1. Elaine R. Ferguson, MD Copyright 2012

2.  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.

3.  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.

4.  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.

5.  His research projects consisted of subjects writing for 15-20 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.

6.  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.

7.  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.

8.  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.

9.  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.

10.  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.

11.  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.

12.  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.

13.  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.

14.  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.

15.  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."

16.  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.

17.  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.

18.  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.

19.  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.

20.  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.

21.  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.

23.  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.

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

25.  Part 2 09.10.12

26.  Underscoring the connection between stress and illness, a study found that patients with arthritis and asthma often got better after writing about painful experiences in their lives such as a car wreck or the death of a loved one.

27.  Dr. Joshua Smyth and colleagues replicated studied the effects of journaling in individuals experiencing asthma and rheumatoid arthritis. The study is believed to be the first to examine how writing about stressful events affects specific illnesses.

28.  The research objective of the study was to determine if writing about stressful life experiences would affect disease status in patients with these two illnesses using standardized, quantitative outcome measures.

29.  The study included 112 patients, 61 asthmatics, and 51 rheumatoid arthritics. Fifty-eight asthmatics and forty-nine arthritics completed the study. Patients were assigned to write either about the most stressful event of their lives or emotionally neutral events for only three days, 20 minutes each day. Four months later, nearly half of those who wrote about stressful events had improved significantly.

30.  Researchers found that asthma patients who wrote about their experiences such as car accidents, physical abuse, divorce, or sexuality improved their lung function by 19 percent on average. Among the patients with rheumatoid arthritis, there was a 28 percent improvement of symptoms.

31. "We can do a good job with medication, but we can do a better job if we also pay attention to people's psychological needs,“ says Dr. Joshua Smith, now an assistant professor of psychology at North Dakota State University and a co-author of the study.

32.  "This indicates that a very minimal psychological social interaction can have very substantial medical effects. And it indicates that stress may play a role in the progression of illnesses like arthritis and asthma."

33.  Until 1999, the research in this area had focused on healthy individuals. Many theorized that expressive writing would be a beneficial adjunct to traditional disease management.

34.  Dr. David Spiegel, a psychiatrist at Stanford Medical School, in an editorial published in the same issue of Journal of the American Medical Association, "Were the authors to have provided similar outcome evidence about a new drug, it likely would be in widespread use within a short time…"

35.  “The authors have provided evidence that medical treatment is more effective when standard pharmacological intervention is combined with management of emotional distress.  “Manufacturers of paper and pencils are not likely to push journaling as a treatment addition for the management of asthma and rheumatoid arthritis.

36.  “But the authors have provided evidence that medical treatment is more effective when standard pharmacological intervention is combined with the management of emotional distress.  “Releasing negative emotion, even just to an unknown reader, seems to have helped these patients acknowledge, bear, and put into perspective their distress. In this and a growing number of studies, it is not simply mind over matter, but it is clear that the mind does matter."

37.  Investigators remain unclear as to the precise physiological mechanism that makes writing effective medicine.

38.  The Journey to Inner Awareness  Prior to Dr. Pennebaker's research, Dr. Ira Progoff, a Jungian scholar and the creator of holistic depth psychology, practiced in New York City where he developed a journaling technique. Since the program was developed over thirty years ago, more than 200 workshop certified leaders have been trained and more than 175,000 individuals have participated in his workshops.

39.  Dr. Progoff passed away in 1997. His son John is now the executive director of Dialogue House. Of journaling, he says, "It is a very helpful technique to get a perspective of your life.  Where it's been, where it's going. It gives you insight into yourself, hobbies, career, your feelings about society, and other important aspects of your life. The process is very helpful in growth, health, and increasing self-esteem. It also helps those ‘stuck’ in a rut to get out of it.

40.  Additionally, giving form to difficult emotional experiences through words and language offers a context and a container. Understanding, insight, and meaning all begin with naming and describing with telling ourselves the truth about what we have experienced, and how we feel about it. That's what this four-day process helps participants to do.

41.  Structured writing exercises aren't for everyone. Some people prefer what Terry Vance, a psychologist in, Chapel Hill, North Carolina, calls "letter therapy."  In a 1998 book Letters Home, Vance describes watching many people get "unstuck" from bad relationships or conflicts by writing letters to others in their lives. “Conversations can dissolve into screaming matches or crying fits,” she says, “but letter writing offers safety.”

42.  Many of us grew up with a taboo on expressing deep emotional feelings and became secretive children, and eventually definitively secretive adults, masking our true feelings. "But masks harm, even deaden, the person underneath. Getting healthy requires becoming visible by taking off the masks and exposing the secrets-finding out who you are by discovering what you feel and think."

43.  Her book shows how letter therapy can help us resolve conflicts, effect change, and recover from our relationship with our parents. Learning to communicate from the heart can help mend crippling conflicts and open up possibilities for intimacy and growth. Expressing feelings and thoughts can create change, even if the letter is never mailed.  The simple act of writing a letter can help us confront our problems, and ultimately, change our lives.

44.  Over twenty years ago, Dr. Vance began assigning letter writing to her psychotherapy patients as a method of addressing past psychological and physical abuses, confronting family members, revealing long-held destructive secretes, facing down the various difficulties in their day-to-day lives, and gaining insight into their own thinking and behavior. Vance believes writing therapy can work for anyone: composing effective and empowering letters to heal and reconstruct relationships.

45.  She says, "In a perfect world, we might have the opportunity to be in family therapy or in a similar situation where we are encouraged to confront the truth and are supported for being authentic with the people who are most important to us.  "Most people, though, can put their feelings on paper, write a letter to parents, have a friend or spouse or sibling read the letter and give feedback, or put the letter away and reread it later, with the enhance perspective a little distance can give.

46.  “Although writing letters to deal with important emotional issues is easier with the insight and support that therapy gives, writing an up-front letter does not usually necessitate being in psychotherapy. In cases of abuse, however, the guidance of a qualified therapist is essential.

47.  “Letter writing can help accomplish what family therapy or couples therapy often does. It can bring the significant people together and help the writer separate his or her contribution to the problem from the parents or spouse in a way that is documented and can be gone over and over in different states of mind."

48.  The letters don't even have to be sent. And you can always write to yourself in a journal.  According to Kathleen Adams, a Colorado based journal therapist, "Journaling literally helps clients get to read their own minds. That process builds self-trust and self- esteem and can complement traditional conversation based psychotherapy.

49.  One of her clients, a holistic practitioner herself, experiencing debilitating migraine headaches, sought out Kathleen's services because she had a feeling writing will help me to get to the root of her issues.  With guided imagery, she received a picture of her headache, a visual image that prepared her for dialogue with her body. She saw the headaches in the form of a swirling, black storm cloud. In the cloud, she saw the face of Yoda, the wise teacher character from Star Wars.

50.  She struggled with the notion that the headaches were a wise teacher, a benevolent messenger. Accepting the message, behavioral changes occurred that were in alignment with the emotional distress she was experiencing. During her eighth session she said, "I'm done." She was a marvelous example of what can occur when people really trust their inner wisdom and guidance.

51.  Kathleen regards journaling as a wonderful opportunity for inner growth. "I think of writing in a spiritual context. It feels to me like a mystical secrete. People who've stated they have a relationship with disincarnate beings are often seen as different. In fact, the best-selling book Conversations with God came from an internal dialogue."

52.  Anais Nin, a diarist who logged an estimated 150,000 pages before her death in 1977, remarked in response to Dr. Progoff's work, "The lack of intimacy with one's self, and consequently with others, is what creates the loneliest and most alienated people in the world. Progoff ultimately proves that the process of growth in a human being, the process out of which a person emerges, is essentially an inward process."

53.  Expressive writing allows you the opportunity to connect with the magic and the mystery that is available.  It is a form of meditation, interactive prayer. I can't imagine how my path might have evolved had I not found journaling.  You don't have to be a skilled writer to benefit from writing about your emotions. It doesn't matter if you can't spell, or you write in sentence fragments-what matters most is that you did it!

54.  EXPRESSIVE WRITING BENEFITS  1. Writing helps integrate and organize our complicated lives in a variety of ways.  2. Writing clears the mind  3. Writing helps resolve traumas that stand in the way of important tasks  4. Writing helps in acquiring and remembering new information  5. Writing fosters problem solving. It forces people to sustain their attention on a given topic for a longer period of time