Therapeutic Writing

Therapeutic journaling is an internal process of using the written word to express the full range of emotions, reactions and perceptions we have related to difficult, upsetting or traumatic life events. This can lead to an increased sense of wellbeing as well as improved physical and mental health. Journaling is proven to improve immune function.

Writing helps us let go of "stuck" memories and it can provide clarity and context. Expressive writing can aid with the treatment of PTSD and depressive symptoms, and was as effective as trauma-based cognitive behavioral therapy (CBT). Writing is particularly helpful for those who do not have another opportunity to disclose.

James W. Pennebaker is the Regents Centennial Chair of Psychology and the Executive Director of Project 2021 at the University of Texas at Austin. He and his students are exploring the links between emotional experiences, natural language, and physical and mental health. His most recent research focuses on how everyday language reflects basic social and personality processes. He created the Expressive Writing Protocol and has written about the therapeutic nature of journaling.

The Importance of Disclosure: Secrets

“Keeping secrets is physical work. When we try to keep a secret, we must actively hold back or inhibit our thoughts, feelings, or behaviors. Keeping secrets from others means that we must consciously restrain, hold back, or in some way exert effort to not think, feel, or behave.

Secrets can produce short-term biological changes and influence long-term health. In the short run, restraining thoughts or feelings can immediately affect our body, for example, by increasing perspiration or causing faster heart rates, as seen during lie detector tests. Over time, the work of keeping secrets servers as a cumulative stressor on the body, increasing the likelihood of illness and other stress-related physical and mental problems. Actively holding back from talking about important topics is one of many general stressors that affect the mind and body. The harder we must work at hiding our thoughts or feelings, the greater the stress on our bodies.

Secrets hurt our thinking abilities. Actively holding back can disrupt the ways we think. If we don’t talk about a powerfully emotional experience with others, it’s almost impossible to organize it in our minds in a broad and integrative way. When keeping a big secret, we don’t translate the event into language. This can prevent us from understanding the event. Major life experiences that are withheld from others are likely to surface in the forms of anxiety, ruminations, disturbing dreams, and other thought disturbances.

The human mind naturally tries to understand the world around it. One reason we often obsess about a disturbing experience is that we are trying to understand it. An efficient way to understanding something is to talk about it--to translate it into words. If we don’t talk about it, we continue to think about it. And if we keep ruminating about it, we have fewer mental resources to think about other things. This helps explain why people under stress often have memory problems and are less attentive to changes in themselves and others.

Disclosure reduces the effects of secrets. The act of disclosing a trauma reduces the physiological work of secrets. During disclosure, the biological stress of holding back is immediately reduced. Over time, if we continue to confront and thereby resolve our emotional upheavals, there will be a lowering of our overall stress level.

Disclosure forces a rethinking of events. Disclosing or confronting a trauma helps us understand and ultimately assimilate the event. By talking or writing about a secret experience, we are translating the event into language. Once it is language based, we can better understand the experience and ultimately put it behind us” (Pennebaker, 2016, pp.10-11).

Pennebaker, J. (2016). Opening up by writing it down: How expressive writing improves health and eases emotional pain. New York: Guilford Press.

Pennebaker Experiments

Experiment #2

Fifty students wrote for 20 minutes a day for four consecutive days about one of two topics. Half wrote about their deepest thoughts and feelings concerning a trauma. The remaining 25 students were expected to write about superficial topics. The major difference was that all the students consented to have their blood drawn the day before writing, after the last writing session, and again six weeks later.

People who wrote about their deepest thoughts and feelings surrounding traumatic experiences evidenced enhanced immune function compared with those who wrote about superficial topics. Although this effect was most pronounced after the last day of writing, it tended to persist six weeks after the study.

In addition, it was again observed that health center visits for illness dropped for the people who wrote about traumas compared to those who wrote on the trivial topics.

Surveys months later: In sharp contrast to the reports immediately after writing, nearly everyone who wrote about traumas now described the study in positive terms. More important, approximately 80 percent explained the value of the study in terms of insight. Rather than explaining that it felt good to get negative emotions off their chests, the respondents noted how they understood themselves better.

Experiment #3

This one had almost 50 participants. Half were asked to write about their deepest thoughts and feelings about getting laid off for 30 minutes a day for five consecutive days. The other half wrote for the same period about how they used their time—a strategy based on “time management”… A third group of 22 former employees did not write at all and served as another comparison group.

Within three months, 27 perfect of the experimental participants landed jobs compared with less than 5 percent of those in the time management and no-writing comparison groups.

By seven months after writing, 53 percent of those who wrote about their thoughts and feelings had jobs compared with only 18 percent of the people in the other conditions. Particularly striking about the study was that the participants in all three conditions had all gone on exactly the same number of job interviews. The only difference was that those who had written about their feelings were offered jobs.

Why did writing about getting laid off help these people find jobs more quickly? The key probably has something to do with the nature of anger. Those who had explored their thoughts and feelings were more likely to have come to terms with their extreme hostility toward their previous employer… and came across as less hostile, more promising job candidates

PTSD

…Compared to those in a control group, people in the expressive writing group had fewer PTSD symptoms in the months after writing. What made this so noteworthy is that the actual rate of PTSD dropped in the emotional writing group but no in the control condition. In a later study, Sloan led a team that examined the effectiveness of expressive writing in a very small study of veterans with PTSD. She found that PTSD symptom severity decreased in the months following the treatment. What’s more, five of the seven veterans no longer met diagnostic PTSD criteria three months later.

Pennebaker, J. (2016). Opening up by writing it down: How expressive writing improves health and eases emotional pain. New York: Guilford Press.

Expressive Writing Protocol

Writing topic. You can write about the same event all four days or different events each day. What you choose to write about should be something that is extremely personal and important for you.

Length and frequency. Write for 15-20 minutes each day for four consecutive days if you can. It is a bit more effective than writing four days over the course of several weeks.

Write continuously. Once you begin writing, write continuously without stopping. Don’t worry about spelling or grammar. If you run out of things to say, simply repeat what you have already written. Keep writing about the topic until the time is up.=

Write only for yourself. You are writing for yourself and no one else. After you complete the expressive writing exercise, you may want to destroy or hide what you have written. Remember this writing can be for your eyes only.

What to avoid. If you feel that you cannot write about a particular event because it would be too upsetting, then don’t write about it. Just write about events or situations that you can handle now.

What to expect. It is common for people to feel somewhat saddened or depressed after writing, especially on the first day or two. Know that this is completely normal, if this happens to you. Typically, the feeling usually lasts just a few minutes or a few hours. It is a good idea to plan some time to yourself after your writing session to reflect on the issues you have been writing about and support yourself in any emotions that come up.

Considerations. Writing about the same topic day after day for too many days is not helpful. If, after several sessions, you feel you are not making progress, then you might need to stop and contact a health care practitioner.

When to discontinue the journaling exercise. Writing exercises aren’t for everyone. If the writing exercise evokes strong feelings that you cannot cope with, stop immediately and do something soothing for yourself. Experiencing symptoms of hypervigilance, stress or distress are signals to discontinue this journaling exercise immediately. Take care of yourself by doing something like practice diaphragmatic breathing, reach out to a friend or loved one, or go for a walk to center and calm yourself. If you experience lingering negative feelings you might benefit some additional help. It is recommended to seek the professional advice of a psychologist, counselor, or physician to discuss these feelings and experiences.