Elaine R. Ferguson, MD Copyright 2012

 Many years ago, I discovered the scientific basis for expressive writing also known as ‘journaling.’ While attending a health conference, I heard Dr. James Pennebaker, a research psychologist at Southern Methodist University at the time, talk about the events that led him to begin researching in a new area in the psychology of expressive emotion.

 He heard an interview with a man who'd recently confessed to a murder that he'd kept secret for several months. It sparked his scientific curiosity. Despite the fact that this man was facing the rest of his life in prison, he expressed relief.  Dr. Pennebaker wondered if the emotional relief translated into physiological changes, and if it was present in other emotionally honest life experiences.

 During the 1980s, he researched the impact of writing about emotional issues had on health. He conducted his research to determine the extent to which it is healthy to express suppressed, "stored," unprocessed, and unresolved emotions. Writing about traumatic events in one's life can have a beneficial impact on the immune system, and on physical and emotional health.

 His research projects consisted of subjects writing for minutes a day, for four consecutive days, about emotionally challenging topics and experiences. At the completion of the study, he discovered that his subjects demonstrated significant physiological changes that correlated to mean increased immune system functioning.

 These positive changes endured for up to six weeks after the end of the four-day writing experiment. And even months later, subjects reported fewer visits to health clinics and medical doctors for stress-related illnesses.  According to Dr. Pennebaker, the psychological state of inhibition-holding things back, or in, rather than giving them expression -is a challenging and difficult physiological state.

 He says, "Active inhibition means that people must consciously restrain, hold back, or in some way exert effort to not think, feel or behave." Inhibiting or holding back one's thoughts, feelings, or behaviors is associated with long-term stress and disease. Actively confronting upsetting experiences can reduce the negative effects of inhibition.

 Dr. Pennebaker compared a group of college students who wrote about trauma with a group who wrote about trivial things (i.e., a description of their dormitory). Before the study, the 46 students visited the campus health clinic at similar rates.

 But after the exercise, the trauma writers' visits were cut in half relative to the others. In another study, published in 1998, researchers found direct physiological evidence writing increased the level of disease-fighting lymphocytes circulating in the blood stream. And preliminary research shows that writing can cause modest declines in blood pressure.

 College freshmen showed evidence of improved health after writing about their thoughts and feelings associated with entering college or about superficial topics for 20 minutes on three consecutive days. One fourth of the subjects in each group wrote during the 1st, 5th, 9 th, or 14th week of classes.

 Doctor visits for illness in the months after writing were lower for the experimental than for control subjects. Self-reports of homesickness and anxiety were higher in the experimental group-even three months after writing.

 By year's end, experiment subjects were either superior or similar to control subjects in grade average and in positive moods. No effects emerged as a function of when people wrote, suggesting that the coping process can be accelerated. Implications for comparing insight treatments with catharsis and for distinguishing between objective and self-report indicators of distress are discussed.

 Other research, includes a study conducted at the University of Miami where healthy college students, who were antibody positive for Epstein-Barr virus. This virus causes mononucleosis, also known as mono. They provided blood samples and were randomly assigned to write or talk about stressful events, or to write about trivial events during three 20 minute sessions, after which they provided a final blood sample.

 Students in the verbal/stressful condition had significantly lower antibody levels, suggesting a better cellular immune control over the latent infection after the intervention than those in the written stressful group, who had significantly lower values than those in the written/trivial group.  He also investigated the impact of expressive writing among worksite wellness- program participants. He found a 28.6 percent reduction in absentee rates from work relative to the eight month period before, compared to a 48.5 percent increase in the absentee rate of participants who wrote about trivial events.

 Dr. Pennebaker wrote, "The degree to which writing or talking about basic thoughts and feelings can produce profound physical or physiological changes is nothing short of amazing."

 Expression Is Good for Your Soul!  People who write about their deepest thoughts and feelings surrounding upsetting events have stronger immunity and visit doctors half as often as those who write only about trivial events. Writing about emotional upheavals has been found to improve the physical and mental health of grade school children, medical students, new mothers, nursing home residents, and victims of crime.

 Even the most well-adjusted and healthiest people acquire emotional baggage during the course of a lifetime, be it childhood angst, conflicts with family and friends, or remorse over missteps and lost opportunities.  In other research studies, researchers asked participants to write about a disturbing experience for 15 to 20 minutes a day for three or four consecutive days. The point was not to craft a perfect essay, but to dig deeply into one's emotional baggage, then translate the experience into language on the page.

 Interestingly, an analysis of participants' writings about trauma indicates that those whose health improves most tend to use a higher proportion of negative emotional words than positive emotional words.  Over several days of writing, the act helps us to improve our insight, and this is linked to health improvement. That is the creation of a coherent story of an expression, in concert with the expression of negative emotions working together in a therapeutic writing.

 In another research project published in 1998, researchers found direct physiological evidence writing increased the level of disease-fighting lymphocytes circulating in the blood stream. And preliminary research shows that writing can cause modest declines in blood pressure.

 I believe this research confers the ancient truth- "to thine ownself be true." Self-honesty, not merely optimistic denial coupled with self- awareness, allows the realization that we have the inherent capacity to define every experience, regardless of the depths of emotional pain it may have caused, rather than allow the experience to define us.  In other words-not only do we possess the psychological and spiritual stamina to survive all experiences, we equally possess the ability to heal and to thrive.

 Even the most well-adjusted and healthiest people acquire emotional baggage during the course of a lifetime, be it childhood angst, conflicts with family and friends, or remorse over missteps and lost opportunities.  This is the creation of a coherent story of an expression, in concert with the expression of negative emotions working together in a therapeutic writing. Evidence of these processes are also seen in specific links between word production and immediate autonomic nervous system activity.

 This groundbreaking research gives us clear and compelling reason to believe that journal writing or in a diary does more than simply chronicle thoughts and feelings or record them for the future.

 Next session we will explore more about journaling!  This week’s assignment:  Consider starting a journal to express yourself.