Expression of negative and positive events through writing: Implications for psychotherapy and health

Previous researchers have found that subjects who wrote about traumatic experiences demonstrated improvements in physical health and have concluded that writing is a form of self-disclosure which helps to decrease inhibition and, thereby, improve health. Our experiment extended this research by examining whether writing about positive life events also affected physical health as well as psychological health and mood. Also investigated were the relationships between self-disclosure and inhibition and we examined how self-disclosure, inhibition and psychological distress differentially effected health outcomes. One hundred and fifty-six participants were randomly assigned to the Negative Feelings Group (NFG). Positive Feelings Group (PFG) and Control Group (CG) and wrote about negative. positive. and neutral life events respectively. No significant improvements in physical health were noted across all three groups. There were significant improvements in psychological health and decreases in psychological distress across all groups with the PFG showing the most improvement followed by the CG and the NFG. Significant increases in physical sensations and changes in mood were found for the NFG and PFG suggesting that writing about negative and positive topics is physically and emotionally arousing. Self-disclosure and inhibition were unrelated to changes in health. although inhibition alone positively correlated with health. Self-disclosure and inhibition were not related to each other and correlated differently with the experimental variables suggesting that they are separate constructs. Psychological distress was negatively related to health and less psychologically distressed participants showed greater changes in health following this intervention. Implications for physical and psychological health and psychotherapy are discussed. SUMMARY This experiment attempted to replicate and expand upon previous research by Pennebaker and colleagues which has demonstrated that writing about traumatic events can enhance health. Our study differed from Pennebaker's in its inclusion of writing about positive life events, in examining the separate contributions of self-disclosure versus inhibition, in more thoroughly examining mood and psychological health and in analyzing the role of psychological distress in health outcomes. Our research did not replicate Pennebaker's findings although did produce results which may clarify discrepancies between our studies, provide further avenues for research and expand upon current findings on physical and psychological health, life events and psychotherapy. First, unlike Pennebaker's studies, we did not find changes in short or long-term physical health following this intervention. While this may be related to inadequate measurement of symptoms and follow-up, it is also possible that this brief intervention by itself may not be powerful enough to induce changes in physical health. Given the contradictory findings with respect to physical health, longitudinal studies, more standardized measures and perhaps changes in this intervention may be helpful in ascertaining how and when this procedure effects physical health. Second, we found that this intervention did impact on measures which assessed for psychological health. However, given the pattern of results, it is more likely that these findings are reflective of changes in mood than actual changes in psychological health. The greatest increase in psychological health was among participants who wrote about positive events while those who wrote about negative events showed the least increase in psychological health. Such findings support the idea that this intervention may be more effective in temporarily altering mood than in changing actual psychological health. This finding is particularly relevant for psychotherapy research since this intervention has been recommended as a form of therapy. Its role in facilitating therapy or serving as an adjunct to the process should be recognized. While it appears helpful in working with salient memories which have both psychological and physical effects on the body, its questionable role in actually altering physical and psychological health should preclude its usage as a substitute for psychotherapy. Third, this experiment found that this intervention was particularly effective in inducing physical sensations in participants. These findings revealed that recalling and writing about negative and positive memories is highly associated with physiological reactions and sensations. Salient memories may, therefore, be accompanied by physical sensations and addressing such sensations may be an important component in the psychotherapy. These findings further suggest the need for additional research on the role that physical sensations may have in contributing to physical health and certain types of psychopathology as well as the therapeutic methods for addressing such sensations. Fourth, we were unable to replicate Pennebaker's findings on self-disclosure/inhibition and further demonstrated significant differences between self-disclosure and inhibition suggesting that these may be different constructs. Self-disclosure was not related to measures of physical or psychological health while inhibition showed significant relationships to many physical and psychological health variables including decreased physical health and increased psychological problems. It is possible for one to be actively inhibiting behaviors, thoughts and feelings yet display either high or low amounts of self-disclosure. Self-disclosure may be measuring an external act or behavioral response while inhibition may be tapping into dimensions of a personality style that relate to qualities of emotional expressiveness. Inhibition may be capturing a more pervasive personality style which has been linked, more consistently, to poorer health outcomes (Taylor, 1990) while self-disclosure may be measuring discrete acts which may vary in their effects and consequences. Discrepancies between studies may, therefore, be related to how this construct has been operationalized and measured. Future research may need to assess these constructs separately and consider the role of personality variables in measuring outcome. Fifth, participants who were less psychologically distressed showed more improvements in mood and psychological health following this intervention. This may be related to findings which suggest that this intervention is more effective in altering mood states yet less efficacious in significantly influencing long-term physical or psychological health. This type of intervention may be more effective with individuals who have less long-term, complicated problems and who are less psychologically distressed. Individuals with higher levels of psychological distress, and more complicated issues and conflicts, will likely require more intensive treatment and be aided less with this type of intervention. This experiment has found that this intervention is particularly effective for altering mood and physical sensations. These findings raise questions concerning the role that physical sensations play in contributing to psychopathology and physical health and the association between salient memories and physical arousal. In addition, future research should include how an intervention, such as a writing exercise, versus psychotherapeutic treatment, differentially affect an individual and how psychotherapy can effectively address the interplay of memories and physical sensations and work with associated physical and psychological health problems.