It’s well established that talking about traumatic incidents with a therapist, supportive family or friends can be therapeutic, producing improvements in psychological and physical health. People who open up about traumatic events they have experienced have been found to benefit from a variety of health improvements, including improved mood, lower rates of infection, and lower blood pressure. And it has been established that not talking about traumatic experiences is associated with poorer health outcomes.

As helpful as talking about trauma maybe, it is often difficult for the victims to discuss it. Particularly difficult traumas, such as sexual abuse and rape—events which victims frequently perceive as shameful—make victims more vulnerable to poor health, including chronic diseases and headaches. Useful alternatives to talking about trauma are available.

Scientists have studied whether writing about trauma might be as effective as talking about it. Typically, this type of study asks trauma victims to participate in a structured writing task where they are encouraged to write about the thoughts and feelings associated with their trauma for about twenty minutes a day, three to five days a week. Several studies of this type have produced similar results, finding that written disclosure of emotional reactions to trauma leads to a wide variety of positive health consequences.

Scientists are unsure how this works. One possibility is that writing about traumatic experience serves as a stress release, decreasing the overall level of bodily stress that victims carry and thus reducing their vulnerability to diseases brought on due to chronic stress.

Evidence for the stress-reduction hypothesis was found in a study where participants were asked to view shocking films. Some participants were asked to suppress their emotional reaction to these films while others were given no such instruction. The group asked to suppress their reactions showed a significantly higher heart rate compared with the other group.

Related studies examining the immune system have found that greater life stress is associated with reduced immune function and susceptibility to infections. When people consciously hide emotions, they show noticeable immune effects, as shown experimentally by higher antibody levels after a vaccination. Expression of emotions, including written disclosure, has been shown many times to improve immune status.

Writing about trauma might also be helpful because it allows the victims to reprocess their experience from a safe place, enabling them to experience a type of mastery and control over their traumatic memories. The act of repetition, the conscious going over of trauma-related events and reactions to those events, also seems to reduce the intensity of trauma reactions.
Studies have shown that people who write even about imaginary traumas display significantly less depressed mood immediately afterward (compared to people who just imagined trauma but didn’t write about it), and subsequently reported fewer visits to their doctor.

Writing about trauma seems to be most effective when the traumatic event is intense. In a study of college students, those who wrote about more severe traumas reported fewer physical symptoms afterward, compared with persons who described lower-severity traumas.

Another important finding suggests that it may not be the act of writing itself which produces the healthy benefit, but rather its ability to help people achieve potent and emotional (and yet still distanced and safe) connections with their traumatic memories. This is illustrated in a study where researchers encouraged one group of trauma victims to write only factual information about their experience, while another group was asked to record both factual and emotional detail. In this study, greater degrees of personalization and detail were associated with less depression and less anxiety.

If writing about trauma produces so many health benefits in the lab, can it be recommended as a general approach for any trauma sufferer to undertake? Unfortunately not, as people vary in their ability to cope with traumatic events. By definition, exposure to traumatic events is overwhelming and outside the range of normal experience. If the nature of the trauma is extreme enough, forcing someone to write about it when they are not ready to do so can be re-traumatizing and can make things worse. For this reason, it is best done in the context of easily accessible social and emotional support.

Warnings aside, the usefulness of writing about trauma to promote healing is based on a substantial background of evidence. When performed with limits on time and subject matter, and by a person who is ready to undertake the task and who has support, the method is cheap, allows the trauma to be confronted at a suitable (self-directed) speed, lets personal meanings and solutions be derived, and may be undertaken by people who would not be likely to enter therapy.

References

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Golding, J. M. et al. Sexual assault history and use of health and mental health services. American Journal of Community Psychology, Vol. 16, October 1988, pp. 625-44.

Greenberg, M. A., Wortman, C. B. and Stone, A. A. Emotional expression and physical health: revising traumatic memories or fostering self-regulation? Journal of Personality and Social Psychology, Vol. 71, September 1996, pp. 588-602.

Greenberg, M. A. and Stone, A. A. Emotional disclosure about traumas and its relation to health: effects of previous disclosure and trauma severity. Journal of Personality and Social Psychology, Vol 63, July 1992, pp. 75-84.

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Pennebaker, J. W. and Susman, J. R. Disclosure of traumas and psychosomatic processes. Social Science & Medicine, Vol. 26, February 1988, pp. 327-32.

Pennebaker, J.W. and Beall, S. K. Confronting a traumatic event: toward an understanding of inhibition and disease. Journal of Abnormal Psychology, Vol. 95, August 1986, pp. 274-81.