eds.], 2002; see record 2002-01516-000) consists of 14 chapters exploring the therapeutic implications of expressive writing. The book succeeds in its efforts to present and evaluate current research on the health benefits of writing. The contributors chart new directions for future research and suggest the clinical and therapeutic applications of writing. One common theme running throughout the book is that writing facilitates cognitive integration. Another theme is that writing leads to self-mastery. The Writing Cure is a groundbreaking book, but the reviewer wishes that the editors had widened their focus to include research in the humanities, particularly literary studies and rhetoric and composition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expressive writing can increase working memory capacity.

The effect of emotional disclosure through expressive writing on available working memory (WM) capacity was examined in 2 semester-long experiments. In the first study, 35 freshmen assigned to write about their thoughts and feelings about coming to college demonstrated larger working memory gains 7 weeks later compared with 36 writers assigned to a trivial topic. Increased use of cause and insight words was associated with greater WM improvements. In the second study, students (n?=?34) who wrote about a negative personal experience enjoyed greater WM improvements and declines in intrusive thinking compared with students who wrote about a positive experience (n?=?33) or a trivial topic (n?=?34). The results are discussed in terms of a model grounded in cognitive and social psychological theory in which expressive writing reduces intrusive and avoidant thinking about a stressful experience, thus freeing WM resources. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expressive writing for gay-related stress: Psychosocial benefits and mechanisms underlying improvement.

Objective: This study tested the effectiveness of an expressive writing intervention for gay men on outcomes related to psychosocial functioning. Method: Seventy-seven gay male college students (mean age = 20.19 years, SD = 1.99) were randomly assigned to write for 20 min a day for 3 consecutive days about either (a) the most stressful or traumatic gay-related event in their lives or (b) a neutral topic. We tested an exposure-based hypothesis of written emotional expression by asking half of the participants who were assigned to write about gay-related stress to read their previous day’s narrative before writing, whereas the other half did not. Posttest and 3-month follow-up outcomes were assessed with common measures of overall psychological distress, depression, physical health symptoms, and positive and negative affect. Gay-specific social functioning was assessed with measures of gay-related rejection sensitivity, gay-specific self-esteem, and items regarding openness and comfort with one’s sexual orientation. Results: Participants who wrote about gay-related stress, regardless of whether they read their previous day’s writing, reported significantly greater openness with their sexual orientation 3 months following writing than participants who wrote about a neutral topic, F(1, 74) = 6.66, p     

Written Emotional Disclosure Buffers the Effects of Social Constraints on Distress Among Cancer Patients.

The aims of the present study were to examine whether written emotional disclosure would reduce distress among cancer patients and whether it would buffer the effects of high levels of social constraint (negative social responses to patients' expressions of emotion regarding their cancer) on distress. Cancer patients (N=104) were randomly assigned to write about their emotions regarding their cancer 20 min a day for 3 days or to write about a nonemotional topic. They completed questionnaires at baseline and 6 months postintervention. Results showed that written disclosure buffered the effects of social constraints on stress at the 6-month follow-up and that avoidance partly mediated these effects. The present data reinforce the notion that interventions should be tailored to patients' needs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnic identity and personal well-being of people of color: A meta-analysis.

This article summarizes research examining the relationship between the constructs of ethnic identity and personal well-being among people of color in North America. Data from 184 studies analyzed with random effects models yielded an omnibus effect size of r = .17, suggesting a modest relationship between the 2 constructs. The relationship was somewhat stronger among adolescents and young adults than among adults over age 40. No differences were observed across participant race, gender, or socioeconomic status, which findings support the general relevance of ethnic identity across people of color. Studies correlating ethnic identity with self-esteem and positive well-being yielded average effect sizes twice as large as those from studies correlating ethnic identity with personal distress or mental health symptoms. Ethnic identity was thus more strongly related to positive well-being than to compromised well-being. Overall, the corpus of research reviewed consisted of correlational designs; limited scholarship has addressed causal mechanisms, mediating factors, or psychological functions of ethnic identity across different social contexts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expressive disclosure and benefit finding among breast cancer patients: Mechanisms for positive health effects.

A randomized trial (n = 60; A. L. Stanton, S. Danoff-Burg, L. A. Sworowski, et al., 2002) revealed that 4 sessions of written expressive disclosure or benefit finding produced lower physical symptom reports and medical appointments for cancer-related morbidities at 3-month follow-up among breast cancer patients relative to a fact-control condition. The goal of this article is to investigate mechanisms underlying these effects. Within-session heart rate habituation mediated effects of expressive disclosure on physical symptoms, and greater use of negative emotion words in essays predicted a decline in physical symptoms. Postwriting mood and use of positive emotion and cognitive mechanism words in essays were not significant mediators, although greater cognitive mechanism word use was related to greater heart rate habituation and negative emotion word use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Acculturation, distress disclosure, and emotional self-disclosure within Asian populations.

Research into youth mentoring suggests that programs focused on specific practices (e.g., emotional disclosure and collaborative relationships) increase the likelihood of a successful mentoring relationship, factors similar to the psychotherapy literature. However, research into psychotherapy with Asians has indicated that these factors, based on Western values, are less effective, especially with those who are less acculturated. To test the relevance of these factors within mentor-type relationships, this study examined the relationship between acculturation and distress disclosure, and the relationship between acculturation and the retrospective willingness to emotionally self-disclose to friends and unrelated, trusted adults in 98 participants representing several ethnic Asian backgrounds. Both values-based and behaviorally based acculturation measures were used. Values-based, but not behaviorally based acculturation, predicted distress disclosure (i.e., less acculturated individuals were less likely to disclose distress). Using an imagery protocol, participants were then asked to think back to adolescence and indicate their willingness to self-disclose emotions to friends and unrelated, trusted adults. Participants were more willing to self-disclose emotions to friends compared to unrelated, trusted adults, regardless of values acculturation level. However, a significant interaction occurred in an unanticipated direction using behaviorally based acculturation. Less behaviorally acculturated individuals were more willing to disclose emotions to unrelated, trusted adults compared to more behaviorally acculturated individuals. Discussion regarding the results revolved around the utility of a behavioral measure of acculturation, values and behaviors in acculturation, the role of older persons in Asian culture, and the possible role of community in the acculturation process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Emotional disclosure about traumas and its relation to health: Effects of previous disclosure and trauma severity": Correction to Greenberg and Stone.

Reports an error in "Emotional disclosure about traumas and its relation to health: Effects of previous disclosure and trauma severity" by Melanie A. Greenberg and Arthur A. Stone (Journal of Personality and Social Psychology, 1992[Jul], Vol 63[1], 75-84). In the article, a sentence was incorrect. The sentence on page 76 that reads "For example, Esterling, Antoni, Kumar, and Schneiderman (1990) found that subjects who wrote more emotion-focused words (high disclosers) had a larger lymphocyte response to mitogen stimulation than low disclosers" should have read as follows: "For example, Esterling, Antoni, Kumar, and Schneiderman (1990) found that subjects whose essays contained greater proportions of emotionfocused words (high disclosers) had better immunological control of latent Epstein-Barr virus, relative to low disclosers." (The following abstract of the original article appeared in record 1992-39142-001.) Sought to replicate previous findings that disclosing traumas improves physical health and to compare the effects of revealing previously disclosed vs undisclosed traumas. According to inhibition theory, reporting about undisclosed traumas should produce greater health benefits. 60 healthy undergraduates wrote about undisclosed traumas, previously disclosed traumas, or trivial events. Contrary to expectations, there were no significant between-groups differences on longer term health utilization and physical symptom measures. However, Ss who disclosed more severe traumas reported fewer physical symptoms in the months following the study, compared with low-severity trauma Ss, and tended to report fewer symptoms than control Ss. Results suggest that health benefits occur when severe traumas are disclosed, regardless of whether previous disclosure has occurred. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does expressive writing reduce health care utilization? A meta-analysis of randomized trials.

This meta-analysis examined whether writing about stressful experiences affects health care utilization (HCU) compared with writing on neutral topics or no-writing control groups. Randomized controlled trials of 30 independent samples representing 2,294 participants were located that contained sufficient information to calculate effect sizes. After omitting one study as an outlier, the effects were combined within 3 homogeneous groups: healthy samples (13 studies), samples with preexisting medical conditions (6 studies), and samples prescreened for psychological criteria (10 studies). Combined effect sizes, Hedges's g (95% confidence interval), with random effects estimation were 0.16 (0.02, 0.31), 0.21 (-0.02, 0.43), and 0.06 (-0.12, 0.24), respectively. Writing about stressful experiences reduces HCU in healthy samples but not in samples defined by medical diagnoses or exposure to stress or other psychological factors. The significance of these effects for individuals' health is unknown. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of occupational stress management intervention programs: A meta-analysis.

A meta-analysis was conducted to determine the effectiveness of stress management interventions in occupational settings. Thirty-six experimental studies were included, representing 55 interventions. Total sample size was 2,847. Of the participants, 59% were female, mean age was 35.4, and average length of intervention was 7.4 weeks. The overall weighted effect size (Cohen's d) for all studies was 0.526 (95% confidence interval = 0.364, 0.687), a significant medium to large effect. Interventions were coded as cognitive-behavioral, relaxation, organizational, multimodal, or alternative. Analyses based on these subgroups suggested that intervention type played a moderating role. Cognitive-behavioral programs consistently produced larger effects than other types of interventions, but if additional treatment components were added the effect was reduced. Within the sample of studies, relaxation interventions were most frequently used, and organizational interventions continued to be scarce. Effects were based mainly on psychological outcome variables, as opposed to physiological or organizational measures. The examination of additional moderators such as treatment length, outcome variable, and occupation did not reveal significant variations in effect size by intervention type. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive and emotional processing through writing among adolescents who experienced the death of a classmate.

This study investigated how written emotional disclosure reflects the processes by which adolescents cope with a traumatic event they experienced collectively—the sudden death of a classmate. Twenty high school students wrote about their emotional reactions to the death on 3 consecutive days. The writings were coded using the Linguistic Inquiry and Word Count (LIWC) and analyzed using a mixed-methods software (T-LAB). A measure of posttraumatic stress symptoms (Impact of Events Scale–Revised) obtained at baseline (14 days after the death) and 1 week and 4 months' postwriting was used to classify the students into four adjustment trajectories: Delayed Distress, Recovery, Stable-Negative, and Stable-Positive. Textual analysis revealed a progressive elaboration of the traumatic event across the 3 writing days, moving from a factual perspective to the processing of emotions to an integrated emotional and cognitive restructuring of the event. The nature of the writing differed across adjustment trajectories. Specifically, students in the Stable-Positive and Recovery trajectories made greater mention of the deceased classmate and reflected greater cognitive processing of the trauma. Students in the Stable-Negative and Delayed Distress trajectories used more self-references and negative emotion words and showed a greater degree of inhibition. The results provide preliminary clues to adjustment processes in adolescent bereavement. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized controlled trial of emotionally expressive writing for women with metastatic breast cancer.

Objective: To test the effects of emotionally expressive writing in a randomized controlled trial of metastatic breast cancer patients and to determine whether effects of the intervention varied as a function of perceived social support or time since metastatic diagnosis. Design: Women (N = 62) living with Stage IV breast cancer were randomly assigned to write about cancer-related emotions (EMO; n = 31) or the facts of their diagnosis and treatment (CTL; n = 31). Participants wrote at home for four 20-min sessions within a 3-week interval. Main Outcome Measures: Depressive symptoms, cancer-related intrusive thoughts, somatic symptoms, and sleep quality at 3 months postintervention. Results: No significant main effects of experimental condition were observed. A significant condition × social support interaction emerged on intrusive thoughts; EMO writing was associated with reduced intrusive thoughts for women reporting low emotional support (η2 = .15). Significant condition × time since metastatic diagnosis interactions were also observed for somatic symptoms and sleep disturbances. Relative to CTL, EMO participants who were more recently diagnosed had fewer somatic symptoms (η2 = .10), whereas EMO participants with longer diagnosis duration exhibited increases in sleep disturbances (η2 = .09). Conclusion: Although there was no main effect of expressive writing on health among the current metastatic breast cancer sample, expressive writing may be beneficial for a subset of metastatic patients (including women with low levels of emotional support or who have been recently diagnosed) and contraindicated for others (i.e., those who have been living with the diagnosis for years). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Approaches to Serious Emotional Disturbance: Involving Multiple Systems.

Practice with children who have serious emotional disturbance (SED) increasingly requires multiple-systems intervention. Through a sample case, this article explores these interventions within the context of current national policy. Mental health collaboration with the systems of juvenile justice, education, child welfare, primary health care, and drug and alcohol services is summarized. The specific programs of multisystemic therapy, Pennsylvania's family-based mental health services, and Wraparound Milwaukee are presented as multiple-systems approaches that are successful with this population. The authors offer suggestions for emerging roles for psychologists within this context. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of writing instruction for adolescent students.

There is considerable concern that the majority of adolescents do not develop the competence in writing they need to be successful in school, the workplace, or their personal lives. A common explanation for why youngsters do not write well is that schools do not do a good job of teaching this complex skill. In an effort to identify effective instructional practices for teaching writing to adolescents, the authors conducted a meta-analysis of the writing intervention literature (Grades 4-12), focusing their efforts on experimental and quasi-experimental studies. They located 123 documents that yielded 154 effect sizes for quality of writing. The authors calculated an average weighted effect size (presented in parentheses) for the following 11 interventions: strategy instruction (0.82), summarization (0.82), peer assistance (0.75), setting product goals (0.70), word processing (0.55), sentence combining (0.50), inquiry (0.32), prewriting activities (0.32), process writing approach (0.32), study of models (0.25), grammar instruction (- 0.32). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional Expression in Cyberspace: Searching for Moderators of the Pennebaker Disclosure Effect via E-Mail.

Research has shown that writing about emotional topics can positively influence physical and mental health. The current study tested the efficacy of an e-mail-based writing treatment and shows how such an implementation can aid in the search for moderators. Participants (N = 546) were randomly assigned to either a long- or short-interval traumatic writing condition or to a nonemotional writing control condition. In contrast to previous disclosure research, participants received and submitted their writing responses via e-mail. Health outcomes were assessed weekly for 5 weeks after treatment and were reported at the conclusion of the study. Results supported the effectiveness of an e-mail-based writing treatment in producing positive health outcomes and successfully identified several moderators of the writing treatment effect. The moderators implicated varied depending on the nature of the health outcome assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of expressive writing following first myocardial infarction: A randomized controlled trial.

Objective: To assess the effects of expressive writing on health care utilization, clinical variables and subjective quality of life following first myocardial infarction (MI). Methods: One-hundred and seventy-nine first MI patients were randomized to Intervention (N = 88) or Control (N = 91) groups. The intervention group wrote about their thoughts and feelings in relation to having had an MI. Controls wrote in a neutral way about daily activities. The main outcome measures were health care utilization, physical status and subjective quality of life (QOL), assessed after one, two, and five months. Results: One-hundred and fifty-six (87%) completed the study. Five months post-intervention, the intervention group had significantly fewer recorded medical appointments compared to controls. The number of prescribed medicines decreased over time within the intervention group but increased within the control group. The intervention group attended significantly more rehabilitation sessions, reported fewer cardiac related symptoms and had lower diastolic blood pressure five months post-intervention. There was no significant group by time interaction on reported physical health. The group by time interaction on reported mental health approached significance, those in the intervention group reporting greater improvement. Conclusion: Expressive writing may be a beneficial strategy which could be incorporated into rehabilitation interventions to help individuals adjust after first MI. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Why doesn't the writing cure help poets?

This paper examines the literature on creative writing and mental illness and relates it to the "writing cure" research that shows that expressive writing improves health. There is an abundance of evidence that professional poets have poorer health outcomes relative to both other writers and to the population at large. Why doesn't the writing cure help them? The formation of a narrative, an element often missing in poetry, may provide the answer. Other possible explanations are that poets may be more depressed to begin with and may be even worse off if they did not write. For female poets, they may be subject to stereotypic expectations about writing themes, which may put them at further risk. Those seeking improvements in health through writing are advised to adopt a narrative style. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Intraindividual relations between the intensity and disclosure of daily emotional events: The moderating role of depressive symptoms.

Individuals with high levels of depressive symptoms tend to engage in lower levels of emotional disclosure than individuals who are lower in depressive symptoms. However, little is known about how depressive symptoms relate to the intraindividual relation between daily disclosure and the intensity of the daily events. The authors addressed these relations using a daily diary methodology. College students (N = 239) completed a measure of depression symptoms. They then completed measures of the intensity of the day’s most unpleasant event and their disclosure of that event each day for 7 days. Results indicated that depression moderated the intensity–disclosure relation such that depression symptoms were associated with diminished emotional disclosure for high-intensity events but not for low-intensity events. Individuals with relatively higher levels of depressive symptoms also experienced unpleasant daily events at a higher intensity level than did individuals with relatively fewer symptoms. Sex differences emerged such that men were less likely than women to disclose high-intensity negative events. These findings extend the use of the diary methodology to the study of emotional disclosure and also suggest possible interventions for counseling psychology practitioners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Sheese et al. (2004).

Reports an error in the original article by B. Sheese et al (Health Psychology, 2004[Sep], Vol 23 [5], 457-464). On page 459, Table 1 contained errors in the reported values. The corrected table is provided. (The following abstract of this article originally appeared in record 2004-18051-003.) Research has shown that writing about emotional topics can positively influence physical and mental health. The current study tested the efficacy of an e-mail-based writing treatment and shows how such an implementation can aid in the search for moderators. Participants (N = 546) were randomly assigned to either a long- or short-interval traumatic writing condition or to a nonemotional writing control condition. In contrast to previous disclosure research, participants received and submitted their writing responses via e-mail. Health outcomes were assessed weekly for 5 weeks after treatment and were reported at the conclusion of the study. Results supported the effectiveness of an e-mail-based writing treatment in producing positive health outcomes and successfully identified several moderators of the writing treatment effect. The moderators implicated varied depending on the nature of the health outcome assessment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of subjective health in older adults: A meta-analysis.

Age-associated changes of subjective health and associations of subjective health with physical health, functional health, and mental health were meta-analyzed in older adults (mean age > 60 yrs). An age-associated decline of subjective health, which was stronger in old-old samples than in young-old samples, was found. Subjective health was correlated with the indicators of objective health, but the association with physical health was stronger than with functional health. Correlations of subjective health with physical health and functional health were lower in the old-old than in the young-old samples, whereas associations of subjective health with mental health were stronger in older samples. Furthermore, the size of the association between subjective and objective health varied by the method of assessment of objective health, showing highest associations with symptom checklists and results of medical examinations due to strict protocols. (PsycINFO Database Record (c) 2010 APA, all rights reserved)