People sometimes privately express in a diary thoughts that they don’t feel comfortable sharing with others.
But does this process actually contribute to healing?
A recent study led by Gail Ironson, MD, PhD, from the University of Miami, investigated whether a written trauma disclosure intervention would be effective with populations of HIV infected individuals.
Dr. Ironson and her colleagues suspected that writing about trauma could reduce PTSD symptoms and depression.
To test this hypothesis, they screened HIV positive individuals, recruiting 244 participants between the ages of 18 and 70.
At the baseline visit, all participants received a questionnaire and interview. For the first study visit, participants were randomly assigned to either the augmented trauma-writing intervention or the daily-event-writing control. They then returned on four occasions during a 2 to 4 week period to write privately in an office for 30 minutes.
After the writing intervention, researchers administered questionnaires, interviews and blood draws at 1, 6 and 12 months.
In the experimental condition, participants were given directions to write about their most traumatic or upsetting experience, and to continue writing about this experience each time they came to visit.
Meanwhile, the control participants were asked to write in detail about what they did on a particular day or their plans for a future day.
The results were not what the researchers expected.
Rather than affirming their hypothesis, the researchers found a gender-moderated effect.
The results showed that women in the trauma-writing condition had a greater reduction in the severity of PTSD symptoms, depression, and HIV-related physical symptoms in comparison to the women in the control. They also found that the effect was even stronger for women with elevated PTSD symptoms at baseline.
Meanwhile, for men, the only significant results seen were that depression decreased in the daily-writing control group, and PTSD decreased in both the experimental and control group. In other words, the intervention did not have a unique effect on the men as it did for the women.
These results lead us to some interesting questions.
Do only people with certain characteristics benefit from expressive writing? Could gender be one of these differences? One theory is that women may benefit more from emotional disclosure writing because in general, they are often better at accessing and expressing their emotions, while men are socialized to inhibit emotional expression.
Future research to see if HIV-positive women with PTSD would benefit from this writing intervention would be useful, as well as whether this treatment can be used with other clinical populations who have PTSD.
To learn more about this study, it was published in the Journal of Consulting and Clinical Psychology, Volume 81, No. 2.
If you’re interested in hearing about other trauma treatments, click here.
Have you used writing with your patients to help them express their emotions? Do you believe particular treatments elicit different responses depending on gender? Please leave a comment below.
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Meanwhile, for men, the only significant results seen were that depression decreased in the daily-writing control group, and PTSD decreased in both the experimental and control group. In other words, the intervention did not have a unique effect on the men as it did for the women.
ME
both men and women have access to their hemispheres. The findings above also conclude that social gender roles and their varied roles and expectations weren’t factored into this study.
Writers have long known about writing’s cathartic aspect. Proprioceptive Writing is something to look into as well. It’s powerful
I would be curious to look at whether left handed men would have a better response to this writing therapy. I have experienced that some left handed men may be better in touch with their emontional tendencies related to differing brain accesses.
I have been working with a 15 y. o. girl who has found writing helpful when she has urges to cut herself.
She loves music also and We have talked about some if her poetry becoming lyrics
I would agree that a therapeutic journal, where present emotions and thoughts are expressed openly, could act as a release of the recurring stress, anxiety and fear associated with past traumatic events by way of being a safety valve you can control. This control can enable the healing process through self efficacy. Maintain
I find that men are more reluctant to do expressive writing than women. However, the most
remarkable results of journaling came from a male client who used journaling to get through the issues that were in the way of his pursuing his dream job. (the goal of my work with him) He was
very willing to do this sort of writing and after several weeks, was less depressed and more motivated to take steps toward his goal. And after several months, he suggested that this work had brought up some psychological issues that he needed to handle in therapy!
One of the reasons why this study found a gender difference might have to do with phonological processing (which is auditory in nature but is critical to the mastery of written language) rather than emotional expression. Males have been found to have phonological processing that’s lateralized to one side of the brain whereas females have been found to have bilateral phonological processing; both hemispheres are involved. As the male neuropsychologist who presented this information in a webinar about written language said, “If something goes wrong, females have a backup plan!” The gender difference in phonological processing is thought to be a reason why boys outnumber girls in special education at a ratio that’s something like 3:1 or 4:1.
In a 1995 study Shaywitz et al. found that men only engaged the left hemisphere on language-related tasks, whereas most females engaged both hemispheres. Could it be that women have the advantage of being able to process negative emotions, (thought to be a right hemisphere function) more thoroughly than men when writing about their trauma?
Oh yeah…stop and smell the crayons! Really.
This study does not surprise me. I think the power of self-expression to evoke, enhance and maintain healing from trauma has been supported yt direct experience in our own recovery, observing the drawings and writings of children and adolescents and others practicing expressive therapy in trauma -based therapy settings. I think it is a way to respectfully challenge defenses as the person comes to understand their response to trauma. I have also noted a broad range of comfort level of therapists to engage clients in expressive processes. My thought here is an attachment to the outcome and a fear of being unable to somehow analyze the content. My encouragement is to note the client’s process is the healing and the relationship is the container conduit for healing energy. Know yourself and your own blocks to process-oriented therapy.
There were too many confounding variables in the study above. This is often a problem with psych. studies. We also want to be very careful about drawing conclusions from one study. Ruth you are usually good at separating these things out as you were with the impressive presentation yesterday! Thanks…
Abundant research has now demonstrated differences between the ways men and women respond to interpersonal trauma. The previous comment seems to question either the fact of a difference (which in my view is uncontestable, given recently published research); or the experimental design’s failure to account for “sample differences” — indicating the “gender difference” found could be attributable not to gender per se, but to a difference between gay men, and straight women (but isn’t that a gender difference? — a separate question). which I challenge. It is my belief, as a practising therapist, that insufficient research has been done addressing this question — some researchers I’ve written to who have reported such a difference do not write back attempting to explain their findings. I found the webinar, reflecting Prof. Dr Lanius degree of compassion, interpersonal sensitivity, and human insight (something also to look forward to in Dr van der Kolk’s future presentation) and the need for more “practice-based evidence” from clinical research with patients — in my experience men and women DO differ and require different therapist styles.
I work primarily with a child population and continue to advocate for increased understanding among educators and even ancillary mental health professionals who lack understanding of the insidious nature of trauma in children’s lives. This is particularly true for those who have been exposed to trauma pre-verbally, chronically or they themselves have a significant disability that compromises their own internal resources for coping with the trauma. Professionals and parents alike often remain unaware.
I concur with Russell’s comments about the Dr. Lanius’ presentation and its implications for treatment. I have developed an expertise in gender differences over the last decade from both reading the literature and conducting clinical practice. DSM V finally speaks to the issue of gender and age differences in diagnostic practice after years of neglect and controversy.
I believe our lack of societal acknowledgement of gender differences has contributed to our blind spots in designing research and in developing diagnostic criteria themselves. It’s a travesty to think we relied on large scale studies like the Framingham Heart Study to advise women about cardiac treatment when the study only had men included as subjects; but then again, we only more recently understood the implications of estrogen on cardiac functioning. Given how much we already know about how differently men and women process strong emotions, let’s keep gender in our frameworks for understanding how to help. It is already abundantly clear that it has major impact on the developmental trajectory of healing.
I have to agree. I feel that the important desire for equality between men and women often becomes an unconscious promotion of sameness.
Were the men in this study gay? I wonder if there is a difference in the way gay men respond than non-gay men? It is just a question.
Interesting conclusions
I question the gender assumptions. Are the gender separations really valid giving the likelihood of different methods of infection and a different cultural meme and support network for gay men over (assuming) straight women. This could be significant and skew the findings
Dennis Mendonca