I wrote yesterday about Jamie Pennebaker's talk at the Manchester BABCP conference and explored various issues including the importance of emotion regulation and the unhelpfulness of high levels of emotional suppression.  In today's post I would like to enlarge on the the important issue of timing and how the values of self-disclosure & expressiveness typically vary with how quickly one uses them after the event one is writing or speaking about - as well as mentioning a few other points Jamie made in his talk.  Seery et al's paper on 9/11 "Expressing thoughts and feelings following a collective trauma: immediate responses to 9/11 predict negative outcomes in a national sample" reported that "Contrary to common belief, participants who chose not to express any initial reaction reported better outcomes over time than did those who expressed an initial reaction. Among those who chose to express their immediate reactions, longer responses predicted worse outcomes over time".  This overlaps with research showing that "psychological debriefing" soon after trauma can actually be damaging.  See, for example, "Psychological debriefing for road traffic accident victims. Three-year follow-up of a randomised controlled trial" and "Emotional or educational debriefing after psychological trauma. Randomised controlled trial".  It further overlaps with the finding that degree of emotional arousal in the hospital casualty department after a road traffic accident contributes to the likelihood of later posttraumatic stress disorder - see "A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder".  In other words, there may be more value in soothing & calming shortly after trauma rather than encouraging ventilation of feelings. 

I think it's important not to "over interpret" these time factor findings for expressive writing and psychological debriefing.  It would be easy to slip into believing that this research suggests it's best to "keep a stiff upper lip" after experiencing trauma.  I don't think this is necessarily the case.  There are major differences between telling a good friend or relative about one's recent experience of trauma and writing out the emotional details on a piece of paper or discussing the trauma in a room full of other traumatised people.  One way of highlighting this is to look at the situation through the lens of attachment theory.  When individuals are or have been severely threatened they may, very understandably, have care-seeking needs strongly activated.  See my blog post on "Behavioural systems: attachment (care seeking), care giving, exploration, sex & power" for more on this.  When care seeking attachment needs are activated our gut instinct is to look for responsive, loving, strong, soothing others who can help us - both emotionally and, if necessary, practically.  A cold piece of paper doesn't stroke our hair, tell us we're loved and of value, that it's going to be all right, that practical support is there when it's needed.  Soothing is typically the appropriate response to emotional care seeking.  Expressive writing acts by a cascade of effects but it doesn't give us a loving hug, do our shopping for us, or visit us in hospital.  Sometimes emotional upset is a social message to others and a drive to make contact with sources of security and reassurance.

Issues about timing of emotional expression fit too with Emily Holmes's work discussed in an earlier conference report.  Jamie Pennebaker alluded to these findings when suggesting that it was "probably bad to write much immediately after trauma" and - certainly in the first hours - likely to be preferable to distance oneself by engaging in other activities (preferably, Holmes would assert, activities demanding visuospatial processing).  Alternatively if one is going to engage in fairly immediate processing/talking about trauma, in the first hours it may be better to be quite analytical & cognitive rather than highly emotional in one's processing.  It's less clear what's most helpful in subsequent days, although Seery's paper (see above) gives us hints as too does Ginzburg's study on the benefits of repressive coping in the initial week after a heart attack.  Jamie suggested the time to consider expressive writing is possibly weeks rather than days later if one finds one is "thinking about it too much" and/or pushing others into compassion fatigue!  There are many studies showing expressive writing is helpful when writing weeks, months or years after traumas have occurred.  There are also studies showing benefits for writing about current stresses and it would be helpful to tease out whether any benefits of writing about one's current life situation (e.g. the challenges of starting college) occur more when facing general life stresses rather than when one is feeling particularly traumatised by one's situation (when other coping strategies  - like problem solving or seeking social support - might be better). 

Jamie also commented that he thought of expressive writing as a "life course correction" so he doesn't recommend writing regularly.  This is in contrast to less evidence-based approaches like the daily "morning pages" suggested in the popular book "The Artist's Way".  I guess one needs more specific research to test out who is right here - and under what circumstances.  Jamie commented one is likely to feel writing is helpful or not quite quickly.  I found it particularly interesting that he said that they now sometimes "just asked people to write about something of personal emotional importance, and that this seems about as helpful as writing about worst traumas".  This makes introducing expressive writing less daunting than the traditional "just jump right in and write your deepest feelings & thoughts about your worst life memories".  Also more recent is the finding that writing for 15 minutes three times with just a 10 minute break between writing episodes seems almost as helpful as spacing the writing episodes out daily or weekly.  In fact Jamie is now looking at writing for just 5 minutes three times with only a 3 minute break between writing episodes!  If you want to participate in an online research study about this visit the "Writing and health" section of his website and follow the link in "To try out the study go to http://www.utpsyc.org/Write."  Jamie has also been exploring "finger writing" (tracing the letters in the air rather than on paper) and talking into a tape recorder.  Both again seem almost as helpful as actual writing. 

Any other comments I noted?  Jamie said that reading what one has written out loud to others can be "a bad idea".  It may be better, if one is speaking about one's writing at all, to simply tell the other person about it rather than reading it verbatim.  This is an interesting comment that I heard with interest and caution.  When, as a therapist, I ask clients to do expressive writing as "homework", I regularly say to them that I want them to write very freely and honestly, so to do so knowing that they won't be expected to share what they've written with anyone else including me, the therapist.  When they bring the writing in to their next session, I check with them whether they'd like me to read any or all of it, or if they would like to read out or tell me about what emerged.  I say somewhat similar things when I give writing as an exercise in groups.  In highly disclosing interpersonal groups I often find that some of us do read out directly what we've written and this can be absolutely fine.  It depends on one's personal experience & style, as well as on the type of relationship one has with one's "audience".  I do underline though that it's crucial that one feels free to write with deep honesty, so to share the writing or not is secondary to wanting to support a very open, authentic exploration. 

Jamie Pennebaker also commented that expressive writing acts by a "cascade" of mechanisms.  He mentioned emotion-relevant theories (not venting or catharsis), cognitive theories (building a new story, finding meaning, changing perspective), and social processes (pre- to post-conversation changes).  He encouraged people exploring the value of expressive writing to be "open & playful" and gave links to his website and to some online writing & other questionnaires.

We then moved on to questions and Jamie made the unfortunate remark that writing was best kept for negative experiences rather than positive ones.  Maybe this is true for expressive writing, but it certainly isn't true for therapeutic writing more generally.  I'll look at this more fully in tomorrow's post.  Overall though a good, stimulating, interesting talk - well worth going to.