This post serves as a supplement to the Community Lesson: Beginning to Respond to Betrayal Trauma.
A few years ago I had a client call me during an anxiety attack. I took the call because I knew that she was in a lot of emotional pain. Unfortunately, I only had a few minutes before my next client would arrive. I quickly assessed her emotional state and how to proceed. The thought that came to my mind in that moment was, "I don't have enough time to help her navigate through this difficult issue. What is the next best alternative?" I knew that she didn't have family or social support that could respond quickly to her need, so that wasn't an option. At that point I suggested that she take out of piece of paper and write down the conversation with her dad that triggered her emotional pain. I invited her to write all of the things that came to her mind. In particular, I wanted her to focus on what the emotional pain she felt from her conversation with her father and then I wanted her to identify what she wanted to say to him. I asked her if she could complete that assignment and then call me back in two hours. She agreed and we hung up phone.
When she called me back I didn't know what to expect. If I had been asked to guess what emotional state she would be in when she called, I would have guessed that she would have still been upset and hurt. Instead, I was surprised by the clarity and conviction that she held in her voice. She described writing about the argument that she had had with her father. During her writing experience she somehow managed to shift her internal pain to what her father was feeling and thinking. She started seeing things from his perspective. Then she described to me the conversation that she wanted to have with her father. She had written down her key points. She then, in an emotionally calm voice said, "I am going to talk with my father this evening." At this point, I was stunned. During that afternoon her writing had helped her understand her own pain, her father's perspective, and what conversation she needed to have with him. That phone conversation was about five minutes long. It was the best therapy I never did.
I have thought a lot about the experience I had with my client. I have wondered why taking time to write down her thoughts and feelings changed her emotional state. What was happening in her mind? After this experience I began reviewing research literature about journaling. I was surprised to discover that for more than 30 years, clinicians have beenstudying the outcomes of expressive writing (journaling). I soon discovered that my client's experience was not unique at all. In fact, researchers have found that journaling can reduce common emotional issues like depression and anxiety (Baikie & Wilhelm, 2005). What is even more impressive is that journaling can improve your physical health as well (Pennebaker, Kiecolt-Glaser, & Glaser, 1988). Journaling has also been found to be an effective tool to use after a job loss (Spera, Buhrfiend, & Pennebaker, 1994), after trauma (Greenberg, Wortman, & Stone, 1996), and after a relationship break-up (Lepore & Greenberg, 2002). The supporting evidence surrounding journaling is clear. Obviously not everyone will experience the same benefits from journaling, but the research indicates that many who journal benefit emotionally and physically.
Why Journaling Can Help
In my research it became clear that journaling was effective, but I began to wonder why it was helpful to so many people. While there is no exact answer, many of the researchers have offered their suggestions. For example, Dr. James Pennebaker, one of the leading researchers in this area, found that many people suppress or inhibit their expression of emotions, which triggers negative emotional and physical consequences. What is especially interesting about Dr. Pennebakers' research is that inhibition of positive emotions also created health problems (Pennebaker, 1990). The general idea is that when individuals suppress emotions, either positive or negative, it takes a negative toll on the body and the mind. On the other hand, when individuals learn how to express their emotions in meaningful ways, they benefit physically and emotionally.
Consider the emotional shift in the client that I mentioned in the introduction. When she slowed her mind down and put her experience on paper, her emotional state of mind changed. As she expressed her frustration regarding the argument she had had with her father, she was able to clarify her own pain and hurt. This expression of emotions via journaling calmed her agitated mind. It also allowed her to consider how her father was feeling. This was a seemingly unintended positive consequence of her journaling.
It truly is a significant finding that expressing emotions through journaling can improve your physical health. I have thought a lot about the idea of suppressing a stressful event and have come to believe that these findings should be highlighted and put in bold letters that read something like this, "SUPRRESSING YOUR EMOTIONS WILL MAKE YOU PHYSICALLY SICK" or "EMOTIONAL EXPRESSION WILL IMPROVE YOUR HEALTH AND WELL-BEING."
Journaling: Who, How, and When It Helps
Since journaling has been found to be effective, many researchers have started asking deeper questions like, "Who benefits the most from journaling?", "When is the best time to journal?", "Can journaling be an aid to therapy?", "Are there side effects or potential negative outcomes associated with journaling?" and "Are there ways or methods that can make journaling more effective?" The final part of this article will address these questions.
Question: Who benefits the most from journaling?
Answer: Journaling can help almost anyone. However, for some groups it may be more beneficial than others. For example, it has been found to be especially effective for individuals who struggle to express themselves emotionally. Those who are shy by nature find that journaling is an effective way to express themselves without being forced to confide in someone they may not know. Another group of individuals who benefit from writing are those who are trying to make sense of a difficult experience or trauma. Sometimes it is journaling that is the first step to dealing with issues that have been plaguing them their entire life. Along this same line of thinking Kate Thompson wrote, "Writing can express material which is previously unexpressed or access previously inaccessible material, allowing it to come to the surface" (Thompson, 2004). Journaling also helps groups of individuals who may not have someone to talk with about their problems (e.g., military personal, individuals living in rural settings, people who feel alone or who have no current close relationships).
Question: When is the best time to journal?
Answer: Journaling can be done at any time of the day or night. In fact, this may be one of the most beneficial elements of journaling. A journal has been described as "an immediate accessible container available at any time, not dependent on the presence of others. It is available when no one else is, at 3 a.m., in the middle of a panic attack" (Thompson, 2004). This is what happened to the client I referred to earlier. I was not available and at the time when she needed me the most. Her ability to turn to paper and write down her painful experience was therapeutic to her.
The National Center for PTSD and other researchers have found that the earlier a difficult or traumatic experience is "dealt with" the less likely the person is to experience long-term emotional issues (Department of Veterans Affairs, 2007) (Levin, 2007). Based on these findings, journaling may be one of the first lines of defense for individuals who have no one to talk to or who, for security reasons, cannot talk about what they have experienced. A good rule of thumb regarding when to journal is this: if you are experiencing something that is stirring up a lot of emotions inside of you, it is a good time to write down what you are feeling and thinking.
Question: Can journaling be an aid to therapy?
Answer: In my personal experience I have found that clients who write down their thoughts and emotions outside of therapy come to therapy more prepared to discuss their progress and what they have learned. My experience with my client is just one of many examples of how journaling can assist my clients and it is a valuable tool that clients can use outside of my office. Furthermore, when I give clients specific writing assignments based on our sessions they make additional progress between our sessions. I have discovered that clients who journal often move through therapy faster than those who don't write.
Question: Are there side effects or potential negative outcomes associated with journaling?
Answer: This is a very good question. The answer is yes there are potential side effects of journaling. Journaling can stir up many emotions, especially when dealing hurtful and painful experiences from the past. Some individuals can trigger memories that are so painful that they don't know how to stop the negative feelings. Consequently, any time a person writes or attempts to deal with mental health related issues, they need to make sure that they have someone who can assist them if necessary.
Dr. James Pennebaker has found in his writing exercise, which consists of writing for 20 minutes a day for four days in a row, that this process can initially elevate stress levels and trigger higher levels of emotional pain. Fortunately, his research shows that individuals who are willing to go through the initial pain of bringing up traumatic memories in their journaling exercise are less depressed and have better physical health scores a few months later (Pennebaker, 1990). When a person stirs up the emotions from the past, it can initially create added stress. However, by addressing the issue through journaling the issue somehow loses its power and the individual reaps the reward of better emotional and physical health.
Question: Are there ways or methods that can make journaling more effective?
Answer: There are certain types of journaling that are more effective than others. Researchers have found that writing about neutral events (e.g., the weather) does not have the powerful effect that writing about how one feels about an event or earlier life experience does. Dr. Pennebaker's work with various groups clearly demonstrates that individuals who open up and disclose emotional pain make greater progress over time.
Here's an example of two different approaches to addressing the journal entry topic: "Tell us about your day." In one example, you will see a neutral response that offers little insight into how this person felt about the day. In the second example, you will see someone who opened up and disclosed her deeper emotions.
Example #1: Today we went to the park and had a picnic with my mom and step-father. We played with the Frisbee and went for a short walk. When we were done at the park we went out for ice cream. Got home late and put the kids to bed. It was a busy day.
Example #2: Today we met mom and her husband (Tom) at the park for a picnic. This is an experience that I don't enjoy as much as I used to. I am still hurt by my mom's decision to marry Tom. I felt like she has ignored us kids since their marriage and when we attend activities like this, I think it is just for show. I don't think her heart is into being a grandmother. It hurts to say this and maybe I am being too sensitive, but that is how I feel about the way things are with my mother right now. I don't like feeling this way. I want to have a better relationship with her, but I don't know where to begin. It seems like I don't ever get the chance to just talk with her alone. Even if I could talk with her alone, I don't know that I trust her enough to tell her how I feel.
According to research what would be the outcome of these two examples? In the first example, a neutral response to the writing topic would not be beneficial emotionally or physically. In fact, if there were negative, suppressed emotions about this experience it could actually have a negative impact on this person's life. In the second example you will notice an open disclosure of frustration, hurt, and pain. This is the type of open disclosure that helps a person make sense of what they are feeling and it helps in the healing process.
Journaling can be a powerful tool that can be used in dealing with difficult emotions and traumatic experiences. Those who participate in it are more likely to reduce symptoms associated with depression and anxiety. They are also likely to have better physical health. The only caution about journaling is that when you are journaling about difficult issues, you may initially experience more emotional pain. However, over time the openness of disclosure will provide health benefits.
So what will you be journaling about tonight?
Dr. Kevin Skinner, Clinical Director, Addo Recovery