Review and Discussion of a Research Article

"Give sorrow words; the grief that does not speak
Whispers the o'erfraught heart and bids it break."

Macbeth, IV, iii, 209

"Written Disclosure Reduces Trauma and Depressive Symptomatology." This is the headline on the front-page review in the October 2004 Clinician's Research Digest.(1)

Earlier work by Pennebaker had shown that individuals assigned to write about traumatic events showed improved physical health but there has been little data looking at the procedure's effect on psychological health.

Accordingly, this study assigned forty-nine college-age women who had experienced at least 1 traumatic stressor and reported moderate Post-Traumatic Stress Disorder (PTSD) symptoms to either "disclosure" or "control" conditions. In the disclosure condition, the women were instructed to write about the most traumatic or distressing experience of their lives with as much emotion as possible during 20 minute writing sessions on three consecutive days. Individuals in the control condition were asked to just write about how they spend their time in as much detail as possible. Self-report measures of PTSD symptom severity, depressive symptoms, and physical health symptoms were assessed prior to the first writing session and four weeks later.

At the 4-week follow-up, the women who had written about the traumatic experience with as much emotion as possible showed significant improvement on all the three measures studied compared with the control group. And that was with just three twenty-minute writing sessions!

The investigators also explored whether "exposure" might account for the positive psychological changes following written disclosure. In exposure treatment, the person relives the trauma in their imagination, and describes it aloud to their therapist. In the jargon of the field, talking about the traumatic event and allowing the feelings is "exposure." The researchers looked at this by examining whether emotional and physiological reactivity during the writing task was associated with a reduction in depressive and PTSD symptomatology. The disclosure group showed greater emotional and physiological reactivity during the first writing session compared with the control group and reactivity declined over time. Furthermore, greater physiological reactivity during the first writing session was significantly related to decreased depressive and PTSD symptomatology. The results suggested that exposure to avoided or feared negative emotional experience may be a mechanism by which written disclosure improves psychological health. The authors conclude that written disclosure may be a useful therapeutic technique.

I have several thoughts about this study. I am very interested in "evidence-based" approaches, so this study certainly caught my attention, as had Pennebaker's earlier work. Research developments in the field of alcohol and drug problems are especially on my mind these days. However, this seems to be an example of how science later proves the insights of poets and writers. In this case, it was Shakespeare, who wrote,

"Give sorrow words; the grief that does not speak
Whispers the o'erfraught heart and bids it break"

Macbeth, IV, iii, 209

In those two short lines that are said to be written in 1605 or 1606 Shakespeare both gives the prescription and summarizes the consequences of ignoring that advice. Unspoken grief can have negative health effects; it has been said before that "dying of a broken heart" does really happen. (Of course, scientific studies have undoubtedly proven some literary "insights" to be incorrect and hence not really insights at all.)

Freud and his early collaborator Breuer also come to mind in connection with this study. Breuer, with the cooperation of a patient by the name of Bertha Pappenheim,

"developed the "cathartic method" - what she referred to as "the talking cure" or "chimney sweeping" - in which the doctor attempts to free the patient of symptoms by encouraging the expression of the memories and emotions connected to them."(2)    

Then we have the literary critic, Harold Bloom, who ties Shakespeare and Freud together, arguing that Shakespeare is Freud's "prime precursor."(3) Bloom flatly states that,

"Shakespeare is the inventor of psychoanalysis, Freud, its codifier."(4) I agree that there is

a strong thread running from Shakespeare's writings through Freud and Breuer's to the present study.

Both the quote from Macbeth and the label of the "talking cure" suggest that the sorrow has to be voiced aloud, or spoken. However, the study reviewed above indicates that writing can also "give sorrow words" and that writers who claim that writing is psychotherapy for themselves are well-justified in making that claim.

(1) The study cited is Sloan, D.M. [Dept. of Psychology, Weiss Hall, Temple Univ., Philadelphia, PA 19122;], & Marx, B .P. (2004) A closer examination of the structured written disclosure procedure. Journal of Consulting and Clinical Psychology, 72,165-175.

(2) Louis Breger, Freud: Darkness in the Midst of Vision (New York, John Wiley & Sons, 2000.), 103.

(3) Harold Bloom, The Western Canon: The Books and School of the Ages (New York, Harcourt Brace & Company, 1994) ,376.

(4) Bloom, 375.
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