Self-disclosure as therapy: The benefits of expressive writing

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As psychiatrists, we often provide our patients with a prescription in the hope that the medication will alleviate their symptoms. Perhaps we engage our patients in psychotherapy, encouraging them to reflect on their thoughts, behaviors, and emotions to alter their cognitions. We may remark that our goal is for the patient to “become their own therapist.” What if we encouraged our patients to express themselves in a less structured manner and become their own therapists through writing?

Benefits of expressive writing

Writing about an experienced traumatic event—specifically, to express emotions related to the event—has been associated with improved health outcomes.1,2 Many of these improvements are related to somatic health and basic function, including decreased use of health services, improved immune functioning, and a boost in grades or occupational performance.1 Patients who participate in expressive writing also have demonstrated improvements in distress, negative affect, depression, and posttraumatic stress disorder (PTSD) symptoms.1,2 Although improvement in PTSD symptoms with expressive writing has varied across studies, it appears that patients with PTSD who score high in trait negative emotion may receive the most benefit from the practice.3

Why does it work?

There are several theories regarding why expressive writing is an effective therapy. Originally, it was believed that the active inhibition of not talking about traumatic events was a form of physiological work and a long-term, low-lying stressor, and that writing about such events could reduce this stress. However, newer studies offer various explanations for its efficacy, including:

  • repeat exposure to stressful or traumatic memories and consequent self-distancing
  • creation of a narrative around the stressful event
  • labeling of emotions
  • self-affirmation and meaning-making related to the negative event.4

Rx writing

Encouraging your patients to use expressive writing is simple. You might ask a patient struggling with distress and negative affect following a traumatic experience to write about his (her) thoughts and feelings regarding the incident. For example:

Spend about 15 minutes writing your deepest thoughts and feelings about going through this traumatic experience. Discuss the ways it affected different areas of your life, including relationships with family and friends, school or work, or self-confidence and self-esteem. Don’t worry about spelling, grammar, or sentence structure.

Assure patients that you do not need to review their writing, but would like to hear about their experience writing. Many studies on expressive writing instructed participants to write for 3 to 5 consecutive days, 15 to 30 minutes each day.1,2 Patients may disclose a dramatic spectrum and intensity of experience and often are willing to do so.

Expressive writing is a simple, low-risk exercise that benefits many people. Perhaps by prescribing a course of writing, you will find your patients can benefit as well.

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