Further Examination of the Exposure Model Underlying the Efficacy of Written Emotional Disclosure.

In the current study, the authors examined the effects of systematically varying the writing instructions for the written emotional disclosure procedure. College undergraduates with a trauma history and at least moderate posttraumatic stress symptoms were asked to write about (a) the same traumatic experience, (b) different traumatic experiences, or (c) nontraumatic everyday events across 3 written disclosure sessions. Results show that participants who wrote about the same traumatic experience reported significant reductions in psychological and physical symptoms at follow-up assessments compared with other participants. These findings suggest that written emotional disclosure may be most effective when individuals are instructed to write about the same traumatic or stressful event at each writing session, a finding consistent with exposure-based treatments. (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)     

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 expression: Effect sizes, outcome types, and moderating variables.

A research synthesis was conducted to examine the relationship between a written emotional expression task and subsequent health. This writing task was found to lead to significantly improved health outcomes in healthy participants. Health was enhanced in 4 outcome types—reported physical health, psychological well-being, physiological functioning, and general functioning—but health behaviors were not influenced. Writing also increased immediate (pre- to postwriting) distress, which was unrelated to health outcomes. The relation between written emotional expression and health was moderated by a number of variables, including the use of college students as participants, gender, duration of the manipulation, publication status of the study, and specific writing content instructions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The costs and benefits of writing, talking, and thinking about life's triumphs and defeats.

Three studies considered the consequences of writing, talking, and thinking about significant events. In Studies 1 and 2, students wrote, talked into a tape recorder, or thought privately about their worst (N = 96) or happiest experience (N = 111) for 15 min each during 3 consecutive days. In Study 3 (N = 112), students wrote or thought about their happiest day; half systematically analyzed, and half repetitively replayed this day. Well-being and health measures were administered before each study's manipulation and 4 weeks after. As predicted, in Study 1, participants who processed a negative experience through writing or talking reported improved life satisfaction and enhanced mental and physical health relative to those who thought about it. The reverse effect for life satisfaction was observed in Study 2, which focused on positive experiences. Study 3 examined possible mechanisms underlying these effects. Students who wrote about their happiest moments--especially when analyzing them--experienced reduced well-being and physical health relative to those who replayed these moments. Results are discussed in light of current understanding of the effects of processing life events. (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)     

Social-cognitive processes as moderators of a couple-focused group intervention for women with early stage breast cancer.

Objective: The purpose was to examine whether social-cognitive variables would moderate the efficacy of a couple-focused group intervention (CG) for women diagnosed with early stage breast cancer. Design: Participants (N = 238) were randomly assigned to 6 sessions of a couple-focused group versus usual care. Intent to treat growth curve modeling analyses indicated that emotional expression and emotional processing moderated CG effects on depression. Main Outcome Measures: The primary outcome measures for this study were psychological distress and psychological well-being. Results: Treatment attrition analyses separating out participants assigned to but not attending CG indicated that emotional expression, emotional processing, and protective buffering moderated the effects of CG among those who attended CG with the most consistent effects noted for emotional processing on indicators of distress and well-being. Conclusion: The CG intervention may be more effective for patients who begin the group experience using emotional approach coping strategies to deal with cancer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Empirical foundations for writing in prevention and psychotherapy: mental and physical health outcomes

The use of writing, alone or in conjunction with traditional psychotherapy, has increased substantially in recent years. The most widespread use of writing has been for single-shot ad hoc purposes or to log behavior. The purpose of this review is to summarize a decade of research demonstrating the efficacy of writing about past traumatic experiences on mental and physical health outcomes. It is widely acknowledged in our culture that putting upsetting experiences into words can be healthy. Research from several domains indicates that talking with friends, confiding to a therapist, praying, and even writing about one's thoughts and feelings can be physically and mentally beneficial. This review highlights advances in written disclosure that determine some therapeutic outcomes. In addition, we attempt to explore the mechanisms that predict improved psychological and physical health. Finally, limitations of previous studies are highlighted, and suggestions for future research and application are made.     

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)     

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)     

What Makes Experiences Satisfying? The Interaction of Approach-Avoidance Motivations and Emotions in Well-Being.

Two studies examined how dispositional approach-related and avoidance-related motivations moderate the degree to which people base satisfaction judgments on past experiences of positive affect (PA) and negative affect (NA). Using both laboratory-based (Study 1) and experience sampling (Study 2) methodologies, the authors found that high approach participants, as compared with low approach participants, made satisfaction ratings that were more strongly tied to PA. In contrast, avoidance-related motivations did not moderate the degree to which satisfaction ratings were based on either PA or NA. Results indicate that approach motivations may influence well-being not only through emotion over time but also through the degree to which people weight particular emotional experiences in broader judgments of satisfaction. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional disclosure through writing or speaking modulates latent Epstein-Barr virus antibody titers.

57 healthy Epstein-Barr virus (EBV) seropositive undergraduates completed a personality inventory, provided blood samples, and were randomly assigned to write or talk about stressful events, or to write about trivial events, during 3 weekly 20-min sessions, after which they provided a final blood sample. Ss assigned to the verbal/stressful condition had significantly lower EBV antibody titers (suggesting better cellular immune control over the latent virus) after the intervention than those in the written/stressful group, who had significantly lower values than those in the written/trivial control group. Ss assigned to the written/stressful condition expressed more negative emotional words than the verbal/stressful and control groups and more positive emotional words than the verbal/stressful group at each time point. The verbal/stressful group expressed more negative emotional words compared with the control group at baseline. Content analysis indicated that the verbal/stressful group achieved the greatest improvements in cognitive change, self-esteem, and adaptive coping strategies. (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)     

Upsetting experiences for the therapist in-session: How they can be dealt with and what they are good for.

Several major schools of psychotherapy require a genuine emotional presence from therapists in-session, as well as a nondefensive awareness of their emotional responses to the client. The present article addresses the part played by upsetting experiences in the context of these requirements. In order to identify relevant issues for a discussion of the literature, grounded theory analysis is presented of a series of conversations with four psychotherapists about their experience with in-session distress. The participants reported client confrontation and rejection evoked a variety of negative emotions ranging from helplessness to anger. Besides traditional professional resources like supervision and personal therapy, they discussed several coping strategies that focused on emotions. One strategy that stood out was to analyze how the emotional impact occurred in order to clarify client issues. This strategy was reported to yield information that improved therapeutic effectiveness in the case at hand, but it also was an effective method for overcoming therapist distress and a means of promoting broader professional growth. These observations suggest issues for integrative psychotherapy research into emotional risk taken by therapists and its payoff. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Similar–other support for men undergoing coronary artery bypass surgery.

This field experiment examined effects of a support intervention on the physical and mental health of coronary artery bypass graft (CABG) surgery patients. Control participants (N?=?90) received usual hospital care; experimental participants (N?=?100) also received visits from a "similar other" while in the hospital. Similar others were Veterans Administration veterans who had CABG surgery previously and were trained in simple supportive techniques. Outcomes were assessed prior to surgery and at 1, 6, and 12 months afterwards. Unexpectedly, the intervention generally had no effects on participants' well-being. Further analysis showed that participants who talked often with fellow cardiac patients in the hospital ("de facto similar others") experienced improvements in their physical and emotional well-being over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cardiovascular correlates of emotional expression and suppression: Do content and gender context matter?

Three studies examined cardiovascular (CV) responses during emotional expression with empathically responsive strangers. Study 1 demonstrated that self-relevant emotional expression fostered CV reactivity consistent with challenge. Study 2 manipulated content of discussion by assigning participants to 1 of 4 conditions: emotional, nonemotional, emotional suppression, nonemotional suppression. In same-sex dyads, emotional suppression elicited CV challenge reactivity whereas emotional suppression evoked CV threat reactivity, both compared with appropriate control groups. In opposite-sex dyads, however, emotional expression engendered CV threat. Because same- and opposite-sex disclosures differed, Study 3 controlled the content of emotional expression while manipulating gender context. Results confirmed findings from the first 2 studies, indicating that both context and content of emotional expression influenced CV effects. Findings are discussed within a theoretical challenge and threat perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Emotional processing in vocal and written expression of feelings about traumatic experiences

The purpose of this study was to compare vocal and written expression of feeling about interpersonal traumatic and trivial events in 20-min sessions over a 4-day period. Similar emotional processing was produced by vocal and written expression of feeling about traumatic events. The painfulness of the topic decreased steadily over the 4 days. At the end, both groups felt better about their topics and themselves and also reported positive cognitive changes. A content analysis of the sessions suggested greater overt expression of emotion and related changes in the vocal condition. Finally, there was an upsurge in negative emotion after each session of either vocal or written expression. These results suggest that previous findings that psychotherapy ameliorated this negative mood upsurge could not be attributed to the vocal character of psychotherapy.     

Manipulation of thinness and restricting expectancies: Further evidence for a causal role of thinness and restricting expectancies in the etiology of eating disorders.

To test the eating disorder expectancy theory contention that expectancies for reinforcement from thinness play a causal role in body dissatisfaction and eating disorder symptoms, the authors manipulated expectancies in 2 studies. Participants were exposed to either a psychoeducational intervention or an experimental manipulation of thinness and restricting expectancies. Study 1 participants were symptomatic college women who attended 3 experimental sessions and 1 follow-up session, each 1 week apart. Study 2 participants were high school girls who received the 3 experimental sessions clustered into 2 meetings; they completed symptom measures at baseline and at follow-up. In both samples, the thinness expectancy manipulation produced greater declines in thinness expectancies and body dissatisfaction than did the psychoeducational intervention. For high school girls, the thinness expectancy manipulation also produced a greater decline in overall eating-disordered attitudes. These results provide further support for the role of expectancies in the etiology of eating-disordered behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)