The benefits of writing about trauma

Health psychologist Jane Collingwood discusses the benefits of writing about trauma:

It's well established that talking about traumatic incidents with a therapist, supportive family or friends can be therapeutic, producing improvements in psychological and sometimes physical health.

But can writing down thoughts and feelings about traumatic experiences improve our health too?

As helpful as talking about trauma may be, it is often difficult to talk about some kinds of traumatic experience. Victims of traumas that are difficult to talk about (such as sexual abuse and rape) are more vulnerable to poor health, including chronic diseases and headaches (Golding 1988).

It would good to know, therefore, that useful alternatives to talking about trauma are available.

A great deal of research has examined whether writing about trauma might be as effective as talking about it. The basic writing paradigm, developed by Pennebaker, in 1994, asks trauma victims to participate in a structured writing task in which they write about the thoughts and feelings associated with their trauma for 15-20 minutes a day, three to five days a week.

Several studies based on this method have produced positive results, finding that written disclosure of emotional reactions to trauma leads to a wide variety of beneficial health consequences (Berkowitz, 1989).

No-one is really sure exactly how this works. One possibility is that writing about traumatic experience serves as a stress release, decreasing the overall level of bodily stress that victims carry and thus reducing their vulnerability to diseases brought on due to chronic stress (Smyth 1999).

Evidence for the 'stress-reduction' hypothesis is found in a study where participants were asked to view shocking films. Some participants were asked to suppress their emotional reaction to these films while others were given no such instruction. The group asked to suppress their reactions to the films showed a significantly higher heart rate compared to the other group (Gross, 1997).

Related studies examining the immune system have found that greater life stress is associated with reduced immune function and susceptibility to infections (Cohen & Herbert, 1996). When people consciously hide emotions, they show noticeable immune effects, as shown experimentally by higher antibody levels after a vaccination (Esterling, 1990). Expression of emotions, including written disclosure, has been shown repeatedly to improve immune status.

Another possible reason why writing about trauma might be helpful is that it affords us the ability to reprocess our experience from a safe place, enabling us to experience a type of mastery and control over the trauma, and overcome the sense of helplessness.
Furthermore, the act of repetition, the conscious going over of trauma related events and reactions to those events, also seems to reduce the intensity of trauma reactions.
Support for this idea may be found in studies showing that people who write even about imaginary traumas display significantly less depressed mood immediately afterwards, compared to people who just imagined trauma but didn't write about it, and subsequently reported fewer visits to their doctor (Greenberg, 1996).

Writing about trauma is perhaps most effective when the trauma being written about is more rather than less intense in nature. In a study on college students, those who wrote about more severe traumas report fewer physical symptoms afterwards, compared with persons who described lower-severity traumas (Pennebaker and Beall, 1986).

Another important finding suggest that it may not be the act of writing itself which produces the healthy benefit, but rather its ability to help us achieve potent and emotional (and yet still distanced and safe) connections with traumatic memories.
This is illustrated in a study where researchers encouraged one group of trauma victims to write only factual information about their experience, while another group was asked to record both factual and emotional detail (Pennebaker and Beall, 1986). In this study, greater degrees of personalisation and detail were associated with less depression and less anxiety.

If writing about trauma produces so many health benefits in the lab, can it be recommended as a general approach for the sufferer of any trauma to undertake? Unfortunately not, as people vary in their ability to cope with traumatic events. By definition, exposure to traumatic events is overwhelming and outside the range of normal experience. If the nature of the trauma is extreme enough, forcing someone to write about it when they are not ready to do so can be re-traumatisng and can make things worse. For this reason, it is best done in the context of easily accessible social and emotional support.

Warnings aside, the usefulness of writing about trauma to promote healing is based on a substantial background of evidence. When performed with limits on time and subject matter, and by a person who is ready to undertake the task and who has support, the method is cheap, allows the trauma to be confronted at a suitable (self-directed) speed, lets personal meanings and solutions be derived, and may be undertaken by people who would not be likely to enter therapy.

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Advances in Experimental Social Psychology, Volume 22. Leonard Berkowitz. Academic Press, 1989.

Cohen, S. and Herbert, T. B. Health psychology: Psychological factors and physical disease from the perspective of human psychoneuroimmunology. Annual Review of Psychology, Vol. 47, 1996, pp. 113-42.

Esterling, B. A. et al. Emotional repression, stress disclosure responses, and Epstein-Barr viral capsid antigen titers. Psychosomatic Medicine, Vol. 52, July 1990, pp. 397-410.
Foa, E. B. and Kozak, M. J. Emotional processing of fear: exposure to corrective information, Psychological Bulletin, Vol. 99, January 1986, pp. 20-35.

Golding, J. M. et al. Sexual assault history and use of health and mental health services. American journal of community psychology, Vol. 16, October 1988, pp. 625-44.

Greenberg, M. A., Wortman, C. B. and Stone, A. A. Emotional expression and physical health: revising traumatic memories or fostering self-regulation? Journal of Personality and Social Psychology, Vol. 71, September 1996, pp. 588-602.

Greenberg, M. A. and Stone, A. A. Emotional disclosure about traumas and its relation to health: effects of previous disclosure and trauma severity. Journal of Personality and Social Psychology, Vol 63, July 1992, pp. 75-84.

Gross, J. J. and Levenson, R. W. Hiding feelings: The acute effects of inhibiting negative and positive emotion. Journal of Abnormal Psychology, Vol. 106, February 1997, pp. 95-103.

Pennebaker, J. W., Kiecolt-Glaser, J. K. and Glaser, R. Disclosure of traumas and immune function: health implications for psychotherapy. Journal of Consulting and Clinical Psychology, Vol. 56, April 1988, pp. 239-45.

Pennebaker, J. W. and Susman, J. R. Disclosure of traumas and psychosomatic processes. Social Science & Medicine, Vol. 26, February 1988, pp. 327-32.

Pennebaker, J.W. and Beall, S. K. Confronting a traumatic event: toward an understanding of inhibition and disease. Journal of Abnormal Psychology, Vol. 95, August 1986, pp. 274-81.

Smyth, J. M. et al. Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis. Journal of the American Medical Association, Vol. 281, 1999, pp. 1304-9.


    • Sally Sugg


      • The Trust

        Thanks for your comment Sally

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