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.ChungTheUniversityofTexasatAustin

CorrespondenceshouldbeaddressedtoJamesW.Pennebaker,DepartmentofPsychologyA8000,UniversityofTexas,Austin,TX78712(e‐mail:Pennebaker@mail.utexas.edu).PreparationofthispaperwasaidedbyfundingfromtheNationalInstitutesofHealth(MH52391),ArmyResearchInstitute(W91WAW‐07‐C‐0029),CIFA(H9c104‐07‐C‐0014),andSTART(Z934002).AnearlierversionofthispaperwaspublishedasPennebakerandChung(2007).

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ExpressiveWriting:ConnectionstoPhysicalandMentalHealth Thereisalonghistoryinpsychologyandmedicinelinkingtheoccurrenceoftraumaticexperienceswithsubsequentphysicalandmentalhealthproblems.Whatisitaboutatraumathatinfluenceshealth?Severalcandidatesimmediatelycometomind.Psychologically,personalupheavalsprovokeintenseandlong‐lastingemotionalchanges.Theunexpectedeventsaregenerallyassociatedwithcognitivedisruptionincludingruminationandattemptstounderstandwhathappenedandwhy.Socially,traumasareknowntocausewholesaledisruptionsinpeople’ssocialnetworks.Dueinparttothesocialandpsychologicalchanges,traumasofteninfluencelifestylechangessuchasunhealthysmoking,drinking,exercise,sleeping,andeatingpatterns.Eachofthesepsychological,social,andbehavioraleffectsresultsinacascadeofbiologicalchangesincludingelevationsincortisol,immunedisruption,cardiovascularchanges,andacascadeofneurotransmitterchanges. Individualswhoarehighlyreactivetonovelstimuli(Vaidya&Garfield,2003),highlyanxious(Miller,2003),avoidant,andself‐blaming(Sutker,Davis,Uddo,&Ditta,1995),orhighinhypnoticability(Bower&Sivers,1998)maybeparticularlysusceptibletotraumaticexperiences.Similarly,themoreextremethetraumaandthelongertimeoverwhichitlastsarepredictorsofPost‐TraumaticStressDisorder(PTSD)incidence(e.g.,Breslau,Chilcoat,Kessler,&Davis,1999).ItisalsogenerallyagreedthatpeoplemostpronetoPTSDhavehadahistoryofdepression,trauma,andotherPTSDepisodesinthepastevenpriortotheirmostrecenttraumaticexperience(Cabrera,Hoge,Bliese,Castro,&Messer,2007;2007;Miller,2003). Acursoryreadingoftheliteraturemightleadmanysmartpeopletoassumethatmentalandhealthproblemsarestandardresponsestoalllargetraumas.Surprisingly,theoppositeistrue:Mostpeopledealwithtraumaticexperiencesquitewellwithnomajorchangesintheirmentalorphysicalhealth.Inaclassicarticle,WortmanandSilver(1989)summarizedalargenumberofstudiesindicatingthatatleasthalfofpeoplewhohavefacedthedeathofaspouseorchilddidnotexperienceintenseanxiety,depression,orgrief.Numerousstudiesreportthatatleast65percentofmaleandfemalesoldierswhohavelivedthroughhorrificbattlesorwar‐zonestressnevershowanyevidenceofPTSD(Keane,1998;Murray,1992).Multiplestudieswithindividualswhohavesurvivedmajormotorvehicleaccidents(Brom,Kleber,&Hofman,1993)orwitnessedtragicairplaneaccidents(Carlier&Gersons,1997)findthatthemajoritydidnotexperiencedepressionorPTSDintheweeksormonthsaftertheirexperiences.Acrossstudies,40‐80percentofrapesurvivorsdidnotevidencesymptomsofPTSD(Kilpatrick,Resnick,Saunders,&Best,1998;Resnick,Kilpatrick,&Lipovsky,1991). Whyisitthatsomepeopleseemtodealwithmajorupheavalsbetterthanothers?Whatistheprofileofhealthycoping?This,ofcourse,isacentralquestionamongtraumaresearchers.Weknow,forexample,thatpeoplewithanintactsocialsupportgroupweatherupheavalsbetterthanothers(e.g.,Murray,1992).Beyondbasicgeneticpredispositions,dosomepeopleadoptcertaincopingstrategiesthatallowthemtomovepastanupheavalmoreefficiently?Ifsuchcopingstrategiesexist,cantheybetrained?Ifsuchtechniquesareavailable,howdotheywork?

Giventhatasmanyas30%ofpeoplewhofacemassivetraumaticexperienceswillexperiencePTSD,whatcanwe,asresearchersandclinicians,dotoreducethisrate?Itislikelythatmany(perhapsmost)PTSD‐proneindividualswillnotbenefitfromanysimple

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interventions.Thenatureoftheirtrauma,theirgenetic,biological,and/orpersonalitypredispositions,orpre‐traumalifeexperienceswilloverridesocialorpsychologicaltherapies.Nevertheless,somePTSD‐proneindividualsaswellasthemajorityofdistressedbutsub‐clinicalcasesmaybenefitbyfocusingontheirpsychologicalandsocialworldsinthewakeoftheirtraumaticexperiences.

Acentralpremiseofthischapteristhatwhenpeopletransformtheirfeelingsandthoughtsaboutpersonallyupsettingexperiencesintolanguage,theirphysicalandmentalhealthoftenimprove.ThelinkstoPTSDarestilltenuous.However,anincreasingnumberofstudiesindicatethathavingpeoplewriteaboutemotionalupheavalscanresultinhealthyimprovementsinsocial,psychological,behavioral,andbiologicalfunctioning.Aswiththetrauma‐illnesslink,however,thereisprobablynotasinglemediatorthatcanexplainthepowerofwriting.Onepromisingcandidatethatisproposedconcernstheeffectsoftranslatingemotionsintolanguageformat,oraswesuggest,ametaphoricaltranslationofananalogexperienceintoadigitalone.EmotionalUpheavals,Disclosure,andHealth Notalltraumaticeventsareequallytoxic.Bythe1960s,HolmesandRahe(1967)suggestedthatthehealthimpactofatraumavariedwiththedegreethatthetraumadisruptedaperson’slife.Interestingly,theoriginalscalestappingthehealthrisksoftraumasgenerallymeasuredsociallyacceptabletraumas–deathofspouse,lossofjob.Noitemsaskediftheparticipanthadbeenraped,hadasexualaffair,orhadcausedthedeathofanother.Bythemid‐1980s,investigatorsstartedtonoticethatupheavalsthatwerekeptsecretweremorelikelytoresultinhealthproblemsthanthosethatcouldbespokenaboutmoreopenly.Forexample,individualswhowerevictimsofviolenceandwhohadkeptthisexperiencesilentweresignificantlymorelikelytohaveadversehealtheffectsthanthosewhoopenlytalkedwithothers(Pennebaker&Susman,1988).Inshort,havinganytypeoftraumaticexperienceisassociatedwithelevatedillnessrates;havinganytraumaandnottalkingaboutitfurtherelevatestherisk.Theseeffectsactuallyarestrongerwhencontrollingforage,sex,andsocialsupport.Apparently,keepingatraumasecretfromanintactsocialnetworkismoreunhealthythannothavingasocialnetworktobeginwith(cf.,Cole,Kemeny,Taylor,&Visscher,1996). Ifkeepingapowerfulsecretaboutanupsettingexperienceisunhealthy,cantalkingaboutit–orinsomeway,puttingitintowordsbebeneficial?Thisisaquestionweaskedovertwodecadesago.Goingontheuntestedassumptionthatmostpeoplewouldhavehadatleastoneemotionalupheavalthattheyhadnotdisclosedingreatdetail,webeganaseriesofstudiesthatinvolvedpeoplewritingand,insomecases,talkingabouttheseevents. Inthefirststudy,peoplewererandomlyassignedtowriteaboutatraumaoraboutsuperficialtopicsforfourdays,15minutesperday.Wefoundthatconfrontingtheemotionsandthoughtssurroundingdeeplypersonalissuespromotedphysicalhealth,asmeasuredbyreductionsinphysicianvisitsinthemonthsfollowingthestudy,fewerreportsofaspirinusage,andoverallmorepositivelongtermevaluationsoftheeffectoftheexperiment(Pennebaker&Beall,1986).Theresultsofthatinitialstudyhaveledtoanumberofsimilardisclosurestudies,inourlaboratoryandbyothers,withawidearrayofintriguingresults. Thebasicwritingparadigm.Thestandardlaboratorywritingtechniquehasinvolvedrandomlyassigningparticipantstooneoftwoormoregroups.Mostwritinggroupsare

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askedtowriteaboutassignedtopicsforonetofiveconsecutivedays,for15to30minuteseachday.Writingisgenerallydoneinthelaboratorywithnofeedbackgiven.Thoseassignedtothecontrolconditionsaretypicallyaskedtowriteaboutsuperficialtopics,suchashowtheyusetheirtime.Thestandardinstructionsforthoseassignedtotheexperimentalgroupareavariationonthefollowing:

Forthenextthreedays,Iwouldlikeforyoutowriteaboutyourverydeepestthoughtsandfeelingaboutthemosttraumaticexperienceofyourentirelife.Inyourwriting,I'dlikeyoutoreallyletgoandexploreyourverydeepestemotionsandthoughts.Youmighttiethistraumatoyourchildhood,yourrelationshipswithothers,includingparents,lovers,friends,orrelatives.Youmayalsolinkthiseventtoyourpast,yourpresent,oryourfuture,ortowhoyouhavebeen,whoyouwouldliketobe,orwhoyouarenow.Youmaywriteaboutthesamegeneralissuesorexperiencesonalldaysofwritingorondifferenttopicseachday.Noteveryonehashadasingletraumabutallofushavehadmajorconflictsorstressors–andyoucanwriteabouttheseaswell.Allofyourwritingwillbecompletelyconfidential.Don'tworryaboutspelling,sentencestructure,orgrammar.Theonlyruleisthatonceyoubeginwriting,continuetodosountilyourtimeisup.

Whereastheoriginalwritingstudiesaskedpeopletowriteabouttraumaticexperiences,laterstudiesexpandedthescopeofwritingtopicstogeneralemotionaleventsortospecificexperiencessharedbyotherparticipants(e.g.,diagnosisofcancer,losingajob,comingtocollege).Theamountoftimepeoplehavebeenaskedtowritehasalsovariedtremendouslyfrom10minutesto30minutesfor3,4,or5days–sometimeswithinthesamedaytoonceperweekforupto4weeks. Thewritingparadigmisquitepowerful.Participants‐‐fromchildrentotheelderly,fromhonorstudentstomaximumsecurityprisoners‐‐disclosearemarkablerangeanddepthofhumanexperiences.Lostloves,deaths,sexualandphysicalabuseincidents,andtragicfailuresarecommonthemesinallofourstudies.Ifnothingelse,theparadigmdemonstratesthatwhenindividualsaregiventheopportunitytodisclosedeeplypersonalaspectsoftheirlives,theyreadilydoso.Eventhoughalargenumberofparticipantsreportcryingorbeingdeeplyupsetbytheexperience,theoverwhelmingmajorityreportthatthewritingexperiencewasvaluableandmeaningfulintheirlives. Theinterestintheexpressivewritingmethodhasgrownovertheyears.Thefirststudywaspublishedin1986.By1996,approximately20studieshadbeenpublished.By2009,over200havebeenpublishedinEnglishlanguagejournals.Althoughmanystudieshaveexaminedphysicalhealthandbiologicaloutcomes,anincreasingnumberhaveexploredwriting’seffectsonattitudechange,stereotyping,creativity,workingmemory,motivation,lifesatisfaction,schoolperformance,andavarietyofhealth‐relatedbehaviors.Itisbeyondthescopeofthischaptertoprovideadetailedreviewofthefindingsofthewritingparadigm.Rather,webrieflysummarizesomeofthemorepromisingfindingsbeforefocusingontheunderlyingmechanismsthatmaybeatwork. Effectsofdisclosureonhealth‐relatedoutcomes.Researchershavereliedonavarietyofphysicalandmentalhealthmeasurestoevaluatetheeffectofwriting.Writingortalkingaboutemotionalexperiencesrelativetowritingaboutsuperficialcontroltopicshasbeenfoundtobeassociatedwithsignificantdropsinphysicianvisitsfrombeforetoafterwritingamongrelativelyhealthysamples.Overthelastdecade,asthenumberof

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expressivewritingstudieshasincreased,severalmeta‐analyseseitherhavebeenconductedorarebeingconductedasofthiswriting. Theoriginalexpressivewritingmeta‐analysiswaspublishedbyJoshuaSmyth(1998)aswasbasedon14studiesusinghealthyparticipants.Hisprimaryconclusionswerethatthewritingparadigmisassociatedwithpositiveoutcomeswithaweightedmeaneffectsizeofd=.47(r=.23,p<.0001),notingthatthiseffectsizeissimilartoorlargerthanthoseproducedbyotherpsychologicalinterventions.Thehighestsignificanteffectsizeswereforpsychological(d=.66)andphysiologicaloutcomes(d=.68),whichweregreaterthanthoseforhealth(d=.42)andgeneralfunctioningoutcomes(d=.33).Anon‐significanteffectsizewasfoundforhealthbehaviors.Healsofoundthatlongerintervalsbetweenwritingsessionsproducedlargeroveralleffectsizes,andthatmalesbenefitedmorefromwritingthandidfemales.

Frisina,Borod,andLepore(2004)performedasimilarmeta‐analysison9writingsstudiesusingclinicalpopulations.Theyfoundthatexpressivewritingsignificantlyimprovedhealthoutcomes(d=.19,p<.05).However,theeffectwasstrongerforphysical(d=.21,p=.01)thanforpsychological(d=.07,p=.17)healthoutcomes.Theauthorssuggestedthatapossiblereasonforthesesmalleffectsizeswereduetotheheterogeneityofthesamples.Writingwaslesseffectiveforpsychiatricthanphysicalillnesspopulations.Almostsevenyearsafterthefirstmeta‐analysis(Smyth,1998)waspublished,anothermeta‐analysisbyMeads(2003)wasreleasedbytheCochranCommission.Inananalysisofdozensofstudies,theauthorconcludedthattherewasnotsufficientevidencetowarrantadoptingthewritingmethodaspartofclinicalpractice.Oneproblemthatthereportunderscoredwasthelackofanylargerandomizedclinicaltrials(RCTs)thatwerebasedonlarge,clearlyidentifiedsamples.Comingfromamedicalbackground,theMeadsarticlewasbefuddledbythefactthatmostoftheexperimentalstudiesofexpressivewritingweremoretheory‐orientedandnotaimedatclinicalapplication.SincethereleaseoftheMeadspaper,anewwaveofRCTshadstartedwithadiversegroupofpatientpopulations.

Harris(2006)recentlyreportedonameta‐analysisofRCTsusingexpressivewriting.Harriscomparedtheuseofhealthcareservicesin30independentsampleswhohadparticipatedinexpressivewritingaboutstressfulexperiences.Usingarandomeffectsapproach,hefoundeffectsizes(Hedges’sg)of.16(.02,.31)forhealthysamples,.21(‐.02,.43)forsampleswithpreexistingmedicalconditions,and.06(‐.12,.24)forsampleswhohadbeenprescreenedforpsychologicalcriteria.Heconcludedthatexpressivewritingonlyhadaneffectforhealthysamples.TheseresultsweresimilartothosefoundinMead’s(2003)meta‐analysis,butwiththeHarris(2006)studyhavingmorepowertodetectsucheffects.Harrisdefendedthefindingsaspotentiallysignificanttothehealthcareofhealthysamples,andtothehealthcaresystemitself.Inaddition,hestatedthatthefindingspointedtowardstheneedtoidentifypeoplewithmedicalandpsychologicalconditionsforwhomexpressivewritingmightbecontraindicated,aswellasanassessmentofpreexistingover‐orunder‐useofhealthcareservicesinordertobetterinterprettheresults.

Finally,Frattaroli(2006)publishedthelargestmeta‐analysisontheeffectsofexpressivewriting.Hermeta‐analysisincludedallrandomizedexpressivewritingexperimentsthathadusedsomevariationoftheoriginalPennebakerandBeall(1986)writinginstructions,alongwiththepresentationofoutcomedata.Usingarandomeffectsapproach,shefoundanoveralleffectsizeofd=.15(equivalenttoanr=.075),whichshenotedwasmeaningfulgiventhathermeta‐analysishadincludedunpublishedstudies

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(whichtendtocontributetomuchloweraverageeffectsizes)andamethodologicallyheterogeneoussetofstudies.Shealsonotedthattheeffectsizewasimportantgiventhatexpressivewritingistimeandcost‐effective,perceivedbyparticipantstohelpful,andeasytoadminister.

Researchershavereliedonavarietyofphysicalandmentalhealthmeasurestoevaluatetheeffectofwriting.Acrossmultiplestudiesinlaboratoriesaroundtheworld,writingortalkingaboutemotionalexperiencesrelativetowritingaboutsuperficialcontroltopicshasbeenfoundtobeassociatedwithsignificantdropsinphysicianvisitsfrombeforetoafterwritingamongrelativelyhealthysamples.Writingand/ortalkingaboutemotionaltopicshasalsobeenfoundtoinfluenceimmunefunctioninbeneficialways,includingt‐helpercellgrowth(usingablastogenesisprocedurewiththemitogenPHA),antibodyresponsetoEpstein‐Barrvirus,andantibodyresponsetohepatitisBvaccinations(forreviews,seeLepore&Smyth,2002;Pennebaker&Graybeal,2001;Sloan&Marx,2004a).

Activityoftheautonomicnervoussystemisalsoinfluencedbythedisclosureparadigm.Amongthoseparticipantswhodisclosetheirthoughtsandemotionstoaparticularlyhighdegree,skinconductancelevelsaresignificantlylowerduringthetraumadisclosuresthanwhendescribingsuperficialtopics.Systolicbloodpressureandheartratedropstolevelsbelowbaselinefollowingthedisclosureoftraumatictopicsbutnotsuperficialones(Pennebaker,Hughes,&O’Heeron,1987).Inshort,whenindividualstalkorwriteaboutdeeplypersonaltopics,theirimmediatebiologicalresponsesarecongruentwiththoseseenamongpeopleattemptingtorelax.McGuire,Greenberg,andGevirtz(2005)haveshownthattheseeffectscancarryovertothelongterminparticipantswithelevatedbloodpressure.Onemonthafterwriting,thosewhoparticipatedintheemotionaldisclosureconditionexhibitedlowersystolicanddiastolicbloodpressure(DBP)thanbeforewriting.Fourmonthsafterwriting,DBPremainedlowerthanbaselinelevels.

Similarly,SloanandMarx(2004b)foundthatparticipantsinadisclosureconditionexhibitedgreaterphysiologicalactivation,asindexedbyelevatedcortisollevels,duringtheirfirstwritingsession,relativetocontrols.Physiologicalactivationthendecreased,andwassimilartothatofcontrolsinsubsequentwritingsessions.Theinitialelevationincortisolfromthefirstwritingsessionpredictedimprovedpsychologicalbutnotphysicalhealthatonemonthfollow‐up.Itispossiblethatconfrontingatraumaticordistressingexperienceledtoreactionsaimedforinexposure‐basedtreatments(e.g.Foa&Kozak,1986).BiologicalsupportforexposureeffectsofexpressivewritingwasfoundinanotherstudythatlookedatindividualsdiagnosedwithPTSD.AlthoughexpressivewritingdidnotleadtodecreasesinPTSD‐relatedsymptomseverity,Smyth,Hockemeyer,andTulloch(2008)founddecreasesincortisollevelsduringtrauma‐relatedimaginalexposure3monthsfollowingexpressivewriting,alongwithdecreasesinnegativemoodstates,andincreasesinpost‐traumaticgrowth(i.e.hopeforthefuture,personalstrength,andappreciationforlife).

Behavioralchangeshavealsobeenfound.Studentswhowriteaboutemotionaltopicsevidenceimprovementsingradesinthemonthsfollowingthestudy(e.g.,Lumley&Provenzano,2003;Pennebaker,Colder,&Sharp,1990).Seniorprofessionalswhohavebeenlaidofffromtheirjobsgetnewjobsmorequicklyafterwriting(Spera,Buhrfeind&Pennebaker,1994).Consistentwiththedirecthealthmeasures,universitystaffmemberswhowriteaboutemotionaltopicsaresubsequentlyabsentfromtheirworkatlowerratesthancontrols(Francis&Pennebaker,1992).Interestingly,relativelyfewreliablechanges

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emergeusingself‐reportsofhealth‐relatedbehaviors.Thatis,intheweeksafterwriting,experimentalparticipantsdonotexercisemoreorsmokeless.Theoneexceptionisthatthestudywithlaidoffprofessionalsfoundthatwritingreducedself‐reportedalcoholintake. Selfreportsalsosuggestthatwritingaboutupsettingexperiences,althoughpainfulinthedaysofwriting,produceslong‐termimprovementsinmoodandindicatorsofwell‐beingcomparedtocontrols.Althoughsomestudieshavefailedtofindclearmoodorself‐reporteddistresseffects,Smyth’s(1998)meta‐analysisonwrittendisclosurestudiesindicatesthat,ingeneral,writingaboutemotionaltopicsisassociatedwithsignificantreductionsindistress. Proceduraldifferencesthataffecttheexpressivewriting.Writingaboutemotionalexperiencesclearlyinfluencesmeasuresofphysicalandmentalhealth.Inrecentyears,severalinvestigatorshaveattemptedtodefinetheboundaryconditionsofthedisclosureeffect.Someofthemostimportantfindingsareasfollows: Topicofdisclosure.Althoughtwostudieshavefoundthathealtheffectsonlyoccuramongindividualswhowriteaboutparticularlytraumaticexperiences(Greenberg&Stone,1992;Lutgendorf,Antoni,Kumar,&Schneiderman,1994),moststudieshavefoundthatdisclosureismorebroadlybeneficial.Choiceoftopic,however,mayselectivelyinfluenceoutcomes.Althoughvirtuallyallstudiesfindthatwritingaboutemotionaltopicshaspositiveeffectsonphysicalhealth,onlycertainassignedtopicsappeartoberelatedtochangesingrades.Forbeginningcollegestudents,forexample,whenaskedtowritespecificallyaboutemotionalissuesrelatedtocomingtocollege,bothhealthandcollegegradesimprove.However,whenotherstudentsareaskedtowriteaboutemotionalissuesrelatedtotraumaticexperiencesingeneral,onlyhealthimprovements–andnotacademicperformance–arefound(seePennebaker,1995;Pennebaker&Keough,1999). Overthelastdecade,anincreasingnumberofstudieshaveexperimentedwithmorefocusedwritingtopics.Individualsdiagnosedwithbreastcancer,lungcancer,orHIV,havebeenaskedtowritespecificallyabouttheirlivingwiththeparticulardisease(e.g.,deMoor,etal,2002;Mann,2001;Petrie,etal.,2004;Stanton&Danoff‐Burg,2002).Similarly,peoplewhohavelosttheirjobhavebeenaskedtowriteaboutthatexperience(Speraetal.,1994).Ineachcase,however,participantsareaskedtowriteaboutthistopicinaverybroadwayandareencouragedtowriteaboutothertopicsthatmaybeonlyremotelyrelated.Forexample,inthejoblayoffproject,participantsintheexperimentalconditionswereaskedtoexploretheirthoughtsandfeelingaboutlosingtheirjobs.Fewerthanhalfoftheessaysdealtdirectlywiththelayoff.Othersdealtwithmaritalproblems,issueswithchildren,money,andhealth. Ithasbeenourexperiencethattraumaticexperiencesoftenbringtotheforeotherimportantissuesinpeople’slives.Asresearchers,weassumethat,say,thediagnosisofalife‐threateningdiseaseisthemostimportantissueforapersontowriteaboutinacancer‐relatedstudy.However,formany,thiscanbesecondarytoacheatinghusband,anabusiveparent,orsomeothertraumathatmayhaveoccurredyearsearlier.Werecommendthatwritingresearchersandpractitionersprovidesufficientlyopeninstructionstoallowpeopletodealwithwhateverimportanttopicstheywanttowriteabout.Asdescribedingreaterdetailbelow,themorethatthetopicorwritingassignmentisconstrained,thelesssuccessfulitusuallyis. Topicorientation:focusingonthegood,thebad,orthebenefits.Thereareanumberoftheoreticalandpracticalreasonstoassumethatsomestrategiesforapproaching

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emotionalupheavalsmightbebetterthanothers.WiththegrowthofthefieldofPositivePsychology,severalresearchershavereportedonthebenefitsofhavingapositiveoroptimisticapproachtolife(Carver&Scheier,2002;Diener,Lucas,&Oishi,2002;Seligman,2000).Particularlypersuasivehavebeenaseriesofcorrelationalstudiesonbenefitfinding–thatis,peoplewhoareabletofindbenefitstonegativeexperiencesgenerallyreportlessnegativeaffect,milderdistress,fewerdisruptivethoughts,andgreatermeaningfulnessinlife.Peoplewhoengageinbenefit‐findingfarebetteronobjectivephysicalandmentalhealthoutcomes(e.g.children’sdevelopmentaltestscores,recurrenceofheartattacks)evenaftercontrollingforahostofpossibleconfoundingfactors(forareview,seeAffleckandTennen,1996).Beingabletoseethingsinapositivelight,then,mightbeacriticalcomponenttosuccessfuladjustment. Inonestudyexaminingadjustmenttocollege,CameronandNicholls(1998)hadparticipantspreviouslyclassifiedasdispositionaloptimistsorpessimistswriteinoneofthreeconditions:aself‐regulationcondition(writingaboutthoughtsandfeelingstowardscomingtocollegeandthenformulatingcopingstrategies),adisclosurecondition(writingaboutthoughtsandfeelingsonly),oracontroltask(writingabouttrivialtopics).Overall,participantsinthedisclosuretaskhadhigherGPAscoresatfollow‐up,butonlythoseintheself‐regulationtaskexperiencedlessnegativeaffectandbetteradjustmenttocollegeoverthecontrolparticipants.Optimistsvisitedtheirdoctorslessinthefollowingmonthiftheyhadparticipatedineitheroftheexperimentalwritingconditions.Ontheotherhand,onlypessimistsintheself‐regulationconditionhadsignificantlyfewervisitstothedoctorafterthestudy.Withtheaddedencouragementofformulatingcopingstrategies,pessimistsmaybeabletoreapthesamehealthbenefitsfromwritingabouttheirthoughtsandfeelingsasoptimistsnaturallymightdo.

Whenconfrontingtraumaticexperiences,isitbesttoaskpeopletosimplywriteaboutthemortowriteaboutthepositivesidesoftheexperiences?Severalstudieshaveaddressedthisquestion.ParticularlyinterestinghasbeenaseriesofstudiesbyLauraKingandhercolleagues.Whenaskedtowriteaboutintenselypositiveexperiences(IPE)orcontroltopics,participantswhowroteaboutIPEsreportedsignificantlybettermood,andfewerillness‐relatedhealthcentervisitsthandidthosewhowroteabouttrivialtopics(Burton&King,2004).Inanotherstudy,studentswereaskedtowriteabouttraumasinthestandardway(King&Miner,2000).Inthebenefit‐findingcondition,participantswereencouragedtofocusonthebenefitsthathavecomefromthetrauma.Finally,inthemixedcondition,participantswerefirstaskedtowriteaboutthetrauma,andthentoswitchtotheperceivedbenefitsarisingfromthetraumaexperience.Countertopredictions,thetraumaonlyandbenefitsonlyparticipantsevidencedhealthimprovementswhereasthemixedgroupdidnot.Itcouldbethatwritingabouttheperceivedbenefitsisenoughtoorganizethoughtsandfeelingsaboutatrauma,andtocopeeffectively.However,asevidencedfromthemixedcondition,ifpeoplearen’tabletointegratetheirperceivedbenefitsintotheirtraumastoryintheirownway,writingmaybeineffective.

Otherstudiessuggestthatfocusingonpositiveemotionsinwritingmayhavemixedeffects.Withasampleofbreastcancerpatients,Stantonandcolleagues(2002)foundthatatraditionalwritinggroupexhibitedslightlymorehealthimprovementsthantheirpositive‐feelings‐onlywritinggroup.Morerecently,Lyubomirsky,Sousa,andDickerhoof(2006)conductedaningeniousseriesofstudieswhereinstudentswroteabouteithertheirbestorworstlifeexperiences.Further,somestudentswereaskedtoeitherreplaytheeventsin

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theirmindwhereasotherswereaskedtoanalyzethemindetail.Theanalysisofnegativeeventsresultedinbetterhealthandlifesatisfactionwhereastheanalysisofpositiveexperiencesresultedinslightlyworsehealthandsatisfaction.Similarly,UllrichandLutgendorf(2002)foundthatparticipantswhowereinstructedtowriteaboutthecognitiveandemotionalaspectsofatraumafaredbetterthanthosewhowereinstructedtofocusonlyonemotionalaspects.

Severalunpublishedstudiesfromourownlabpaintasimilarpictureabouttheproblemsofconstrainingparticipants’orientations.Forherdissertation,CherylHughes(1994)askedstudentstowriteeitheraboutthepositiveorthenegativeaspectsoftheircomingtocollegefor3days.Neithergroupevidencedanybenefitsofwritingcomparedtoanon‐emotionalcontrolcondition.Indeed,bothgroupscomplainedthatthereweresomerealnegative(inthepositivecondition)andpositive(inthenegativecondition)aspectsofcomingtocollegethattheyalsowantedtowriteabout.Similarly,inanunpublishedprojectbyLoriStone(2002),studentswereaskedtowriteabouttheirthoughtsandfeelingsabouttheSeptember11attacks.Inonecondition,theyreceivedthestandardunconstrainedinstructions.Inasecondcondition,participantswereaskedtofocusontheirownfeelingsononedayandonotherperspectivesonalternatingdays.Theperspective‐switchinginstructionsprovedtobelessbeneficialthantheunconstrainedmethods. Althoughseveralvariationsontheexpressivewritingmethodhavebeentested,nonehavebeenfoundtobeconsistentlysuperiortotheoriginaltraumawritingorothermethodsthatencouragetheparticipants’freelychoosingtheirwritingtopic.Forcingindividualstowriteaboutaparticulartopicorinaparticularwaymaycausethemtofocusonthewritingitselfratherthanthetopicandtheroleoftheiremotionsintheoverallstory. Writingversustalkingaloneversustalkingtoothers.Moststudiescomparingwritingalonetotalkingeitherintoataperecorder(Esterling,etal.,1994)ortoatherapistinaone‐wayinteraction(Murray,Lamnin,&Carver,1989;Donnelly&Murray,1991)findcomparablebiological,mood,andcognitiveeffects.Talkingandwritingaboutemotionalexperiencesarebothsuperiortowritingaboutsuperficialtopics. 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 one’s traumas in a group format after writing may pose unexpected problems. Clearly, additional research is needed to help understand this process.

Actualorimpliedsocialfactors.Indeed,unlikepsychotherapyandeverydaydiscussionsabouttraumas,thewritingparadigmdoesnotemployfeedbacktotheparticipant.Rather,afterindividualswriteabouttheirownexperiences,theyareaskedtoplacetheiressaysintoananonymous‐lookingboxwiththepromisethattheirwritingwillnotbelinkedtotheirname.Inonestudycomparingtheeffectsofhavingstudentseitherwriteonpaperthatwouldbehandedintotheexperimenteroronamagicpad(whereinthewritingdisappearswhenthepersonliftstheplasticwritingcover),noautonomicorself‐reportdifferenceswerefound(Czajka,1987).Thebenefitsofwriting,then,occur

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withoutexplicitsocialfeedback.Nevertheless,thedegreetowhichpeoplewriteholdingthebeliefthatsomesymbolicotherpersonmay“magically”readtheiressayscanneverbeeasilydetermined.

Severalstudieshaveshownthatself‐disclosurethroughbloggingcanincreaseperceivedsocialsupport(Baker&Moore,2008),subjectivewell‐being(Ko&Kuo,inpress),andsuccessinweightloss(Chung&Pennebaker,2009),primarilythroughreceivingandsendingcommentsonablogorwithinablogcommunity.However,bloggingisaverydifferententerprisethansolitaryexpressivewriting.Notonlydopeoplesharetheirentrieswithothersbuttheyclearlyseekfeedbackfromothers.Blogging,then,isasocialprocess–perhapsmorethanitisaself‐reflective,andinsight‐seekingorinsightprovokingself‐changestrategy.Ontheotherhand,expressivewritingprovidesbenefitstothewritersthemselves,withlaterimprovementsinsocialrelationshipsasoneofmanypotentialindirecteffects. Timing:Howlongafteratrauma.Inthelast30years,advancesinemergencymedicinehavebeenastounding.Althoughweknowhowtotreatpeoplemedicallyinthefirsthoursanddaysafteratrauma,ourknowledgeaboutpsychologicalinterventionsduringthesametimeperiodhasgrownverylittle.Withouttheguidanceofanyresearch,severalgroupshavecreatedimmediatecrisisinterventionbusinesses.Perhapsthemostcommerciallysuccessful,nowcalledCriticalIncidentStressManagement(CISM,e.g.,Mitchell&Everly,1996),arguesthatpeoplevictimizedbytraumashouldbeattendedtowithinthefirst72hoursafteratrauma.AlthoughtheCISMsystemhasmanycomponents,themostinterestingandcontroversialencouragesindividualstoopenlyacknowledgetheiremotionsandthoughtswithinagroupconcerningthetrauma.TheCISMsystemhasnowbeenadoptedbythousandsofbusinesses,governmentalorganizations,andothergroupsaroundtheworld.DespitetheintuitiveappealofCISM,thereisverylittleevidencethatitworks.Indeed,moststudiessuggestthatitismorelikelytocauseharmthanbenefits(McNally,Byrant,&Ehlers,2003). TheCISMfindingsaswellasotherprojectsinterestedinself‐disclosureimmediatelyafteranupheavalhaverelevanceforthetimingforanexpressivewritingintervention.Forexample,onestudyaskedwomenwhohadrecentlygivenbirthtotalkabouttheirdeepestthoughts,feelings,andfearstotheirmidwives.Thesewomenwereactuallymorelikelytosubsequentlyexperiencedepressionthanwomennotaskedtotalkaboutthesetopics(Small,Lumley,Donohue,Potter,&Waldenstrom,2000).Womenwhowereaskedtowriteaboutthetreatmenttheywereundergoingforbreastcancerduringthelastweekofradiationtreatmentevidencednobenefitsforanymeasurescomparedtocontrols(Walker,Nail,&Croyle,1999). Isthereanoptimaltimeafteratraumathatexpressivewritingwouldmostlikelywork?Unfortunately,noparametricstudieshavebeenconductedonthis.Overtheyears,wehavebeeninvolvedinseveralprojectsthathaveattemptedtotappeople’snaturaldisclosurepatternsinthedaysandweeksafterupheavals.Forexample,usingarandomdigitdialingintheweeksandmonthsafterthe1989LomaPrietaEarthquakeintheSanFranciscoBayarea,weaskeddifferentgroupsofpeoplethenumberoftimesthattheyhadthoughtaboutandtalkedabouttheearthquakeintheprevious24hours.Weusedasimilarmethodayearlatertotappeople’sresponsestothedeclarationofwarwithIraqduringthefirstPersianGulfWar.Inbothcases,wefoundthatpeopletalkedwithoneanotheratveryhighratesinthefirst2‐3weeks.Bythe4thweek,however,talkingrateswereextremely

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low.Ratesofthinkingabouttheearthquakeandwarshowedadifferentpattern:ittookconsiderablylonger(about8weeks)beforepeoplereportedthinkingaboutthematlowrates(fromPennebaker&Harber,1993). Morerecently,wehaveanalyzedtheblogsofalmost1100frequentusersofaninternetsiteinthetwomonthsbeforeandtwomonthsaftertheSeptember11attacks.Ratesofwritingincreaseddramaticallyforabouttwoweeksaftertheattacks.Morestrikingwastheanalysisofwordusage.Useof1stpersonsingular(I,me,andmy),droppedalmost15%within24hoursoftheattacksandremainedlowforaboutaweek.However,overthenexttwomonths,I‐wordusageremainedbelowbaseline(Cohn,Mehl,&Pennebaker,2004).Usageof1stpersonsingularissignificantbecauseitcorrelateswithdepression(Rude,Gortner,&Pennebaker,2004).Whatwasstrikingwasthatthesebloggers–whoexpressedanelevatedrateofnegativemoodsinthedaysafter9/11–weregenerallyquitehealthy.Theywerepsychologicallydistancingthemselvesfromtheemotionalturmoiloftheevent. Consideringthecurrentevidence,itislikelythatdefensessuchasdenial,detachment,distraction,anddistancingmay,infact,bequitehealthyinthehoursanddaysafteranupheaval.Atechniquesuchasexpressivewritingmaybeinappropriateuntilseveralweeksormonthslater.Indeed,wenowencourageclinicianstodelaytheiruseofexpressivewritinguntilatleast1‐2monthsafteranupheavaloruntiltheythinktheirpatientisthinking“toomuch”abouttheevent.Obsessingandruminatingaboutatraumaafewweeksafterithasoccurredisprobablynottoomuch.Thinkingaboutitatthesamehighratesixmonthslatermightinfactsignalthatexpressivewritingmightbebeneficial.

Timingofwritingsessions.AlthoughSmyth’s(1988)meta‐analysisfoundnoeffectforthelengthofwritingsessions,Frattaroli’s(2006)meta‐analysissuggestedthatwritingsessionsgreaterthan15minutesweremorepotentthanwritingsessionslessthan15minutes.Recently,inanadmirablybrazentestofthelowerboundaryofexpressivewriting’seffectiveness,BurtonandKing(2008)had49healthyparticipantswriteaboutanegativeevent,apositiveevent,oracontroltopicforjust2minutesadayfor2consecutivedays(foragrandtotalof4minutes).Bothoftheexpressive(negativeeventandpositiveevent)writinggroupsreportedexperiencingfewerphysicalsymptomsat4‐6weeksfollow‐upthandidcontrols.Theauthorssuggestedthatperhapsthe2minutesisallthatwasneededinordertokick‐starttheprocessingofemotionalevents.Indeed,itwaslikelythatthe2minutewritingsessionleftparticipantswith“unfinishedbusiness”,suggestingthatthetimebetweenwritingsessionswasspentprocessingthewritingtopic. Timingbetweenwritingsessions.Differentexperimentshavevariouslyaskedparticipantstowriteforonetofivedays,rangingfromconsecutivedaystosessionsseparatedbyaweek,rangingfrom10to45minutesforeachwritingsession,foranywherefrom1to7sessions.InSmyth’s(1998)meta‐analysis,hefoundatrendsuggestingthatthemoredaysoverwhichtheexperimenttakesplace,thestrongertheimpactonoutcomes.TwosubsequentstudiesthatactuallymanipulatedthetimesbetweenwritingfailedtosupportSmyth’sfindings. 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 time-course 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.Noconsistentpersonalitymeasureshavedistinguishedwhodoesversuswhodoesnotbenefitfromwriting.Anumberofvariableshavebeenunrelatedtooutcomes,includingage,anxiety(orNegativeAffectivity),andinhibitionorconstraint.Asmallnumberofstudiesthathaveeitherpreselectedparticipantsorperformedamediansplitonaparticularvariablehavereportedsomeeffects.However,giventhelargenumberofstudies,theseeffectsshouldprobablybeviewedaspromisingratherthandefinitive. Christensenetal.(1996)preselectedstudentsonhostilityandfoundthatthosehighinhostilitybenefitedmorefromwritingthanthoselowinhostility.Acouplestudieshavefoundthatindividualshighonalexithymia(atraitthattapstheinabilityofpeopletolabelorfeelparticularnegativeemotions)tendedtobenefitfromwritingmorethanthoselowonalexithymia(Paez,Velasco,&Gonzalez,1999;Solanoetal.,2003).Indeed,arecentstudybyBaikie(2008)showedthatalexithymicsandsplitters(thosewhotendtoseetheworldasallgoodorallbad)experiencedfewerhealthvisitsafterexpressivewriting,thandidrepressivecopers(thosewhotendtoavoidanddenyemotionalresponses).Baikiesuggestedthatthestructureandtime‐limitofexpressivewritingallowedalexithymicsandsplitterstofeelmorecomfortableprocessingemotionaleventsthanintalkingtherapies,forwhichtheytendtoexperiencepooreroutcomes.However,researchbyLumley(2004)suggeststhatunliketheparticipantsintheaforementionedstudies,alexithymicssufferingfromchronicillnessesorelevatedstressmaynotreapthesamebenefitsafterwriting.Similarly,WongandRochon(2009)hadmenwhotendtobeemotionallyrestrictedwriteexpressivelyabouttheirbestpossibleemotionalconnectednesswithanimaginedromantic

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partner(current,imaginary,orfuture)oraboutacontroltopic.Theauthorsfounddecreaseddistressfortheexpressivewritinggroup,buttheyfoundnoothereffectsofrelationshipqualityorlikelihoodofbeinginarelationshipbetweenthetwogroups. Finally,therehasbeenagreatdealofinterestinknowingifsexdifferencesexistinthepotentialbenefitsofexpressivewriting.Smyth’s(1998)meta‐analysisrevealedthatmalestendtobenefitmorefromthewritingparadigmthanfemales.Severalstudieshaveexploredthiswithreasonablylargesamples–usuallywithcollegestudents–andhavenotreplicatedthemeta‐analyticresults.However,expressivewritingstudieswithheterosexualromanticcoupleshavefoundimprovedrelationshipoutcomeswhenthemaleisassignedtotheexpressivewritingcondition.SlatcherandPennebaker(2006)foundanon‐significanttrendforacoupletobemorelikelytoexperiencerelationshipstabilityifthemalewasassignedtotheexpressivewritingcondition.Amorerecentstudyconfirmedthisfindinginheterosexualmilitarycouples.BaddeleyandPennebaker(2009)founddecreasesinaggressivebehaviorswithinthedyadwhenthemalewasassignedtotheexpressivewritingcondition.Interestingly,whenthefemalehadbeenassignedtotheexpressivewritingcondition,therewasastrongdecreaseinmaritalsatisfactionwithinthecouple.Takentogether,theresultscorroboratewhatwomenhaveknownforcenturies:whenitcomestorelationships,menneedtotalk(orrather,write)abouttheirfeelingsmore. Educational,linguistic,orculturaleffects.WithintheUnitedStates,thedisclosureparadigmhasbenefitedseniorprofessionalswithadvanceddegreesatratescomparabletoratesofbenefitinmaximumsecurityprisonerswith6thgradeeducations(Speraetal.,1994;Richards,Beal,Segal,&Pennebaker,2000).Amongcollegestudents,wehavenotfounddifferencesasafunctionofthestudents’ethnicityornativelanguage.ThedisclosureparadigmhasproducedpositiveresultsamongFrench‐speakingBelgians(Rimé,1995),Spanish‐speakingresidentsofMexicoCity(Dominguez,etal.,1995)andnorthernSpain(Paezetal.,1999),multiplesamplesofadultsandstudentsinTheNetherlands(Schoutrop,Lange,Brosschot,&Everaerd,1997)andItaly(e.g.,Solanoetal.,2003),English‐speakingNewZealandmedicalstudents(Petrie,etal.,1995),Japaneseundergraduates(Yogo&Fujihara,2008),andKorean/EnglishandSpanish/EnglishbilingualsintheUnitedStates(Kim,2008).

Summary.Whenindividualswriteortalkaboutpersonallyupsettingexperiencesinthelaboratory,consistentandsignificanthealthimprovementsarefound.Theeffectsincludebothsubjectiveandobjectivemarkersofhealthandwell‐being.Thedisclosurephenomenonappearstogeneralizeacrosssettings,manyindividualdifferencefactors,andseveralWesterncultures,andisindependentofsocialfeedback.WhyDoesExpressiveWritingWork? Psychology,likemostsciences,isdedicatedtounderstandinghowthingswork.Wearealsodrivenbythelawofparsimonyandassumethat,ideally,asingleexplanatorymechanismforaphenomenonshouldexist.Ifyouareexpectingacleanandsimpleexplanationfortheeffectivenessofwriting,wehavesomeverybadnews:Thereisnosinglereasonthatexplainsit.Overthelasttwodecades,adauntingnumberofexplanationshavebeenputforwardandmanyhavebeenfoundtobepartiallycorrect.Ultimately,thereisnosuchthingasasinglecauseforacomplexphenomenon.Thereasonistwo‐fold.First,anycausalexplanationcanbedissectedatmultiplelevelsofanalysisrangingfromsocialexplanationstochangesinneurotransmitterlevels.Second,aneventthattakesweeksor

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evenmonthstounfoldwillnecessarilyhavemultipledeterminantsthatcaninhibitorfacilitatetheprocessovertime. Inthissection,webrieflysummarizesomeofthemorecompellingexplanationsfortheexpressivewriting‐healthrelationship.Keepinmindthatmanyoftheseprocessesoccursimultaneouslyormayinfluenceoneanother. Individualandsocialinhibition.Thefirstexpressivewritingprojectswereguidedbyageneraltheoryofinhibition(cf.,Pennebaker&Beall,1986;Pennebaker,1989).Earlierstudieshaddiscoveredthatpeoplewhohadexperiencedoneormoretraumasintheirlivesweremorelikelytoreporthealthproblemsiftheydidnotconfideinothersabouttheirtraumasthaniftheyhaddoneso(e.g.,Pennebaker&Susman,1988).Theinhibitionideawasthattheactofinhibitingorinsomewayholdingbackthoughts,emotions,orbehaviorsisassociatedwithlowlevelphysiologicalwork–muchthewaythatSapolsky(2004)orSelye(1978)thoughtaboutstress.Further,peoplewereespeciallylikelytoinhibittheirthoughtsandfeelingsabouttraumaticexperiencesthatweresociallythreatening.Hence,individualswhohadexperiencedasexualtraumawouldbefarlesslikelytotalkaboutitwithothersthaniftheyhadexperiencedthedeathofagrandparent. Followingthelogicofinhibition,itwasassumedthatifpeoplewereencouragedtotalkorwriteaboutapreviouslyinhibitedevent,healthimprovementswouldbeseen.Perhaps,wereasoned,oncepeopleputtheirexperienceintowords,theywouldnolongerhavetheneedtoinhibit.Despitethehelpfulnessofthetheoryingeneratinginterestingandtestablehypotheses,thesupportingevidencehasbeendecidedlymixed.Severalearlystudiesattemptedtoevaluatethedegreetowhichpeoplewroteaboutsecretversusmorepublictraumasandpreviouslydisclosedversusnotpreviouslydisclosedevents.Innocasedidthesefactorsdifferentiallypredictimprovementsinhealth(e.g.,Greenberg&Stone,1992;Pennebaker,Kiecolt‐Glaser,&Glaser,1988).

Someevidencefortheinhibitiontheorycomesfromarecentstudyofgaymeninacommunitysamplewithsocialconstraintsonself‐expression(Swanbon,Boyce,&Greenberg,2008).Sixty‐twogaymenwereaskedtowriteeitheraboutgay‐relatedthoughtsandfeelings,oraboutcontroltopics.Theauthorsfoundthattheexpressivewritinggroupexperiencedlessavoidanceaboutbeinggayandreportedexperiencingfewersomaticsymptomsrelativetothecontrolgroup,suggestingthatdisclosurecouldhelptodecreasethecognitiveloadofinhibitingthoughtsabouttheself.However,thesampleincludedolder,moreeducated,andopenlygaymen.Futurestudieswouldhavetotestclosetedgaymeninordertoprovideabettertestoftheinhibitiontheoryofexpressivewriting. PromisingresearchinthisveinhasbeenconductedbySteveLeporeandhiscolleagues(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 don’t 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 people’s social behaviors after expressive writing in order to infer the possibility of inhibition. Emotionsandemotionalexpression.Emotionalreactionsarepartofallimportantpsychologicalexperiences.FromthetimeofBreuerandFreud(1957/1895),mosttherapistshaveexplicitlyortacitlybelievedthattheactivationofemotionisnecessaryfortherapeuticchange.Theveryfirstexpressivewritingstudyfoundthatifpeoplejustwroteaboutthefactsofatrauma,theydidnotevidenceanyimprovement(Pennebaker&Beall,1986).Consistentwithanexperientialapproachtopsychotherapeuticchange,emotionalacknowledgementultimatelyfostersimportantcognitivechanges(Ullrich&Lutgendorf,2002). Althoughexperiencingemotionswhilewritingisclearlyanecessarycomponentoftheexpressivewritingeffects,cognitiveworkisrequiredaswell.Asanexample,studentswererandomlyassignedtoeitherexpressatraumaticexperienceusingbodilymovement,ortoexpressanexperienceusingmovementandthenwriteaboutit,ortoexerciseinaprescribedmannerfor3days,10minutesperday(Krantz&Pennebaker,2007).Whereasthetwomovementexpressiongroupsreportedthattheyfelthappierandmentallyhealthierinthemonthsafterthestudy,onlythemovementpluswritegroupevidencedsignificantimprovementsinphysicalhealthandgradepointaverage.Themereemotionalexpressionofatraumaisnotsufficient.Healthgainsappeartorequiretranslatingexperiencesintolanguage. Habituationtoemotionalstimuli.Avariationontheemotionalexpressionideaisthatthebenefitsofwritingaccruebecauseindividualshabituatetotheaversiveemotionsassociatedwiththetraumatheyareconfronting.Theroleofhabituationtoemotionalstimulihasalongandrichhistoryinclassicalconditioningandavarietyofbehavioraltherapies(e.g.,Wolpe,1968).MorenuancedapproacheshavebeenproposedbyEdnaFoaandhercolleagues(e.g.,Foa&Kozak,1986;Meadows&Foa,1999).Repeatedexposuretoemotionalstimulicanhelptoextinguishtheclassicallyconditionedlinkbetweenaneventandpeople’sreactionstoit.Atthesametime,theseauthorsnote,peoplechangeintheirunderstandingand/orrepresentationofit.

Sloan,Marx,andEpstein(2005)testedtheideathatrepeatedexposuretoawritingtopicmightbeamorepotentstrategythantopic‐switching.UndergraduatestudentswithmildPTSDsymptomsintheir“samedisclosure”conditionwroteaboutasingleeventoverthreewritingsessions;the“differentdisclosure”conditionwroteaboutadifferenttraumaticeventduringeachwritingsession;controlswroteabouttrivial,non‐traumatictopics.Participantsinthe“samedisclosure”groupreportedthegreatestimprovementsinphysicalhealthandPTSDsymptomseverityat4‐and8‐weekfollow‐upsrelativetoothertwogroups,supportingtheirtheoryofexpressivewritingasexposuretherapy.Inaddition,theyfoundthatthedegreeofsalivarycortisolincreasesinresponsetothefirstwritingsessionwerestronglyassociatedwithdecreasesinPTSDsymptomseverity.

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Anothertestofahabituationmodelwouldbetoseeifpeoplewhowroteaboutthesametopicinthesamegeneralwayfromessaytoessaywouldbenefitmorethanpeoplewhochangedtopics.Inearlierstudies(e.g.,Pennebaker&Francis,1996),judgesevaluatedthenumberofdifferenttopicspeoplewroteaboutacrossa3‐daywritingstudy.Numberoftopicswasunrelatedtohealthimprovements.AmoreelegantstrategyinvolvedtheuseofLatentSemanticAnalysis(LSA,Landauer,Foltz,&Laham,1998).LSA,atechniquedevelopedbyexpertsinArtificialIntelligence,isabletomathematicallyevaluatethesimilarityofcontentofanysetsoftext,suchasessays.UsingLSA,weattemptedtolearnifthecontentsimilarityofessayswrittenbypeopleintheexperimentalconditionsinthreepreviouswritingstudieswasrelatedtohealthimprovements.Theanswerisno.Ifanything,themoresimilarthewritingcontentwasfromdaytoday,thelesslikelypeople’shealthwastoimprove(Campbell&Pennebaker,2002). Apurehabituationargumentisprobablyinsufficientinexplainingtheexpressivewritingeffects.Thefindingsfromtheemotion‐onlyconditioninthePennebakerandBeall(1986)studytogetherwiththeexpressivemovement‐onlyconditionintheKrantzandPennebaker(2007)experimentbothsuggestthatthemereactivationofemotionsassociatedwithatraumacanprovideonlylimitedbenefits.Beyondanyhabituationprocesses,someformofcognitivechangeisalsoimportant. Languageandemotions:TowardsanA‐to‐Dtheoryofemotionalprocessing.Whathappenswhenemotionsoremotionalexperiencesareputintowords?Researchhasshownthatverballylabelinganemotionmayitselfinfluencetheemotionalexperience.Keltner,Locke,andAudrain(1993)foundthatafterreadingadepressingstory,participantswhoweregiventheopportunitytolabeltheiremotionssubsequentlyreportedhigherlifesatisfactionthanthosewhodidnotlabelthem.BerkowitzandTroccoli(1990)foundthatafterlabelingtheirownemotions,participantsweremoremagnanimousinevaluatingothersthanifnotgiventheemotionlabelingopportunity.TheseapproachesareconsistentwithSchwarz(1990)whohasdemonstratedthatdefiningandmakingattributionsforinternalfeelingscanaffectthefeelingsthemselves.Similarly,Wilson(2002)summarizedseveralstudiesindicatingthatwhenindividualsfocusontheirfeelings,thecorrespondencebetweenattitudesandbehaviorsincreases,whereasattendingtothereasonsforone'sattitudesreducesattitude‐behaviorconsistency.

Indeed,changinganysensoryexperienceintolanguageaffectstheexperience.Inanimportantstudyonlanguage’seffectsonsensoryexperience,SchoolerandEngstler‐Schooler(1990)suggestedthatonceanindividualattemptstotranslateapictureintowords,itchangesthememoryofthepicture.Mostexperiencesarelikepictures.Sights,sounds,smells,andfeelingsareoftenvague,complicated,anddynamic.Toprovideadetailedimageofanyexperiencewouldrequiremorethanthepresumedonethousandwordlimit.However,becauselanguageisflexible,relativelyfewwordsorevenseveralthousandwordscanbeusedtodescribeasingleexperience.

Theproblemofcapturinganexperiencewithlanguageiscomparabletotheengineeringdifficultyofdefiningananalogsignalusingdigitaltechnology.Intheworldofmeasuringskinconductance,forexample,aperson’sfingerswillchangeintheirsweatinessalmostcontinuously.Skinconductancelevel(SCL),asmeasuredbyanold‐fashionedpolygraph,initiallyincreasesafterthepersonhearsaloudtoneandthengraduallyreturnstonormal.Forthissignaltobecomputeranalyzed,theanaloglinemustbeconvertedintonumbersusingananalog‐to‐digital(A‐to‐D)converter.Toconvertthelinetonumbers,

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however,oneneedstodecidehowfrequentlythenumbersshouldbesampled.ShouldonesampleSCLhundredsoftimespersecond,oncepersecond,onceevery5seconds?Obviously,themoretimesonesamples,thetruertherepresentationofthelinewillbe.However,samplingatsuchahighfrequencycanbeatremendouswasteoftimeandcomputerspacesincemostoftheadjacentreadingswillberedundant.Similarly,ifthesamplingrateisonceevery5seconds,mostoftheinformationofthechangeinSCLwillbelost. Verballylabelinganemotionismuchlikeapplyingadigitaltechnology(language)toananalogsignal(emotionandtheemotionalexperience).Assumethatnoveloremotion‐provokingexperiencestendtoremaininawarenessuntiltheyareeithercognitivelyunderstoodortheyextinguishwithtime.Itishypothesizedthatifanemotionorexperienceremainsinanalogform,itcannotbeunderstoodorconceptuallytiedtothemeaningofanevent.Theonlywaybywhichanemotionorexperienceinnon‐linguisticformcanleaveawarenessisthroughhabituation,extinction,ortheintroductionofaneworcompetingemotion.Onceanexperienceistranslatedintolanguage,however,itcanbeprocessedinaconceptualmanner.Inlanguageformat,theindividualcanassignmeaning,coherence,andstructure.Thiswouldallowfortheeventtobeassimilatedand,ultimately,resolvedand/orforgotten,therebyalleviatingthemaladaptiveeffectsofincompleteemotionalprocessingonhealth. Followingfromtheabovereasoning,ifanexperienceanditsemotionsaredescribedtoobriefly,theexperiencewillnotadequatelycaptureorrepresenttheevent(hereafterreferredtoasverbalunderrepresentation).Inthiscase,itwouldbepredictedthatthemanypartsoftheexperiencethatwerenotrepresentedinthebrieflinguisticdescriptionwouldcontinuetobeprocesseduntiltheygraduallyextinguishedovertime.Ifamoderatenumberofwordsareusedtodescribetheexperience(moderaterepresentation),itsrepresentationshouldadequatelymirrortheevent.Thisshouldreducethedegreetowhichtheeventtakesupcognitivecapacity,and,atthesametime,enhanceself‐regulation,coping,andhealth.Ontheotherhand,iftheemotionaleventisdescribedinexhaustivedetail(overrepresentation),theexperienceisessentiallyreconfiguredinitsentirety,butinanewformat. Theargument,basedontheA‐to‐DEmotionTheory,isthatonceaneventisadequatelyrepresentedinlanguageformat,theverbal/conceptualprocessingtakesover.Intheory,onecouldarguethattheidealwaytotalkaboutanemotionaleventistoemploylanguageintheformofmoderaterepresentation.Themoderaterepresentationviewisthatthemostefficientwaytoprocessaneventistouseasfewwordsaspossiblethatadequatelycapturetheentireemotionalexperience.Theevent,then,wouldbesummarizedinarelativelytightwaythatwouldallowforlaterlevelingandsharpening.Alternatively,theoverrepresentationviewwouldarguethatrepresentingtheeventindetailedlinguisticformwouldlessenthepossibilityforreappraisalorassimilationintobroaderknowledgestructuresandidentity. LisaFeldmanBarrett(Feldman,1995;FeldmanBarrett,1998)hasdistinguishedbetweenindividualswhodescribetheiremotionexperienceusinghighlydifferentiatedemotionterms,andthosewhomoreorlesscategorizetheiremotionexperienceusinglike‐valencedtermsinterchangeably.Inherstudies,participantsareaskedtokeepadailydiaryfortwoweekstoratetheirmostintenseemotionalexperienceeachdayonseveralaffecttermsusingaLikertscale.Emotionaldifferentiationisreflectedbyasmallcorrelation

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betweenpositiveemotionswords(e.g.happiness,joy,enthusiasm,andamusement),andasmallcorrelationbetweennegativeemotionswords(e.g.nervous,angry,sad,ashamed,guilty).FeldmanBarrett,Gross,Conner,Christensen,andBenvenuto(2001)showedthatthemoreindividualsdifferentiatedtheirnegativeemotions,themoretheyendorsedengaginginvariousemotionregulationstrategies(situationselection,situationmodification,attentionaldeployment,cognitivechange,andresponsemodulation)overthecourseofthestudy,especiallyformoreintensenegativeemotionexperiences.ThesefindingsprovidesupportfortheAtoDtheory.Thatis,individualswhomorepreciselyidentifyaverballabelrepresentingtheiractualemotionexperiencearemorelikelytomakeattributionsandeffectivelyplanforfutureactions. Useofemotionwordsinwriting.TheA‐to‐Dapproachisavaluableworkingmodelbywhichtounderstandtheconnectionbetweenemotionalexperienceanditstranslationintowords.Acomplementaryapproachtotheunderstandingofemotionalprocessesintheexpressivewritingparadigmistolookatthewordspeopleusewhiledescribingtraumaticexperience.Ifwemerelycountedthewayspeopleuseemotionwordsinnaturaltext,couldwebegintocapturetheunderlyingemotionalprocessesthatoccurduringwriting?

Althoughanumberofcomputerizedtextanalysisprogramshavebeendeveloped(forareview,seePennebaker,Mehl,&Niederhoffer,2003),wearemostfamiliarwithLinguisticInquiryandWordCount(LIWC)whichwasinitiallycreatedtoanalyzeessaysfromemotionalwritingstudies.LIWCwasdevelopedbyhavinggroupsofjudgesevaluatethedegreetowhichabout2,000wordsorwordstemswererelatedtoeachofseveraldozencategories(forafulldescription,seePennebaker,Francis,&Booth,2001).Thecategoriesincludenegativeemotionwords(sad,angry),positiveemotionwords(happy,laugh),causalwords(because,reason),andinsightwords(understand,realize).Foreachessay,LIWCcomputesthepercentageoftotalwordsthattheseandotherlinguisticcategoriesrepresent. TheLIWCprogramenabledlanguageexplorationsintopreviouswritingstudies,linkingwordusageamongindividualsintheexperimentalconditionswithvarioushealthandbehavioraloutcomes(Pennebaker,Mayne,&Francis,1997).Onere‐analysisofdatawasbasedon6writingstudies:twostudiesinvolvingcollegestudentswritingabouttraumaswherebloodimmunemeasureswerecollected(Pennebaker,Kiecolt‐Glaser,&Glaser,1988;Petrieetal.,1995),twostudiesincludedfirstyearcollegestudentswhowroteabouttheirdeepestthoughtsandfeelingsaboutcomingtocollege(Pennebaker,Colder,&Sharp,1990;Pennebaker&Francis,1996),onestudybymaximumsecurityprisonersinastatepenitentiary(Richardsetal.,2000),andonestudyusingprofessionalmenwhohadunexpectedlybeenlaidofffromtheirjobsafterover20yearsofemployment(Speraetal.,1994). Analyzingtheuseofnegativeandpositiveemotionworduseyieldedtwoimportantfindings.First,themorethatpeopleusedpositiveemotionwords,themoretheirhealthimproved.Negativeemotionworduse,however,wascurvilinearlyandnotlinearlyrelatedtohealthchangeafterwriting.Individualswhousedamoderatenumberofnegativeemotionsintheirwritingaboutupsettingtopicsevidencedthegreatestdropsinphysicianvisitsinthemonthsafterwriting.Thecurvilinearemotionindiceswerecomputedusingtheabsolutevalueofthedifferencebetweeneachperson’semotionworduseandthemeansofthesample.Thesimplecorrelationsbetweenchangeinphysicianvisitswiththecurvilinear

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negativeemotionindexwasr(152)=.27,p<.05whereasthepositivewordswereunrelated,r=‐.14,ns. Individualswhouseveryfewnegativeemotionwordsorwhouseaveryhighrateofthemaretheonesmostlikelytoremainsickafterwriting,comparedwiththosewhouseamoderatenumberofnegativeemotionwords.ThefindingssupporttheAtoDtheory,and,inmanyways,alsosquarewithotherliteratures.Individualswhomaintainverbalunderrepresentationandtendtouseveryfewnegativeemotionwordsaremostlikelytobecharacterizedasrepressivecopers(cf.,Schwartz&Kline,1995)oralexithymics(Lumley,Tojek,&Macklem,2002).ThosewhooverusenegativeemotionwordsmaywellbetheclassichighNegativeAffectindividualsdescribedbyWatsonandClark(1984).Thatis,thoseindividualswhodescribetheirnegativeconditionsinsuchdetailmaysimplybeinarecursiveloopofcomplainingwithoutattainingclosure(overrepresentation).Indeed,asdiscussedbelow,thismaybeexacerbatedbytheinabilityoftheseindividualstodevelopastoryornarrative(Nolen‐Hoeksema,2000). Beyondemotions:Theconstructionofastory.Oneofthebasicfunctionsoflanguageandconversationistocommunicatecoherentlyandunderstandably.Byextension,writingaboutanemotionalexperienceinanorganizedwayishealthierthaninachaoticway.Indeed,growingevidencefromseverallabssuggestthatpeoplearemostlikelytobenefitiftheycanwriteacoherentstory(e.g.,Smyth,True,&Sotto,2001).Anytechniquethatdisruptsthetellingofthestoryortheorganizationofthestoryisundoubtedlydetrimental.Forexample,thosewhohaveabroodingruminativestyle(whereacoherentstoryisperhapsnotformedanddoesnotchangeorgetsmorenegativeovertime)aremorelikelytobenefitfromexpressivewritingthanthosewhohaveareflectiveponderingruminativestyle(i.e.thosewhotendtoorganizetheirthoughtsabouttheirsituationinordertoengageinadaptiveproblemsolving;Sloan,Marx,Epstein,&Dobbs,2008). Unfortunately,wearenotyetatthepointofbeingabletopreciselydefinewhatismeantbycoherent,understandable,ormeaningfulwhenitcomestowritingaboutemotionalupheavals(cf.,Graybeal,Seagal,&Pennebaker,2002).Oneperson’smeaningmaybeanother’srumination.Manytimesinourownresearchwehavebeenstruckhowapersonappearstobewritinginawaythatavoidsdealingwithwhatweseeasacentralissue.Nevertheless,theperson’shealthimprovesandheorsheexclaimshowbeneficialthestudywas.Meaning,then,mayultimatelybeintheeyeofthewriter.

Althoughtalkingabouttheupsettingexperiencewillhelptoorganizeandgiveitstructure,talkingaboutsuchamonumentalexperiencemaynotalwaysbepossible.Othersmaynotwanttoorevenbeabletohearaboutit.Withinthediscourseliterature,particularattentionhasbeenpaidtotheroleofwrittenlanguageindemandingmoreintegrationandstructurethanspokenlanguage(Redeker,1984;seealsoBrewin&Lennard,1999).Itwouldfollowthatwriting‐‐andtoalesserdegreetalking‐‐abouttraumaticexperienceswouldrequireastructurethatwouldbecomeapparentinthewayspeoplewroteortalkedabouttheevents. Thecomponentsofastory:Theanalysisofcognitivewords.Itisbeyondtheboundsofthischaptertoexplorethephilosophicaldefinitionsofknowledge,narrative,ormeaning.Forcurrentpurposes,knowledgeofaneventcanencompassacausalexplanationofitortheabilitytounderstandtheeventwithinabroadercontext.Thedegreetowhichindividualsareabletocognitivelyorganizetheeventintoacoherentnarrativeisamarkerthattheeventhasachievedknowledgestatus.Inmanyways,itispossibletodeterminethe

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degreetowhichpeoplehavecometoknowtheiremotionsandexperiencesbythelanguagetheyuse.Wordsorphrasessuchas,“Inowrealizethat...”or“Iunderstandwhy...”suggestthatpeopleareabletoidentifywhentheyhaveachievedaknowingstateaboutanevent.

TheLIWCanalysesfindpromisingeffectsforchangesininsightandcausalwordsoverthecourseofemotionalwriting(seealsoKlein&Boals,2001;Petrie,Booth,&Pennebaker,1998).Specifically,peoplewhosehealthimproves,whogethighergrades,andwhofindjobsafterwritinggofromusingrelativelyfewcausalandinsightwordstousingahighrateofthembythelastdayofwriting.Inreadingtheessaysofpeoplewhoshowthispatternoflanguageuse,judgesoftenperceivetheconstructionofastoryovertime(Graybealetal.,2002).Buildinganarrative,then,maybecriticalinreachingunderstandingorknowledge.Interestingly,thosepeoplewhostartthestudywithacoherentstorythatexplainedsomepastexperiencegenerallydonotbenefitfromwriting. Thosewhousemoreinsightandcausalwordsintheiremotionalwritingtendtogainthemostimprovementsinworkingmemory,and,atthesametime,reportdropsinintrusivethinkingaboutnegativeevents(Boals&Klein,2005;Klein&Boals,2001).ConsistentwiththeA‐to‐DEmotionTheory,forthoseintheexperimentalcondition,thewritingexperiencepackagestheeventinawaythatfreestheirmindsforothercognitivetasks.Anotherwaytointerpretthesalutaryeffectsofusinginsightandcausalwordsisthat,togetherwiththeuseofpositiveemotionwords,thistypeoflanguagereflectsapositivereappraisalofevents,whichfuelscognitivebroadening(Fredrickson,1998;2001).Narratinganemotionaleventintothebiggerpicturemighthelptointegratetheexperienceintoone’sgreaterknowledgestructuresandpersonalidentity. Eitherway,thefindingsareconsistentwithcurrentviewsonnarrativeandpsychotherapy(e.g.,Mahoney,1995)insuggestingthatitiscriticalfortheclienttocreateandcometotermswithastorytoexplainandunderstandbehavioralormentalproblemsandtheirhistory.Merelyhavingastorymaynotbesufficientsincethequalityofstoriesaswellasthepeoplethemselveschangeovertime.Astory,then,isatypeofknowledge.Further,anarrativethatprovidesknowledgemustlabelandorganizetheemotionaleffectsofanexperienceaswellastheexperienceitself.

Writingasawaytochangeperspective.Acentraltenetofallinsight‐orientedtherapiesisthatthroughpsychotherapypeopleareabletodevelopabetterunderstandingoftheirproblemsandreactionstothem(e.g.,Rogers,1980).Inherentinthisunderstandingistheabilitytostandbackandlookatoneselffromdifferentperspectives.Althoughmosttherapistswouldagreewiththeimportanceofshiftingperspectives,thedifficultyforaresearcherisindevisingawaytotrackthisshift.Somerecentlinguisticanalysesoffersomepromisingnewstrategies.

Asdescribedearlier,latentsemanticanalysisorLSAisapowerfulmathematicaltoolthatallowsinvestigatorstodeterminethesimilarityofanysetsofessays.LSAwasoriginallydesignedtolookatthelinguisticcontentoftextsamples.Consequently,mostLSAapplicationsroutinelydeleteallnon‐contentwords.Thesenon‐contentor“junk”wordsincludepronouns,prepositions,conjunctions,articles,andauxiliaryverbs.Amoreformaldesignationofjunkwordswouldbefunctionwordsorparticles.Functionwordscanbethoughtofasthegluethatholdcontentwordstogether.Ratherthanreflectingwhatpeoplearesaying,thesefunctionwordsconnotehowtheyarespeaking.Inshort,functionwordsreflectlinguisticstyle(cf.,Pennebaker&King,1999;Pennebakeretal.,2003).

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Isitpossiblethatpeoples’linguisticstylescanpredictwhobenefitsfromwriting?UsingLSA,wediscoveredthattheanswerisyes.Analyzingthreepreviousexpressivewritingstudies,wediscoveredthatthemorethatpeoplechangeintheiruseoffunctionwordsfromdaytodayintheirwriting,themoretheirhealthimproved(Campbell&Pennebaker,2003).Closeranalysesrevealedthattheseeffectswereentirelyduetochangesinpronounuse.Specifically,themorethatpeopleoscillatedintheiruseof1stpersonsingularpronouns(I,me,my)andallotherpersonalpronouns(e.g.,we,you,she,they),themorepeople’shealthimproved.Ifindividualswroteaboutemotionalupheavalsacrossthe3‐4daysofwritingbuttheyapproachedthetopicinaconsistentway–asmeasuredbypronounuse,theywereleastlikelytoshowhealthimprovements.Thefindingssuggestthattheswitchingofpronounsreflectachangeinperspectivefromonewritingdaytothenext.Interestingly,itdoesn’tmatterifpeopleoscillatebetweenanI‐focustoawe‐orthem‐focusorviceversa.Rather,healthimprovementsmerelyreflectachangeintheorientationandpersonalattentionofthewriter.

Anoteoncausalityisinorder.Thevariousstudiesthathaveexaminedtherelationshipbetweenworduseandhealthoutcomesintheemotionalwritingconditionsimplyacausalarrow:peoplewhochangeperspectives,usepositiveemotionwords,andpeoplewhoconstructastoryultimatelyevidencebetterhealth.Becautiousininterpretingthesefindings.Theuseofthesewordpatternsmaysimplybereflectingsomeunderlyingcognitiveandemotionalchangesoccurringintheperson.Asnotedearlier,somestudieshaveattemptedtogetpeopletowritewithmorepositiveemotionwords,changingperspectives,andevenconstructingastory.Thesemanipulationshavenotbeenparticularlysuccessful.Theissuesofmediation,moderation,andemergentpropertiesofworduse,cognitiveandemotionalactivity,andlongtermhealthwillprovidefertilegroundsforresearchintheyearstocome.

Inrecentyears,therehasbeenacallforfindingtheboundariesofexpressivewriting(Smyth&Pennebaker,2008).Inonestudythatwaspublishedinaspecialissueexaminingtheboundaryeffectsofexpressingwriting,Seihandhiscolleagues(2008)adaptedPsychologicalDisplacementinDiaryWriting(PDDP;Jin2005)forexpressivewriting.PDDPisaparadigminwhichpeoplewritediaryentriesinafirstpersonperspective.Next,theywriteaboutthesameeventusingasecondpersonperspective.Finally,theywriteaboutthesameeventinathirdpersonperspective.Seihandhiscolleaguesfoundthatexperimentalmanipulationsofchangingperspectiveswassuccessfulinreducinglevelsofanxietyandanger.Ongoingstudiesinourlabsuggestthatrequiringpeopletoswitchperspectivesdoesnotconferbenefitsabovestandardwritinginstructions(Seih&Pennebaker,2009).Theseintriguingfindingsindicatethatchangesinwritingperspectivesaremoreanemergentpropertyofsuccessfulwriting.Thatis,itreflectspsychologicalimprovementratherthannecessarilycausingit.

Expressivewritingandsocialdynamics.Oneofthepopularappealsoftheexpressivewritingparadigmisthatitsoundsalmostmagical.Writefor15minutesadayforthreedays(atotalof45minutes)andyourhealthwillimproveformonths.Youmayalsogetajob,fallinlove,andmakebettergrades.Thisisabitofanoverstatement.Whenpeoplewriteaboutemotionalupheavalsforthreeorfourdays,theyreportthinkingaboutthetopicsquitefrequently.Manyspontaneouslytellusthattheyhavebeendreamingaboutthetopics.Expressivewriting’seffectsexistbeyondthewallsoftheexperiment.

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Evenmorestrikinghavebeensomeofthesocialchangesthatoccurasaresultofexpressivewriting.Acrossmultiplestudies,individualsreportthattheytalktoothersabouttheirwritingtopics.Manyyearsago,weconductedastudywithHolocaustsurvivorsandaskedthemtotelltheirstoriesorally.Priortothestudy,approximately70%reportedthattheyhadnottalkedabouttheirexperiencesduringWorldWarIIinanydetailtoanyone.Aftertheinterview,allparticipantsweregivenacopyoftheirvideotapedtestimony.Amonthlater,theaveragepersonreportedwatchingthevideotape2.3timesandshowingitto2.5otherpeople(Pennebaker,Barger,&Tiebout,1989).Disclosurebegetsdisclosure.

Recently,wehavedevelopedadigitalrecordingdevicecalledtheElectronicallyActivatedRecorder,ortheEAR(Mehl&Pennebaker,2003).TheEARhasbeenengineeredtorecordfor30secondsevery12‐13minutes.Therecordingsarethentranscribedandratedbyjudgesconcerningwheretheparticipantisandwhatheorsheisdoing.Recently,YoungsukKim(2008)had95bilingualstudentseitherwriteabouttraumaticexperiencesorparticipateincontroltasksfor4days,15minuteseachday.Priortowritingandassignmenttocondition,individualsworetheEARfortwodays.Approximatelyonemonthafterwriting,theyworetheEARagainfortwodays.Overall,thosewhowroteaboutemotionalupheavalstalkedmorewithothersafterwritingthanbeforewriting.Anearlierpilotstudyofapproximately50studentshadfoundasimilareffect(Pennebaker&Graybeal,2001).

Acrossthevariousstudies,wearenowbecomingconvincedthatoneofthepowersofexpressivewritingisthatitbringsaboutchangesinpeople’ssociallives.Considerthatwritinghasbeenshowntoincreaseworkingmemoryandthattheseeffectsapparentlylastseveralweeks(Klein&Boals,2001).Afterpeoplewriteabouttroublingevents,theydevotelesscognitiveeffortonthem.Thisallowsthemtobebetterlisteners,betterfriends.Theywritingmayalsoencouragepeopletotalkmoreopenlywithothersaboutthesecretsthattheyhavebeenkeeping. Thebigpicture:Lifecoursecorrection.Partofthehumanexperienceisthatwealldealwithavarietyofmajorandminorlifeissues.Often,wearetakenoffguardbyanupheavalanddon’thavesufficienttimetothinkaboutitortoexplorethebroaderimplicationstheeventmighthaveonusandthosearoundus.Onereasonthatwebelievethatexpressivewritinghasbeeneffectiveisthatitservesasalifecoursecorrection.Occasionally,mostofusbenefitfromstandingbackandexaminingourlives.Thisrequiresaperspectiveshiftandtheabilitytodetachourselvesfromoursurroundings.Ifwearestillinthemidstofamassiveupheaval,itisvirtuallyimpossibletomakethesecorrections. Theideaofexpressivewritingasalifecoursecorrectionhasnotbeentestedempirically.TheideaiscertainlyconsistentwithMcAdam’s(2001)lifestoryapproach.Itisalsorelevanttoworkinautobiographicalmemory(e.g.,Neisser&Fivush,1994;Conway,1990).Therearetimeswhenweareforcedtostopandlookbackatourlivesandevaluatewhatissuesandeventshaveshapedwhoweare,whatwearedoing,andwhy.SummaryandConclusions Thepurposeofthispaperhasbeentoprovideabroadoverviewoftheexpressivewritingparadigm.Sinceitsfirstuseinthe1980s,dozensofstudieshavebeenexploringtheparametersandboundaryconditionsofitseffectiveness.Perhapsmostinterestinghasbeenthegrowingawarenessthatitsvaluecannotbeexplainedbyasinglecauseortheory.Expressivewritingultimatelysetsoffacascadeofeffects.

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Thereisacertainironythattheoriginalexplanationforthewritingphenomenonwasinhibition.Inthe1980s,ourbeliefwasthatwhenpeopledidn’ttalkaboutemotionalupheavals,theworkofinhibitionultimatelyledtostressandillness.Theexplanationwaspartiallycorrect.Now,however,weareallbeginningtoappreciatethenuancesoftheproblem.Nottalkingaboutatraumaticexperienceisalsoassociatedwithabreakdownofone’ssocialnetwork,adecreaseinworkingmemory,sleepdisruptions,alcoholanddrugabuse,andanincreasedriskforadditionaltraumaticexperiences.Expressivewritingortheunfetteredtalkingaboutatraumacanoftenshortcircuitthisprocess. Writingforcespeopletostopandreevaluatetheirlifecircumstance.Themereactofwritingalsodemandsacertaindegreeofstructureaswellasthebasiclabelingoracknowledgingoftheiremotions.Aparticularlyrichfeatureoftheprocessisthattheseinchoateemotionsandemotionalexperiencesaretranslatedintowords.Thisanalog‐to‐digitalprocessdemandsadifferentrepresentationoftheeventsinthebrain,inmemory,andinthewayspeoplethinkonadailybasis. Allofthesecognitivechangeshavethepotentialforpeopletocometoadifferentunderstandingoftheircircumstances.Thecognitivechangesthemselvesnowallowtheindividualstobegintothinkaboutandusetheirsocialworldsdifferently.Theytalkmore;theyconnectwithothersdifferently.Theyarenowbetterabletotakeadvantageofsocialsupport.Andwiththesecognitiveandsocialchanges,manyoftheirunhealthybehaviorsabate.Asrecentdatasuggest,expressivewritingpromotessleep,enhancedimmunefunction,reducedalcoholconsumption,etc. Despitethelargenumberofpromisingstudies,expressivewritingisnotapanacea.Theoveralleffectsizeofwritingismodestatbest.Westilldon’tknowforwhomitworksbest,whenitshouldbeused,orwhenothertechniquesshouldbeusedinitsplace.Oneofthedifficultiesofstudyingexpressivewritingisthatthebeststudieshavefoundthatwritinginfluencesslowmovingbutimportantoutcomemeasuressuchasphysicianvisits,illnessepisodes,andotherrealworldbehaviorsthatmaytakemonthstosee.Self‐reportoutcomes,althoughcommonandeasytouse,generallydonotbringaboutextremelystrongfindings.Futureresearcherswouldbewisetotrytoagreeononeormoreoutcomemeasuresthataresufficientlyrobustandalsoeasytomeasure. Aftertwodecadesofresearchonexpressivewriting,twostrategiesmustcontinuetogrow.ThefirstisapplyingthemethodtolargesamplesofpeoplewithdifferingdiagnosesusingrigorousRCTdesigns.This“bigscience,bigmedicine”approachisessential.Atthesametime,weshouldcontinuetonurtureinnovativesmallerscience.Itwillbetheindividuallabsaroundtheworldthatwillultimatelytellustheboundaryconditionsofthephenomenonandtheunderlyingmechanismsthatexplainitseffectiveness.

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