February 25, 2014
By Michael Craig Miller M.D.
Harvard Medical School
Many of us are looking for simple ways to improve our mental health. And why not? It makes sense to try any simple practice that might boost your mood or enhance your well-being. Meditation and exercise are two excellent and established ways to accomplish this.
Expressive writing is another option. It has been around a long time, too. Writing down your thoughts and feelings about a difficult, stressful life experience may help you cope with the emotional fallout of such events. Stress, trauma and unexpected life developments — such as a cancer diagnosis, a car accident or a layoff — can throw you off stride emotionally and mentally. It's natural to wonder why something bad happened and what to do next. This can lead some people to dwell unproductively on the event — and possibly lead to a mental health problem that goes past the stress itself, such as depression or an anxiety disorder.
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What the Research Shows
Expressive writing appears to be more effective for healthy people who have had an emotional blow than it is for people struggling with ongoing or severe mental health problems. But it is a straightforward exercise that almost anyone can use.
Dr. James W. Pennebaker is a social psychologist and chair of the psychology department at the University of Texas, Austin. He has conducted much of the research on the health benefits of expressive writing.
One study of college students is a good example of his research: Students were divided into two groups. One group wrote about personally traumatic life events for 15 minutes on four consecutive days. The other group of students wrote about trivial topics.
Compared to those who wrote about trivia, the students who wrote about traumatic experiences used fewer pain relievers over the next six months. They also visited the campus health center less often.
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How It's Done
The instructions are simple:
- Set a length of time to write, for example, 15 or 30 minutes.
- Set a schedule, such as daily for 5 days or weekly for a month.
- Focus on a stressful experience.
- Write nonstop and freely (that is, whatever comes to mind) during the time you've set aside.
- Don't concern yourself with grammar, punctuation or writing style.
- While writing, try to explore your innermost thoughts and feelings without holding back.
- Keep the writing confidential, so you're less likely to inhibit yourself.
You may want to use the exercise to understand how a given stress or conflict relates to other significant aspects of your life — childhood memories, important relationships, how you have evolved as a person, or your hopes for the future.
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Expressive Writing and General Health
Many studies have evaluated the effect of expressive writing on people with physical health conditions, such as sleep apnea, asthma, migraine headaches, rheumatoid arthritis, HIV and cancer. In these studies, researchers measure physical outcomes, such as blood pressure and heart rates. The results suggest that expressive writing initially may upset people, but eventually helps them to relax.
Other research has looked at whether expressive writing helps to reduce stress and anxiety. The studies have shown positive effects in various situations. For example, expressive writing has reduced stigma-related stress in gay men. It has helped chronically stressed caregivers of older adults. And anxious test takers who wrote briefly about their thoughts and feelings before taking an important exam earned better grades than those who did not.
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Why Writing May Help
People studying expressive writing initially thought expressing emotions about a stressful experience might help a person move past it.
But that is probably an oversimplification, especially since other research has shown that venting emotions, on its own, may actually reinforce the painful aspects of a traumatic experience.
Thinking about an experience — making sense of it, putting it in some perspective, understanding how it connects to other aspects of personal development — seems to be an important ingredient. By writing, a person constructs a story and opens up about a traumatic event.
Expressive writing may help a person:
- Find meaning in a stressful event
- Better manage emotions
- Stop obsessing or brooding about a difficult experience
- Find it easier to talk about it with other people
- Find it easier to reach out to others for support
Timing also matters. It may help to put some distance between yourself and a bad experience before doing this exercise. Some research indicates that people who do expressive writing about a stressful event immediately after it occurs may actually feel worse, possibly because they are not yet ready to face it.
Even with these cautions, expressive writing is such an easy, low-cost technique — much like taking a good brisk walk — that it may be worth trying.
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Michael Craig Miller, M.D. is the former editor-in-chief of the Harvard Mental Health Letter and an assistant professor of psychiatry at Harvard Medical School. Dr. Miller has an active clinical practice and has been on staff at Beth Israel Deaconess Medical Center for more than 30 years.