Physical and Psychological Benefits of Written Emotional Expression
Review of Meta-Analyses and Recommendations
Abstract
Abstract. The last several decades have witnessed a substantial increase in the number of individuals suffering from both diagnosable and subsyndromal mental health problems. Consequently, the development of cost-effective treatment methods, accessible to large populations suffering from different forms of mental health problems, became imperative. A very promising intervention is the method of expressive writing (EW), which may be used in both clinically diagnosable cases and subthreshold symptomatology. This method, in which people express their feelings and thoughts related to stressful situations in writing, has been found to improve participants’ long-term psychological, physiological, behavioral, and social functioning. Based on a thorough analysis and synthesis of the published literature (also including most recent meta-analyses), the present paper presents the expressive writing method, its short- and long-term, intra-and interpersonal effects, different situations and conditions in which it has been proven to be effective, the most important mechanisms implied in the process of recovery, advantages, disadvantages, and possible pitfalls of the method, as well as variants of the original technique and future research directions.
References
2007). Stress, coping, and development. An integrative perspective. London, UK: Guilford.
(2007). Expressive writing as a smoking cessation treatment adjunct for young adult smokers. Nicotine & Tobacco Research, 9, 185–194.
(2009). Internet based interventions for traumatic stress-related mental health problems: A review and suggestions for future research. Clinical Psychology Review, 29, 410–420.
(2006). Challenges for career interventions in changing contexts. International Journal for Educational and Vocational Guidance, 6, 3–14.
(2011). Cost-effectiveness of internet-based cognitive behavior therapy for irritable bowel syndrome: Results from a randomized controlled trial. BioMed Central Public Health, 11, 1–7.
(2000). The impact of expressive writing on prospective teachers’ sense of efficacy, stress, burnout, and satisfaction with teaching (Doctoral dissertation, University of Florida, 2000). Dissertation Abstracts International, 61, 2259.
(2005). Psychological impact of writing about abuse or positive experiences. Violence and Victims, 20, 717–728.
(2012). Expressive writing and positive writing for participants with mood disorders: An online randomized controlled trial. Journal of Affective Disorders, 136, 310–319.
(2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11, 338–346.
(2009). Understanding the effects of extreme stress and of psychological harm. New York, NY: Routledge.
, (2003). Use of the internet for health information and communication. JAMA, 290, 2256–2257.
(2012).
(Emotional expression and disclosure . In S. SegerstromEd., The oxford handbook of psychoneuroimmunology (pp. 107–128). Oxford, UK: Oxford University Press.1998). Expression of stressful experiences through writing: Effects of a self-regulation manipulation for pessimists and optimists. Health Psychology, 17, 84–92.
(2003). Psychological risk factors for HIV pathogenesis: Mediation by the autonomic nervous system. Biological Psychiatry, 54, 1444–1456.
(2007). Psychological treatments of subthreshold depression: A meta-analytic review. Acta Psychiatrica Scandinavica, 115, 434–441.
(2006). Feedback to a prototype self-help computer program for anxiety disorders in adolescents. Advances in Mental Health, 5, 216–224.
(2007). Subsyndromal depression: An impact on quality of life? Journal of Affective Disorders, 100, 163–169.
(2006). Benefit finding and expressive writing in adults with lupus or rheumatoid arthritis. Psychology and Health, 21, 651–665.
(2005). Medical and psychosocial aspects of chronic illness and disability (3rd ed.). Sudbury, MA: Jones and Bartlett.
(1992). Putting stress into words: The impact of writing on physiological, absentee, and self-reported emotional well-being measures. American Journal of Health Promotion, 6, 280–286.
(2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132, 823–865.
(2004). A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations. The Journal of Nervous and Mental Disease, 192, 629–634.
(2007).
(A cultural and historical perspective on confession . In J. W. PennebakerEd., Emotion, disclosure and health (pp. 11–22). Washington, DC: American Psychological Association.2002). Effects of guided written disclosure of stressful experiences on clinic visits and symptoms in frequent clinic attenders. Family Practice, 19, 161–166.
(2008). Written emotional disclosure: A controlled study of the benefits of expressive writing homework in outpatient psychotherapy. Psychotherapy Research, 18, 389–399.
(1996). Emotional expression and physical health: Revising traumatic memories or fostering self-regulation? Journal of Personality and Social Psychology, 71, 588–602.
(1992).
(Overcoming traumatic memories . In S. Å. ChristiansonEd., The handbook of emotion and memory: Research and theory (pp. 359–387). Hillsdale, NJ: Erlbaum.2006). Does expressive writing reduce health care utilization? A meta-analysis of randomized trials. Journal of Consulting and Clinical Psychology, 74, 243–252.
(2005). Does writing affect asthma? A randomized trial. Psychosomatic Medicine, 67, 130–136.
(2005). Get out of your mind and into your life. The new acceptance and commitment therapy. Oakland, CA: Harbinger.
(2012). An investigation of the efficacy of online expressive writing for trauma-related psychological disorders in Hispanic individuals. Behavior Therapy, 43, 812–824.
(2002). Evaluating the feasibility and efficacy of a self-administered manual-based stress management intervention for individuals with asthma: Results from a controlled study. Behavioral Medicine, 27, 161–172.
(2013). Effects of an expressive writing intervention on cancer-related distress in Danish breast cancer survivors – results from a nationwide randomized clinical trial. Psychooncology, 22, 1492–1500.
(2004).
(Medical regimen adherence: Concepts, assessment, and interventions . In T. J. BollJ. M. RaczynskiL. C. LevitonEds., Handbook of clinical health psychology: Vol. 2. Disorders of behavior and health (pp. 329–354). Washington, DC: American Psychological Association.2009). Psychological trauma and physical health: A psychoneuroimmunology approach to etiology of negative health effects and possible interventions. Psychological Trauma: Theory, Research, Practice, and Policy, 1, 35–48.
(2001). The health benefits of writing about life goals. Personality and Social Psychology Bulletin, 27, 798–807.
(2002).
(Gain without pain? Expressive writing and self-regulation . In S. J. LeporeJ. M. SmythEds., The writing cure: How expressive writing promotes health and emotional well-being (pp. 119–134). Washington, DC: American Psychological Association.2000). Writing about the perceived benefits of traumatic events: Implications for physical health. Personality and Social Psychology Bulletin, 26, 220–230.
(2009). A therapist-assisted internet-based CBT intervention for posttraumatic stress disorder: Preliminary results. Cognitive Behavior Therapy, 38, 121–131.
(2001). Expressive writing can increase working memory capacity. Journal of Experimental Psychology: General, 130, 520–533.
(2007). Low-cost approaches to promote physical and mental health. Theory, research, and practice. New York, NY: Springer.
(2010). The impact of early life trauma on health and disease: The hidden epidemic. Cambridge, UK: Cambridge University Press.
(2002). Mending broken hearts: Effects of expressive writing on mood, cognitive processing, social adjustment and health following a relationship breakup. Psychology and Health, 17, 547–560.
(2006). Essentials of psychosomatic medicine. Arlington, VA: American Psychiatric Publishing.
(2007). A randomized, controlled proof-of-concept trial of an internet-based, therapist-assisted self-management treatment for posttraumatic stress disorder. American Journal of Psychiatry, 164, 1676–1683.
(2003). Stress management through written emotional disclosure improves academic performance among college students. Journal of Educational Psychology, 95, 641–649.
(1993). Extraversion and neuroticism as predictors of objective life events: A longitudinal analysis. Journal of Personality and Social Psychology, 65, 1046–1053.
(2005). Autonomic effects of expressive writing in individuals with elevated blood pressure. Journal of Health Psychology, 10, 197–207.
(2003). The impact of the emotional disclosure intervention on physical and psychological health – A systematic review. Birmingham, UK: West Midlands Health Technology Assessment Collaboration.
(2005). Does emotional disclosure have any effects? A systematic review of the literature with meta-analyses. International Journal of Technology Assessment in Health Care, 21, 153–164.
(2001). Mind, body and medicine: An integrative text. Oxford, UK: Oxford University Press.
(2008). Computer-supported psychotherapy should pay attention to e-learning. Cogniţie, Creier, Comportament/Cognition, Brain, Behavior, 12, 131–139.
(2009). Distress management clinical practice guidelines in oncology, version 1, Retrieved from www.nccn.org/professionals/physician_gls/f_guidelines.asp#supportive
. (2002). Guidance on the use of computerized cognitive behavioral therapy for anxiety and depression. Technology Appraisal, 51, 1–38.
. (2002). Pattern of change in prolonged exposure and cognitive-processing therapy for female rape victims with posttraumatic stress disorder. Journal of Consulting and Clinical Psychology, 70, 880–886.
(2004). For whom does it work? Moderators of the effects of written emotional disclosure in a randomized trial among women with chronic pelvic pain. Psychosomatic Medicine, 66, 174–183.
(2007). Emotion, disclosure, and health. Washington, DC: American Psychological Association.
(2010). Expressive writing in clinical settings. Independent Practitioner, 30, 23–25.
(1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274–281.
(2007).
(Expressive writing, emotional upheavals, and health . In H. FriedmanR. SilverEds., Handbook of health psychology (pp. 263–284). New York, NY: Oxford University Press.2011).
(Expressive Writing: Connections to physical and mental health . In H. S. FriedmanEd., The Oxford handbook of health psychology (pp. 417–437). Oxford, UK: Oxford University Press.2001). Patterns of natural language use: Disclosure, personality, and social integration. Current Directions in Psychological Science, 10, 90–93.
(1987). The psychophysiology of confession: Linking inhibitory and psychosomatic processes. Journal of Personality & Social Psychology, 52, 781–793.
(2009). Clinician-assisted Internet-based treatment is effective for depression: Randomized controlled trial. The Australian and New Zealand Journal of Psychiatry, 43, 571–578.
(2004). Effect of written emotional expression on immune function in patients with human immunodeficiency virus infection: a randomized trial. Psychosomatic Medicine, 66, 272–275.
(2010). Internet-based expressive writing for kidney transplant recipients: Effects on post-traumatic stress and quality of life. Traumatology, 16, 49–54.
(2006). Efficacy and utility of computer-assisted cognitive behavioral therapy for anxiety disorders. Clinical Psychologist, 10, 43–53.
(2010). Who benefits from Pennebaker’s expressive writing? Research recommendations from three ender theories. Sex Roles, 63, 149–163.
(2007).
(Interpersonal emotion regulation . In J. GrossEd., Handbook of emotion regulation (pp. 466–485). New York, NY: Guilford.2004).
(The social sharing of emotion. Illusory and real benefits of talking about emotional experiences . In I. NyklíčekL. TemoshokA. VingerhoetsEds., Emotional expression and health (pp. 221–244). New York, NY: Hoveland.2002). Expressive disclosure and health outcomes in a prostate cancer population. International Journal of Psychiatry in Medicine, 32, 37–53.
(2004). Trauma and health: Physical health consequences of exposure to extreme stress. Washington, DC: American Psychological Association.
. (2002). Experimental and quasi-experimental designs for generalized causal inference. Boston, MA: Houghton-Mifflin.
(2004). Emotional expression in cyberspace: Searching for moderators of the Pennebaker disclosure effect via e-mail. Health Psychology, 23, 457–464.
(2004). Taking pen to hand: Evaluating theories underlying the written disclosure paradigm. Clinical Psychology: Science and Practice, 11, 121–137.
(2005). Further examination of the exposure model underlying the efficacy of written emotional disclosure. Journal of Consulting and Clinical Psychology, 73, 549–554.
(1998). Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66, 174–184.
(2000).
(A meta-analytic evaluation of workbook effectiveness in physical and mental health . In L. L’AbateM. ToremEds., Distance writing and computer assisted intervention in psychiatry and mental health (pp. 239–255). Westport, CT: Ablex.2008).
(Expressive writing in the clinical context . In A. J. J. M. VingerhoetsI. NyklíčekJ. DenolletEds., Emotion regulation. Conceptual and clinical issues (pp. 215–233). New York, NY: Springer.2004). Treating affair couples: Extending the written disclosure paradigm to relationship trauma. Clinical Psychology: Science and Practice, 11, 155–159.
(1994). Expressive writing and coping with job loss. Academy of Management Journal, 37, 722–733.
(2002). Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients. Journal of Clinical Oncology, 20, 4160–4168.
(2010). Who benefits from Pennebaker’s Expressive Writing? More research recommendations: A commentary on Range and Jenkins. Sex Roles, 63, 165–172.
(2009). Shyness programme: Longer term benefits, cost-effectiveness, and acceptability. The Australian and New Zealand Journal of Psychiatry, 43, 36–44.
(2008). Mental capital. The economic significance of mental health. Maastricht, The Netherlands: Universitaire Pers Maastricht.
(2008). Enhanced wound healing after emotional disclosure intervention. British Journal of Health Psychology, 13, 95–102.
(2007).
(Conceptual issues underlying stress management . In P. M. LehrerR. L. WoolfolkW. E. SimeEds., Principles and practice of stress management (pp. 3–15). New York, NY: Guilford.