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9 posts categorized "Research"

November 09, 2006

What About the Research on Writing and Falling Apart?

In 1983, James Pennebaker, a psychologist, then at Southern Methodist University, conducted, along with one of his graduate students, Sandra Beall, a study of forty-six college students. Students in one group—the experimental group—were instructed to write continuously for fifteen minutes about the most upsetting or traumatic experience of their lives.

Their instructions included the following:

In your writing, I want you to discuss your deepest thoughts and feelings about the experience. You can write about anything you want. But whatever you choose, it should be something that has affected you very deeply. Ideally, it should be something you have not talked [about] with others in detail. It is critical, however, that you let yourself go and touch those deepest emotions and thoughts that you have. In other words, write about what happened and how you felt about it, and how you feel about it now.

In essence, these students were being invited to write about a time when something had fallen apart.

Students wrote sitting alone in a small cubicle in the psychology building. They wrote on four consecutive days and did not sign their names to their pieces. These were not students who had been recruited because they were experiencing emotional or physical problems. These were ordinary college students recruited from introductory psychology classes. They wrote about the divorce of parents, about loss and abuse, about alcoholism and suicide attempts. They wrote about secrets. And in interviews conducted after finishing the four writing sessions, students actually reported feeling worse than they had before the writing.

But four months later, these same students, compared to students who had written about trivial topics, reported improvements in mood and in outlook on life, and, perhaps most surprisingly, improvements in their physical health. When data came in from the student health center, it revealed that this same group of students had in fact visited the student health center for illness, on average, only half as often as their peers.

This particular kind of writing—writing one’s deepest thoughts and feelings about trouble—is sometimes called expressive writing. And it’s the kind of writing about which much of the research on writing and health has been conducted. Since that early study in 1983, expressive writing has been tested in a wide range of settings. It’s been shown to improve self-reported health, psychological well-being, grade point average, and re-employment after lay-off. It’s been shown to benefit women with breast cancer, to decrease blood pressure in people with hypertension, to mitigate pain and fatigue in those with fibromyalgia, and to improve markers of immune function for those with AIDS.

In an afterward to The Writing Cure, a compilation of research and theory published nearly twenty years after Pennebaker’s first study on expressive writing and health, he reflects on some of the implications of the body of research in the field.

He writes:

All of the evidence would suggest that writing brings about a general reduction in biological stress. That is, when an individual has come to terms with an upsetting experience, he or she is less vigilant about the world and potential threats. This results in an overall lowering of defenses. . . . Given the broad range of improvements in health outcomes, it would be prudent to conclude that writing provokes a rather broad and nonspecific pattern of biological changes that are generally salutary.

I find this research on writing and health a reason for hope. It suggests that though bringing painful fragments of experience to the surface through the process of writing may feel painful in the short term, there’s a potential for a tangible benefit in the wake of this pain. That is, writing about such fragments can lead to health benefits on the other side. At the same time, I feel like each person (of course) gets to make that choice: if and when to touch on painful fragments. I, for one, never push people to do this before they’re ready. I’ve come to learn that most people have a kind of inner sense or knowing that lets them know when they’re ready to write about trouble. And if they’re unsure? Well, one way to deal with being unsure is to write the question at the top of a blank sheet of paper. The question itself can become a kind of title: Is Now a Good Time to Write About Falling Apart? Is Now a Good Time to Touch Grief? And then a person can write and write and see what comes----

[Note: For sources on this brief review of writing about trouble, I used Opening Up, by James Pennebaker, The Writing Cure, edited by Stephen Lepore and Joshua Smyth, and some of the articles on the right sidebar of this page that I've listed under Selected Research and that I’ve linked, whenever possible, to their abstracts.]

December 18, 2006

Is the Struggle to Make Meaning Good for Your Health? [Part 1]

There are two pieces of research I’ve been thinking about this month. Both are about the struggle to make meaning through language and both, I think, are relevant to this whole question of what kinds of forms healing writing can take.

The first study, conducted by James Pennebaker and colleagues in 1997, shows that when people used increasing numbers of insight words or causal words in their writing they showed improvements in health. Examples of insight words are realize, understand, think, and consider. Examples of causal words are such words as cause, effect, reason, and because. In a discussion of this study, Pennebaker writes: “The present analyses indicated that changes in thinking patterns—as opposed to static thinking patterns, which do not change over time—predict improved health.”

I find this study terribly interesting. The researchers weren’t trying to measure how insightful these narratives people wrote were, or whether or not they were “good” narratives. What they were measuring—and what seemed to matter—was this process of finding meaning—this indication that, over time, thinking patterns changed. And this process of finding meaning is suggested by sentences that included cognitive words and that might look something like this:

I’m beginning to realize . . .
I think perhaps . . .
I thought I understood what had happened, but now I'm considering . . .

Changes in thinking patterns—as opposed to static thinking patterns, which do not change over time—predict improved health.

It’s the kind of statement that’s worth considering, I think, and coming back to. It’s the kind of finding that has implications not just for writing and healing, but for healing itself-----

[I’ll be continuing this post—putting up Part 2—another piece of research--later this week]

December 20, 2006

Is the Struggle to Make Meaning Good for Your Health? [part 2]

Here's a second study relevant to struggling, this one conducted by psychologist Eugene Gendlin in the early sixties, and discussed in the first chapter of Ann Weiser Cornell’s book, The Power of Focusing. Apparently, Gendlin, then at the University of Chicago, was interested in the question: “Why is psychotherapy helpful for some people and not others?” What he did, first, was to tape hundreds of therapy sessions, gathered from many different therapists and clients. Then he asked therapists and clients to rate whether the psychotherapy had been successful. If both agreed, and if psychological testing supported this finding, the therapy was deemed successful. This successful therapy was then compared to therapy that was considered by the participants to be a failure.

When researchers listened to the tapes of successful therapy vs. unsuccessful therapy they noted one key difference. Clients in successful therapy struggled more. Ann Weiser Cornell writes:

. . . at some point in the session, the successful therapy clients would slow down their talk, become less articulate, and begin to grope for words to describe something that they were feeling at the moment. If you listened to the tapes, you would hear something like this: ‘Hmmmm. How would I describe this? It’s right here. It’s . . . uh . . . it’s . . . it’s not exactly anger . . . hmmmm.’ Often the clients would mention that they experienced this feeling in their bodies, saying things like, ‘It’s right here in my chest,’ or ‘I have this funny feeling in my stomach.’

In contrast, clients who felt like the therapy was a failure didn't struggle in this way. They were actually more articulate—or more apparently articulate—in the sense that they spoke in smooth, less interrupted ways. (They were, it would seem, more glib. They had things figured out--but nothing changed.) I find this comparison fascinating, and not inconsistent with what I often see with patients. This week, for instance, it often seemed like we were all struggling to make meaning--patients as well as myself. And I love how this study offers a rationale for not only tolerating such struggle for meaning but in fact encouraging it and perhaps celebrating it.

I find myself wondering about this question: Why is writing more healing for some people than it is for others?

Could it have something to do with how much a person is willing to struggle on the page? A kind of willingness, perhaps, to be initially inarticulate—and halting—and groping—in the service of eventually coming to a new understanding—perhaps a new story—or a new form for one’s story.

January 07, 2007

Asking a New Question: More Research on Writing and Healing

I’ve written here before about the research begun by James Pennebaker, a psychologist at the University of Texas. In 1983 he asked a question that has more or less framed the field of writing and health: Can writing one’s deepest thoughts and feelings about a difficult life event result in fewer illness visits to a health clinic? The answer to that question turned out to be yes—writing can influence health visits. And in the years since, the data has been fairly consistent: expressive writing about difficult life circumstances leads to improved health outcomes.

Fifteen years after Pennebaker’s groundbreaking study, Laura King, a researcher at the University of Missouri, asked a new question--a series of questions actually--that moved the research in a bit of a different direction. Her questions:
What other kinds of writing might be healing?
Does writing, for instance, have to be painful in order to heal?
What about writing that focuses on the good part?
Might that kind of writing be healing as well?

Research had already shown that writing about mundane topics was not especially healing. For instance, in Pennebaker’s first study, one group of students was instructed to describe their dorm room, a topic chosen specifically because of its lack of emotional freight. And, though it’s possible that, for some students at least, the dorm room did strike a meaningful chord, as a group, and as predicted, those students who wrote about their posters and rugs and lamps did not show changes in health outcome.

But what about topics that are neither painful nor mundane? What about topics that carry a more pleasant emotional charge? What health effects might writing about those topics have?

Laura King asked a group of volunteers to reframe a difficult life event by writing for twenty minutes on four consecutive days on the perceived benefits of this difficult life event. Volunteers were instructed to consider a traumatic event that they had experienced and then “focus on the positive aspects of the experience. . . write about how you have changed or grown as a person as a result of the experience.” When King and her associates analyzed the results they found that the health benefits for this group were identical to those for the group that had written their deepest thoughts and feelings about a trauma. Both groups benefited equally.

Perhaps this finding doesn’t surprise you. Perhaps, in hindsight, it even feels like common sense. But, after fifteen years of research on writing about trouble, it introduced a new wrinkle into the research in expressive writing and health. It opened the door to a possibility that many people had perhaps long suspected: that a vast array of different kinds of writing might be healing. Writing about the difficult part is healing. Writing about the good part is healing too. Not either or. But both and.

[The source for this brief piece is The Writing Cure, edited by Stephen Lepore and Joshua Smyth, and especially Chapter 7, “Gain Without Pain? Expressive Writing and Self-Regulation,” contributed by Laura King.]

January 09, 2007

A Research Study of Interest: Writing and Healing and Breast Cancer

Is there a benefit to writing for women with breast cancer?
What kind of writing is most beneficial?
(And might the answers to these questions be extrapolated to other groups?)

To look at the first two questions, Annette Stanton, a psychologist at the University of Kansas, and Sharon Danoff-Burg, psychologist at State University of New York in Albany, conducted a study several years ago now in which they divided a group of women with breast cancer into three groups:

  1. A group instructed to write a detailed account of the facts of their breast cancer and its treatment
  2. A group instructed to write their deepest thoughts and feelings about their experience with breast cancer.  This is often called expressive writing.
  3. A group instructed to write only about their positive thoughts and feelings in connection to their experience of cancer

All of the women completed four twenty-minute writing sessions.  And here are some things they learned from this group of women:

  • Women who wrote about facts and women who did expressive writing reported more distress immediately after writing when compared with women who wrote only about positive feelings.
  • At one and three months after writing, women in all three groups reported overall more positive quality of life, less distress, and “high vigor” compared with similar cancer patients who hadn’t written.
  • Three months after writing, women who did expressive writing, and the women who wrote about positive thoughts and feelings reported a significant decrease in physical symptoms and they also had fewer visits to the doctor for cancer-related illness than women who wrote only about facts—or women who didn’t write at all.  Writing about thoughts and feelings led to significant physical benefit.

Thus, along with expressive writing, writing about positive thoughts and feelings—writing about the good part—was shown to be beneficial for women with breast cancer.  Interestingly, though, and, I think, wisely, the authors, in the wake of these finding, advise caution in asking (or, worse, prescribing) persons who are facing adversity to find a positive benefit.  They write:

Indeed, exhorting individuals to ‘look on the bright side’ or to focus on a specific advantage in their misfortune is likely to be interpreted as minimizing or not understanding their plight.

And they go on to name three reasons they think asking for a positive benefit was effective in this particular study:

  • They did not suggest any woman find a particular benefit—but, instead, let women have complete control over any benefit they named and explored.
  • The women were asked to write only after the primary treatment for their cancer had been completed. 
  • They had evidence that these women had already had opportunities to process negative emotions in other settings.

This is an interesting, and potentially significant, study.  And, granting, first, that all research in this field is still preliminary and that more research needs to be done, I’m taking from this study five useful bits:

  • First, that women with breast cancer (And all women with cancer?  All people with cancer?  All people with illness?) have the potential to gain significant benefit from writing—whether they’re writing about all their thoughts and feelings or whether they’re writing about positive thoughts and feelings that have begun to emerge.
  • Second, that there may be value, at some point, in focusing solely on the good part.
  • Third, that writing about the good part, in general, probably causes less distress and feels more pleasant than writing about the difficult parts; thus it can offer a bit of reprieve—a break—
  • Fourth, that this focusing on the good part is probably best done late rather than early—and, in particular, after it’s become possible to vent at least some of one’s negative thoughts and feelings.
  • Finally, that always, always, each person gets to choose on any given day, whether to write (or speak) about the bad part or the good part—or both.  (Remembering that both—expressing the difficult stuff and the good stuff—has the potential to contribute to healing.)

    [Note: a summary of this study by Stanton and Danoff-Berg, with commentary by the authors, can be found in Chapter 3 of The Writing Cure.]

January 21, 2007

The Research on Fiction Writing and Health

There’s a piece of research that dovetails well with Lee Smith’s experience that I wrote about last week. It’s the only piece of research I know of that looks at what happens in terms of health when people write fiction.

The study was conducted ten years ago by Greenberg et. al. and is cited in The Writing Cure, p. 106. Participants in this study—college students—were divided into three groups:

  • A group who wrote about nonemotional events
  • A group who wrote their deepest thoughts and feelings about a previous trauma
  • A group who wrote their deepest thoughts and feelings about an imaginary trauma

Both the group who wrote about a previous trauma and the group who wrote about an imaginary trauma had significantly fewer visits to the student health center in the month following the writing than the group who wrote about nonemotional events. Thus, writing about real trauma was beneficial. And writing about an imaginary trauma—writing fiction—was beneficial.

(Granted, not all fiction has to do with trauma or difficult life events but one could argue that a fair amount of fiction touches on this area. Consider, for instance, Stephen King. Edgar Allen Poe and that telltale heart. J.R. Tolkien’s Lord of the Rings. J.K. Rowling’s Harry Potter series. Charles Dickens and all those stories of orphans. Grimm’s fairy tales. I can’t help but wonder, as I write this, if reading these stories—holding strong emotions through reading—might not also offer a kind of healing—but that perhaps is a different question for a different day----)

In a discussion of this study, the authors propose a reason that writing about imaginary trauma might be beneficial. They propose that writing about imaginary trauma may have allowed people to “accommodate themselves to negative emotions in a safe context.” This resonates for me with the words that Lee Smith used when she talked about writing her novel:

I was in a very heightened emotional state the whole time I was writing it, and it meant everything to me to have it to write. And Molly’s story became my story, or at least a receptacle of all this emotion I didn’t have anything to do with.

Story as a (safe) receptacle for emotion?
Writing fiction as a (safe) way to hold strong emotions?

Writing fiction may, of course, lead to a lot of other things as well. Beautiful novels. Moving short stories. A deeper understanding of life. A new way of looking at the world. Entertainment. Joy. All of this may happen for the reader—or for the writer. But maybe one of the other things that can happen—sometimes—for any one of us—and not just published novelists—is this opportunity for writing fiction to become a safe way to hold and digest—and perhaps transform—strong deep emotions.

January 30, 2007

Is Shifting One’s Point of View a Healing Habit?

In 2003, James Pennebaker and R.S. Campbell published an article that carried the intriguing title, “The Secret Life of Pronouns”. The authors proposed, based on the analysis of thousands of texts, that flexibility in a person’s use of pronouns when writing about painful memories is associated with improved health.

This was not a predicted finding. It emerged when Pennebaker and associates persisted in asking the question: Why it is that writing about emotional topics results in better physical health? What actually happens? The most consistent finding prior to this 2003 study had been that people who participated in expressive writing reported that, afterwards, they actually thought differently about the experiences after they wrote about them. Pennebaker’s question then became: “Is this change in thinking reflected in the ways people write?”

In other words, do people become healthier as their writing changes in some way?

To try and answer this question Pennebaker used a computer program developed by researchers on artificial intelligence, a program which performs linguistic analysis on written texts. 7501 writing samples were examined. A total of 3,445,940 words. A virtual sea of words. In this sea, he looked at how a person’s writing changed over successive days—and whether or not these changes were correlated with better health.

The first thing Pennebaker looked at was content. Did changing the content of one’s writing over a period of days affect health? For instance, did the health of those persons who wrote about a different topic on successive days fare better than the health of those who wrote about the same topics? The answer? It appeared to make no difference.

Next, Pennebaker looked at writing style. And he discovered that when people changed their writing styles over several days they were more likely to show improvements in health. When he narrowed down these changes in style, he discovered that participants were most likely to show improvement in health if, over the course of different writing samples, they changed what pronouns they used.

It’s an intriguing finding. For instance, writing from the I point of view some of the time, and then you, then we, then he or she or they correlated with better health. The finding was not a directional finding. It was not better, for instance, to move from first person to third person, or visa versa. What mattered was the simple fact of variability—flexibility.

In his remarks about the study, Pennebaker makes this comment: “Pronoun choice is based on perspective.” He also admits that the finding is enigmatic. It raises more questions than it answers. For instance, does pronoun flexibility actually cause improved health, or is it a feature that merely emerges coincident with improved health?

Is pronoun flexibility a skill that can be learned? Could it be like yoga? Flexibility increasing with practice? Or, to put this yet another way: is there any benefit to be gained from intentionally writing from a different point of view? Is shifting one’s point of view a potentially healing habit?

May 15, 2007

Expressive Letter-Writing and a Better Night's Sleep?

Last December (2006) a study, “Health Effects of Expressive Letter Writing,” by Catherine Mosher and Sharon Danoff-Burg, was published in the Journal of Social and Clinical Psychology. The study looked at what can happen when healthy college students write a letter to someone of significance in their life.

108 students were randomly divided into three groups:
• Experimental group 1—students were asked to write an expressive letter to a person of significance in their life who had helped them
• Experimental group 2—students were asked to write an expressive letter to a person of significance in their life who had hurt them
• The control group—students were asked to write a letter to a school official on an impersonal topic

At one-month follow-up two significant differences were discovered between the experimental groups and the control group.
1. As a group, those who had written to a person of significance in their life slept longer—they slept a mean of 7.1 hours compared to 6.4 hours
2. They also reported significantly fewer days in the previous month when physical or mental health symptoms prevented them from engaging in routine activities.

Interestingly, no significant difference was reported between those who had written to someone who had helped them and those who had written to someone who had hurt them. Both kinds of expression—conveying thoughts and feelings to someone who had helped and to someone who had hurt—seemed of value when it came to health.

And they slept longer. It’s an intriguing finding. I can’t say that I know quite what it means. But I can say that for a whole host of conditions—from depression to fibroymyalgia to treatment for cancer to the stresses and strains of ordinary life—it has been my observation, over and over, that sleep can be enormously healing. Something seems to happen when we sleep—a kind of deep restoration—that does not happen at any other time. So if a single letter like this could enhance sleep duration—well, that would seem to be of significance.

[Thank you to Susan Bernard for sending me the link for this study.]

July 03, 2007

A Research Study on the Health Benefits of Writing About Goals and Dreams

In 2001, Laura King, one of the researchers in the field of writing and health, conducted a study in which she looked at what happened when college students wrote about something she calls “their best possible future self.” By this time, a large amount of data had already been collected on the benefits of writing to work through difficult past experiences. King became interested in exploring what other kinds of writing might be beneficial to health. Her study is one that I don’t think has been written about enough.

She looked at 81 undergraduate students, randomly dividing them into four groups: a group which wrote about their most traumatic life event; a group which wrote about a best possible future self; a group which was asked to write about both; and a group which wrote about a non-emotional or control topic. Each group wrote for 20 minutes a day for 4 consecutive days.

Those students selected to write about a best possible future self were instructed to write in response to this prompt:

Think about your life in the future. Imagine that everything has gone as well as it possibly could. You have worked hard and succeeded at accomplishing all of your life goals. Think of this as the realization of all your life dreams. Now, write about what you imagined.

A couple of interesting results came out of this study. First, when students were tested three weeks after writing, it was found that writing about a best possible self was significantly less upsetting than writing about a traumatic life event. Second, the distress of writing about a traumatic life event was short-term. It had dissipated by five months. Third, both kinds of writing were beneficial. That is, when students were studied five months after writing, those students who wrote about a traumatic life event, those students who wrote about a best possible self, and those students who wrote about both—all of them experienced a decrease in illness. Only those students who wrote about a non-emotional topic showed no change.

The study is published in the July 2001 issue of Personality and Social Psychology Bulletin. In her discussion, King draws the following conclusion:

The act of writing down our deepest thoughts and feelings is key to the benefits of writing. However, and importantly, the contents of our deepest thoughts and feelings need not be traumatic or negative. Quite the contrary, examining the most hopeful aspects of our lives through writing—our best imagined futures, our ‘most cherished self-wishes’—might also bestow on us the benefits of writing that have been long assumed to be tied only to our traumatic histories.

I think this an enormously interesting and useful study. What I do not think is that this study should be used as a reason to counsel anyone and everyone to “move forward” to “think about the future” and “let go of the past.” Rather, I think what this study does is offer evidence that both are fruitful. Looking back toward unfinished business in the past is fruitful. Looking forward to a possible future is fruitful.

And it seems reasonable to conjecture that in the best possible circumstances, each person would be permitted to choose for themselves—perhaps at times with some guidance—when to look back—and when it might be time to look forward.

In my own experience, as a writer, and as a person who’s had the privilege to listen to lots and lots of stories of healing, it strikes me that after one has looked back and resolved unfinished business it becomes increasingly possible to feel free to look forward. This the reason that I’ve placed Looking Ahead not at the beginning of One Year of Writing and Healing but at its culmination.

I’ve often thought of it this way: that one may have to look back in order to truly go forward. And King’s research, I think, offers guidance—a starting point—a way to use writing as a tool—a kind of blueprint—when one is ready to go forward.