Transcript Free Full Presentation

the healing potential of
writing, stories & poems
key points
 the evidence base
for therapeutic writing
 practical writing exercise
 how does therapeutic
writing work; implications
 reflection & questions
therapeutic writing: evidence base
 there’s a considerable amount of research out there – for
example I have about 50 articles on writing & health in my
own database
 the research goes back at least 20 years, e.g: Pennebaker JW,
& O'Heeron RC. Confiding in others and illness rate among
spouses … J Abnorm Psychol 1984;93:473-6
 a careful literature search in the mid ’90’s found 13 research
studies that could be included in a meta-analysis: Smyth JM.
Written emotional expression: effect sizes, outcome types …
J Consult Clin Psychol 1998;66:174-84
 there have been several further research studies involving
clinical populations since this meta-analysis
therapeutic writing: meta-analysis
the Smythe meta-analysis came to several interesting conclusions:
 the therapeutic writing intervention produced significant
improvements in 4 health areas – reported physical health,
psychological wellbeing, physiological functioning, and general
functioning – but not health behaviours
 writing produced immediate (pre- to post-writing) increases in
distress, which wasn’t related to health outcomes
 effect sizes produced by writing were similar to those
produced by other psychological, behavioural, or educational
health interventions
 most of the studies involved healthy, student populations
therapeutic writing: evidence base
 Petrie KJ, Pennebaker JW et al Disclosure of trauma & immune
response J Consult Clin Psychol 1995;63:787-92
 Spera SP et al Expressive writing and coping with job loss
Academy of Management J 1994; 37(2): 722-733
 Kelley JE, Lumley MA, et al Health effects of emotional
disclosure in rheumatoid arthritis patients Health Psychology
1997;16(4):331-40.
 Smyth JM et al Effects of writing about stressful experiences
on … asthma or rheumatoid arthritis JAMA 1999; 281(14):
1304-9
 Hannay D, & Bolton G. Therapeutic writing in primary care: a
feasibility study Prim Care Psych 1999;5(4):157-160.
therapeutic writing: evidence base
Smyth JM, Gould O, et al. The role of narrative in medicine: a
multi-theoretical perspective. Adv Mind-Body Med 2000;16:186-93
Klapow JC, Schmidt SM, et al. Symptom management in older
primary care patients: feasibility of an experimental, written selfdisclosure protocol. Ann Intern Med 2001;134(9 Pt 2):905-11.
Gidron Y, Duncan E, et al. Effects of guided written disclosure of
stressful experiences on clinic visits and symptoms in frequent
clinic attenders. Fam Pract 2002;19(2):161-6.
Hockemeyer J, & Smyth J. Evaluating the feasibility and efficacy of
a self-administered manual-based stress management intervention
for individuals with asthma: results from a controlled study. Behav
Med 2002;27(4):161-72.
Smyth J, & Helm R. Focused expressive writing as self-help for
stress and trauma. J Clin Psychol 2003;59(2):227-35.
… but please avoid missionary zeal!! …
therapeutic writing exercise
 a chance to experiment with therapeutic writing
 see the handout description for a typical James
Pennebaker set of instructions
 feel free to water these down for today –
for example you could just write about
a minor/moderate stress (current or past)
 write really digging down into your feelings
and thoughts about what happened
 what you write will remain entirely private to you
mechanisms and effects
 stops the cumulative stress
& vulnerability produced by  reduction in intrusive
memories and thoughts
constant work of inhibition
 recovering/working through  improved psychological
well being
deeply upsetting memories
 improvements in immune
encourages reassessment
function & physical health
 increases personal sense of
resilience & one’s ability to  reduced dependence on
health professionals and
tolerate intense emotions
other helping agencies
 reduces isolation and makes
sharing with others easier
mechanisms and effects
stops cumulative stress produced by constant work of inhibition:
 Cole, S. W., M. E. Kemeny, et al. (1996). "Elevated physical health
risk among gay men who conceal their homosexual identity."
Health Psychology 15: 243 - 251.
 Larson, D. G. and R. L. Chastain (1990). "Self concealment:
conceptualization, measurement, and health implications."
Journal of Social and Clinical Psychology 9(4): 439 - 455.
 Finkenauer, C. and Rimé, B. (1998). "Keeping emotional
memories secret : health and subjective wellbeing when
emotions are not shared." J Health Psychology 3(1): 47 - 58.
 Hunt, M. G. (1998). "The only way out is through: emotional
processing and recovery after a depressing life event." Behaviour
Research and Therapy 36(4): 361 - 384.
mechanisms and effects
working through upsetting memories promotes reassessment:
making “emotional” memories more “autobiographical” & promot-ing
reassessment are considered key cognitive therapy interventions
 Reynolds, M. & C. Brewin (1999). "Intrusive memories in depression
and posttraumatic stress disorder." Behav Res Ther 37(3): 201-15.
 Smyth, J., N. True, et al. (2001). "Effects of writing about traumatic
experiences: the necessity for narrative structuring." Journal of
Social and Clinical Psychology 20(2): 161-172..
 Brewin, C. R. (2001). "A cognitive neuroscience account of
posttraumatic stress disorder and its treatment." Behav Res Ther
39(4): 373-93.
mechanisms and effects
increases personal sense of resilience & one’s
ability to tolerate intense emotions:
 Hunt, M. G. (1998). "The only way out is through: emotional
processing and recovery after a depressing life event." Behaviour
Research and Therapy 36(4): 361-84.
reduces isolation and makes
sharing with others easier:
 Pennebaker, J., J. M. Smyth, et al. (1999). "Disclosure and health:
an interview with James W Pennebaker; plus comments by
various other authors." Advances in Mind-Body Medicine 15(3):
161-195.
information from the web
go to the “good knowledge” page of
www.goodmedicine.org.uk , then open
“past lectures and training seminars” in the
“lectures, leaflets and what’s new” section;
this talk, the writing handout, research links
and other related talks can all be found in
“emotional expression & therapeutic writing
seminars”; look too in http://homepage.
psy.utexas.edu/HomePage/Faculty/
Pennebaker/Home2000/JWPhome.htm