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Can Creative Writing Help in Early Healing of Physical Injuries and Trauma

The International Journal Of Humanities & Social Studies (ISSN 2321 - 9203)
315 Vol 4 Issue 4 April, 2016
Can Creative Writing Help in Early Healing of Physical Injuries and Trauma
1. Introduction
Over the past thirty years, an emergent body of writing has established the extent of favorable impact of engaging in creative
compositions on ‘traumatic or stressful events has on physical and emotional health’ in both non-clinical and clinical populations
(Baikie & Wilhelm, 2005, p. 338). Pennebaker & Beall (1986), Baikie and Wilhelm revealed that this first study on creative writing
expressionism subjected various college students for four uninterrupted, successive days to delve into ‘the most traumatic or upsetting
experiences of their entire lives,’ (2005, p. 338), while control groups were left to confer in consequential write-ups on topics such as
their abode or their footwear. The study subjects who participated in creative and expressionistic writings, after pouring out their
heartfelt contemplations and feelings, and pointing out their injuries for a further period of four months, supplied researchers with
improvements in their physical health, less psychological and physical burden owing to their illness, and a reduced amount of
recurrent visits to the clinics and health care centers; whereas their self-reported subjective assessments further corroborated with the
objective reports of the investigation as well. In light of the study, the researchers clearly concluded that ‘writing about earlier
traumatic experience was associated with both short-term increases in physiological arousal and long-term decreases in health
problems’ (Pennebaker & Beall, 1986: p. 280; cited in Baikie & Wilhelm, 2005, p. 338).
In a similar research study conducted and led by Elizabeth Broadbent, Szalavitz (2013) revealed about the experiment conducted on
forty-nine participants, aged 64 to 97, on the same expressionistic premise, proving yet once again that the appeasing and soothing
effect of creative writing ‘can cut physical wound healing time nearly in half’ (2013, p. 1). Half of the subjects, who despite being
rather healthy senior citizens were still recovering from some past physical injury, just like the rest of the population sample, were
assigned to spend three consecutive days (more specifically, twenty minutes each day) by writing about the events leading to the
physical trauma they had experienced. In addition, they were inspired and motivated to divulge all information openly, disclosing
exactly what they had thought and how they felt at the time, not holding in even that information that they had not shared or expressed
in front of any other third person or party before. The rest of the population sample spent the same amount of days and time writing
about superficial events or happenings, without stating their feelings, sentiments, thoughts, ideas or beliefs. Two days following the
commencement of the writing sessions, skin samples were collected from the participants showing signs of wounds. Seven days later,
Shivkumar Revashetty
Ph.D. Research Scholar,
Dr. Babasaheb Ambedkar Marathwada University, Aurangabad, Maharashtra, India
Ravi Bhushan
Ph.D. Research Scholar,
Dr. Babasaheb Ambedkar Marathwada University, Aurangabad, Maharashtra, India
Dr. Pravin P. Shiledar
HOD, Department of Physical Education, JBSPM’s Mahila College, Georai, Beed, Maharashtra, India
The present article seeks to examine how acts of creative expressionistic writing can serve as a kind of therapy, miraculously
healing physical wounds faster than many other alternative methods can. Taking the aforementioned as a basic premise, the
article will take into account empirical evidence collected from modern research studies conducted by various scientists on
the mind-body connection suggesting that the venting of dark emotions regarding a physical trauma, stressful or emotional
events can actually ensure speedy recovery of not just the psyche and the mind, but the injured hominoid body as well.
Specific reference will be made to the studies conducted on human subjects suffering from various traumatic experiences,
and the controlled experiments conducted on them by having them undergo writing sessions for about fifteen to twenty
minutes over a fixed duration of a particular number of days, wherein they shared even the most distressing and tense
experiences involving their physical injuries. The same was reported to have altered their skin tissue structures immensely,
and provided evidence of much better physical and psychological outcomes as compared to the subjects that did not undergo
the same process, or wrote on inconsequential and neutral topics. With such investigations as background, the writer will
present an overview of the creative and expressionistic writing paradigm, point out the populations with physical injuries for
whom the model’s beneficial impact has been scientifically observed, and deliberation probable and potential procedures
triggering the perceived fitness gains. Furthermore, the article will suggest the way creative writing can be utilized as a
healing instrument for both physically damaged patients and psychiatrically distressed survivors as well.
The International Journal Of Humanities & Social Studies (ISSN 2321 - 9203)
316 Vol 4 Issue 4 April, 2016
Broadbent and her team started taking pictures of the wounds intermittently, after every few days till they healed completely. Almost
two weeks following the writing experiment, ‘76% of the group that had written about trauma had fully healed while only 42% of the
other group had’ (Szalavitz, 2013).
Also in lieu with this tide is the perspective often referred to as ‘Ego-State Therapy, Ystavansa (2013). Since creative acts of writing,
be it in the form of composing poetry, drama, or fiction, give us an opportunity to express our multiple personalities and thoughts
hypnotherapisticaly, they naturally free the mind from the cold and harsh realities of the medical world. Ystavansa (2013) in her
capacity as a medical professional doesn’t overlook the efficacy of medical aids in curing physical injuries and diseases, yet, the same
is not the only perspective she looks to when it comes to thinking about patient centered health care facilities. Patients, according to
her conceptual ideology, need to be provided with a kind of freedom for them to be able to recuperate well. Medicines, on the
contrary, might subjugate them, their medical diagnosis might bind them under a kind of identity, thus forcing the patient to accept the
diagnosis as proper, and affiliate and associate himself as if he were subordinate to the medical world. And hence it is the mechanism
of writing which serves to heal the body, as is explained below.
1.1. The Expressionistic and Creative Writing Paradigm
In various studies conducted both within laboratory settings and from without, researchers utilized a particular writing mechanism, a
kind of paradigm, inducing creative acts of writing, thereby encouraging patients suffering from a variety of physical injuries to write,
to put their thoughts on paper, as a kind of therapy. See, for instance, Pennebaker (1985), Pennebaker (1994), Pennebaker (1997a),
Pennebaker (1997b), as cited by Baikie & Wilhelm (2005); and Khanna (2010). All studies refer to a similar involuntary and
compellingly uncontrollable mechanism that by merely controlling human emotions heals the injury, and settles the body.
Discussing the writing paradigm, Khanna (2010) mentions Wallas’s four stages of creative writing process: ‘preparation (finding a
theme, reviewing your style), incubation (ideas develop, often in the unconscious mind), illumination (ideas spring to life when least
expected) and verification (a time for evaluation and revision).’In the first stage, patients suffering from physical injuries are supposed
to discover a theme and review their stylistic constraints. In the second phase, they allow their subconscious and at times the
unconscious mind to foster ideas, giving them space to develop on their own natural course. The third step allows them to build more
on their ideas in a spontaneous way, without controlling anything; whereby even subservient ideas, hidden in the deepest terrains of
the mind, ‘spring to life when least expected.’ This is followed by the fourth and final stage, wherein the patients evaluate their
writings and conduct necessary revision of their expression (Khanna, 2010).
In another paradigm suggested by researchers, we have Degraff & Lawrence (2002), who prefer a similar holistic approach to
fostering creative expressionism, through their Creativity Mapping Framework (CMF), which is a verbal map used to define creativity
and is based upon four major profiles of creativity: Imagine, invest (or participate), Improve, and Incubate (or develop). These roughly
relate to various stages of creativity, but may be found to overlap as well. Additionally, each profile has its own distinctive practices.
Imagine practices, such as jump-starting and forecasting are based on a divergent approach. Invest practices, such as partnering (in
pairs or in workshop formatted groups) produce results quickly by taking a convergent approach. Improve practices, such as genre
designing focus on external samples and are therefore based upon a convergent approach. Incubate practices, such as further
development of ideas or genre development may be based upon both approaches, but is generally ‘convergent in nature’ since authors
prefer taking inspiration from samples and emulate extensively. To achieve creative writing purposes, students are encouraged to
utilize the infrastructure of creative composition in the right manner, and to accomplish that they are to locate their own current
profile, diagnose their situation and assess where they are with respect to creativity. Once they get a clear understanding of where they
are and where they need to go, they will be able to navigate toward their purposes of reaching there. They will also have to locate
where they are with respect to their individual dimensions of creativity:
1. Focus (internal versus external)
2. Approach (divergent versus convergent / or expressionism versus impressionism)
3. Magnitude (big versus small)
4. Speed (fast versus slow)
A similar mechanism has been likewise identified by Jarvie (2013). Jarvie’s paradigm observes creative expressionism as ‘an
opportunity to self-explore using the medium of writing’. The purpose of her writing activities is not to teach subjects what is involved
in the process of writing creatively. Instead it is to have them learn the art of expressing ‘oneself using words, images and writing,’
and the art of sharing their thoughts (Jarvie, 2013). The process of writing continues for several sessions, for some time, and with each
individual and personal or subjective and self-revelatory expression the purpose of her participants becomes more clear, as to which
kind of injury they wish to heal through this process, and how they’re able to achieve the same.
Because of the way patients with physical injuries purge out their negative emotions through expressive writing, ‘creative writing can
definitely heal the body’ says Davis (2013). The mechanism to achieve the same, according to his perspective, is to have them
‘actually see scenes from their lives in a graphic way;’ urging them to write on their existing manner of life, which they believe is no
longer adequate or sufficient to help them fulfill their goals and desires; having them talk about what went wrong, or what went right,
or what else happened, that not only changed their outlook of life but also helped them survive their physical ordeal; and finally make
the patients compose dialogue on this altered positive character trait of their psyche, and their previous negative one, which is now
neither necessary nor a part of their new found existence.
The International Journal Of Humanities & Social Studies (ISSN 2321 - 9203)
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1.2. Detailed Explanation of How the Expressionistic or Creative Writing Process Works
Most detailed a practice, however, is the process outlined by Sloan & Marx (2004), also cited and worked upon by Baikie and
Wilhelm (2005) in their own research. In their paradigm, participants were told to write down their experiences centering on their
physical injury, during three to five sessions or sittings, often over consecutive days, for approximately half an hour per sitting. The
participants were urged to let go, and investigate their deepest conflicts, thoughts and feelings. During this process of setting
themselves free from the realistic world, they were encouraged to connect their injury experiences realistically or imaginatively with
their relationship with family members, ‘including parents, friends or relatives’, or even someone they knew in the past, their present,
or an imaginary someone they would like to be close to in the near future (Baikie & Wilhelm, 2005). The participants were given an
open choice on whether they preferred writing about other wide-ranging concerns or occurrences, events, happenings, and encounters
throughout, as well, or if they wanted to include details about a variety of topics other than their injury issue, or write about
themselves in relation to their injury. Things like what kind of mental frame of mind they had before, or then, or what kind of a person
they would like to be in the future, without worrying about things like using proper spelling, grammar, or sentence structure while
writing. The information generated was to be kept confidential, until permitted by the participants to do otherwise (2005). Particular
details of the project are as follows:
a. The patient was to write on a stressful incident whence he received the physical injury, but without mentioning the injury
b. The patient was told to not impose a particular linguistic structure to his written expression, but rather to deal with his writing
freely, by allowing it to take a structure of its own, without following any linguistic convention.
c. It was up to the patient whether he chose to write by hand or type his written expression on a computer. The former was
preferred over the later.
d. The injured personnel were informed in advance that their writing was for themselves, and not meant for the public, nor even
the session conductor. Their private words were treated as confidential and anonymous, and their work was neither read out
loud, nor shared, or discussed, unless it was with their consent.
e. Feedback was not a part of these sessions, and all resulting expressive creative writing pieces were returned to the patients,
and not combined with their clinical files.
Once the procedure was over, the research generated various recommendations for other participants suffering from a variety of
physical injuries, including those related to sports. The recommendations were as follows:
a. Subjects suffering from physical health disorders should be given creative expression tasks as homework or as a precession,
mid-session, or follow-up activity after a particular sitting.
b. Such form of written expression should be worked upon in a personal or private space, where the subject could work without
being distracted by anyone else.
c. A continuous or consecutive writing scheme, be it on every other day or consecutive weeks, is more preferable than working
every now and then.
d. The writing process should take no more than half an hour, subdivided into a twenty-minute writing activity and a ten-minute
slot for patients to take a breath and self-reflect on themselves.
Since the conduct and application of such writing sessions outside the laboratory research settings was not abundant, or recurrent, it
was further recommended that physical health care practitioners should conduct further research and generate more data to review the
efficacy of creative or expressive writing practices in their own particular setting, for their own cases, ‘including appropriate pre- and
post-writing measures of physical health, psychological health or general functioning’ (Baikie & Wilhelm, 2005). According to this
study, though the odds of creative expressionism operating through ‘a process of emotional catharsis or venting of negative feelings,’
and thereby increasing physical recovery through emotional relief, are highly unlikely, yet there are other aspects associated with the
mechanism through which this form of writing can provide health benefits over physical injuries. Thus, for instance, writing about the
physical injury, confronting it, describing the event that caused such injury in words, and dealing with the concurrent emotional
aftereffects, requires the patient to strive tirelessly to reach a cognitive understanding of his condition, which leads to intensive
physiological activity on his part. The process itself not only serves as a de-stressing mechanism of some sort, but by reducing the
biochemical strain on the mental psyche, it automatically contributes to better physical functioning and a much better immune system
as well. The process, on the whole, has therefore conclusively ‘demonstrated significant improvements in physical health’ (Baikie &
Wilhelm, 2005).
1.3. Various Health Benefits Associated with Creative and Expressionistic Writing
Speaking objectively, as per clinical trial assessments of physically injured patients partaking expressionistic writings, following
outcomes have been reported thus far:
a. An extensive reduction in symptoms related to physical disorders/injuries/ailments.
b. A remarkable improvement in lung function in patients suffering from asthma.
c. Less severity of disease in rheumatoid arthritis.
d. Reduction of pain and physical health deformities in personnel suffering from sporting injuries.
e. A remarkable improvement in liver functions, and immune functions of the body suffering from cancer, HIV infection, cystic
fibrosis, chronic pelvic pain, and postoperative injuries, including those related to sports.
The International Journal Of Humanities & Social Studies (ISSN 2321 - 9203)
318 Vol 4 Issue 4 April, 2016
f. Reduced blood pressure, and a regenerated better memory prowess.
g. A significant recovery of the physical body tissues, thus allowing fewer visits at the hospital.
h. Fewer post-traumatic intrusion, depression, and avoidance symptoms. i- Improved sporting performance.
2. Conclusion
The creative and expressionistic writing paradigm is therefore a tried and tested process of dealing with individuals with physical
injuries as a healing antidote. This mechanism has procured a highly successful beneficial impact, one that has been scientifically
observed by conducting potential procedures on the affected populace, triggering various fitness gains as well. Through control
experiments, various researchers have proven how the paradigm can be utilized as a healing instrument for both physically damaged
patients, ones who suffer from a variety of medical problems, and psychiatrically distressed survivors as well. Once subjected to the
written activity processing, individuals suffering from asthma ended showing improved lung functioning; cancer and fibrosis patients
were found in better health physically, and suffered from reduced bouts of pain; HIV infectees ‘showed improved immune response’;
whereas individuals suffering from sports injuries and arthritis showed less severity in tissue degeneration.
Despite the aforementioned physical health benefits, some potential risks have been found as well. Thus, for instance, at times
expressive creative writing can destabilize a patient, by making him/her recall all painful experiences they might have wanted to put
behind them. Yet, despite the same, this distressing and negative impact on the injured individual’s psyche has not been proven to
present a risk to the injured (Hockemeyer et al, 1999). Among the entire repertoire of extensive number of investigations conducted
thus far, on the issue of writing about traumatic experiences, only a few exceptional studies have found negative impact on the injured
personnel’s psyche. Given the success rate of the rest of investigations, the creative expressionistic writing paradigm has been deemed
as safe to be used as a healing antidote for physically injured individuals, even if the same mechanism fails to obtain any specific
health related benefits. All in all, given that such individuals be informed at the outset of possessing a choice to stop writing when they
wish to do so, and their option to request for some extra time with the process conductor in case of psychological distress, any number
of injured personnel should be encouraged to participate in writing activities for about 20 to 30 minutes per session. That way, the
procedure will not necessarily seem excessively devastating or over powering to them, and the freedom of choice to continue or
discontinue their writing once the time is up will endow patients with a relaxing feasibility as well. Notwithstanding the potential
benefits of the creative and expressionistic writing paradigm, the same should not be utilized as a replacement for appropriate and
required medical treatment in physically injured populations, but rather as a supplementary treatment along with standard procedure,
while waiting for further results.
3. References
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ResearchGate has not been able to resolve any citations for this publication.
Full-text available
Research by Pennebaker and his colleagues supports the healing power of writing about traumatic events. This study explored the importance of writing about the perceived benefits of traumatic events as a factor in this process. The study included 118 participants who were randomly assigned to write about one of four topics in a 2 (writing about perceived benefits vs. not writing about perceived benefits)×2 (writing about trauma vs. not writing about trauma) factorial design. Participants also completed questionnaire measures of subjective well-being and released health center information for the year. Participants who wrote only about trauma or perceived benefits showed significantly fewer health center visits for illness 3 months after writing. In addition, 5 months after writing, the trauma-only and perceived-benefits-only groups maintained a difference from the control group. These results suggest that writing about perceived benefits from traumatic events may provide a less upsetting but effective way to benefit from writing.
Full-text available
Writing about traumatic, stressful or emotional events has been found to result in improvements in both physical and psychological health, in non-clinical and clinical populations. In the expressive writing paradigm, participants are asked to write about such events for 15-20 minutes on 3-5 occasions. Those who do so generally have significantly better physical and psychological outcomes compared with those who write about neutral topics. Here we present an overview of the expressive writing paradigm, outline populations for which it has been found to be beneficial and discuss possible mechanisms underlying the observed health benefits. In addition, we suggest how expressive writing can be used as a therapeutic tool for survivors of trauma and in psychiatric settings.
Full-text available
We conducted a randomized clinical trial of a 3-session written self-disclosure intervention for patients with cystic fibrosis (CF). Patients (n = 39) who were at least 15 years of age and diagnosed with CF participated in the intervention. Participants in the intervention arm were asked to write in the health care setting about an important emotionally distressing issue of personal significance for a 20-min period of time and two additional 20-min writing episodes at the patient's home, which were prompted by telephone calls. Patients in the control condition received standard care alone. Findings revealed that the intervention resulted in a reduction of the number of days patients spent in the hospital over a 3-month period. The intervention did not have an impact on physiological (Forced Expiratory Volume and Body Mass Index or subjective markers of health status. These findings extend those of Pennebaker's (cf., J. Smyth, 1998) demonstrating an effect of the written-self-disclosure intervention on health care utilization. These preliminary findings are promising and justify further investigation of the modified intervention in other chronic illness populations.
Full-text available
Examined whether writing about traumatic events would influence long-term measures of health as well as short-term indicators of physiological arousal and reports of negative moods in 46 introductory psychology students. Also examined were aspects of writing about traumatic events (i.e., cognitive, affective, or both) that were most related to physiological and self-report variables. Ss wrote about either personally traumatic life events or trivial topics on 4 consecutive days. In addition to health center records, physiological measures and self-reported moods and physical symptoms were collected throughout the experiment. Findings indicate that, in general, writing about both the emotions and facts surrounding a traumatic event was associated with relatively higher blood pressure and negative moods following the essays, but fewer health center visits in the 6 mo following the experiment. It is concluded that, although findings should be considered preliminary, they bear directly on issues surrounding catharsis, self-disclosure, and a general theory of psychosomatics based on behavioral inhibition. (24 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
An emotive writing intervention (Pennebaker. 1997a. 1997b) was applied to improve our understanding of the previously observed negative relationship between mood awareness and the athletic performance of collegiate tennis players (Scott, Stiles. Raines. & Koth. 2002). A comparison group, interrupted time series design was employed to study a sample of 13 Division II collegiate tennis players who participated during the Spring 2002 season. It was expected that participants who were classified as mood monitors would experience a differential benefit from emotive writing compared to those classified as mood labelers. Mood monitors" athletic performance showed a delayed benefit from the writing intervention while mood labelers' athletic performance showed no appreciable improvement following intervention. Based on these data, sport psychologists should consider closely inspecting the mood awareness tendencies of athletes before attempting an emotive writing intervention.
Proposes a model of the relationship between traumatic experience and psychosomatic disease, which includes the following propositions: (1) To actively inhibit one's behavior is stressful and disease-related. (2) When individuals do not or cannot express thoughts and feelings concerning a traumatic event (i.e., behavioral inhibition), there is an increased probability of obsessing about the event as well as long-term illness consequences. (3) The act of confiding or otherwise translating the event into language reduces autonomic activity (in the short run) and disease rates. How the event is discussed, the possibility of ever coming to terms with the event, and the ultimate consequences of discussing the experience are all variables that may influence the outcome of confiding, inhibition, and, ultimately, health. Experimental research is cited in support of the model. (French abstract) (40 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In recent years the written disclosure paradigm has been related to improvements in physical health in a number of populations. However, it still remains unclear why this paradigm is effective. In this paper the literature on the written disclosure paradigm is reviewed, and possible explanations for its beneficial effects are explored. It is concluded that, although the paradigm may produce beneficial effects for some individuals, more attention needs to be directed toward understanding why it works and for whom this approach might be best suited. Methodological considerations for future research are also offered.
This pilot study explored the feasibility and the efficacy of a brief, well-defined psychosocial intervention (expressive disclosure) in improving behavioral, medical, immunological, and emotional health outcomes in men with diagnosed prostate cancer. Thirty prostate cancer patients receiving outpatient oncology care were randomized into experimental (disclosure) and control (non-disclosure) groups. All had been previously treated by surgery or radiation within the last 4 years and were being monitored without further intervention for change in PSA levels. Psychological and physical health surveys were administered and peripheral blood for PSA levels and immune assays was obtained upon study enrollment and again at 3 and 6 months post enrollment. Multivariate analyses were used to examine how the expressive disclosure impacted the hypothesized domains of functioning: physical and psychological symptoms; health care utilization; and immunocompetence. Compared to controls, patients in the expressive disclosure condition showed improvements in the domains of physical symptoms and health care utilization, but not in psychological variables nor in disease relevant aspects of immunocompetence. Study results support the feasibility of an expressive disclosure intervention for men with prostate cancer. The intervention was well accepted by this population, and participation/adherence was quite high. Results provide only limited support for the hypothesis that a written emotional disclosure task can positively impact health outcomes in a cancer population. However, this pilot study may have lacked adequate power to detect possible intervention benefits. Further studies with larger samples are needed to better assess the intervention's impact on psychological well-being and immunocompetence.
To determine whether writing about emotional topics compared with writing about neutral topics could affect CD4+ lymphocyte count and human immunodeficiency virus (HIV) viral load among HIV-infected patients. Thirty-seven HIV-infected patients were randomly allocated to 2 writing conditions focusing on emotional or control topics. Participants wrote for 4 days, 30 minutes per day. The CD4+ lymphocyte count and HIV viral load were measured at baseline and at 2 weeks, 3 months, and 6 months after writing. The emotional writing participants rated their essays as more personal, valuable, and emotional than those in the control condition. Relative to the drop in HIV viral load, CD4+ lymphocyte counts increased after the intervention for participants in the emotional writing condition compared with control writing participants. The results are consistent with those of previous studies using emotional writing in other patient groups. Based on the self-reports of the value of writing and the preliminary laboratory findings, the results suggest that emotional writing may provide benefit for patients with HIV infection.