Expressive Writing: New Narratives or Intuitive Insights?

A couple of years ago my wife, a freelance writer, was conducting a phone interview while I worked in the next room. I overheard her say something that caught my attention: “why do you think that writing helps people, Dr. Pennebaker?” I immediately ran into the room and started scribbling down additional questions that I wanted her to ask. She laughed and then had to explain her husband’s academic-fanboy behavior to her interviewee.

James Pennebaker is a fellow psychologist, and the father of expressive writing studies. In this approach, patients are given a blank sheet of paper with a general instruction like “write down your thoughts and feelings about [a particular event].” The idea behind this intervention is that writing about a traumatic experience might provide emotional relief and a chance to work through the event, resulting in a consolidated sense of self and an ability to let go of the things that were written. More detailed instructions for therapeutic writing can be found on Pennebaker’s web page. The suggested minimum writing time in his original studies was 20 minutes, and patients were encouraged to write for several consecutive days rather than only once. An important aspect of Pennebaker’s original research is that no one was to read the expressive writing – it was intended for the patient alone.

Results of research with chronically or terminally ill populations suggest a positive impact of therapeutic writing on self-report measures of health and well-being, with slightly larger effects for physical outcomes like pain than for psychological outcomes like depression. Therapeutic writing has well-documented benefits on both physical and mental health indicators based on results from more than 100 studies (Farber B, 2006, Self-Disclosure in Psychotherapy, New York: Guilford).
Although this approach is not specifically based on psychodynamic principles, it is certainly informed by them and influenced by a psychodynamic that consciously working through trauma will tend to reduce its nonconscious impact on behavior. The psychodynamic ideas of free association (writing whatever comes to mind), letting go of inhibition, and releasing emotional tension are central to Pennebaker’s conception of why therapeutic writing works (Pennebaker J, 1990, Opening Up: The Healing Power of Expressing Emotions, New York: Guilford). In this view, the effects of therapeutic writing might be conceptualized at the Intuitive-System level, by directly reducing one’s immediate stress response to new situations that remind one of past trauma. Specific physiological pathways that have been studied include more synchronized brain activity between the left and right hemispheres after writing (Pennebaker J, 1990, ibid), as well as lowered heart rate, improved immune function, increased antibody production, better mood, and muscular activity (Pennebaker J, 1997, Writing about emotional experiences as a therapeutic process. Psychological Science, 8, 162-166). All of these might suggest a direct effect by way of the Intuitive System. In fact, Intuitive-level pathways might not require any conscious processing of the written material at all — mere exposure to it might be enough to produce results.

From a TMT point of view, writing also may help people to craft new interpretations via the Narrative System that then become one of the inputs for future Intuitive-level reactions and behaviors. Because the Narrative System is so powerfully social, TMT might suggest a modification of Pennebaker’s model in which one does share the writing with someone else. (A colleague in grad school, Amit Raval, actually studied this variation for his dissertation, but I have not been able to track down his results). On the negative side, a plan to share the writing might also reduce people’s willingness to do it. Pennebaker himself noted that the social aspect of writing may have important therapeutic benefits, whether there is an actual reader or one is merely implied by the act of written communication; other potential mechanisms for an intervention effect are the use of language to create distance from an experience, and the process of increasing one’s sense of coherence about past events by constructing a narrative (Pennebaker J, 1997, Writing about emotional experiences as a therapeutic process. Psychological Science, 8, 162-166). Some evidence for the latter perspective is shown by the analysis of actual writing samples, which tend to evolve from simpler to more complex stories as participants write about the same event over time (Pennebaker, 1997, ibid). To me this suggests the technique has its beneficial effects via a Narrative-System mechanism.

At the moment, it seems clear that therapeutic writing helps, and either an Intuitive-level or a Narrative-level process might be able to account for its benefits. It seems like the field is ripe for some clever researcher to design a study that would disentangle these two possible mechanisms, and help us to understand just why many people find writing so helpful.