• Identifying “trait negative emotion” may be more important to determining level of success using expressive writing for mediation of trauma symptoms than revisions to the Pennebaker expressive writing protocol or to the delivery of writing instructions.
• Individuals with high trait negative emotion reported greater distress in therapeutic writing exercises. However, these same individuals showed a significant decrease in symptoms associated with PTSD.
• Individuals with both high and low trait negative emotions reported that expressive writing exercises were helpful.
• Individuals with high trait negative emotion acclimated to emotions occurring during expressive writing exercises and reported decrease in symptoms of PTSD.
“Trait negative emotion has been identified as a potential moderator of the effect of expressive writing on symptoms of post-traumatic stress. The goal of this study was to investigate whether individuals who differed in degree of trait negative emotion (high vs. low) responded differently to three different writing tasks. These tasks included an expressive writing condition in which participants wrote about a traumatic event, an active control condition in which participants wrote about a traumatic event in a nonemotional manner, and a control condition in which participants wrote about daily activities. One hundred twenty undergraduates completed one of these writing tasks for 30 minutes on two consecutive days. Results revealed that participants high in trait negative emotion endorsed significantly greater symptoms of post-traumatic stress and emotional arousal than participants low in trait negative emotion, regardless of writing condition. Results further showed a significant reduction in post-traumatic stress symptoms among high trait negative emotion individuals assigned to the expressive writing condition but no significant reduction in other conditions. Participants high in trait negative emotion also rated the writing task as significantly more difficult and distressing than participants low in trait negative emotion; nonetheless, both groups indicated that the task was equally helpful.”
The concept of trait negative emotions derives from the work of D. Watson and L. Clark who, in the 1980s, described a self-reported measure for the degree to which individuals feel negative emotion. Watson, it is worth noting, has also worked with James Pennebaker, the developer of what is now called the Pennebaker protocol for assessing the benefits of expressive writing. The authors of the current study investigated how high levels of self-reported negative emotion might affect the outcomes of expressive writing exercises. In particular, they were responding to research that suggested that expressive writing might heighten symptomology of trauma in those subjects with high trait negative emotion. The authors found that while those subjects did indeed experience higher levels of distress during the writing exercises, they also reported the greatest benefit. This study is one of a long line of investigations that point to mental health benefits of expressive writing. However, it also suggests the need for close monitoring and high degrees of training for anyone implementing expressive writing as an intervention for trauma symptoms. While it affirms previous findings of increased distress of subjects who employ expressive writing, practitioners who use writing as a tool for treatment of PTSD need to be prepared for possible short-term effects on those individuals with trait negative emotion.
The Department of Veterans Affairs (VA) is currently running a research project aimed at understanding whether or not expressive writing can benefit veterans with PTSD. As the VA develops programs and treatment processes to help veterans and family members understand and live with trauma, some of which fall in the category of non-traditional treatments (e.g., art therapy, play therapy), a clear understanding of both short-term and long-term benefits is necessary. VA programs that help veterans with depression, in particular, can benefit from longitudinal studies that track ongoing effects of new treatment methodologies. Significant funding and incentives for veterans to participate in longer term studies is necessary and needs to be addressed by policy makers. Equally as important is securing funding to train counselors and therapists to use expressive writing. This study suggests that those individuals with trait negative emotions may activate trauma while writing, therefore counselors and therapists need to be aware of writing interventions results. Training that makes clinicians aware of these possible negative effects is necessary before any large-scale implementation of writing interventions is undertaken.
For Future Research
The focus of the study on PTSD symptoms is particularly useful for clinicians working with veterans. While the study does not directly control for veteran status, it nonetheless points to the need for a deeper and more nuanced understanding of the value of writing in mitigating the impact of trauma and disruptions to mental health. The study uses undergraduate students at a medium-sized southwestern university, a group likely not inherently comparable to veterans. Further research that focuses solely on the effects of writing on veterans’ trauma, similar to that currently underway at the VA, will provide more actionable data. Further, more research on how subjects negotiate the initial deepening of negative emotion in response to writing exercises is needed in order to determine whether expressive writing provides long-term benefits. Finally, measures of improvement for this and similar studies remain self-reported measures. Future research that uses assessments of physiological impacts or other trauma indicators would provide additional, more verifiable findings on which to base changes in practice or policy.