Expressive Writing as Therapeutic Intervention

... for Reducing Stress and Diabetic Symptoms

Diabetes is one of the leading causes of blindness, kidney failure, and other fatal diseases in the world. Conditions such as stress and depression have been shown to worsen diabetic symptoms. Expressive writing – writing about one's deepest thoughts and feelings – enhances physical and psychological well-being. It may help change the way diabetes patients think and feel about their disease. Data indicate that expressive writing (an activity during which individuals deal with stressful experiences by writing about them on paper) has beneficial effects on psychological and physiological outcomes. Diabetes patients can also benefit from expressive writing as effective stress management has a positive result in improving their diabetic symptoms.

Certain life events may be more likely than others to have deleterious health consequences because of their links to emotional expression. Life events related to stress are silent killers as they are the main reasons behind the onset of diseases like diabetes. Under circumstances such as a post traumatic stress disorder, individuals often try to inhibit thoughts and feelings about their experiences. Often attempts at thought suppression may actually lead to an increase in thoughts about the very experience that they are trying to erase from memory. Such inhibition, especially if it continues for extended period of time can exacerbate stress and in turn lead to declines in immune system functioning and other markers of physical health.

In recent years there has been a rapid growth in research examining emotional expression and health. It has been proved that expression of emotion brings about changes in people’s psycho-social worlds. One method of emotional expression is expressive writing which has powerful effects that are particularly relevant to our understanding of the links among upheavals, emotion, language and health. There are number of ways in which people are able to express their thoughts and emotion about important events in their lives. Beyond simple venting, perhaps most common is that people talk to others or write. This translation of an emotional experience into language is the basis of expressive writing. Though expressive writing is not a panacea, expressive writing intervention has generally positive results.

Meta analyses of the writing paradigms have suggested that this method produces positive effects for various maters of physical health like diabetes. The health benefits for writing are evident in measures of physical and mental health and hold up across samples of widely varying social class ethnicity, language and cultures. It may be more effective for people dealing with more traumatic than expected upheavals and with events that happened several weeks or months after the event as opposed to immediately afterwards. The act of converting emotion and images into words changes the way a person cognitively organizes and thinks about an emotional experience. By integrating thought and feelings about an emotional experience, one can then construct a coherent narrative of that experience. Once this integration takes place, the event can be summarized, stored and forgotten more effectively. Expressive writing that is a way of organized cognitive and narrative writing results in health and mood improvements thus reducing stress consequently having a positive effect on diabetes management. Constructing a narrative over the course of writing about emotional topics that induce stress helps individuals to better integrate the experience.

Emotional expression by nature is an inherently social activity. The ultimate purpose of language is to communicate ideas and thoughts with other people. When one talks to other people about his or her experiences, it allows him/her to remain socially tied to them. Conversely people who have traumatic experiences but do not tell their friends are more likely to live in a detached, isolated state. Disclosure thus has the power to change the quality of a person’s social network by bringing people closer together and serves as a force of social integration and stress reducer by consequence. Even private disclosure in the form of expressive writing helps free a person from the stress of a non-disclosed even showing that perceptual, cognitive, emotional, linguistic and social processes all undoubtedly contribute and influence each other.

Studies have shown that when diabetic patients were randomly assigned to engage in expressive writing about personal traumatic or stressful events or neutral writing on topics that do not affect them emotionally. The patients engaged in expressive writing showed improved symptoms rather than those engaged in neutral writing. A better physical quality of life was also reported. Assessing psychological and social outcomes following the writing, including quality of life, benefit finding, and reports of whether the writing changed the way participants thought and felt about their diabetic experience Thoughts and feelings, or the cognitive processing and emotions related to diabetes, are key writing elements associated with health benefits. Writing about only the facts has shown no benefit.

Expressive writing, which is defined as writing done to explore one’s innermost thoughts and feelings, has long been used as a method for self understanding and as a behavioural therapy to treat patients who have psychological stress in a therapeutic mind-body context. Expressive writing, or disclosure about meaningful personal thoughts and feelings, thus confers physical as well as mental health benefits; emotional expression improves psychosocial adjustment and thus reduces stress, one of the main determinants for the worsening of diabetes.

Susan Ayres, Andrew Baum, Chris McManus(ed.): Cambridge Handbook of Psychology, Health and Medicine, 2nd Edition, Cambridge University Press, 2007.
Sala Horowitz: Alternative and Complementary Therapies, August 2008.14(4):194-198

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More by :  Dr. Sutapa Chaudhuri

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