What is expressive writing?
Expressive writing is the process of exploring thoughts and feelings around a given topic, often traumatic in nature, for brief (15-20 minute) spurts, over the course of three to four days.
Expressive writing has been found to be a low-cost, effective intervention for a variety of patient populations. Some areas of study include how the content of writing affects outcome, as well as an attempt to understand the mechanism behind those outcomes.
School nurses, home care nurses, oncology nurses, bedside nurses, psychiatric nurses, nurses of all kinds can utilize this intervention and make a difference in their patient’s lives.
Here are five different studies, all published within the last two years, which looked at expressive writing as an intervention in a variety of patient populations.
5 Patient Populations That May Benefit From Expressive Writing
1. Early High School Adolescent Males
In this study, approximately 200 first-year male high school students participated in an expressive writing workshop for three consecutive days. One group wrote about the benefits of transitioning to high school, one group wrote about their deepest thoughts and feelings associated with the transition, and one group wrote about school activities. The group that focused on benefits demonstrated a greater sense of academic self-concept, especially among those who had a low self-concept at the onset of the intervention. One note, however, was that the effects were relatively short-lasting — no more than two months after the intervention. The authors suggest a booster session to maintain the outcome.
(Facchin, F., Margola, D., Molgora, S., & Revenson, T. A. (2013). Effects of Benefit‐Focused Versus Standard Expressive Writing on Adolescents’ Self‐Concept During the High School Transition. Journal of Research on Adolescence.)
2. Individuals With Wounds
This study divided a group of 49 healthy adults into two writing groups; an expressive writing group who were each asked to write about upsetting life events, and a group who were asked to write about the events of their day. Two weeks after this intervention, the adults underwent a 4-mm punch biopsy in the inner, upper arm, followed by 21 days of wound healing observation. The group who wrote about upsetting life events showed improved wound healing, with fully reepithelialized wounds found in 76% of participants, versus 42% in the Daily Events group.
(Koschwanez, H. E., Kerse, N., Darragh, M., Jarrett, P., Booth, R. J., & Broadbent, E. (2013). Expressive Writing and Wound Healing in Older Adults: A Randomized Controlled Trial. Psychosomatic medicine, 75(6), 581-590.)
3. Childhood Sexual Abuse Survivors
In this study, 70 women with a history of childhood sexual abuse participated in an expressive writing intervention. One group wrote about their trauma and the other group wrote about their sexual schema or sexual self-view. Both groups demonstrated improved depression and PTSD scores. However, the group that focused on the sexual schema were more likely to recover from sexual dysfunction.
(Meston, C. M., Lorenz, T. A., & Stephenson, K. R. (2013). Effects of expressive writing on sexual dysfunction, depression, and PTSD in women with a history of childhood sexual abuse: Results from a randomized clinical trial.The journal of sexual medicine, 10(9), 2177-2189.)
4. GLBT Victims of Hate Speech
This study focused on 46 individuals who identify as lesbian, gay or bisexual and were victims of hate speech. Divided into three groups, one group focused on benefit-finding, one group about the trauma itself, and a third group served as the control. The researchers found that a benefit-focused writing intervention was associated with forgiveness and lower cortisol levels. The group that focused on the trauma aspect demonstrated increased speed of cortisol recovery. From a linguistic analysis, writing with more emotional words was associated with accelerated cortisol recovery, while cognitive words were associated with a theme of forgiveness.
(Crowley, J. P. (2013). Expressive Writing to Cope with Hate Speech: Assessing Psychobiological Stress Recovery and Forgiveness Promotion for Lesbian, Gay, Bisexual, or Queer Victims of Hate Speech. Human Communication Research.)
5. Early Breast Cancer Survivors
This study looked at 120 women participants who were survivors of early breast cancer. The sample was divided into four groups: a control group, and three expressive writing groups, each focusing on one of three topics: breast cancer trauma, any self-selected trauma, and breast cancer facts. Those women who wrote about their breast cancer trauma or facts about breast cancer showed significantly improved quality-of-life outcomes, up to six months post-intervention.
(Craft M.A., Davis G.C. & Paulson R.mM. (2012) Expressive writing in early breast cancer survivors. Journal of Advanced Nursing69(2), 305–315. doi: 10.1111/j.1365-2648.2012.06008.x.)