An Emotionally Expressive Writing Intervention

Putting positive reactions on paper led to one positive result.

Expressive writing (EW), which involves nonstop writing or journaling about a stressful or traumatic experience for 15 to 20 minutes for 3 to 5 consecutive days, has been studied for individuals with social, behavioral, and psychological concerns. The results have been mixed: some suggest this technique helps subjects deal with a range of social, behavioral, psychological, and health concerns, while other studies have not shown lasting effects.

Modifications to EW procedures have also been made, in which the duration and or frequency of writing and the location (lab vs. home) are altered in hopes of increasing impact. One such change has been to concentrate on positive aspects of one’s life rather than on negative or stressful events.

EW has been applied to patients with eating disorders and may be helpful during recovery (Eur Eat Disord Rev. 2010; 18:180). Some work suggests it may diminish the effect of stress on eating pathology, as was shown in a student population (Psychology and Health. 2012; 27:210) and  may also improve body image in a group of undergraduates (Lafont, master’s dissertation, Texas State University, 2011).

Dr. Nuriye Kupeli and fellow researchers at University College, London, recently tested the effects of an Emotionally Expressive Writing intervention (EW) on 71 female student volunteers before they were scheduled for a round of exams. Could writing about intensely positive experience influence changes in eating pathology and weight during an exam period, and would changes in eating pathology and weight be due to changes in affect regulatory systems and processes?

The students filled out several questionnaires, including the Eating Disorder Examination Questionnaire (EDE-Q), the Perceived  Stress Scale-4 (PSS-4), the Short Depression-Happiness Scale (SDHS), a 6-item questionnaire that measures greater depressed mood and greater happiness, the Social Comparison Rating Scale (SCRS), Vulnerable Attachment Style Questionnaire (VASQ), and forms of the Self-Criticizing/Attacking and Self-Reassuring Scale.

Two writing groups, two different assignments

Next, the participants were assigned to one of two writing conditions: writing about “the most wonderful experience in your  life …happiest moments,” and to try to imagine yourself at that moment.”  Participants were asked to write about the experience in as much detail as possible, making sure to include feelings, thoughts, and emotions.  In a second group (controls), the students were instructed to write a review of a film or book they had recently seen or read. On the second and third days of writing, the controls were instructed to either write about the same positive experience/film/book as the day before or they could choose to write about another positive experience/film, or book.

After each writing session, the participants rated their mood, and completed a 3-item scale that measured how “personal and meaningful”. Follow-up ratings were collected after 8 weeks.

Immediate and longer-lasting effects

Compared with the control group, the EW participants reported significantly higher mood levels than controls, and also indicated that they felt their diary entries were more personal and meaningful with each writing session. Immediately after EW, mood was improved.

Dietary restraint, but none of the other EDE-Q subscales, was significantly reduced in the EW group; there were no significant reductions of any EDE-Q subscale among the controls. No changes in body mass index were recorded in either group. Those who had improved dietary restraint scores wrote significantly more words over the writing period compared to those with no improvement.

These findings were similar to those of earlier studies. There was no immediate explanation for the changes in dietary restraint. The authors speculated that “dietary restraint is a more threat-based construct, based on fear of weight gain and the risk of breaking dietary rules, while the other subscales of the EDE-Q include elements of dissatisfaction and the desire to change (improve) rather than just the far of negative change.” The authors were appropriately cautious about their findings and noted the need for replication; nonetheless, the results are intriguing.

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