Pennebaker, J. W., & Chung, C. K. (in press). Expressive writing and its links to mental and physical health.

In H. S. Friedman (Ed.), Oxford handbook of health psychology. New York, NY: Oxford University Press. ExpressiveWriting:ConnectionstoPhysicalandMentalHealth JamesW.PennebakerandCindyK.Chung TheUniversityofTexasatAustin CorrespondenceshouldbeaddressedtoJamesW.Pennebaker,DepartmentofPsychology A8000,UniversityofTexas,Austin,TX78712(email:Pennebaker@mail.utexas.edu). PreparationofthispaperwasaidedbyfundingfromtheNationalInstitutesofHealth (MH52391),ArmyResearchInstitute(W91WAW07C0029),CIFA(H9c10407C0014), andSTART(Z934002).AnearlierversionofthispaperwaspublishedasPennebakerand Chung(2007).

ExpressiveWriting:ConnectionstoPhysicalandMentalHealth Thereisalonghistoryinpsychologyandmedicinelinkingtheoccurrenceof traumaticexperienceswithsubsequentphysicalandmentalhealthproblems.Whatisit aboutatraumathatinfluenceshealth?Severalcandidatesimmediatelycometomind. Psychologically,personalupheavalsprovokeintenseandlonglastingemotionalchanges. Theunexpectedeventsaregenerallyassociatedwithcognitivedisruptionincluding ruminationandattemptstounderstandwhathappenedandwhy.Socially,traumasare knowntocausewholesaledisruptionsinpeoplessocialnetworks.Dueinparttothesocial andpsychologicalchanges,traumasofteninfluencelifestylechangessuchasunhealthy smoking,drinking,exercise,sleeping,andeatingpatterns.Eachofthesepsychological, social,andbehavioraleffectsresultsinacascadeofbiologicalchangesincludingelevations incortisol,immunedisruption,cardiovascularchanges,andacascadeofneurotransmitter changes. Individualswhoarehighlyreactivetonovelstimuli(Vaidya&Garfield,2003), highlyanxious(Miller,2003),avoidant,andselfblaming(Sutker,Davis,Uddo,&Ditta, 1995),orhighinhypnoticability(Bower&Sivers,1998)maybeparticularlysusceptibleto traumaticexperiences.Similarly,themoreextremethetraumaandthelongertimeover whichitlastsarepredictorsofPostTraumaticStressDisorder(PTSD)incidence(e.g., Breslau,Chilcoat,Kessler,&Davis,1999).Itisalsogenerallyagreedthatpeoplemostprone toPTSDhavehadahistoryofdepression,trauma,andotherPTSDepisodesinthepast evenpriortotheirmostrecenttraumaticexperience(Cabrera,Hoge,Bliese,Castro,& Messer,2007;2007;Miller,2003). Acursoryreadingoftheliteraturemightleadmanysmartpeopletoassumethat mentalandhealthproblemsarestandardresponsestoalllargetraumas.Surprisingly,the oppositeistrue:Mostpeopledealwithtraumaticexperiencesquitewellwithnomajor changesintheirmentalorphysicalhealth.Inaclassicarticle,WortmanandSilver(1989) summarizedalargenumberofstudiesindicatingthatatleasthalfofpeoplewhohavefaced thedeathofaspouseorchilddidnotexperienceintenseanxiety,depression,orgrief. Numerousstudiesreportthatatleast65percentofmaleandfemalesoldierswhohave livedthroughhorrificbattlesorwarzonestressnevershowanyevidenceofPTSD(Keane, 1998;Murray,1992).Multiplestudieswithindividualswhohavesurvivedmajormotor vehicleaccidents(Brom,Kleber,&Hofman,1993)orwitnessedtragicairplaneaccidents (Carlier&Gersons,1997)findthatthemajoritydidnotexperiencedepressionorPTSDin theweeksormonthsaftertheirexperiences.Acrossstudies,4080percentofrape survivorsdidnotevidencesymptomsofPTSD(Kilpatrick,Resnick,Saunders,&Best,1998; Resnick,Kilpatrick,&Lipovsky,1991). Whyisitthatsomepeopleseemtodealwithmajorupheavalsbetterthanothers? Whatistheprofileofhealthycoping?This,ofcourse,isacentralquestionamongtrauma researchers.Weknow,forexample,thatpeoplewithanintactsocialsupportgroup weatherupheavalsbetterthanothers(e.g.,Murray,1992).Beyondbasicgenetic predispositions,dosomepeopleadoptcertaincopingstrategiesthatallowthemtomove pastanupheavalmoreefficiently?Ifsuchcopingstrategiesexist,cantheybetrained?If suchtechniquesareavailable,howdotheywork? Giventhatasmanyas30%ofpeoplewhofacemassivetraumaticexperienceswill experiencePTSD,whatcanwe,asresearchersandclinicians,dotoreducethisrate?Itis likelythatmany(perhapsmost)PTSDproneindividualswillnotbenefitfromanysimple

interventions.Thenatureoftheirtrauma,theirgenetic,biological,and/orpersonality predispositions,orpretraumalifeexperienceswilloverridesocialorpsychological therapies.Nevertheless,somePTSDproneindividualsaswellasthemajorityofdistressed butsubclinicalcasesmaybenefitbyfocusingontheirpsychologicalandsocialworldsin thewakeoftheirtraumaticexperiences. Acentralpremiseofthischapteristhatwhenpeopletransformtheirfeelingsand thoughtsaboutpersonallyupsettingexperiencesintolanguage,theirphysicalandmental healthoftenimprove.ThelinkstoPTSDarestilltenuous.However,anincreasingnumber ofstudiesindicatethathavingpeoplewriteaboutemotionalupheavalscanresultin healthyimprovementsinsocial,psychological,behavioral,andbiologicalfunctioning.As withthetraumaillnesslink,however,thereisprobablynotasinglemediatorthatcan explainthepowerofwriting.Onepromisingcandidatethatisproposedconcernsthe effectsoftranslatingemotionsintolanguageformat,oraswesuggest,ametaphorical translationofananalogexperienceintoadigitalone. EmotionalUpheavals,Disclosure,andHealth Notalltraumaticeventsareequallytoxic.Bythe1960s,HolmesandRahe(1967) suggestedthatthehealthimpactofatraumavariedwiththedegreethatthetrauma disruptedapersonslife.Interestingly,theoriginalscalestappingthehealthrisksof traumasgenerallymeasuredsociallyacceptabletraumasdeathofspouse,lossofjob.No itemsaskediftheparticipanthadbeenraped,hadasexualaffair,orhadcausedthedeath ofanother.Bythemid1980s,investigatorsstartedtonoticethatupheavalsthatwerekept secretweremorelikelytoresultinhealthproblemsthanthosethatcouldbespokenabout moreopenly.Forexample,individualswhowerevictimsofviolenceandwhohadkeptthis experiencesilentweresignificantlymorelikelytohaveadversehealtheffectsthanthose whoopenlytalkedwithothers(Pennebaker&Susman,1988).Inshort,havinganytypeof traumaticexperienceisassociatedwithelevatedillnessrates;havinganytraumaandnot talkingaboutitfurtherelevatestherisk.Theseeffectsactuallyarestrongerwhen controllingforage,sex,andsocialsupport.Apparently,keepingatraumasecretfroman intactsocialnetworkismoreunhealthythannothavingasocialnetworktobeginwith(cf., Cole,Kemeny,Taylor,&Visscher,1996). Ifkeepingapowerfulsecretaboutanupsettingexperienceisunhealthy,cantalking aboutitorinsomeway,puttingitintowordsbebeneficial?Thisisaquestionweasked overtwodecadesago.Goingontheuntestedassumptionthatmostpeoplewouldhavehad atleastoneemotionalupheavalthattheyhadnotdisclosedingreatdetail,webegana seriesofstudiesthatinvolvedpeoplewritingand,insomecases,talkingaboutthese events. Inthefirststudy,peoplewererandomlyassignedtowriteaboutatraumaorabout superficialtopicsforfourdays,15minutesperday.Wefoundthatconfrontingthe emotionsandthoughtssurroundingdeeplypersonalissuespromotedphysicalhealth,as measuredbyreductionsinphysicianvisitsinthemonthsfollowingthestudy,fewerreports ofaspirinusage,andoverallmorepositivelongtermevaluationsoftheeffectofthe experiment(Pennebaker&Beall,1986).Theresultsofthatinitialstudyhaveledtoa numberofsimilardisclosurestudies,inourlaboratoryandbyothers,withawidearrayof intriguingresults. Thebasicwritingparadigm.Thestandardlaboratorywritingtechniquehasinvolved randomlyassigningparticipantstooneoftwoormoregroups.Mostwritinggroupsare

askedtowriteaboutassignedtopicsforonetofiveconsecutivedays,for15to30minutes eachday.Writingisgenerallydoneinthelaboratorywithnofeedbackgiven.Those assignedtothecontrolconditionsaretypicallyaskedtowriteaboutsuperficialtopics,such ashowtheyusetheirtime.Thestandardinstructionsforthoseassignedtothe experimentalgroupareavariationonthefollowing: Forthenextthreedays,Iwouldlikeforyoutowriteaboutyourverydeepest thoughtsandfeelingaboutthemosttraumaticexperienceofyourentirelife. Inyourwriting,I'dlikeyoutoreallyletgoandexploreyourverydeepest emotionsandthoughts.Youmighttiethistraumatoyourchildhood,your relationshipswithothers,includingparents,lovers,friends,orrelatives.You mayalsolinkthiseventtoyourpast,yourpresent,oryourfuture,ortowho youhavebeen,whoyouwouldliketobe,orwhoyouarenow.Youmaywrite aboutthesamegeneralissuesorexperiencesonalldaysofwritingoron differenttopicseachday.Noteveryonehashadasingletraumabutallofus havehadmajorconflictsorstressorsandyoucanwriteabouttheseaswell. Allofyourwritingwillbecompletelyconfidential.Don'tworryaboutspelling, sentencestructure,orgrammar.Theonlyruleisthatonceyoubeginwriting, continuetodosountilyourtimeisup. Whereastheoriginalwritingstudiesaskedpeopletowriteabouttraumatic experiences,laterstudiesexpandedthescopeofwritingtopicstogeneralemotionalevents ortospecificexperiencessharedbyotherparticipants(e.g.,diagnosisofcancer,losinga job,comingtocollege).Theamountoftimepeoplehavebeenaskedtowritehasalsovaried tremendouslyfrom10minutesto30minutesfor3,4,or5dayssometimeswithinthe samedaytoonceperweekforupto4weeks. Thewritingparadigmisquitepowerful.Participantsfromchildrentotheelderly, fromhonorstudentstomaximumsecurityprisonersdisclosearemarkablerangeand depthofhumanexperiences.Lostloves,deaths,sexualandphysicalabuseincidents,and tragicfailuresarecommonthemesinallofourstudies.Ifnothingelse,theparadigm demonstratesthatwhenindividualsaregiventheopportunitytodisclosedeeplypersonal aspectsoftheirlives,theyreadilydoso.Eventhoughalargenumberofparticipantsreport cryingorbeingdeeplyupsetbytheexperience,theoverwhelmingmajorityreportthatthe writingexperiencewasvaluableandmeaningfulintheirlives. Theinterestintheexpressivewritingmethodhasgrownovertheyears.Thefirst studywaspublishedin1986.By1996,approximately20studieshadbeenpublished.By 2009,over200havebeenpublishedinEnglishlanguagejournals.Althoughmanystudies haveexaminedphysicalhealthandbiologicaloutcomes,anincreasingnumberhave exploredwritingseffectsonattitudechange,stereotyping,creativity,workingmemory, motivation,lifesatisfaction,schoolperformance,andavarietyofhealthrelatedbehaviors. Itisbeyondthescopeofthischaptertoprovideadetailedreviewofthefindingsofthe writingparadigm.Rather,webrieflysummarizesomeofthemorepromisingfindings beforefocusingontheunderlyingmechanismsthatmaybeatwork. Effectsofdisclosureonhealthrelatedoutcomes.Researchershavereliedona varietyofphysicalandmentalhealthmeasurestoevaluatetheeffectofwriting.Writingor talkingaboutemotionalexperiencesrelativetowritingaboutsuperficialcontroltopicshas beenfoundtobeassociatedwithsignificantdropsinphysicianvisitsfrombeforetoafter writingamongrelativelyhealthysamples.Overthelastdecade,asthenumberof

expressivewritingstudieshasincreased,severalmetaanalyseseitherhavebeen conductedorarebeingconductedasofthiswriting. TheoriginalexpressivewritingmetaanalysiswaspublishedbyJoshuaSmyth (1998)aswasbasedon14studiesusinghealthyparticipants.Hisprimaryconclusions werethatthewritingparadigmisassociatedwithpositiveoutcomeswithaweightedmean effectsizeofd=.47(r=.23,p<.0001),notingthatthiseffectsizeissimilartoorlargerthan thoseproducedbyotherpsychologicalinterventions.Thehighestsignificanteffectsizes wereforpsychological(d=.66)andphysiologicaloutcomes(d=.68),whichweregreater thanthoseforhealth(d=.42)andgeneralfunctioningoutcomes(d=.33).Anonsignificant effectsizewasfoundforhealthbehaviors.Healsofoundthatlongerintervalsbetween writingsessionsproducedlargeroveralleffectsizes,andthatmalesbenefitedmorefrom writingthandidfemales. Frisina,Borod,andLepore(2004)performedasimilarmetaanalysison9writings studiesusingclinicalpopulations.Theyfoundthatexpressivewritingsignificantly improvedhealthoutcomes(d=.19,p<.05).However,theeffectwasstrongerforphysical (d=.21,p=.01)thanforpsychological(d=.07,p=.17)healthoutcomes.Theauthors suggestedthatapossiblereasonforthesesmalleffectsizeswereduetotheheterogeneity ofthesamples.Writingwaslesseffectiveforpsychiatricthanphysicalillnesspopulations. Almostsevenyearsafterthefirstmetaanalysis(Smyth,1998)waspublished,another metaanalysisbyMeads(2003)wasreleasedbytheCochranCommission.Inananalysisof dozensofstudies,theauthorconcludedthattherewasnotsufficientevidencetowarrant adoptingthewritingmethodaspartofclinicalpractice.Oneproblemthatthereport underscoredwasthelackofanylargerandomizedclinicaltrials(RCTs)thatwerebasedon large,clearlyidentifiedsamples.Comingfromamedicalbackground,theMeadsarticlewas befuddledbythefactthatmostoftheexperimentalstudiesofexpressivewritingwere moretheoryorientedandnotaimedatclinicalapplication.SincethereleaseoftheMeads paper,anewwaveofRCTshadstartedwithadiversegroupofpatientpopulations. Harris(2006)recentlyreportedonametaanalysisofRCTsusingexpressive writing.Harriscomparedtheuseofhealthcareservicesin30independentsampleswho hadparticipatedinexpressivewritingaboutstressfulexperiences.Usingarandomeffects approach,hefoundeffectsizes(Hedgessg)of.16(.02,.31)forhealthysamples,.21(.02, .43)forsampleswithpreexistingmedicalconditions,and.06(.12,.24)forsampleswho hadbeenprescreenedforpsychologicalcriteria.Heconcludedthatexpressivewritingonly hadaneffectforhealthysamples.TheseresultsweresimilartothosefoundinMeads (2003)metaanalysis,butwiththeHarris(2006)studyhavingmorepowertodetectsuch effects.Harrisdefendedthefindingsaspotentiallysignificanttothehealthcareofhealthy samples,andtothehealthcaresystemitself.Inaddition,hestatedthatthefindingspointed towardstheneedtoidentifypeoplewithmedicalandpsychologicalconditionsforwhom expressivewritingmightbecontraindicated,aswellasanassessmentofpreexistingover orunderuseofhealthcareservicesinordertobetterinterprettheresults. Finally,Frattaroli(2006)publishedthelargestmetaanalysisontheeffectsof expressivewriting.Hermetaanalysisincludedallrandomizedexpressivewriting experimentsthathadusedsomevariationoftheoriginalPennebakerandBeall(1986) writinginstructions,alongwiththepresentationofoutcomedata.Usingarandomeffects approach,shefoundanoveralleffectsizeofd=.15(equivalenttoanr=.075),whichshe notedwasmeaningfulgiventhathermetaanalysishadincludedunpublishedstudies

(whichtendtocontributetomuchloweraverageeffectsizes)andamethodologically heterogeneoussetofstudies.Shealsonotedthattheeffectsizewasimportantgiventhat expressivewritingistimeandcosteffective,perceivedbyparticipantstohelpful,andeasy toadminister. Researchershavereliedonavarietyofphysicalandmentalhealthmeasuresto evaluatetheeffectofwriting.Acrossmultiplestudiesinlaboratoriesaroundtheworld, writingortalkingaboutemotionalexperiencesrelativetowritingaboutsuperficialcontrol topicshasbeenfoundtobeassociatedwithsignificantdropsinphysicianvisitsfrombefore toafterwritingamongrelativelyhealthysamples.Writingand/ortalkingaboutemotional topicshasalsobeenfoundtoinfluenceimmunefunctioninbeneficialways,includingt helpercellgrowth(usingablastogenesisprocedurewiththemitogenPHA),antibody responsetoEpsteinBarrvirus,andantibodyresponsetohepatitisBvaccinations(for reviews,seeLepore&Smyth,2002;Pennebaker&Graybeal,2001;Sloan&Marx,2004a). Activityoftheautonomicnervoussystemisalsoinfluencedbythedisclosure paradigm.Amongthoseparticipantswhodisclosetheirthoughtsandemotionstoa particularlyhighdegree,skinconductancelevelsaresignificantlylowerduringthetrauma disclosuresthanwhendescribingsuperficialtopics.Systolicbloodpressureandheartrate dropstolevelsbelowbaselinefollowingthedisclosureoftraumatictopicsbutnot superficialones(Pennebaker,Hughes,&OHeeron,1987).Inshort,whenindividualstalk orwriteaboutdeeplypersonaltopics,theirimmediatebiologicalresponsesarecongruent withthoseseenamongpeopleattemptingtorelax.McGuire,Greenberg,andGevirtz(2005) haveshownthattheseeffectscancarryovertothelongterminparticipantswithelevated bloodpressure.Onemonthafterwriting,thosewhoparticipatedintheemotional disclosureconditionexhibitedlowersystolicanddiastolicbloodpressure(DBP)than beforewriting.Fourmonthsafterwriting,DBPremainedlowerthanbaselinelevels. Similarly,SloanandMarx(2004b)foundthatparticipantsinadisclosurecondition exhibitedgreaterphysiologicalactivation,asindexedbyelevatedcortisollevels,during theirfirstwritingsession,relativetocontrols.Physiologicalactivationthendecreased,and wassimilartothatofcontrolsinsubsequentwritingsessions.Theinitialelevationin cortisolfromthefirstwritingsessionpredictedimprovedpsychologicalbutnotphysical healthatonemonthfollowup.Itispossiblethatconfrontingatraumaticordistressing experienceledtoreactionsaimedforinexposurebasedtreatments(e.g.Foa&Kozak, 1986).Biologicalsupportforexposureeffectsofexpressivewritingwasfoundinanother studythatlookedatindividualsdiagnosedwithPTSD.Althoughexpressivewritingdidnot leadtodecreasesinPTSDrelatedsymptomseverity,Smyth,Hockemeyer,andTulloch (2008)founddecreasesincortisollevelsduringtraumarelatedimaginalexposure3 monthsfollowingexpressivewriting,alongwithdecreasesinnegativemoodstates,and increasesinposttraumaticgrowth(i.e.hopeforthefuture,personalstrength,and appreciationforlife). Behavioralchangeshavealsobeenfound.Studentswhowriteaboutemotional topicsevidenceimprovementsingradesinthemonthsfollowingthestudy(e.g.,Lumley& Provenzano,2003;Pennebaker,Colder,&Sharp,1990).Seniorprofessionalswhohave beenlaidofffromtheirjobsgetnewjobsmorequicklyafterwriting(Spera,Buhrfeind& Pennebaker,1994).Consistentwiththedirecthealthmeasures,universitystaffmembers whowriteaboutemotionaltopicsaresubsequentlyabsentfromtheirworkatlowerrates thancontrols(Francis&Pennebaker,1992).Interestingly,relativelyfewreliablechanges

emergeusingselfreportsofhealthrelatedbehaviors.Thatis,intheweeksafterwriting, experimentalparticipantsdonotexercisemoreorsmokeless.Theoneexceptionisthatthe studywithlaidoffprofessionalsfoundthatwritingreducedselfreportedalcoholintake. Selfreportsalsosuggestthatwritingaboutupsettingexperiences,althoughpainful inthedaysofwriting,produceslongtermimprovementsinmoodandindicatorsofwell beingcomparedtocontrols.Althoughsomestudieshavefailedtofindclearmoodorself reporteddistresseffects,Smyths(1998)metaanalysisonwrittendisclosurestudies indicatesthat,ingeneral,writingaboutemotionaltopicsisassociatedwithsignificant reductionsindistress. Proceduraldifferencesthataffecttheexpressivewriting.Writingaboutemotional experiencesclearlyinfluencesmeasuresofphysicalandmentalhealth.Inrecentyears, severalinvestigatorshaveattemptedtodefinetheboundaryconditionsofthedisclosure effect.Someofthemostimportantfindingsareasfollows: Topicofdisclosure.Althoughtwostudieshavefoundthathealtheffectsonlyoccur amongindividualswhowriteaboutparticularlytraumaticexperiences(Greenberg&Stone, 1992;Lutgendorf,Antoni,Kumar,&Schneiderman,1994),moststudieshavefoundthat disclosureismorebroadlybeneficial.Choiceoftopic,however,mayselectivelyinfluence outcomes.Althoughvirtuallyallstudiesfindthatwritingaboutemotionaltopicshas positiveeffectsonphysicalhealth,onlycertainassignedtopicsappeartoberelatedto changesingrades.Forbeginningcollegestudents,forexample,whenaskedtowrite specificallyaboutemotionalissuesrelatedtocomingtocollege,bothhealthandcollege gradesimprove.However,whenotherstudentsareaskedtowriteaboutemotionalissues relatedtotraumaticexperiencesingeneral,onlyhealthimprovementsandnotacademic performancearefound(seePennebaker,1995;Pennebaker&Keough,1999). Overthelastdecade,anincreasingnumberofstudieshaveexperimentedwithmore focusedwritingtopics.Individualsdiagnosedwithbreastcancer,lungcancer,orHIV,have beenaskedtowritespecificallyabouttheirlivingwiththeparticulardisease(e.g.,deMoor, etal,2002;Mann,2001;Petrie,etal.,2004;Stanton&DanoffBurg,2002).Similarly,people whohavelosttheirjobhavebeenaskedtowriteaboutthatexperience(Speraetal.,1994). Ineachcase,however,participantsareaskedtowriteaboutthistopicinaverybroadway andareencouragedtowriteaboutothertopicsthatmaybeonlyremotelyrelated.For example,inthejoblayoffproject,participantsintheexperimentalconditionswereaskedto exploretheirthoughtsandfeelingaboutlosingtheirjobs.Fewerthanhalfoftheessays dealtdirectlywiththelayoff.Othersdealtwithmaritalproblems,issueswithchildren, money,andhealth. Ithasbeenourexperiencethattraumaticexperiencesoftenbringtotheforeother importantissuesinpeopleslives.Asresearchers,weassumethat,say,thediagnosisofa lifethreateningdiseaseisthemostimportantissueforapersontowriteaboutinacancer relatedstudy.However,formany,thiscanbesecondarytoacheatinghusband,anabusive parent,orsomeothertraumathatmayhaveoccurredyearsearlier.Werecommendthat writingresearchersandpractitionersprovidesufficientlyopeninstructionstoallowpeople todealwithwhateverimportanttopicstheywanttowriteabout.Asdescribedingreater detailbelow,themorethatthetopicorwritingassignmentisconstrained,theless successfulitusuallyis. Topicorientation:focusingonthegood,thebad,orthebenefits.Thereareanumber oftheoreticalandpracticalreasonstoassumethatsomestrategiesforapproaching

emotionalupheavalsmightbebetterthanothers.WiththegrowthofthefieldofPositive Psychology,severalresearchershavereportedonthebenefitsofhavingapositiveor optimisticapproachtolife(Carver&Scheier,2002;Diener,Lucas,&Oishi,2002;Seligman, 2000).Particularlypersuasivehavebeenaseriesofcorrelationalstudiesonbenefitfinding thatis,peoplewhoareabletofindbenefitstonegativeexperiencesgenerallyreportless negativeaffect,milderdistress,fewerdisruptivethoughts,andgreatermeaningfulnessin life.Peoplewhoengageinbenefitfindingfarebetteronobjectivephysicalandmental healthoutcomes(e.g.childrensdevelopmentaltestscores,recurrenceofheartattacks) evenaftercontrollingforahostofpossibleconfoundingfactors(forareview,seeAffleck andTennen,1996).Beingabletoseethingsinapositivelight,then,mightbeacritical componenttosuccessfuladjustment. Inonestudyexaminingadjustmenttocollege,CameronandNicholls(1998)had participantspreviouslyclassifiedasdispositionaloptimistsorpessimistswriteinoneof threeconditions:aselfregulationcondition(writingaboutthoughtsandfeelingstowards comingtocollegeandthenformulatingcopingstrategies),adisclosurecondition(writing aboutthoughtsandfeelingsonly),oracontroltask(writingabouttrivialtopics).Overall, participantsinthedisclosuretaskhadhigherGPAscoresatfollowup,butonlythoseinthe selfregulationtaskexperiencedlessnegativeaffectandbetteradjustmenttocollegeover thecontrolparticipants.Optimistsvisitedtheirdoctorslessinthefollowingmonthifthey hadparticipatedineitheroftheexperimentalwritingconditions.Ontheotherhand,only pessimistsintheselfregulationconditionhadsignificantlyfewervisitstothedoctorafter thestudy.Withtheaddedencouragementofformulatingcopingstrategies,pessimistsmay beabletoreapthesamehealthbenefitsfromwritingabouttheirthoughtsandfeelingsas optimistsnaturallymightdo. Whenconfrontingtraumaticexperiences,isitbesttoaskpeopletosimplywrite aboutthemortowriteaboutthepositivesidesoftheexperiences?Severalstudieshave addressedthisquestion.ParticularlyinterestinghasbeenaseriesofstudiesbyLauraKing andhercolleagues.Whenaskedtowriteaboutintenselypositiveexperiences(IPE)or controltopics,participantswhowroteaboutIPEsreportedsignificantlybettermood,and fewerillnessrelatedhealthcentervisitsthandidthosewhowroteabouttrivialtopics (Burton&King,2004).Inanotherstudy,studentswereaskedtowriteabouttraumasinthe standardway(King&Miner,2000).Inthebenefitfindingcondition,participantswere encouragedtofocusonthebenefitsthathavecomefromthetrauma.Finally,inthemixed condition,participantswerefirstaskedtowriteaboutthetrauma,andthentoswitchtothe perceivedbenefitsarisingfromthetraumaexperience.Countertopredictions,thetrauma onlyandbenefitsonlyparticipantsevidencedhealthimprovementswhereasthemixed groupdidnot.Itcouldbethatwritingabouttheperceivedbenefitsisenoughtoorganize thoughtsandfeelingsaboutatrauma,andtocopeeffectively.However,asevidencedfrom themixedcondition,ifpeoplearentabletointegratetheirperceivedbenefitsintotheir traumastoryintheirownway,writingmaybeineffective. Otherstudiessuggestthatfocusingonpositiveemotionsinwritingmayhavemixed effects.Withasampleofbreastcancerpatients,Stantonandcolleagues(2002)foundthata traditionalwritinggroupexhibitedslightlymorehealthimprovementsthantheirpositive feelingsonlywritinggroup.Morerecently,Lyubomirsky,Sousa,andDickerhoof(2006) conductedaningeniousseriesofstudieswhereinstudentswroteabouteithertheirbestor worstlifeexperiences.Further,somestudentswereaskedtoeitherreplaytheeventsin

theirmindwhereasotherswereaskedtoanalyzethemindetail.Theanalysisofnegative eventsresultedinbetterhealthandlifesatisfactionwhereastheanalysisofpositive experiencesresultedinslightlyworsehealthandsatisfaction.Similarly,Ullrichand Lutgendorf(2002)foundthatparticipantswhowereinstructedtowriteaboutthe cognitiveandemotionalaspectsofatraumafaredbetterthanthosewhowereinstructedto focusonlyonemotionalaspects. Severalunpublishedstudiesfromourownlabpaintasimilarpictureaboutthe problemsofconstrainingparticipantsorientations.Forherdissertation,CherylHughes (1994)askedstudentstowriteeitheraboutthepositiveorthenegativeaspectsoftheir comingtocollegefor3days.Neithergroupevidencedanybenefitsofwritingcomparedto anonemotionalcontrolcondition.Indeed,bothgroupscomplainedthatthereweresome realnegative(inthepositivecondition)andpositive(inthenegativecondition)aspectsof comingtocollegethattheyalsowantedtowriteabout.Similarly,inanunpublishedproject byLoriStone(2002),studentswereaskedtowriteabouttheirthoughtsandfeelingsabout theSeptember11attacks.Inonecondition,theyreceivedthestandardunconstrained instructions.Inasecondcondition,participantswereaskedtofocusontheirownfeelings ononedayandonotherperspectivesonalternatingdays.Theperspectiveswitching instructionsprovedtobelessbeneficialthantheunconstrainedmethods. Althoughseveralvariationsontheexpressivewritingmethodhavebeentested, nonehavebeenfoundtobeconsistentlysuperiortotheoriginaltraumawritingorother methodsthatencouragetheparticipantsfreelychoosingtheirwritingtopic.Forcing individualstowriteaboutaparticulartopicorinaparticularwaymaycausethemtofocus onthewritingitselfratherthanthetopicandtheroleoftheiremotionsintheoverallstory. Writingversustalkingaloneversustalkingtoothers.Moststudiescomparingwriting alonetotalkingeitherintoataperecorder(Esterling,etal.,1994)ortoatherapistinaone wayinteraction(Murray,Lamnin,&Carver,1989;Donnelly&Murray,1991)find comparablebiological,mood,andcognitiveeffects.Talkingandwritingaboutemotional experiencesarebothsuperiortowritingaboutsuperficialtopics. AstrikingexceptiontothiswasastudybyGidron, Peri, Connolly, and Shalev (1996) where a group of 14 Israeli PTSD patients were randomly assigned to either write about traumas (N = 8) or about superficial topics (N = 6) on three occasions. After writing, experimental participants were asked to discuss their most traumatic events to a group whereas controls were asked to describe a daily routine. Unlike all other published writing studies, this one found that experimental participants were significantly more distressed with poorer health at 5-week followup. Because other studies have been conducted with participants coping with PTSD, the findings are not solely due to the nature of the participants or disorder. Rather, reading or discussing ones traumas in a group format after writing may pose unexpected problems. Clearly, additional research is needed to help understand this process. Actualorimpliedsocialfactors.Indeed,unlikepsychotherapyandeveryday discussionsabouttraumas,thewritingparadigmdoesnotemployfeedbacktothe participant.Rather,afterindividualswriteabouttheirownexperiences,theyareaskedto placetheiressaysintoananonymouslookingboxwiththepromisethattheirwritingwill notbelinkedtotheirname.Inonestudycomparingtheeffectsofhavingstudentseither writeonpaperthatwouldbehandedintotheexperimenteroronamagicpad(wherein thewritingdisappearswhenthepersonliftstheplasticwritingcover),noautonomicor selfreportdifferenceswerefound(Czajka,1987).Thebenefitsofwriting,then,occur

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withoutexplicitsocialfeedback.Nevertheless,thedegreetowhichpeoplewriteholdingthe beliefthatsomesymbolicotherpersonmaymagicallyreadtheiressayscanneverbe easilydetermined. Severalstudieshaveshownthatselfdisclosurethroughbloggingcanincrease perceivedsocialsupport(Baker&Moore,2008),subjectivewellbeing(Ko&Kuo,inpress), andsuccessinweightloss(Chung&Pennebaker,2009),primarilythroughreceivingand sendingcommentsonablogorwithinablogcommunity.However,bloggingisavery differententerprisethansolitaryexpressivewriting.Notonlydopeoplesharetheirentries withothersbuttheyclearlyseekfeedbackfromothers.Blogging,then,isasocialprocess perhapsmorethanitisaselfreflective,andinsightseekingorinsightprovokingself changestrategy.Ontheotherhand,expressivewritingprovidesbenefitstothewriters themselves,withlaterimprovementsinsocialrelationshipsasoneofmanypotential indirecteffects. Timing:Howlongafteratrauma.Inthelast30years,advancesinemergency medicinehavebeenastounding.Althoughweknowhowtotreatpeoplemedicallyinthe firsthoursanddaysafteratrauma,ourknowledgeaboutpsychologicalinterventions duringthesametimeperiodhasgrownverylittle.Withouttheguidanceofanyresearch, severalgroupshavecreatedimmediatecrisisinterventionbusinesses.Perhapsthemost commerciallysuccessful,nowcalledCriticalIncidentStressManagement(CISM,e.g., Mitchell&Everly,1996),arguesthatpeoplevictimizedbytraumashouldbeattendedto withinthefirst72hoursafteratrauma.AlthoughtheCISMsystemhasmanycomponents, themostinterestingandcontroversialencouragesindividualstoopenlyacknowledgetheir emotionsandthoughtswithinagroupconcerningthetrauma.TheCISMsystemhasnow beenadoptedbythousandsofbusinesses,governmentalorganizations,andothergroups aroundtheworld.DespitetheintuitiveappealofCISM,thereisverylittleevidencethatit works.Indeed,moststudiessuggestthatitismorelikelytocauseharmthanbenefits (McNally,Byrant,&Ehlers,2003). TheCISMfindingsaswellasotherprojectsinterestedinselfdisclosureimmediately afteranupheavalhaverelevanceforthetimingforanexpressivewritingintervention.For example,onestudyaskedwomenwhohadrecentlygivenbirthtotalkabouttheirdeepest thoughts,feelings,andfearstotheirmidwives.Thesewomenwereactuallymorelikelyto subsequentlyexperiencedepressionthanwomennotaskedtotalkaboutthesetopics (Small,Lumley,Donohue,Potter,&Waldenstrom,2000).Womenwhowereaskedtowrite aboutthetreatmenttheywereundergoingforbreastcancerduringthelastweekof radiationtreatmentevidencednobenefitsforanymeasurescomparedtocontrols(Walker, Nail,&Croyle,1999). Isthereanoptimaltimeafteratraumathatexpressivewritingwouldmostlikely work?Unfortunately,noparametricstudieshavebeenconductedonthis.Overtheyears, wehavebeeninvolvedinseveralprojectsthathaveattemptedtotappeoplesnatural disclosurepatternsinthedaysandweeksafterupheavals.Forexample,usingarandom digitdialingintheweeksandmonthsafterthe1989LomaPrietaEarthquakeintheSan FranciscoBayarea,weaskeddifferentgroupsofpeoplethenumberoftimesthattheyhad thoughtaboutandtalkedabouttheearthquakeintheprevious24hours.Weusedasimilar methodayearlatertotappeoplesresponsestothedeclarationofwarwithIraqduringthe firstPersianGulfWar.Inbothcases,wefoundthatpeopletalkedwithoneanotheratvery highratesinthefirst23weeks.Bythe4thweek,however,talkingrateswereextremely

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low.Ratesofthinkingabouttheearthquakeandwarshowedadifferentpattern:ittook considerablylonger(about8weeks)beforepeoplereportedthinkingaboutthematlow rates(fromPennebaker&Harber,1993). Morerecently,wehaveanalyzedtheblogsofalmost1100frequentusersofan internetsiteinthetwomonthsbeforeandtwomonthsaftertheSeptember11attacks. Ratesofwritingincreaseddramaticallyforabouttwoweeksaftertheattacks.Morestriking wastheanalysisofwordusage.Useof1stpersonsingular(I,me,andmy),droppedalmost 15%within24hoursoftheattacksandremainedlowforaboutaweek.However,overthe nexttwomonths,Iwordusageremainedbelowbaseline(Cohn,Mehl,&Pennebaker, 2004).Usageof1stpersonsingularissignificantbecauseitcorrelateswithdepression (Rude,Gortner,&Pennebaker,2004).Whatwasstrikingwasthatthesebloggerswho expressedanelevatedrateofnegativemoodsinthedaysafter9/11weregenerallyquite healthy.Theywerepsychologicallydistancingthemselvesfromtheemotionalturmoilof theevent. Consideringthecurrentevidence,itislikelythatdefensessuchasdenial, detachment,distraction,anddistancingmay,infact,bequitehealthyinthehoursanddays afteranupheaval.Atechniquesuchasexpressivewritingmaybeinappropriateuntil severalweeksormonthslater.Indeed,wenowencourageclinicianstodelaytheiruseof expressivewritinguntilatleast12monthsafteranupheavaloruntiltheythinktheir patientisthinkingtoomuchabouttheevent.Obsessingandruminatingaboutatraumaa fewweeksafterithasoccurredisprobablynottoomuch.Thinkingaboutitatthesame highratesixmonthslatermightinfactsignalthatexpressivewritingmightbebeneficial. Timingofwritingsessions.AlthoughSmyths(1988)metaanalysisfoundnoeffect forthelengthofwritingsessions,Frattarolis(2006)metaanalysissuggestedthatwriting sessionsgreaterthan15minutesweremorepotentthanwritingsessionslessthan15 minutes.Recently,inanadmirablybrazentestofthelowerboundaryofexpressive writingseffectiveness,BurtonandKing(2008)had49healthyparticipantswriteabouta negativeevent,apositiveevent,oracontroltopicforjust2minutesadayfor2consecutive days(foragrandtotalof4minutes).Bothoftheexpressive(negativeeventandpositive event)writinggroupsreportedexperiencingfewerphysicalsymptomsat46weeks followupthandidcontrols.Theauthorssuggestedthatperhapsthe2minutesisallthat wasneededinordertokickstarttheprocessingofemotionalevents.Indeed,itwaslikely thatthe2minutewritingsessionleftparticipantswithunfinishedbusiness,suggesting thatthetimebetweenwritingsessionswasspentprocessingthewritingtopic. Timingbetweenwritingsessions.Differentexperimentshavevariouslyasked participantstowriteforonetofivedays,rangingfromconsecutivedaystosessions separatedbyaweek,rangingfrom10to45minutesforeachwritingsession,foranywhere from1to7sessions.InSmyths(1998)metaanalysis,hefoundatrendsuggestingthatthe moredaysoverwhichtheexperimenttakesplace,thestrongertheimpactonoutcomes. Twosubsequentstudiesthatactuallymanipulatedthetimesbetweenwritingfailedto supportSmythsfindings. The first, by Sheese, Brown, and Grazziano (2004), asked students to write either once per week for three weeks or for three continuous days about traumatic experiences or superficial topics. Although the experimental-control difference was significant for health center differences, no trend emerged concerning the relative benefits of once a week versus daily writing. More recently, the authors randomly assigned 100 students to write either about major

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life transitions or about superficial topics. Participants wrote three times, 15 minutes each time, either once a day for three days, once an hour for three hours, or three times in a little more than an hour (Chung & Pennebaker, 2008). Immediately after the last writing session and again at one month follow-up, no differences were found between the daily versus 3-times-in-one-hour condition. Indeed, at follow-up, the three experimental groups evidenced lower symptom reports (p = .05, one-tailed test) than the controls after controlling for the pre-writing symptom levels. Several later studies also support that benefits can accrue from short 10 to 15 minute breaks between expressive writing sessions (e.g. Baddeley & Pennebaker, 2009; Smyth et al., 2008). Time until follow-up. Another suspect for inconsistent or null results across writing studies is the varied duration between the final writing session and the follow-up assessment. Expressive writing outcomes have been measured up to about 6 months after the writing sessions are completed. While some psychological and physical health changes may be immediately apparent, they may be fleeting. On the other hand, some effects may take days, weeks, months, or even years to emerge as significant changes on various health measures, if at all. The timing of improvements may also vary as a function of sampling characteristics. In an expressive writing study examining those suffering from asthma or rheumatoid arthritis (RA), health benefits were seen in asthmatics in the experimental writing condition as early as 2 weeks after writing. However, the health profile of RAs in the experimental writing condition did not differ from those in the control condition until the 4-month assessment period (Smyth, Stone, Hurewitz, & Kaell, 1999). Considering all the other variants on the writing method already mentioned, it would be difficult to come up with some standard time for follow-up. Instead, knowing the general timecourse of proposed underlying mechanisms, and providing multiple convergent measures to validate specific outcomes may be a more practical approach in thinking about follow-up assessments. Individualdifferences.Noconsistentpersonalitymeasureshavedistinguishedwho doesversuswhodoesnotbenefitfromwriting.Anumberofvariableshavebeenunrelated tooutcomes,includingage,anxiety(orNegativeAffectivity),andinhibitionorconstraint.A smallnumberofstudiesthathaveeitherpreselectedparticipantsorperformedamedian splitonaparticularvariablehavereportedsomeeffects.However,giventhelargenumber ofstudies,theseeffectsshouldprobablybeviewedaspromisingratherthandefinitive. Christensenetal.(1996)preselectedstudentsonhostilityandfoundthatthosehigh inhostilitybenefitedmorefromwritingthanthoselowinhostility.Acouplestudieshave foundthatindividualshighonalexithymia(atraitthattapstheinabilityofpeopletolabel orfeelparticularnegativeemotions)tendedtobenefitfromwritingmorethanthoselow onalexithymia(Paez,Velasco,&Gonzalez,1999;Solanoetal.,2003).Indeed,arecentstudy byBaikie(2008)showedthatalexithymicsandsplitters(thosewhotendtoseetheworld asallgoodorallbad)experiencedfewerhealthvisitsafterexpressivewriting,thandid repressivecopers(thosewhotendtoavoidanddenyemotionalresponses).Baikie suggestedthatthestructureandtimelimitofexpressivewritingallowedalexithymicsand splitterstofeelmorecomfortableprocessingemotionaleventsthanintalkingtherapies, forwhichtheytendtoexperiencepooreroutcomes.However,researchbyLumley(2004) suggeststhatunliketheparticipantsintheaforementionedstudies,alexithymicssuffering fromchronicillnessesorelevatedstressmaynotreapthesamebenefitsafterwriting. Similarly,WongandRochon(2009)hadmenwhotendtobeemotionallyrestrictedwrite expressivelyabouttheirbestpossibleemotionalconnectednesswithanimaginedromantic

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partner(current,imaginary,orfuture)oraboutacontroltopic.Theauthorsfound decreaseddistressfortheexpressivewritinggroup,buttheyfoundnoothereffectsof relationshipqualityorlikelihoodofbeinginarelationshipbetweenthetwogroups. Finally,therehasbeenagreatdealofinterestinknowingifsexdifferencesexistin thepotentialbenefitsofexpressivewriting.Smyths(1998)metaanalysisrevealedthat malestendtobenefitmorefromthewritingparadigmthanfemales.Severalstudieshave exploredthiswithreasonablylargesamplesusuallywithcollegestudentsandhavenot replicatedthemetaanalyticresults.However,expressivewritingstudieswithheterosexual romanticcoupleshavefoundimprovedrelationshipoutcomeswhenthemaleisassignedto theexpressivewritingcondition.SlatcherandPennebaker(2006)foundanonsignificant trendforacoupletobemorelikelytoexperiencerelationshipstabilityifthemalewas assignedtotheexpressivewritingcondition.Amorerecentstudyconfirmedthisfindingin heterosexualmilitarycouples.BaddeleyandPennebaker(2009)founddecreasesin aggressivebehaviorswithinthedyadwhenthemalewasassignedtotheexpressive writingcondition.Interestingly,whenthefemalehadbeenassignedtotheexpressive writingcondition,therewasastrongdecreaseinmaritalsatisfactionwithinthecouple. Takentogether,theresultscorroboratewhatwomenhaveknownforcenturies:whenit comestorelationships,menneedtotalk(orrather,write)abouttheirfeelingsmore. Educational,linguistic,orculturaleffects.WithintheUnitedStates,thedisclosure paradigmhasbenefitedseniorprofessionalswithadvanceddegreesatratescomparableto ratesofbenefitinmaximumsecurityprisonerswith6thgradeeducations(Speraetal., 1994;Richards,Beal,Segal,&Pennebaker,2000).Amongcollegestudents,wehavenot founddifferencesasafunctionofthestudentsethnicityornativelanguage.Thedisclosure paradigmhasproducedpositiveresultsamongFrenchspeakingBelgians(Rim,1995), SpanishspeakingresidentsofMexicoCity(Dominguez,etal.,1995)andnorthernSpain (Paezetal.,1999),multiplesamplesofadultsandstudentsinTheNetherlands(Schoutrop, Lange,Brosschot,&Everaerd,1997)andItaly(e.g.,Solanoetal.,2003),Englishspeaking NewZealandmedicalstudents(Petrie,etal.,1995),Japaneseundergraduates(Yogo& Fujihara,2008),andKorean/EnglishandSpanish/EnglishbilingualsintheUnitedStates (Kim,2008). Summary.Whenindividualswriteortalkaboutpersonallyupsettingexperiencesin thelaboratory,consistentandsignificanthealthimprovementsarefound.Theeffects includebothsubjectiveandobjectivemarkersofhealthandwellbeing.Thedisclosure phenomenonappearstogeneralizeacrosssettings,manyindividualdifferencefactors,and severalWesterncultures,andisindependentofsocialfeedback. WhyDoesExpressiveWritingWork? Psychology,likemostsciences,isdedicatedtounderstandinghowthingswork.We arealsodrivenbythelawofparsimonyandassumethat,ideally,asingleexplanatory mechanismforaphenomenonshouldexist.Ifyouareexpectingacleanandsimple explanationfortheeffectivenessofwriting,wehavesomeverybadnews:Thereisno singlereasonthatexplainsit.Overthelasttwodecades,adauntingnumberofexplanations havebeenputforwardandmanyhavebeenfoundtobepartiallycorrect.Ultimately,there isnosuchthingasasinglecauseforacomplexphenomenon.Thereasonistwofold.First, anycausalexplanationcanbedissectedatmultiplelevelsofanalysisrangingfromsocial explanationstochangesinneurotransmitterlevels.Second,aneventthattakesweeksor

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evenmonthstounfoldwillnecessarilyhavemultipledeterminantsthatcaninhibitor facilitatetheprocessovertime. Inthissection,webrieflysummarizesomeofthemorecompellingexplanationsfor theexpressivewritinghealthrelationship.Keepinmindthatmanyoftheseprocesses occursimultaneouslyormayinfluenceoneanother. Individualandsocialinhibition.Thefirstexpressivewritingprojectswereguidedby ageneraltheoryofinhibition(cf.,Pennebaker&Beall,1986;Pennebaker,1989).Earlier studieshaddiscoveredthatpeoplewhohadexperiencedoneormoretraumasintheirlives weremorelikelytoreporthealthproblemsiftheydidnotconfideinothersabouttheir traumasthaniftheyhaddoneso(e.g.,Pennebaker&Susman,1988).Theinhibitionidea wasthattheactofinhibitingorinsomewayholdingbackthoughts,emotions,orbehaviors isassociatedwithlowlevelphysiologicalworkmuchthewaythatSapolsky(2004)or Selye(1978)thoughtaboutstress.Further,peoplewereespeciallylikelytoinhibittheir thoughtsandfeelingsabouttraumaticexperiencesthatweresociallythreatening.Hence, individualswhohadexperiencedasexualtraumawouldbefarlesslikelytotalkaboutit withothersthaniftheyhadexperiencedthedeathofagrandparent. Followingthelogicofinhibition,itwasassumedthatifpeoplewereencouragedto talkorwriteaboutapreviouslyinhibitedevent,healthimprovementswouldbeseen. Perhaps,wereasoned,oncepeopleputtheirexperienceintowords,theywouldnolonger havetheneedtoinhibit.Despitethehelpfulnessofthetheoryingeneratinginterestingand testablehypotheses,thesupportingevidencehasbeendecidedlymixed.Severalearly studiesattemptedtoevaluatethedegreetowhichpeoplewroteaboutsecretversusmore publictraumasandpreviouslydisclosedversusnotpreviouslydisclosedevents.Innocase didthesefactorsdifferentiallypredictimprovementsinhealth(e.g.,Greenberg&Stone, 1992;Pennebaker,KiecoltGlaser,&Glaser,1988). Someevidencefortheinhibitiontheorycomesfromarecentstudyofgaymenina communitysamplewithsocialconstraintsonselfexpression(Swanbon,Boyce,& Greenberg,2008).Sixtytwogaymenwereaskedtowriteeitheraboutgayrelated thoughtsandfeelings,oraboutcontroltopics.Theauthorsfoundthattheexpressive writinggroupexperiencedlessavoidanceaboutbeinggayandreportedexperiencingfewer somaticsymptomsrelativetothecontrolgroup,suggestingthatdisclosurecouldhelpto decreasethecognitiveloadofinhibitingthoughtsabouttheself.However,thesample includedolder,moreeducated,andopenlygaymen.Futurestudieswouldhavetotest closetedgaymeninordertoprovideabettertestoftheinhibitiontheoryofexpressive writing. PromisingresearchinthisveinhasbeenconductedbySteveLeporeandhis colleagues(e.g.,Lepore, Fernandez-Berrocal, Ragan, & Ramos, 2004; Lepore, Ragan & Jones, 2000). Across several studies, they find that people who are encouraged to talk about an emotional experience such as a movie are less reactive to the movie if what they say is validated. That is, if their comments about seeing the movie on the first occasion are supported by another person, they find the movie less aversive on a second screening on another day. However, if another person disagrees with their thoughts and feelings about the movie, the participants are more biologically around on a second screening even though they are watching the movie alone. Ultimately, real-world inhibitory processes are almost impossible to measure. For example, people have great difficulty in evaluating the degree to which they have been actively

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holding back in telling others about an emotional experience. Some people who dont tell others about an upsetting experience may never think about the event and others do. Of those who think about it, some may want to tell others; others may not. Of these various cases, it is not clear which people are inhibiting or even who might benefit most from writing. Although experimental studies may be effective in demonstrating the potential dangers of inhibition, the task of isolating these psychological processes in the real world will be a far more difficult enterprise. As described in a later section on the social dynamics of expressive writing, one potential strategy is to simply track changes in peoples social behaviors after expressive writing in order to infer the possibility of inhibition. Emotionsandemotionalexpression.Emotionalreactionsarepartofallimportant psychologicalexperiences.FromthetimeofBreuerandFreud(1957/1895),most therapistshaveexplicitlyortacitlybelievedthattheactivationofemotionisnecessaryfor therapeuticchange.Theveryfirstexpressivewritingstudyfoundthatifpeoplejustwrote aboutthefactsofatrauma,theydidnotevidenceanyimprovement(Pennebaker&Beall, 1986).Consistentwithanexperientialapproachtopsychotherapeuticchange,emotional acknowledgementultimatelyfostersimportantcognitivechanges(Ullrich&Lutgendorf, 2002). Althoughexperiencingemotionswhilewritingisclearlyanecessarycomponentof theexpressivewritingeffects,cognitiveworkisrequiredaswell.Asanexample,students wererandomlyassignedtoeitherexpressatraumaticexperienceusingbodilymovement, ortoexpressanexperienceusingmovementandthenwriteaboutit,ortoexerciseina prescribedmannerfor3days,10minutesperday(Krantz&Pennebaker,2007).Whereas thetwomovementexpressiongroupsreportedthattheyfelthappierandmentally healthierinthemonthsafterthestudy,onlythemovementpluswritegroupevidenced significantimprovementsinphysicalhealthandgradepointaverage.Themereemotional expressionofatraumaisnotsufficient.Healthgainsappeartorequiretranslating experiencesintolanguage. Habituationtoemotionalstimuli.Avariationontheemotionalexpressionideais thatthebenefitsofwritingaccruebecauseindividualshabituatetotheaversiveemotions associatedwiththetraumatheyareconfronting.Theroleofhabituationtoemotional stimulihasalongandrichhistoryinclassicalconditioningandavarietyofbehavioral therapies(e.g.,Wolpe,1968).MorenuancedapproacheshavebeenproposedbyEdnaFoa andhercolleagues(e.g.,Foa&Kozak,1986;Meadows&Foa,1999).Repeatedexposureto emotionalstimulicanhelptoextinguishtheclassicallyconditionedlinkbetweenanevent andpeoplesreactionstoit.Atthesametime,theseauthorsnote,peoplechangeintheir understandingand/orrepresentationofit. Sloan,Marx,andEpstein(2005)testedtheideathatrepeatedexposuretoawriting topicmightbeamorepotentstrategythantopicswitching.Undergraduatestudentswith mildPTSDsymptomsintheirsamedisclosureconditionwroteaboutasingleeventover threewritingsessions;thedifferentdisclosureconditionwroteaboutadifferent traumaticeventduringeachwritingsession;controlswroteabouttrivial,nontraumatic topics.Participantsinthesamedisclosuregroupreportedthegreatestimprovementsin physicalhealthandPTSDsymptomseverityat4and8weekfollowupsrelativetoother twogroups,supportingtheirtheoryofexpressivewritingasexposuretherapy.Inaddition, theyfoundthatthedegreeofsalivarycortisolincreasesinresponsetothefirstwriting sessionwerestronglyassociatedwithdecreasesinPTSDsymptomseverity.

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Anothertestofahabituationmodelwouldbetoseeifpeoplewhowroteaboutthe sametopicinthesamegeneralwayfromessaytoessaywouldbenefitmorethanpeople whochangedtopics.Inearlierstudies(e.g.,Pennebaker&Francis,1996),judgesevaluated thenumberofdifferenttopicspeoplewroteaboutacrossa3daywritingstudy.Numberof topicswasunrelatedtohealthimprovements.Amoreelegantstrategyinvolvedtheuseof LatentSemanticAnalysis(LSA,Landauer,Foltz,&Laham,1998).LSA,atechnique developedbyexpertsinArtificialIntelligence,isabletomathematicallyevaluatethe similarityofcontentofanysetsoftext,suchasessays.UsingLSA,weattemptedtolearnif thecontentsimilarityofessayswrittenbypeopleintheexperimentalconditionsinthree previouswritingstudieswasrelatedtohealthimprovements.Theanswerisno.Ifanything, themoresimilarthewritingcontentwasfromdaytoday,thelesslikelypeopleshealth wastoimprove(Campbell&Pennebaker,2002). Apurehabituationargumentisprobablyinsufficientinexplainingtheexpressive writingeffects.ThefindingsfromtheemotiononlyconditioninthePennebakerandBeall (1986)studytogetherwiththeexpressivemovementonlyconditionintheKrantzand Pennebaker(2007)experimentbothsuggestthatthemereactivationofemotions associatedwithatraumacanprovideonlylimitedbenefits.Beyondanyhabituation processes,someformofcognitivechangeisalsoimportant. Languageandemotions:TowardsanAtoDtheoryofemotionalprocessing.What happenswhenemotionsoremotionalexperiencesareputintowords?Researchhasshown thatverballylabelinganemotionmayitselfinfluencetheemotionalexperience.Keltner, Locke,andAudrain(1993)foundthatafterreadingadepressingstory,participantswho weregiventheopportunitytolabeltheiremotionssubsequentlyreportedhigherlife satisfactionthanthosewhodidnotlabelthem.BerkowitzandTroccoli(1990)foundthat afterlabelingtheirownemotions,participantsweremoremagnanimousinevaluating othersthanifnotgiventheemotionlabelingopportunity.Theseapproachesareconsistent withSchwarz(1990)whohasdemonstratedthatdefiningandmakingattributionsfor internalfeelingscanaffectthefeelingsthemselves.Similarly,Wilson(2002)summarized severalstudiesindicatingthatwhenindividualsfocusontheirfeelings,thecorrespondence betweenattitudesandbehaviorsincreases,whereasattendingtothereasonsforone's attitudesreducesattitudebehaviorconsistency. Indeed,changinganysensoryexperienceintolanguageaffectstheexperience.Inan importantstudyonlanguageseffectsonsensoryexperience,SchoolerandEngstler Schooler(1990)suggestedthatonceanindividualattemptstotranslateapictureinto words,itchangesthememoryofthepicture.Mostexperiencesarelikepictures.Sights, sounds,smells,andfeelingsareoftenvague,complicated,anddynamic.Toprovidea detailedimageofanyexperiencewouldrequiremorethanthepresumedonethousand wordlimit.However,becauselanguageisflexible,relativelyfewwordsorevenseveral thousandwordscanbeusedtodescribeasingleexperience. Theproblemofcapturinganexperiencewithlanguageiscomparabletothe engineeringdifficultyofdefiningananalogsignalusingdigitaltechnology.Intheworldof measuringskinconductance,forexample,apersonsfingerswillchangeintheirsweatiness almostcontinuously.Skinconductancelevel(SCL),asmeasuredbyanoldfashioned polygraph,initiallyincreasesafterthepersonhearsaloudtoneandthengraduallyreturns tonormal.Forthissignaltobecomputeranalyzed,theanaloglinemustbeconvertedinto numbersusingananalogtodigital(AtoD)converter.Toconvertthelinetonumbers,

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however,oneneedstodecidehowfrequentlythenumbersshouldbesampled.Shouldone sampleSCLhundredsoftimespersecond,oncepersecond,onceevery5seconds? Obviously,themoretimesonesamples,thetruertherepresentationofthelinewillbe. However,samplingatsuchahighfrequencycanbeatremendouswasteoftimeand computerspacesincemostoftheadjacentreadingswillberedundant.Similarly,ifthe samplingrateisonceevery5seconds,mostoftheinformationofthechangeinSCLwillbe lost. Verballylabelinganemotionismuchlikeapplyingadigitaltechnology(language)to ananalogsignal(emotionandtheemotionalexperience).Assumethatnoveloremotion provokingexperiencestendtoremaininawarenessuntiltheyareeithercognitively understoodortheyextinguishwithtime.Itishypothesizedthatifanemotionor experienceremainsinanalogform,itcannotbeunderstoodorconceptuallytiedtothe meaningofanevent.Theonlywaybywhichanemotionorexperienceinnonlinguistic formcanleaveawarenessisthroughhabituation,extinction,ortheintroductionofanew orcompetingemotion.Onceanexperienceistranslatedintolanguage,however,itcanbe processedinaconceptualmanner.Inlanguageformat,theindividualcanassignmeaning, coherence,andstructure.Thiswouldallowfortheeventtobeassimilatedand,ultimately, resolvedand/orforgotten,therebyalleviatingthemaladaptiveeffectsofincomplete emotionalprocessingonhealth. Followingfromtheabovereasoning,ifanexperienceanditsemotionsaredescribed toobriefly,theexperiencewillnotadequatelycaptureorrepresenttheevent(hereafter referredtoasverbalunderrepresentation).Inthiscase,itwouldbepredictedthatthe manypartsoftheexperiencethatwerenotrepresentedinthebrieflinguisticdescription wouldcontinuetobeprocesseduntiltheygraduallyextinguishedovertime.Ifamoderate numberofwordsareusedtodescribetheexperience(moderaterepresentation),its representationshouldadequatelymirrortheevent.Thisshouldreducethedegreetowhich theeventtakesupcognitivecapacity,and,atthesametime,enhanceselfregulation, coping,andhealth.Ontheotherhand,iftheemotionaleventisdescribedinexhaustive detail(overrepresentation),theexperienceisessentiallyreconfiguredinitsentirety,butin anewformat. Theargument,basedontheAtoDEmotionTheory,isthatonceaneventis adequatelyrepresentedinlanguageformat,theverbal/conceptualprocessingtakesover. Intheory,onecouldarguethattheidealwaytotalkaboutanemotionaleventistoemploy languageintheformofmoderaterepresentation.Themoderaterepresentationviewisthat themostefficientwaytoprocessaneventistouseasfewwordsaspossiblethat adequatelycapturetheentireemotionalexperience.Theevent,then,wouldbesummarized inarelativelytightwaythatwouldallowforlaterlevelingandsharpening.Alternatively, theoverrepresentationviewwouldarguethatrepresentingtheeventindetailedlinguistic formwouldlessenthepossibilityforreappraisalorassimilationintobroaderknowledge structuresandidentity. LisaFeldmanBarrett(Feldman,1995;FeldmanBarrett,1998)hasdistinguished betweenindividualswhodescribetheiremotionexperienceusinghighlydifferentiated emotionterms,andthosewhomoreorlesscategorizetheiremotionexperienceusinglike valencedtermsinterchangeably.Inherstudies,participantsareaskedtokeepadailydiary fortwoweekstoratetheirmostintenseemotionalexperienceeachdayonseveralaffect termsusingaLikertscale.Emotionaldifferentiationisreflectedbyasmallcorrelation

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betweenpositiveemotionswords(e.g.happiness,joy,enthusiasm,andamusement),anda smallcorrelationbetweennegativeemotionswords(e.g.nervous,angry,sad,ashamed, guilty).FeldmanBarrett,Gross,Conner,Christensen,andBenvenuto(2001)showedthat themoreindividualsdifferentiatedtheirnegativeemotions,themoretheyendorsed engaginginvariousemotionregulationstrategies(situationselection,situation modification,attentionaldeployment,cognitivechange,andresponsemodulation)overthe courseofthestudy,especiallyformoreintensenegativeemotionexperiences.These findingsprovidesupportfortheAtoDtheory.Thatis,individualswhomoreprecisely identifyaverballabelrepresentingtheiractualemotionexperiencearemorelikelyto makeattributionsandeffectivelyplanforfutureactions. Useofemotionwordsinwriting.TheAtoDapproachisavaluableworkingmodel bywhichtounderstandtheconnectionbetweenemotionalexperienceanditstranslation intowords.Acomplementaryapproachtotheunderstandingofemotionalprocessesinthe expressivewritingparadigmistolookatthewordspeopleusewhiledescribingtraumatic experience.Ifwemerelycountedthewayspeopleuseemotionwordsinnaturaltext,could webegintocapturetheunderlyingemotionalprocessesthatoccurduringwriting? Althoughanumberofcomputerizedtextanalysisprogramshavebeendeveloped (forareview,seePennebaker,Mehl,&Niederhoffer,2003),wearemostfamiliarwith LinguisticInquiryandWordCount(LIWC)whichwasinitiallycreatedtoanalyzeessays fromemotionalwritingstudies.LIWCwasdevelopedbyhavinggroupsofjudgesevaluate thedegreetowhichabout2,000wordsorwordstemswererelatedtoeachofseveral dozencategories(forafulldescription,seePennebaker,Francis,&Booth,2001).The categoriesincludenegativeemotionwords(sad,angry),positiveemotionwords(happy, laugh),causalwords(because,reason),andinsightwords(understand,realize).Foreach essay,LIWCcomputesthepercentageoftotalwordsthattheseandotherlinguistic categoriesrepresent. TheLIWCprogramenabledlanguageexplorationsintopreviouswritingstudies, linkingwordusageamongindividualsintheexperimentalconditionswithvarioushealth andbehavioraloutcomes(Pennebaker,Mayne,&Francis,1997).Onereanalysisofdata wasbasedon6writingstudies:twostudiesinvolvingcollegestudentswritingabout traumaswherebloodimmunemeasureswerecollected(Pennebaker,KiecoltGlaser,& Glaser,1988;Petrieetal.,1995),twostudiesincludedfirstyearcollegestudentswhowrote abouttheirdeepestthoughtsandfeelingsaboutcomingtocollege(Pennebaker,Colder,& Sharp,1990;Pennebaker&Francis,1996),onestudybymaximumsecurityprisonersina statepenitentiary(Richardsetal.,2000),andonestudyusingprofessionalmenwhohad unexpectedlybeenlaidofffromtheirjobsafterover20yearsofemployment(Speraetal., 1994). Analyzingtheuseofnegativeandpositiveemotionworduseyieldedtwoimportant findings.First,themorethatpeopleusedpositiveemotionwords,themoretheirhealth improved.Negativeemotionworduse,however,wascurvilinearlyandnotlinearlyrelated tohealthchangeafterwriting.Individualswhousedamoderatenumberofnegative emotionsintheirwritingaboutupsettingtopicsevidencedthegreatestdropsinphysician visitsinthemonthsafterwriting.Thecurvilinearemotionindiceswerecomputedusingthe absolutevalueofthedifferencebetweeneachpersonsemotionworduseandthemeansof thesample.Thesimplecorrelationsbetweenchangeinphysicianvisitswiththecurvilinear

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negativeemotionindexwasr(152)=.27,p<.05whereasthepositivewordswere unrelated,r=.14,ns. Individualswhouseveryfewnegativeemotionwordsorwhouseaveryhighrateof themaretheonesmostlikelytoremainsickafterwriting,comparedwiththosewhousea moderatenumberofnegativeemotionwords.ThefindingssupporttheAtoDtheory,and, inmanyways,alsosquarewithotherliteratures.Individualswhomaintainverbal underrepresentationandtendtouseveryfewnegativeemotionwordsaremostlikelyto becharacterizedasrepressivecopers(cf.,Schwartz&Kline,1995)oralexithymics (Lumley,Tojek,&Macklem,2002).Thosewhooverusenegativeemotionwordsmaywell betheclassichighNegativeAffectindividualsdescribedbyWatsonandClark(1984).That is,thoseindividualswhodescribetheirnegativeconditionsinsuchdetailmaysimplybein arecursiveloopofcomplainingwithoutattainingclosure(overrepresentation).Indeed,as discussedbelow,thismaybeexacerbatedbytheinabilityoftheseindividualstodevelopa storyornarrative(NolenHoeksema,2000). Beyondemotions:Theconstructionofastory.Oneofthebasicfunctionsoflanguage andconversationistocommunicatecoherentlyandunderstandably.Byextension,writing aboutanemotionalexperienceinanorganizedwayishealthierthaninachaoticway. Indeed,growingevidencefromseverallabssuggestthatpeoplearemostlikelytobenefitif theycanwriteacoherentstory(e.g.,Smyth,True,&Sotto,2001).Anytechniquethat disruptsthetellingofthestoryortheorganizationofthestoryisundoubtedlydetrimental. Forexample,thosewhohaveabroodingruminativestyle(whereacoherentstoryis perhapsnotformedanddoesnotchangeorgetsmorenegativeovertime)aremorelikely tobenefitfromexpressivewritingthanthosewhohaveareflectiveponderingruminative style(i.e.thosewhotendtoorganizetheirthoughtsabouttheirsituationinordertoengage inadaptiveproblemsolving;Sloan,Marx,Epstein,&Dobbs,2008). Unfortunately,wearenotyetatthepointofbeingabletopreciselydefinewhatis meantbycoherent,understandable,ormeaningfulwhenitcomestowritingabout emotionalupheavals(cf.,Graybeal,Seagal,&Pennebaker,2002).Onepersonsmeaning maybeanothersrumination.Manytimesinourownresearchwehavebeenstruckhowa personappearstobewritinginawaythatavoidsdealingwithwhatweseeasacentral issue.Nevertheless,thepersonshealthimprovesandheorsheexclaimshowbeneficialthe studywas.Meaning,then,mayultimatelybeintheeyeofthewriter. Althoughtalkingabouttheupsettingexperiencewillhelptoorganizeandgiveit structure,talkingaboutsuchamonumentalexperiencemaynotalwaysbepossible.Others maynotwanttoorevenbeabletohearaboutit.Withinthediscourseliterature,particular attentionhasbeenpaidtotheroleofwrittenlanguageindemandingmoreintegrationand structurethanspokenlanguage(Redeker,1984;seealsoBrewin&Lennard,1999).It wouldfollowthatwritingandtoalesserdegreetalkingabouttraumaticexperiences wouldrequireastructurethatwouldbecomeapparentinthewayspeoplewroteortalked abouttheevents. Thecomponentsofastory:Theanalysisofcognitivewords.Itisbeyondthebounds ofthischaptertoexplorethephilosophicaldefinitionsofknowledge,narrative,ormeaning. Forcurrentpurposes,knowledgeofaneventcanencompassacausalexplanationofitor theabilitytounderstandtheeventwithinabroadercontext.Thedegreetowhich individualsareabletocognitivelyorganizetheeventintoacoherentnarrativeisamarker thattheeventhasachievedknowledgestatus.Inmanyways,itispossibletodeterminethe

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degreetowhichpeoplehavecometoknowtheiremotionsandexperiencesbythelanguage theyuse.Wordsorphrasessuchas,Inowrealizethat...orIunderstandwhy...suggest thatpeopleareabletoidentifywhentheyhaveachievedaknowingstateaboutanevent. TheLIWCanalysesfindpromisingeffectsforchangesininsightandcausalwords overthecourseofemotionalwriting(seealsoKlein&Boals,2001;Petrie,Booth,& Pennebaker,1998).Specifically,peoplewhosehealthimproves,whogethighergrades,and whofindjobsafterwritinggofromusingrelativelyfewcausalandinsightwordstousinga highrateofthembythelastdayofwriting.Inreadingtheessaysofpeoplewhoshowthis patternoflanguageuse,judgesoftenperceivetheconstructionofastoryovertime (Graybealetal.,2002).Buildinganarrative,then,maybecriticalinreachingunderstanding orknowledge.Interestingly,thosepeoplewhostartthestudywithacoherentstorythat explainedsomepastexperiencegenerallydonotbenefitfromwriting. Thosewhousemoreinsightandcausalwordsintheiremotionalwritingtendto gainthemostimprovementsinworkingmemory,and,atthesametime,reportdropsin intrusivethinkingaboutnegativeevents(Boals&Klein,2005;Klein&Boals,2001). ConsistentwiththeAtoDEmotionTheory,forthoseintheexperimentalcondition,the writingexperiencepackagestheeventinawaythatfreestheirmindsforothercognitive tasks.Anotherwaytointerpretthesalutaryeffectsofusinginsightandcausalwordsis that,togetherwiththeuseofpositiveemotionwords,thistypeoflanguagereflectsa positivereappraisalofevents,whichfuelscognitivebroadening(Fredrickson,1998;2001). Narratinganemotionaleventintothebiggerpicturemighthelptointegratetheexperience intoonesgreaterknowledgestructuresandpersonalidentity. Eitherway,thefindingsareconsistentwithcurrentviewsonnarrativeand psychotherapy(e.g.,Mahoney,1995)insuggestingthatitiscriticalfortheclienttocreate andcometotermswithastorytoexplainandunderstandbehavioralormentalproblems andtheirhistory.Merelyhavingastorymaynotbesufficientsincethequalityofstoriesas wellasthepeoplethemselveschangeovertime.Astory,then,isatypeofknowledge. Further,anarrativethatprovidesknowledgemustlabelandorganizetheemotionaleffects ofanexperienceaswellastheexperienceitself. Writingasawaytochangeperspective.Acentraltenetofallinsightoriented therapiesisthatthroughpsychotherapypeopleareabletodevelopabetterunderstanding oftheirproblemsandreactionstothem(e.g.,Rogers,1980).Inherentinthisunderstanding istheabilitytostandbackandlookatoneselffromdifferentperspectives.Althoughmost therapistswouldagreewiththeimportanceofshiftingperspectives,thedifficultyfora researcherisindevisingawaytotrackthisshift.Somerecentlinguisticanalysesoffer somepromisingnewstrategies. Asdescribedearlier,latentsemanticanalysisorLSAisapowerfulmathematicaltool thatallowsinvestigatorstodeterminethesimilarityofanysetsofessays.LSAwas originallydesignedtolookatthelinguisticcontentoftextsamples.Consequently,mostLSA applicationsroutinelydeleteallnoncontentwords.Thesenoncontentorjunkwords includepronouns,prepositions,conjunctions,articles,andauxiliaryverbs.Amoreformal designationofjunkwordswouldbefunctionwordsorparticles.Functionwordscanbe thoughtofasthegluethatholdcontentwordstogether.Ratherthanreflectingwhatpeople aresaying,thesefunctionwordsconnotehowtheyarespeaking.Inshort,functionwords reflectlinguisticstyle(cf.,Pennebaker&King,1999;Pennebakeretal.,2003).

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Isitpossiblethatpeopleslinguisticstylescanpredictwhobenefitsfromwriting? UsingLSA,wediscoveredthattheanswerisyes.Analyzingthreepreviousexpressive writingstudies,wediscoveredthatthemorethatpeoplechangeintheiruseoffunction wordsfromdaytodayintheirwriting,themoretheirhealthimproved(Campbell& Pennebaker,2003).Closeranalysesrevealedthattheseeffectswereentirelydueto changesinpronounuse.Specifically,themorethatpeopleoscillatedintheiruseof1st personsingularpronouns(I,me,my)andallotherpersonalpronouns(e.g.,we,you,she, they),themorepeopleshealthimproved.Ifindividualswroteaboutemotionalupheavals acrossthe34daysofwritingbuttheyapproachedthetopicinaconsistentwayas measuredbypronounuse,theywereleastlikelytoshowhealthimprovements.The findingssuggestthattheswitchingofpronounsreflectachangeinperspectivefromone writingdaytothenext.Interestingly,itdoesntmatterifpeopleoscillatebetweenanI focustoaweorthemfocusorviceversa.Rather,healthimprovementsmerelyreflecta changeintheorientationandpersonalattentionofthewriter. Anoteoncausalityisinorder.Thevariousstudiesthathaveexaminedthe relationshipbetweenworduseandhealthoutcomesintheemotionalwritingconditions implyacausalarrow:peoplewhochangeperspectives,usepositiveemotionwords,and peoplewhoconstructastoryultimatelyevidencebetterhealth.Becautiousininterpreting thesefindings.Theuseofthesewordpatternsmaysimplybereflectingsomeunderlying cognitiveandemotionalchangesoccurringintheperson.Asnotedearlier,somestudies haveattemptedtogetpeopletowritewithmorepositiveemotionwords,changing perspectives,andevenconstructingastory.Thesemanipulationshavenotbeen particularlysuccessful.Theissuesofmediation,moderation,andemergentpropertiesof worduse,cognitiveandemotionalactivity,andlongtermhealthwillprovidefertile groundsforresearchintheyearstocome. Inrecentyears,therehasbeenacallforfindingtheboundariesofexpressive writing(Smyth&Pennebaker,2008).Inonestudythatwaspublishedinaspecialissue examiningtheboundaryeffectsofexpressingwriting,Seihandhiscolleagues(2008) adaptedPsychologicalDisplacementinDiaryWriting(PDDP;Jin2005)forexpressive writing.PDDPisaparadigminwhichpeoplewritediaryentriesinafirstperson perspective.Next,theywriteaboutthesameeventusingasecondpersonperspective. Finally,theywriteaboutthesameeventinathirdpersonperspective.Seihandhis colleaguesfoundthatexperimentalmanipulationsofchangingperspectiveswassuccessful inreducinglevelsofanxietyandanger.Ongoingstudiesinourlabsuggestthatrequiring peopletoswitchperspectivesdoesnotconferbenefitsabovestandardwritinginstructions (Seih&Pennebaker,2009).Theseintriguingfindingsindicatethatchangesinwriting perspectivesaremoreanemergentpropertyofsuccessfulwriting.Thatis,itreflects psychologicalimprovementratherthannecessarilycausingit. Expressivewritingandsocialdynamics.Oneofthepopularappealsofthe expressivewritingparadigmisthatitsoundsalmostmagical.Writefor15minutesaday forthreedays(atotalof45minutes)andyourhealthwillimproveformonths.Youmay alsogetajob,fallinlove,andmakebettergrades.Thisisabitofanoverstatement.When peoplewriteaboutemotionalupheavalsforthreeorfourdays,theyreportthinkingabout thetopicsquitefrequently.Manyspontaneouslytellusthattheyhavebeendreamingabout thetopics.Expressivewritingseffectsexistbeyondthewallsoftheexperiment.

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Evenmorestrikinghavebeensomeofthesocialchangesthatoccurasaresultof expressivewriting.Acrossmultiplestudies,individualsreportthattheytalktoothers abouttheirwritingtopics.Manyyearsago,weconductedastudywithHolocaustsurvivors andaskedthemtotelltheirstoriesorally.Priortothestudy,approximately70%reported thattheyhadnottalkedabouttheirexperiencesduringWorldWarIIinanydetailto anyone.Aftertheinterview,allparticipantsweregivenacopyoftheirvideotaped testimony.Amonthlater,theaveragepersonreportedwatchingthevideotape2.3times andshowingitto2.5otherpeople(Pennebaker,Barger,&Tiebout,1989).Disclosure begetsdisclosure. Recently,wehavedevelopedadigitalrecordingdevicecalledtheElectronically ActivatedRecorder,ortheEAR(Mehl&Pennebaker,2003).TheEARhasbeenengineered torecordfor30secondsevery1213minutes.Therecordingsarethentranscribedand ratedbyjudgesconcerningwheretheparticipantisandwhatheorsheisdoing.Recently, YoungsukKim(2008)had95bilingualstudentseitherwriteabouttraumaticexperiences orparticipateincontroltasksfor4days,15minuteseachday.Priortowritingand assignmenttocondition,individualsworetheEARfortwodays.Approximatelyonemonth afterwriting,theyworetheEARagainfortwodays.Overall,thosewhowroteabout emotionalupheavalstalkedmorewithothersafterwritingthanbeforewriting.Anearlier pilotstudyofapproximately50studentshadfoundasimilareffect(Pennebaker& Graybeal,2001). Acrossthevariousstudies,wearenowbecomingconvincedthatoneofthepowers ofexpressivewritingisthatitbringsaboutchangesinpeoplessociallives.Considerthat writinghasbeenshowntoincreaseworkingmemoryandthattheseeffectsapparentlylast severalweeks(Klein&Boals,2001).Afterpeoplewriteabouttroublingevents,theydevote lesscognitiveeffortonthem.Thisallowsthemtobebetterlisteners,betterfriends.They writingmayalsoencouragepeopletotalkmoreopenlywithothersaboutthesecretsthat theyhavebeenkeeping. Thebigpicture:Lifecoursecorrection.Partofthehumanexperienceisthatweall dealwithavarietyofmajorandminorlifeissues.Often,wearetakenoffguardbyan upheavalanddonthavesufficienttimetothinkaboutitortoexplorethebroader implicationstheeventmighthaveonusandthosearoundus.Onereasonthatwebelieve thatexpressivewritinghasbeeneffectiveisthatitservesasalifecoursecorrection. Occasionally,mostofusbenefitfromstandingbackandexaminingourlives.Thisrequires aperspectiveshiftandtheabilitytodetachourselvesfromoursurroundings.Ifwearestill inthemidstofamassiveupheaval,itisvirtuallyimpossibletomakethesecorrections. Theideaofexpressivewritingasalifecoursecorrectionhasnotbeentested empirically.TheideaiscertainlyconsistentwithMcAdams(2001)lifestoryapproach.Itis alsorelevanttoworkinautobiographicalmemory(e.g.,Neisser&Fivush,1994;Conway, 1990).Therearetimeswhenweareforcedtostopandlookbackatourlivesandevaluate whatissuesandeventshaveshapedwhoweare,whatwearedoing,andwhy. SummaryandConclusions Thepurposeofthispaperhasbeentoprovideabroadoverviewoftheexpressive writingparadigm.Sinceitsfirstuseinthe1980s,dozensofstudieshavebeenexploringthe parametersandboundaryconditionsofitseffectiveness.Perhapsmostinterestinghas beenthegrowingawarenessthatitsvaluecannotbeexplainedbyasinglecauseortheory. Expressivewritingultimatelysetsoffacascadeofeffects.

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Thereisacertainironythattheoriginalexplanationforthewritingphenomenon wasinhibition.Inthe1980s,ourbeliefwasthatwhenpeopledidnttalkaboutemotional upheavals,theworkofinhibitionultimatelyledtostressandillness.Theexplanationwas partiallycorrect.Now,however,weareallbeginningtoappreciatethenuancesofthe problem.Nottalkingaboutatraumaticexperienceisalsoassociatedwithabreakdownof onessocialnetwork,adecreaseinworkingmemory,sleepdisruptions,alcoholanddrug abuse,andanincreasedriskforadditionaltraumaticexperiences.Expressivewritingorthe unfetteredtalkingaboutatraumacanoftenshortcircuitthisprocess. Writingforcespeopletostopandreevaluatetheirlifecircumstance.Themereactof writingalsodemandsacertaindegreeofstructureaswellasthebasiclabelingor acknowledgingoftheiremotions.Aparticularlyrichfeatureoftheprocessisthatthese inchoateemotionsandemotionalexperiencesaretranslatedintowords.Thisanalogto digitalprocessdemandsadifferentrepresentationoftheeventsinthebrain,inmemory, andinthewayspeoplethinkonadailybasis. Allofthesecognitivechangeshavethepotentialforpeopletocometoadifferent understandingoftheircircumstances.Thecognitivechangesthemselvesnowallowthe individualstobegintothinkaboutandusetheirsocialworldsdifferently.Theytalkmore; theyconnectwithothersdifferently.Theyarenowbetterabletotakeadvantageofsocial support.Andwiththesecognitiveandsocialchanges,manyoftheirunhealthybehaviors abate.Asrecentdatasuggest,expressivewritingpromotessleep,enhancedimmune function,reducedalcoholconsumption,etc. Despitethelargenumberofpromisingstudies,expressivewritingisnotapanacea. Theoveralleffectsizeofwritingismodestatbest.Westilldontknowforwhomitworks best,whenitshouldbeused,orwhenothertechniquesshouldbeusedinitsplace.Oneof thedifficultiesofstudyingexpressivewritingisthatthebeststudieshavefoundthat writinginfluencesslowmovingbutimportantoutcomemeasuressuchasphysicianvisits, illnessepisodes,andotherrealworldbehaviorsthatmaytakemonthstosee.Selfreport outcomes,althoughcommonandeasytouse,generallydonotbringaboutextremely strongfindings.Futureresearcherswouldbewisetotrytoagreeononeormoreoutcome measuresthataresufficientlyrobustandalsoeasytomeasure. Aftertwodecadesofresearchonexpressivewriting,twostrategiesmustcontinue togrow.Thefirstisapplyingthemethodtolargesamplesofpeoplewithdiffering diagnosesusingrigorousRCTdesigns.Thisbigscience,bigmedicineapproachis essential.Atthesametime,weshouldcontinuetonurtureinnovativesmallerscience.It willbetheindividuallabsaroundtheworldthatwillultimatelytellustheboundary conditionsofthephenomenonandtheunderlyingmechanismsthatexplainits effectiveness.

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