April 11, 2003

Studies look at improving health through expressive writing

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Mayor Bill Purcell welcomed the visiting students last weekend at Vanderbilt. (photo by Anne Rayner Pollo)

Studies look at improving health through expressive writing

Men and women have long been writing in journals or keeping a diary to vent emotions, release pent-up feelings about daily problems and obstacles, or divulge private thoughts about relationships or some other problem in their lives.

Now, a series of studies at Vanderbilt School of Nursing is examining whether something similar to the age-old “Dear Diary” can make a difference — not just in your emotional health, but your physical health as well.

Ken Wallston, Ph.D., professor of Psychology in the School of Nursing, as well as Peabody College, and the College of Arts and Science, and associate in the John F. Kennedy Center, and Lois Wagner, M.S.N., senior associate in Pediatrics and clinical instructor of Nursing, are conducting several research studies to look at whether expressive writing can have an impact on the emotional and physical health of patients with a chronic illness—specifically patients with HIV, diabetes, and people wanting to stop smoking.

Wagner says the idea of using expressive writing in their research came from the book, “Opening Up: The Healing Power of Confiding in Others,” by James Pennebaker, Ph.D., who is now a professor at the University of Texas in Austin. He revealed a connection between emotions, the immune system, and endocrine activity.

Pennebaker says words, particularly the written word, have the power to heal. In one experiment, Pennebaker and his colleagues found that college students who could write about traumatic experiences with signs of emotional engagement were likely to make fewer visits to the doctor and have higher grade point averages than students who wrote about the same type of experiences in a more detached way, as if they were observers rather than participants.

Wagner says Pennebaker’s research turned a light on in her mind. “It was like everything came together, and I kept thinking something important is going on here. I wanted to do more research on this, and I thought, ‘I’m going to look at this intervention in a population that’s never been studied before, people with HIV or AIDS.’”

Wagner decided to conduct research on expressive writing in HIV patients for her dissertation, and that’s when she reached out to Wallston, her dissertation advisor. Together, they applied for and were awarded a grant from the National Institute of Mental Health (NIMH). Wallston is the principal investigator on the HIV study, with Wagner as co-investigator and project director.

While waiting for the grant approval, Wallston and Wagner decided not to stop with patients with HIV. They also wanted to study the effects of expressive writing in patients with diabetes, another chronic illness. So, they invited Kathleen Wolff, M.S.N., clinical instructor of Nursing and a diabetes nurse practitioner, to join their team.

The pilot and feasibility study involving patients with diabetes is funded through a grant from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), awarded to the Vanderbilt Diabetes Research and Training Center (DRTC).

Each study is similar in design. The participants write in private for about 20 minutes, four days in a row, or 20 minutes, once a week for four weeks. Some subjects are asked to write about the most traumatic or stressful event in their lives. Other subjects are asked to write about a non-emotional event, like what they have scheduled for the day, how they manage their time, or how they might better organize their life.

Prior to starting the writing sessions, participants are asked to complete a basic health questionnaire asking about their perceived physical and emotional health status. They are also asked about adherence to their treatment regimen.

When the writing session begins, participants can write as much or as little as they want within the 20-minute time period. Then, at various times after the intervention, the perceived health status questionnaire is repeated for both groups.

“It is somewhat amazing that something like this could have an effect, but in previous research it has shown to make a significant difference,” Wagner said. “People in the expressive writing condition, having had the opportunity to disclose to themselves their inner feelings about stressful events in their life, have had significant reductions in visits to primary care doctors, lower reports of symptoms, and even improvements in immunologic function. Exploring their thoughts and feelings seems to change their immune system as a result of doing this.”

Wallston agrees. “This is speculation, but there seems to be a tie-in between one’s emotions and one’s immune system. If you can get people to feel better after writing about their stressful or emotional event, it can possibly change their immune system,” he said. “Positive benefits accrue down the line. Months later some patients have demonstrated improved functional capacity. Almost all previously published studies, some 40 to 50, have shown health improvements of some kind.”

Wallston has submitted another grant proposal to the National Cancer Institute (NCI), with co-investigators Joe Hepworth, Ph.D., research associate professor of Nursing, Barbara Forbes, M.S.N., of the Kim Dayani Center, and Dr. Cynthia Moriarty of Meharry Medical College to expand the research using expressive writing with people trying to quit smoking. The grant has been approved and Wallston hopes to begin this new line of research this summer.

Wallston says this technique of expressive writing has never before been applied to people wrestling with health behaviors that are difficult to change. “This intervention is potentially applicable to a lot of areas where people might be looking to change their behavior.”

If you have diabetes or HIV and want to find out more about enrolling in the expressive writing studies, call the research office at 322-8182.