Verbal and non‐verbal disclosure of recalled negative experiences: Relation to well‐being

This study investigated the relationship between methods of disclosure of recalled negative experience and well‐being. Six first‐year undergraduate class groups (N = 100) at an Australian university completed pre‐ and post‐intervention measures of psychological and psychophysical well‐being. For the disclosure intervention, three groups wrote, drew, or drew‐and‐wrote about a recalled negative experience (RNE groups); the three non‐disclosure groups wrote, drew, or drew‐and‐wrote on neutral topics (NT groups). The expectation that disclosure of negative experiences would enhance well‐being was partly supported, with writing and drawing‐and‐writing disclosure groups reporting increased psychological, but not psychophysical, well‐being. As predicted, verbal disclosure methods were more effective than non‐verbal methods, with the draw‐and‐write group showing the greatest improvement. Unexpectedly, disclosure via drawing alone was associated with decreased psychological well‐being. Against predictions, changes were found in two NT groups: The draw‐and‐write group reported improved psychological, and the draw group improved psychophysical well‐being. It was concluded that verbal disclosure, especially when combined with the non‐verbal method of drawing, may enhance psychological well‐being, but that drawing, without accompanying verbalization, may decrease psychological well‐being. It is suggested that future studies address variables such aslevel of disclosure, content and time of the negative experience, with time taken to manifest changes in well‐being, using both subjective and objective indicators.     

Further examination of the exposure model underlying the efficacy of written emotional disclosure

In the current study, the authors examined the effects of systematically varying the writing instructions for the written emotional disclosure procedure. College undergraduates with a trauma history and at least moderate posttraumatic stress symptoms were asked to write about (a) the same traumatic experience, (b) different traumatic experiences, or (c) nontraumatic everyday events across 3 written disclosure sessions. Results show that participants who wrote about the same traumatic experience reported significant reductions in psychological and physical symptoms at follow-up assessments compared with other participants. These findings suggest that written emotional disclosure may be most effective when individuals are instructed to write about the same traumatic or stressful event at each writing session, a finding consistent with exposure-based treatments.     

Encouraging acceptance of ambivalence using the expressive writing paradigm

Objectives. Ambivalence is regarded as a key target for psychotherapeutic change. This study aimed to examine the effectiveness of a brief expressive writing intervention for reducing distress about goal ambivalence. Design. A sample of 40 undergraduate students were randomly allocated to an experimental ‘expressive writing’ condition or a control condition. Method. Participants rated their ambivalence about the 10 most important goals they were currently pursuing and rated how distressing they found these feelings of ambivalence. Participants then completed three short expressive writing sessions on consecutive days. Participants in the experimental condition participants wrote about their deepest thoughts and feelings relating to their ambivalence, and participants in the control condition wrote about how they had spent their time that day or week. Results. When controlling for baseline distress about ambivalence, there was a significant effect of writing condition on distress about ambivalence at follow‐up; individuals who wrote about their ambivalence experienced a significant reduction in their level of distress about ambivalence. Conclusion. It was concluded that expressive writing might represent an analogue of therapeutic approaches to encourage acceptance of ambivalence.     

Mindfulness and experiential avoidance as predictors and outcomes of the narrative emotional disclosure task

This randomized study examined whether narrative emotional disclosure improves mindfulness, experiential avoidance, and mental health, and how baseline levels of and changes in mindfulness and experiential avoidance relate to mental health. Participants (N=233) wrote repeated traumatic (experimental condition) or unemotional daily events narratives (control condition). Regression analyses showed neither condition nor gender effects on mental health or experiential avoidance at a 1‐month follow‐up, although the control condition significantly increased in one component of mindfulness. Decreased experiential avoidance (across conditions) and increased mindfulness (in the experimental condition) significantly predicted improved mental health. Narrative disclosure thus did not improve outcomes measured here. However, increasing mindfulness when writing narratives with traumatic content, and decreasing experiential avoidance regardless of writing content, was associated with improved mental health. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–18, 2009.     

Written disclosure of experiences with racial discrimination and antibody response to an influenza vaccine

This study examined whether Blacks who wrote about their experiences with racial discrimination in a laboratory-based disclosure intervention would show greater levels of antibody production in response to an influenza vaccine compared with Blacks who wrote about a neutral topic. Forty-seven participants were randomized to write about their thoughts and feelings around their experiences with racism, or to write about their schedule for the week. Participants wrote on the same topic during each of three 20-min sessions. Blood was drawn prior to the intervention and at 1 and 3 months postvaccination to assess antibody production. Participants in the racism disclosure group produced significantly less antibodies to 2 of 3 viral strains. Post hoc analysis suggests that participants who were unsure about whether their events were due to racism or due to other factors had reduced levels of antibody to 1 viral strain. The attributional ambiguity sometimes associated with racism may inhibit the benefits of disclosure interventions for these types of stressors.     

Respiratory sinus arrhythmia predicts written disclosure outcome

Research has indicated that writing about traumatic experiences is associated with beneficial health effects compared with writing about emotionally neutral topics. What remains unclear are those factors that moderate the beneficial effects associated with written disclosure. This study examined respiratory sinus arrhythmia (RSA) as a moderator of written disclosure outcome. Findings indicated that individuals with the highest RSA during the first written disclosure session benefited most from written disclosure in terms of physical health complaints and depression symptoms. As expected, RSA did not impact outcome for participants assigned to a control condition. These findings indicate that individuals who display good emotion regulation skills are best served by written disclosure.     

Effects of emotional disclosure on psychological and physiological outcomes in patients with rheumatoid arthritis: an exploratory home-based study

The effects of an exploratory, home-based emotional disclosure intervention on psychological and physiological outcomes were assessed in patients with rheumatoid arthritis. Patients were randomly assigned to a disclosure group (n = 19) in which they wrote/talked about traumatic personal experiences, or to a control group (n = 15) in which they wrote/talked about the events of a particular day. Participants undertook these tasks for periods of 20 minutes on 4 consecutive days. The disclosure group demonstrated increases in negative mood and objective markers of disease activity at 1 week post-intervention. However, there were significant trends for the disclosure group to demonstrate minor improvements in mood and stability in disease activity, compared with the control group. These group differences appeared to be due to deteriorations in the control group more than improvements in the disclosure group.     

Expressive writing and post‐traumatic stress disorder: Effects on trauma symptoms,mood states,and cortisol reactivity

Objectives. This study investigates the boundary conditions (feasibility, safety, and efficacy) of an expressive writing intervention for individuals with post‐traumatic stress disorder [PTSD]. Design. Randomized trial with baseline and 3‐month follow‐up measures of PTSD severity and symptoms, mood states, post‐traumatic growth, and (post‐only) cortisol reactivity to trauma‐related stress. Methods. Volunteers with a verified diagnosis of PTSD (N = 25) were randomly assigned to an experimental group (writing about their traumatic experience) or control group (writing about time management). Results. Expressive writing was acceptable to patients with PTSD and appeared safe to utilize. No changes in PTSD diagnosis or symptoms were observed, but significant improvements in mood and post‐traumatic growth were observed in the expressive writing group. Finally, expressive writing greatly attenuated neuroendocrine (cortisol) responses to trauma‐related memories. Conclusions. The present study provides insight into several boundary conditions of expressive writing. Writing did not decrease PTSD‐related symptom severity. Although patients continue to exhibit the core features of PTSD, their capacity to regulate those responses appears improved following expressive writing. Dysphoric mood decreased after writing and when exposed to traumatic memories, participants' physiological response is reduced and their recovery enhanced.     

Working memory capacity can be improved by expressive writing: A randomized experiment in a Japanese sample

This study examined the influence of expressive writing on working memory capacity (WMC), a component of executive function. Japanese undergraduates (N = 104) were individually tested across six separate experimental sessions (baseline, three writing, and two follow‐up sessions at 1 and 5 weeks). Participants were randomly assigned to write about a traumatic experience, their best possible future selves (BPS), or a trivial topic for 20 minutes. WMC tests were completed at baseline and follow‐ups. Results indicate that expressive writing about traumatic experience can improve WMC at 5 weeks after writing, but that writing about BPS or trivial topics has no effect on WMC.     

Writing about the benefits of an interpersonal transgression facilitates forgiveness

The authors examined the effects of writing about the benefits of an interpersonal transgression on forgiveness. Participants (N = 304) were randomly assigned to one of three 20-min writing tasks in which they wrote about either (a) traumatic features of the most recent interpersonal transgression they had suffered, (b) personal benefits resulting from the transgression, or (c) a control topic that was unrelated to the transgression. Participants in the benefit-finding condition became more forgiving toward their transgressors than did those in the other 2 conditions, who did not differ from each other. In part, the benefit-finding condition appeared to facilitate forgiveness by encouraging participants to engage in cognitive processing as they wrote their essays. Results suggest that benefit finding may be a unique and useful addition to efforts to help people forgive interpersonal transgressions through structured interventions. The Transgression-Related Interpersonal Motivations Inventory--18-Item Version (TRIM-18) is appended.     

Are alexithymia and emotional characteristics of disclosure associated with blood pressure reactivity and psychological distress following written emotional disclosure/

Objectives This study had three aims: 1) to investigate whether cardiovascular responses to laboratory stress and levels of emotional distress were attenuated following written emotional disclosure; 2) to test, in addition to the potential main effects, whether levels of alexithymia moderated the impact of writing; and 3) to examine whether alexithymics who successfully disclosed emotion in their essays would experience positive effects following writing. Design and methods Eighty‐seven participants wrote about their most stressful life experience or about a non‐stressful experience, for 15 minutes, over 3 consecutive days. Two weeks later, blood pressure (BP) responses to laboratory stress and levels of emotional distress were assessed. Emotional characteristics of the disclosure essays were analysed with the Linguistic Inquiry and Word Count programme and alexithymia was assessed at baseline using the Toronto Alexithymia Scale‐20. Results Analyses found no evidence in support of the main effects of disclosure on cardiovascular responses to stress or on emotional distress. However, alexithymia was found to moderate the impact of writing such that non‐alexithymic participants in the experimental condition reported significantly lower emotional distress 2 weeks later. In addition, alexithymic participants who disclosed a greater number of negative when compared with positive emotion words exhibited reduced systolic and diastolic responses to stress. Conversely, non‐alexithymic participants who disclosed more positive and less negative emotion words displayed attenuated BP reactivity to stress. Conclusions The results of this exploratory study are important as they highlighted, in the absence of main effects, the importance of examining potential moderators of the emotional writing process. These findings may have implications for the development of cardiovascular health interventions.     

Macrophage PPARγ and impaired wound healing in type 2 diabetes

Macrophages undergo a transition from pro‐inflammatory to healing‐associated phenotypes that is critical for efficient wound healing. However, the regulation of this transition during normal and impaired healing remains to be elucidated. In our studies, the switch in macrophage phenotypes during skin wound healing was associated with up‐regulation of the peroxisome proliferator‐activated receptor (PPAR)γ and its downstream targets, along with increased mitochondrial content. In the setting of diabetes, up‐regulation of PPARγ activity was impaired by sustained expression of IL‐1β in both mouse and human wounds. In addition, experiments with myeloid‐specific PPARγ knockout mice indicated that loss of PPARγ in macrophages is sufficient to prolong wound inflammation and delay healing. Furthermore, PPARγ agonists promoted a healing‐associated macrophage phenotype both in vitro and in vivo, even in the diabetic wound environment. Importantly, topical administration of PPARγ agonists improved healing in diabetic mice, suggesting an appealing strategy for down‐regulating inflammation and improving the healing of chronic wounds. Copyright © 2015 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

The effect of positive writing on emotional intelligence and life satisfaction

This study explored the effect of writing about positive emotional experiences on emotional intelligence and life satisfaction. One hundred and seventy-five adults wrote about one of the following three topics: positive experiences with a cue for emotion regulation reflection, positive experiences without this cue, or a control writing topic. Multivariate analysis showed a significant time (pretest, posttest, and follow-up) by group effect. Writing about positive emotional experiences with an emotion regulation cue led to significant increases in emotional intelligence and life satisfaction at posttest and the increase in life satisfaction was maintained at 2-week follow-up. Further, participants who were cued to reflect on emotional regulation while writing about positive experiences rated their emotional intelligence significantly higher than the participants in the control writing group both at posttest and at follow-up. There were no significant differences in emotional intelligence or life satisfaction between those who were cued to reflect on emotional regulation while writing about positive experiences and those who wrote about positive experiences without such a cue.     

Immune- and non-immune-mediated roles of regulatory T-cells during wound healing

The immune system has a well-established contribution to tissue homeostasis and wound healing. However, in many cases immune responses themselves can cause severe tissue damage. Thus, the question arose to which extent cells of the immune system directly contribute to the process of wound healing and to which extent the resolution of excessive immune responses may indirectly contribute to wound healing. FoxP3-expressing CD4 T-cells, so-called regulatory T-cells (T_regs), have an important contribution in the regulation of immune responses; and, in recent years, it has been suggested that T_regs next to an immune-regulatory, ‘damage-limiting’ function may also have an immune-independent ‘damage-resolving’ direct role in wound healing. In particular, the release of the epidermal growth factor-like growth factor Amphiregulin by tissue-resident T_regs during wound repair suggested such a function. Our recent findings have now revealed that Amphiregulin induces the local release of bio-active transforming growth factor (TGF)β, a cytokine involved both in immune regulation as well as in the process of wound repair. In light of these findings, we discuss whether, by locally activating TGFβ, T_reg-derived Amphiregulin may contribute to both wound repair and immune suppression. Furthermore, we propose that T_reg-derived Amphiregulin in an autocrine way may enable an IL-33-mediated survival and expansion of tissue-resident T_regs upon injury. Furthermore, T_reg-derived Amphiregulin may contribute to a constitutive, low-level release of bio-active TGFβ within tissues, leading to continuous tissue regeneration and to an immune-suppressive environment, which may keep inflammation-prone tissues in an homeostatic state.     

Small spheroids of adipose‐derived stem cells with time‐dependent enhancement of IL‐8 and VEGF‐A secretion

Wound‐healing factors secreted from mesenchymal stem cells (MSCs) modulate the immune response and facilitate proliferation of neighboring cells. Although in vitro three‐dimensional (3D) culture techniques have improved the therapeutic potential of MSCs, no studies have focused on the effects of cell aggregation alone. In this study, the effect of cell aggregation on the up‐regulation of wound‐healing proteins secretions was investigated by constructing small spheroids of human adipose‐derived stem cells (hADSCs) on a micropatterned surface. These spheroids were mostly unaffected by the secondary effects of cell aggregation, such as hypoxia, low‐nutrient supply, and metabolic waste accumulation. Small spheroids of hADSCs, which were of 100 μm in diameter, were successfully constructed using micropatterned surface. Expression of the wound‐healing‐related factors, VEGF‐A and IL‐8, was markedly enhanced at the gene and protein levels, whereas the enhancement of VEGF‐A expression was transient and IL‐8 enhancement was maintained for a long time.     

Variations in the spacing of expressive writing sessions

Objectives. In a test to determine whether a brief version of the expressive writing (EW) method was viable, 106 college students participated in an experiment dealing with the study of life transitions. Design. Individuals were randomly assigned to write for 15 minutes on three occasions: either three times separated by 10‐min break (1‐hour condition), 35‐min break (3‐hour condition), or 24‐hour break (3‐day condition). Methods. Participants were randomly assigned to write about their thoughts and feelings about the transitions (N = 80), or to describe daily behaviours surrounding the transitions in a non‐emotional way (N = 26). Results. The three emotional writing conditions did not vary in terms of their engagement with writing, their emotional reactions, short‐ or long‐term reactions to the intervention. Compared to controls, those in the experimental conditions evidenced fewer symptom reports 9 months after writing. Conclusions. The findings suggest that a brief 1‐hour EW is more emotionally demanding, but that it has comparable effects on physical symptoms as the traditional 3‐day method.     

Effects of written emotional disclosure on caregivers of children and adolescents with chronic illness

OBJECTIVE: Tested feasibility of a written emotional disclosure intervention with caregivers of youths with chronic illness and its effects on measures of mood, physical symptoms, health-related quality of life, distress, and caregiver appraisal of stress and efficacy. METHODS: Measures were administered prior to and immediately after writing and 4 months later. Experimental group (n = 29) wrote about traumas and stressors while the control group (n = 25) wrote about summer activities for 20 minutes on three different days. RESULTS: Consistent with hypotheses, the experimental group experienced less positive affect, F(1, 54) = 4.68, p <.05, and more negative affect, F(1, 54) = 7.92, p <.01, and physical symptoms, F(1, 54) = 4.30, p <.05, immediately following writing than the control group. There were no significant Group x Time interactions on long-term mood, distress, health-related quality of life, or caregiver appraisal. Contrary to hypotheses, the control group had more vitality over time, F(1, 53) = 21.29, p <.001, than the experimental group. CONCLUSIONS: Recommendations include modifying the procedures to attain more control in applied settings and identifying specific processes that contribute to the efficacy of written emotional disclosure on well-being.     

Effects of written emotional disclosure on implicit self-esteem and body image

Objectives. Negative body image has a significant impact on self‐esteem, disordered eating, and general health. Writing about distressing events and experiences has been found to have beneficial effects on psychological and physical health outcomes. This study investigated whether a written self‐disclosure intervention, compared to a writing about body image success stories (WSS) intervention, had beneficial effects on self‐esteem and body image. Design and methods. One hundred and fifty‐eight women (aged 18–22 years) were allocated to either: written emotional disclosure (WED); WSS; or a control, non‐emotional writing condition. All measures were completed at baseline and at follow‐up 4 weeks later. Results. A condition by time interaction was observed for implicit self‐esteem, such that levels of self‐esteem were improved 4 weeks later in the WED condition. Implicit self‐esteem was also found to be greater following WED compared to the control condition, but not following WSS. Conclusions. This is the first study to demonstrate that WED has beneficial effects on implicit outcome measures such as self‐esteem indicating that the positive effects of expressive writing may initially operate by influencing automatically activated attitudes towards the self. The impact of WED on implicit self‐esteem may have implications for future health.     

Expressive writing in context: The effects of a confessional setting and delivery of instructions on participant experience and language in writing

Objectives. Manipulations of the setting and instructions were tested for effects on language use and reported health following expressive writing (EW). Methods. Participants (N = 76) wrote in one of three conditions that differed by setting and the delivery of writing instructions. Results. The results showed that altering the context for EW influences participants' language use and their perceptions of the experience. There was no effect of conditions on self‐reported health. Conclusions. Future research should attend to the ways in which manipulations of EW context affect proposed mediators such as language, as well as outcomes of EW.