Heal Write NowChristine “Cissy” White

How Expressive Writing Improves HealthThere are documented physical and emotional health benefits for those who do expressive writing. Few people know about them. The technique is easy, requires little money or training and can be practiced as needed once learned. Yet it is mostly used by writers and researchers. It is time to make expressive writing accessible to more people. This paper

describes how expressive writing was discovered and how people can use this tool to improve health.

History of Expressive Writing The term expressive writing was coined by James W. Pennebaker, Ph.D. who is currently a professor in the Psychology department at the University of Texas. Pennebaker is author of Opening Up: The Healing Power of Expressing Emotions first published in 1990 which will be updated and re-released in a few months. It’s the definitive and accessible resource still on this topic.

Expressive writing is fairly new. Writing in journals or penning letters is not a new practice. In fact, diary keeping has been done for centuries by

human beings throughout the world. Many of us have done so occasionally or frequently and most often when upset.

But why? Why do people write when hurt or down? Does writing have measurable health benefits and if so, what writing style is most beneficial? These were the types of questions fueling Pennebaker’s research which began in the 1980’s when Sandra Beall, one of his

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James W. Pennebaker

graduate students announced her intention to do a thesis on the relationship between writing and health. His job was to guide her. Pennebaker and Beall developed a study and worked with volunteers (students).

Group one would write about traumatic experiences and the other write about insignificant or mundane experiences. Additionally, the group writing about trauma was sub-divided into groups writing from three difference perspectives, as follows:

1. Group one wrote about mundane matters. It would be the only group to do so.

2. Group two would write about trauma venting emotions only.

3. Group three relayed only the facts about the trauma(s) experienced.

4. Group four shared facts and vented emotions about the trauma(s).

That meant there were four groups and student were randomly assigned to be in each one. All groups wrote for fifteen minutes, four days in a row and without regard to spelling, grammar or punctuation. All four wrote quickly and without stopping.

Every student wrote alone and without being identified or using a name so they would be anonymous. In fact, students had the option of never turning in their writing if they chose not to share it and could withdraw from the study at any time without penalty. Not one student withdrew and even that was notable as students don’t always comply with study requirements.

Follow-up was done, in person, with each student at two different times. The first was immediately following the study and the second was done four months later. Students agreed to have their medical records reviewed so Pennebaker and Beall could compare the number of visits

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for medical care (and reasons) in the three months prior to the study and the three months following for every participant.

In the initial interviews following the fourth day of writing many of the students who wrote about traumatic experiences were upset and cried. They shared how they frequently thought about the topics they wrote about during their 15-minute writing sessions. Though none were required to share their writing most did. Students wrote about parental divorce, the death of loved ones, childhood abuse, past suicide attempts, public humiliation, sexual secrets and drug and alcohol addiction.

Those who wrote about trauma felt sadder than those who wrote about superficial topics. Pennebaker worried that they created a study which caused students to get depressed. No one felt “good” or happy having written about trauma, secrets or hardships.

However, months later, data was gathered and students were interviewed again.

What are the Documented Health Benefits?Students who wrote about their deepest feelings and details about trauma had a 50% reduction in visits to the health center reporting colds, flus or health problems compared with the other three groups. Prior to writing all four groups had visited health services at the same rate.

In addition, participants reported to Beall and Pennebaker that: “Writing about their deepest thoughts and feelings about traumas resulted in improved moods, more positive outlook, and greater physical health.” The participants felt good about having written and the insights and changes they experienced as a result.

Pennebaker did not intend to create a new form of writing therapy. He was a social scientist not a therapist. What he was most interested in was

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understanding why and how this combination of writing in detail, with both feeling and factual details was most beneficial.

So he set out to do another study and teamed up with an interesting research duo. Janice K. Kiecolt-Glaser was a clinical psychologist and her immunologist husband, Ronald Glaser worked at Ohio State University. They had been studying the negative health consequences of trauma and hardship and even mood states such as loneliness by measuring the action of T-lymphocytes. They studied the “relaxation response” showing it improved health and immune system functioning in the elderly long before the public understood the benefits of mindfulness-based health practices.

With their help, Pennebaker could explore the immune system response of study participants. He could compare it in those doing expressive writing with emotion and feeling to those writing with only emotion or feeling as well as to the group writing about superficial matters.

Again, the group writing expressively (thoughts and feelings) showed the most “heightened immune function” compared with those who wrote about superficial events. The improvements were highest immediately following the study but remained six weeks. And, sicknesses and visits to the health center also decreased again.

The two initial studies were relatively small and done decades ago but they opened up an entire field of inquiry. The studies have been repeated and expanded. Thirty years later Pennebaker is still working in the field. He co-authored Expressive Writing: Words that Heal published in 2014, with John F. Evans, Ed.D.

Many others are now doing similar research on the benefits of writing. Last month I contacted Pennebaker to make sure there were no new

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advances on the horizon I was unaware of. He said that there are so many new studies coming out now he can’t keep up with them. And this is his field of expertise! He recommends anyone interested use Google Scholar to search “expressive writing” to find more about how writing improves health and even prevents illness.

The public is becoming more and more aware of the health benefits of writing. Earlier this year, the New York Times ran an article entitled “Writing Your Way to Happiness” by Tara Parker-Pope which reported:

“The scientific research on the benefits of so-called expressive writing is surprisingly vast. Studies have shown that writing about oneself and personal experiences can improve mood disorders, help reduce symptoms among cancer patients, improve a person’s health after a heart attack, reduce doctor visits and even boost memory.”

In addition, Louise DeSalvo who is a researcher, trauma survivor and author of several memoirs also summarizes much of the research about expressive writing in her book Writing as a Way of Healing:How Telling Our Stories Transforms Our Lives. DeSalvo wrote:

“Other experiments established that people who linked traumatic events and feelings in this way had “T Lymphocytes (that) were more ‘energetic’ than the control group.” Their bodies, then, were more able to fight infection (having greater antibody response to Epstein-Barr virus, and hepatitis-B vaccination, for which they were tested) than before writing. Their heart rates lowered. Other tests showed too, that they were in a more relaxed physiological state.

…Writing thoughtfully and emotionally about traumatic experiences, rather than writing about superficial topics or venting

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feeling or simply describing what happens, seems to improve our immune system.” `

She also wrote:

“Further experiments with other groups of students and people in distress (laid off from jobs; people whose spouses had died tragically; people with illnesses) showed that substantial behavioral changes are also associated with this kind of writing. Students’ grades improve. People get new jobs more quickly. Sick people are somewhat healthier; if they are terminally ill, they seem, nonetheless, to be in a state of emotional and spiritual healing – more accepting, secure, serene.”

Expressive writing has great emotional, physical and even spiritual benefits. It helps many people. What’s not exactly clear is why.

How Does Expressive Writing Promote Health? Many have relied on writing to “clear the mind,” “lighten the load” or “get thoughts down.” Many people practice expressive writing alone, casually in writing groups or even more formally in therapy. Science can’t yet explain why it improves health, wound healing, sleep, immune function, etc. only that it does.

One theory is that suppressing painful memories or keeping secrets or keeping “bottled up” is toxic. It requires energy and strain to suppress and this wears on the immune system and telling in writing offers relief and improved health.

People who have strong social support and share traumatic events with loved ones are generally healthier following trauma, loss and grief that those who do not.

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Therefore, the act of writing is believed to be a form of telling, sharing or confiding which unburdens a person and improves health even if done after a traumatic event. Months, years or decades after and even if the only audience for the writing is the author.

People such as DeSalvo stress that it is the linking of thoughts and feelings about trauma that is beneficial. Others believe it is the act of organizing experiences which creates a narrative. Recent research by Pennebaker suggests that those who shift pronoun use (one day using “I” and the next day writing “he” or “she” show greatest health benefits). He suggests it is because these people take on different vantage points which encourage different perspectives (for example, a rational person might consider an emotional approach and an emotional one might ponder a more rational approach).

DeSalvo wrote about one study showing “there was a congruence in brain wave activity between the left and right hemisphere, indicating that both emotional and linguistic information was being processed simultaneously.” In her writing she says the body responds to expressive writing in much the same way it responds to yoga and meditation. Positively.

Studies are still being done to better understand exactly why and how expressive writing improves health. But there’s little debate that it does.

Nancy Slonim Aronie, author of Writing from the Heart: The Power of Tapping Your Inner Voice has been teaching writing workshops for thirty-five years. Her workshops happen to run for four days in a row and participants write one to three times a day, for at least 20 minutes and only positive feedback is allowed to be given.

When I asked her why she thinks the studies show improved health from expressive writing. She said:

72Nancy Slonim Aronie

“It’s healthy because getting the story out, getting the truth out of your body….You don’t have to carry the weight. You’re still going to have the wounds. But it’s not so heavy. Getting the rage on the page you don’t have to carry it anymore.”

Aronie often says in her workshops, “When you write about pain you write it out of the body” and she notices a visible difference in people. “I do see people get younger,” she said, “they lose wrinkles and frowns. They reclaim their innocence.”

(Disclosure: I met Aronie almost twenty years ago when I took her workshop. She is now a friend, colleague, mentor and we’re co-authoring the book Your Childhood is Making You Fat, Sick & Dead: Write to Heal).

Expressive Writing is Not Journal Writing Writing expressively about trauma is not the same as journal writing. Journal keepers are a varied bunch. Some write lists. Some write letters. Some draft only descriptions of nature while others keep detailed accounts of moments or events they are grateful for. Journals can be rational, emotional, included doodles or art work or scrapbooking.

Others use similar techniques. For example, free-writing is done without regard to grammar or punctuation and links feelings and thoughts but writers explore all topics and not just traumatic events. It has been popularized by Natalie Goldberg in her book Writing Down the Bones in 1986 and again by Julia Cameron in The Artist’s Way in 1992. However it was first described by Dorothea Brande in her book Becoming a Writer published in 1934. Brande recommended people write every morning for a half hour as quickly as possible.

The major difference between free-writing and expressive writing is that free-writing can be about any topic, not only trauma, and that there’s no set plan for the number of consecutive days one starts and stops.

Expressive writing is done without stopping, for a specific period of time (usually fifteen to twenty minutes) and without worrying about grammar or spelling and for a specific number of consecutive days (most often,

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four). Expressive writing is specifically used to address difficult and traumatic experiences and is believed to be most effective when a person writes about something they’ve kept secret.

While expressive writing is good for people it does not always feel good. Just as exercise can require effort and feel hard, that does not mean it should not be done. People do get sad or emotional for hours or days after writing expressively. While getting upset is an appropriate response to trauma or difficulty it is not pleasant so it is important for people to expect to feel sad or more emotional than usual. And that those feelings will pass. It helps to remind people that writing does not cause the upset it allows people to express that upset that’s been carried within.

Side Effects? Cautions & Considerations

Not everyone likes to write. Some people are afraid of the empty page, lack confidence or have had negative writing experiences. Some were criticized or discouraged in school, had language or learning barriers. Ohers have had diaries read without permission and therefore

stopped writing completely.

The research suggests it’s worthwhile to push through resistance.

However, if writing remains impossible the research shows that expressive talking into a recorder is equally beneficial and can be done instead as long as it is done in a similar fashion (talking done combining facts and emotion about trauma, for fifteen minutes at a time and without stopping and for four consecutive days).

As for the frequency of expressive writing some, like DeSalvo, believe more is better. As a writer with a tremendous amount of loss and

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traumatic stress in her life, she finds frequent writing improves her health and mood. Pennebaker is not convinced that this is true for everyone. He worries daily writing can increase obsessing or ruminating about topics. Instead, he recommends expressive writing be done as needed, shortly after major life transitions or occasionally to process past trauma. He describes expressive writing as an occasional “life course correction.” DeSalvo believes a regular writing practice promotes and improves health.

It’s notable that they are both reviewing the same literature and come to difference conclusions about how often one should write.

As for sharing writing with others some studies suggest that people will not write as deeply or truthfully if they think their writing will be viewed. It is agreed that a negative response can be hurtful or harmful so if there’s any chance of that not sharing writing is best. Yet, sharing stories is also a tradition and many enjoy and find solace in the process. If safe settings are available sharing may add increased health benefits.

We know that writing need not be shared to improve health. Individuals can choose if, when or with whom to share writing based on personal preference. Expressive writing allows those who do it the option of complete privacy.

For organizations looking to promote health while managing personal and professional boundaries the not sharing writing might also be appropriate or even preferred.

My personal experience with sharing free-writing, one on one or in groups, is that it’s a positive experience but only if the feedback given is warm, positive and given to everyone following the sharing of work. This is an area of research needing further study.

As for individuals who benefit most from expressive writing Evans and Pennebaker report that it is “buttoned up” types who don’t generally share personal details in daily life who benefit most. There are no

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additional benefits in writing by hand as opposed to computer so modern devices or “old-fashioned” paper and pen can be used.

ConclusionWriters have long known writing is curative, helpful and healthful. Many experience agitation or depression or angst when done writing a book or when life does not allow us to get to the page frequently enough. Life is hard, painful and sometimes filled with loss, for everyone. But writers know something that few others have known.

Every life experience, even trauma, can be more than pain. It is also material. It can be used, worked and sculpted into story, to enrich a character and to better understand someone. In any good piece of writing, characters are complicated, layered and complex. No one is all good or all bad and no one gets through life without having been hurt.

Sometimes, it’s not the hurt that causes the most damage. It is the silence, secrecy or the keeping experiences or memories buried. Writers have a way to release the pressure, to share and to tell the truth.

Expressive writing has now been studied for four decades. Those that might never call themselves a writer are being introduced to this writing style and finding measurable benefit. Expressive writing can be a healthful way to process toxic, painful and difficult experiences. Like exercising expressive writing is healthful. Unlike exercise, expressive writing need not be done three to five times a week to be beneficial.

Expressive writing requires 15 minutes a day for four days in a row to improve health and mood. It requires a small investment of time, little to no money and limited guidance. Like a hammer or screwdriver, it’s a tool most everyone will likely need at least once and should at least know how to use.

It seems appropriate to give the last word to a writer. DeSalvo wrote:

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“Writing has helped me heal. Writing has changed my life. Writing has saved my life…How often have I uttered these words, and meant them… a hundred times… a thousand? And how often have others – acquaintances, friends, student, published writer – told me that writing has helped them heal from loss, grief, or personal tragedy, that writing gave them unimaginably plentiful spiritual and emotional advantages? That writing changed them, has helped them come to terms with something difficult, that writing has saved their lives? Often.

Copyright © 2015 [Christine Cissy White). All Rights Reserved.

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