Disclosure of trauma and immune response to a hepatitis B vaccination program.

This study investigated whether emotional expression of traumatic experiences influenced the immune response to a hepatitis B vaccination program. Forty medical students who tested negative for hepatitis B antibodies were randomly assigned to write about personal traumatic events or control topics during 4 consecutive daily sessions. The day after completion of the writing, participants were given their first hepatitis B vaccination, with booster injections at 1 and 4 months after the writing. Blood was collected before each vaccination and at a 6-month follow-up. Compared with the control group, participants in the emotional expression group showed significantly higher antibody levels against hepatitis B at the 4 and 6-month follow-up periods. Other immune changes evident immediately after writing were significantly lower numbers of circulating T helper lymphocytes and basophils in the treatment group. The finding that a writing intervention influences immune response provides further support for a link between emotional disclosure and health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of written emotional expression: The role of positive expectancies.

Objective: Writing in an emotional way about stressful or traumatic experiences has beneficial effects on emotional well-being and physical health. Yet the mechanisms that underlie these effects still need to be explored. Integrating research on the effects of positive expectancies, the authors suggest that positive effects of written emotional expression may, in part, depend on expectancies induced by writing about emotional experiences. Design: Two studies were conducted to test this hypothesis. In both studies, participants wrote about either an upsetting event or trivial issues. After the writing period, participants rated their expectancies that the writing intervention would improve (or impair) their emotional well-being over time. Main Outcome Measures: Study 1 assessed the emotional impact of an upsetting event, whereas Study 2 assessed subjective reports of physical symptoms. In both studies, outcome variables were collected both before and 6 weeks after the writing intervention. Results: The results showed that (a) writing about upsetting experiences induced higher positive expectancies than writing about trivial issues and (b) expectancies associated with written emotional expression were related to a reduction in the emotional impact of an upsetting event (Study 1) and to a reduction in physical symptoms (Study 2). Conclusions: There may be 2 alternative ways to render written emotional expression effective in reducing negative emotions: (a) by rendering an emotional experience more meaningful and (b) by inducing positive affect regulation expectancies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Closer Examination of the Structured Written Disclosure Procedure.

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirical study on the healing nature of mandalas.

Mandalas were first used in therapy by Carl Jung, who found that the act of drawing mandalas had a calming effect on patients while at the same time facilitating psychic integration. There is a scarcity of controlled empirical studies of the healing impact of mandalas on mental health. Based on the efficacy of James Pennebaker's written disclosure paradigm in promoting mental well-being (Pennebaker, 1997a, 1997b), the purpose of our study was to examine the benefits for those suffering from post traumatic stress disorder (PTSD) of processing traumatic events through the creation of mandalas. Benefits to participants were measured in terms of changes in the variables of PTSD symptoms, depressive symptoms, anxiety, spiritual meaning, and the frequency of physical symptoms and illness. Relative to those in the control condition, individuals assigned to the experimental mandala-creation group reported greater decreases in symptoms of trauma at the 1-month follow up. There were no other statistically significant outcome differences. Alternative modes of processing traumatic events (e.g., visually symbolically) may serve individuals who are either reluctant or unable to write about their experiences. (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)     

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)     

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)     

Emotional expression and physical heath: Revising traumatic memories or fostering self-regulation?

Health benefits derived from personal trauma disclosure are well established. This study examined whether disclosing emotions generated by imaginative immersion in a novel traumatic event would similarly enhance health and adjustment. College women, preselected for trauma presence, were randomly assigned to write about real traumas, imaginary traumas, or trivial events. Yoked real-trauma and imaginary-trauma participants wrote about real-trauma participants' experiences. Imaginary-trauma participants were significantly less depressed than real-trauma participants at immediate posttest, but they were similarly angry, fearful, and happy. Compared with control group participants, both trauma groups made significantly fewer illness visits at 1-month follow-up: however, real-trauma participants reported more fatigue and avoidance than did the other groups. Imaginary-trauma group effects could reflect catharsis, emotional regulation, or construction of resilient possible selves. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Healing the wounds of organizational injustice: Examining the benefits of expressive writing.

Clinical and health psychology research has shown that expressive writing interventions—expressing one's experience through writing—can have physical and psychological benefits for individuals dealing with traumatic experiences. In the present study, the authors examined whether these benefits generalize to experiences of workplace injustice. Participants (N = 100) were randomly assigned to write on 4 consecutive days about (a) their emotions, (b) their thoughts, (c) both their emotions and their thoughts surrounding an injustice, or (d) a trivial topic (control). Post-intervention, participants in the emotions and thoughts condition reported higher psychological well-being, fewer intentions to retaliate, and higher levels of personal resolution than did participants in the other conditions. Participants in the emotions and thoughts condition also reported less anger than did participants who wrote only about their emotions. (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)     

Emotional self-disclosure and emotional avoidance: Relations with symptoms of depression and anxiety.

Research suggests that individuals with heightened symptoms of mood and anxiety disorders engage in diminished emotional disclosure. On the basis of emotion regulation theories, the authors hypothesized that this symptom–disclosure relationship would be mediated by the avoidance of emotional experience and expression. In Study 1, college students (N = 831) completed measures of depression and anxiety symptoms, measures of tendencies to avoid emotional expression, and measures of tendencies to self-disclose distress. Structural equation modeling revealed that anhedonic depression and anxious arousal were associated with lessened emotional self-disclosure tendencies as mediated by avoidance of emotional expression. In Study 2, participants (N = 153) completed new measures of depression and anxiety symptoms, reflected on the most significant emotional event experienced during the past week, and rated their avoidance of emotion about the event and their self-disclosure of the event. Depression (but not anxiety) symptoms were negatively related to the disclosure of a specific event, but avoidance of emotional experience did not mediate this depression–disclosure relationship. These findings extend emotion dysregulation theory and suggest that depressive symptoms in particular are associated with reduced emotional disclosure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Opening up in the classroom: Effects of expressive writing on graduate school entrance exam performance.

Our study sought to determine whether experimental disclosure could improve exam performance and psychological health in students taking a graduate school entrance exam. Students preparing for the GRE, MCAT, LSAT, or PCAT were randomly assigned to write expressively about their upcoming exam or to a neutral writing condition. Participants completed measures of depressive symptoms and test anxiety before and after writing, and exam scores were collected. The experimental disclosure group had significantly higher test scores and significantly lower pre-exam depressive symptoms than the neutral writing group. Although benefits for depressive symptoms were found in expressive writers regardless of exam type, the advantage of expressive writing for test performance was only observed in students taking the MCAT or LSAT. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Expressive writing moderates the relation between intrusive thoughts and depressive symptoms.

The author investigated whether expressive writing enhances emotional adaptation to a stressful event (graduate entrance exams) by reducing event-related intrusive thoughts or by desensitizing people to such thoughts. Participants in the experimental group, who were instructed to write their deepest thoughts and feelings about the exam, exhibited a significant decline in depressive symptoms from 1 month (Time 1) to 3 days (Time 2) before the exam. Participants in the control group, who wrote about a trivial topic, maintained a relatively high level of depressive symptoms over this same period. Expressive writing did not affect the frequency of intrusive thoughts, but it moderated the impact of intrusive thoughts on depressive symptoms. Specifically, intrusive thoughts at Time 1 were positively related to depressive symptoms at Time 2 in the control group and were unrelated to symptoms in the expressive writing group. (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)     

Effects of disclosure of traumatic events on illness behavior among psychiatric prison inmates.

To assess the health effects of writing about traumatic events in a clinical population, 98 psychiatric prison inmates were randomly assigned to 1 of 3 conditions in which they were asked to write about their deepest thoughts and feelings surrounding upsetting experiences (trauma writing condition), write about trivial topics (trivial writing control), or go about their daily routine without writing (no-writing control). Both writing groups wrote for 20 min per day for 3 consecutive days. Participants in the trauma condition reported experiencing more physical symptoms subsequent to the intervention relative to those in the other conditions. Despite this, controlling for prewriting infirmary visits, sex offenders in the trauma writing condition decreased their postwriting infirmary visits. These results are congruent with predictions based on stigmatization and inhibition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of acceptance-oriented versus evaluative emotional processing on heart rate recovery and habituation.

The effects of emotional processing on stress response trajectories may depend on the nature of processing, as evaluative rumination about emotions can prolong distress. In contrast, observing negative emotions in an accepting manner may promote efficient recovery from stressful situations. The present study examined the effect of acceptance-oriented versus evaluative emotional processing on cardiovascular habituation and recovery. Across two experimental sessions, 81 participants were randomly assigned to write about an ongoing stressful experience while either (1) evaluating the appropriateness of their emotional response (EVAL), (2) attending to their emotions in an accepting way (ACC), or (3) describing the objective details of the experience (CTL). Heart rate was assessed continuously throughout baseline, writing, and recovery. Results suggest that writing about emotions in an evaluative way leads to less efficient heart rate habituation and recovery than processing emotions in an accepting manner. These findings highlight a potential mechanism of mindfulness- and acceptance-based interventions' effects on health outcomes and further suggest that habitually evaluating the appropriateness of one's emotional responses rather than accepting them as they unfold may have consequences for cardiovascular health. (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)