Focused Expressive Writing as Self-Help
for Stress and Trauma

Joshua Smyth and Rebecca Helm
Syracuse University

In the therapy process, the process of disclosing about stressful or traumatic
events is often considered essential. One such manner is through
focused expressive writing (FEW) about stressful or traumatic experiences.
FEW is related to improvements in health and well-being, across a
wide array of outcomes and participant characteristics. As FEW requires
limited involvement of other individuals, is relatively low cost, and portable,
it has tremendous potential as self-help. In particular, FEW may be an
effective means to reach populations unwilling or unable to engage in
psychotherapy. A case illustration of FEW is presented. Evidence and future
directions for FEW as self-help are reviewed.

Mechanisms of Action
So why is FEW beneficial? Researchers had originally hypothesized that its benefits were
due to participants being able to circumvent the personal and social constraints preventing
them from disclosing their thoughts and emotions regarding traumatic experiences.
By not disclosing, participants were forced to actively inhibit their thoughts and emotions
surrounding the event. Disclosing about the stressful or traumatic event was thought to
reduce the negative influences of inhibition (e.g., disinhibit) and therefore reduce the risk
of illness. Perhaps surprisingly, the notion that the effect of writing is due to the reduction
in inhibition has received little support from research. Inhibitory personality styles are
not reliably related to the benefits of disclosure. Additionally, writing about traumatic
events that have been previously disclosed does not appear to have different health benefits
than writing about traumatic events that have not been disclosed (Greenberg &
Stone, 1992). Therefore, more recent research has focused on other theoretical frameworks
(Lepore & Smyth, 2002).
One view is that FEW helps the individual reorganize the memories involving the
traumatic event. FEW may promote alterations in memory structure, making the memory
more coherent and organized (Smyth & Greenberg, 2000). Research suggests that the
reorganization of the traumatic memory into a narrative may be a critical factor in expressive
interventions for traumatized individuals (DeSavino et al., 1993) and for FEW more
generally (Smyth, True, & Souto, 2001). Indeed, research suggests that merely writing
about an event may not be sufficient to produce benefit. Rather, the writing may need to
be narrative in format (Smyth et al., 2001).

How can one best use FEW as a self-help tool?


Although it is difficult to make concrete suggestions
that encompass the range of individual cases, some general suggestions for the use of
FEW follow.
• Find a location where the writer will not be disturbed (from others, the phone, etc.). This
may be in the safe environment of a clinical setting or a private spot and time at home.
• Set aside about 30 to 45 min each session—20 to 30 min for writing with a few minutes
afterwards for the writer to compose her/his self.
• Write for three or four sessions. There is no magical number of sessions. Evidence suggests
that some individuals will respond to a single writing session; others require more.
• Writing can be conducted on several consecutive days or spaced out over a period of time
(weekly or even monthly). Although there is some evidence that spacing the writing out
to once a week may be most helpful, each of these can prove helpful. Ultimately, the
FEW schedule should be adapted to the constraints of the situation.
• Encourage the writer to explore her/his deepest thoughts and feelings about the experiences
or topics that are important to them. Encourage them to explore how this topic is
related to a variety of issues in their life: childhood, relationships, who you are, who you
would like to be, and so forth. In many cases, FEW has focused on traumatic or stressful
events. Others have used FEW to explore the perceived benefits of traumatic experiences,
or even to imagine positive future events or future selves. In all cases, it is important
that the writer include both thoughts and feelings about the event, as either in isolation
tends not to facilitate improvement.
• Write continuously, without regard for spelling or grammar. It appears best not to try to
impose too much structure, but rather allow the writer to formulate her/his own process.
One exception to this suggestion is that the writer should try to bring their experiences
together into a coherent narrative, particularly over multiple sessions.
• Remind the writer that the FEW is for them, not someone else. It should be private and
not written for another person to read. If intending to use the writing in the therapeutic
context, explicitly clarify this fact prior to writing. Evidence suggests that the greater the
presumed audience, the more constrained disclosure is likely to be.

thank you for this interesting subject Skeptic:redrose:

I remember when i used to talk to a counselor that she adviced me to write, she told me to write everything that comes to my mind ... it was really helpful for me at that time

(f)