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Autonomic Effects of Expressive Writing in Individuals with Elevated Blood Pressure
Abstract and Figures
We evaluated systolic and diastolic blood pressure, heart rate variability and skin conductance at baseline, and 1 and 4 months in 38 participants with elevated blood pressure, randomly assigned to expressive writing or control groups. There was a significant interaction such that the very low frequency wave of heart rate variability increased over time only in controls, suggesting potentially protective buffering in expressive writing. Systolic and diastolic blood pressure also decreased significantly from baseline to 1 month in expressive writing. Consistent with inhibition, Anger-In moderated effects of writing on 4-month DBP. Overall, expressive writing demonstrated short-term autonomic benefits and longer-term moderated effects.
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... Social psychologist James Pennebaker, suggested in his research nearly forty years ago, that expressive writing has positive effects [27]. Since then, hundreds of subsequent studies have followed up Pennebaker's work to suggest writing also benefits us physically [18], physiologically [19], psychologically [20], socially [21], and can influence our behavior in positive ways. Reading for just 6 minutes has also proven to reduce stress [22], more than listening to music, walking or drinking a hot cup of tea. ...
... The results of these studies support positive health and psychological outcomes. For example, in relation to physical outcomes, expressive writing studies have shown decreased hospitalization, physical complaints, respiratory difficulties, cardiovascular issues, fatigue, and chronic pain (Hockemeyer and Smyth, 2002;Rosenberg et al., 2002;Norman et al., 2004;McGuire et al., 2005;Danoff-Burg et al., 2006). On the psychological side, expressive writing studies have shown decreased levels of distress, anxiety, depression, suicidal ideation, and grief (Nishith et al., 2002;Antal and Range, 2005;Graf et al., 2008;Range and Jenkins, 2010). ...
Investigations of the expressive writing paradigm have shown that writing about one's experiences have positive effects on wellbeing. Understanding the writing processes facilitating self-discovery which underpin these positive outcomes is currently lacking. Prior research has suggested two writing processes that can lead to discovery: (1) Knowledge Constituting involving the fast synthesis of verbal and non-verbal memory traces into text; and (2) Knowledge Transforming involving controlled engagement with written text for revision. Here, two genres—autoethnographic poetry and freewriting–were studied as they manifest a different pattern design for Knowledge Constituting and Knowledge Transforming . One hundred and seventeen, L1 English speaking participants from 3 northwestern universities in the US completed a two-stage, genre specific writing process. Participants were randomly assigned to a writing condition. Poetry writers first did a Knowledge Constituting writing task followed by a Knowledge Transforming task. Freewriters repeated a Knowledge Constituting task. Participants completed insight and emotional clarity scales after stage one and stage two. Data was analyzed using a two-way repeated measures ANOVA with one between (writing condition) and one within subject (time of prompt) variables. Descriptive results show that it is the Knowledge Constituting process which elicits high levels of insight and emotional clarity for both genres at the first time point. Knowledge Transforming at time-point 2 significantly reduced insight. While Knowledge Constituting at time-point 2 significantly increased emotional clarity. The results provide initial support for the position that it is the Knowledge Constituting writing process which facilitates self-discovery and underpins writing-for-wellbeing outcomes.
... Typically, participants repeatedly write about the respective topics for around 15-20 minutes per writing session over several consecutive days. Research has shown that expressively writing about negative experiences has many benefits across a range of health and non-health outcomes: It can decrease depression and lowering depressive symptoms [5,6], decrease blood pressure [7] and lead to a reduction in consultations [8] or absenteeism from work [9]. Moreover, the use of the expressive writing in educational fields can improve the physical health of undergraduates [10], increase students' exam performance [11] and reduce test anxiety [12], and improve teachers' physical health [13]. ...
The aim of the present preregistered study was to examine whether expressive writing can help teacher students to develop functional expected teaching-related emotions. In a variation of James W. Pennebaker´s expressive writing paradigm, 129 teacher students were randomly assigned to write on three consecutive days either about the future teaching-related events that personally trigger the greatest fear and joy (treatment group: n = 67) or about a walk in a forest and a city park (control group: n = 62). In both groups, expected teaching-related positive emotions increased and expected teaching-related negative emotions decreased with increased writing sessions. After the writing sessions, the treatment group reported a stronger change in their view about their future professional life as a teacher, a more active personal involvement with their future professional life, and an increased motivation to use expressive writing in the future. These results demonstrate that expressive writing is a promising tool to promote teacher students’ expected teaching-related emotions.
... Past studies of the ANS report HR and BP changes in response to stressor tests (Bellenger et al., 2016;Borresen & Lambert, 2008;Castiglioni et al., 2011;Freeman, 2006;Gonzaga et al., 2017;Martinez et al., 2010;McGuire et al., 2005;Michael et al., 2017;Pagani & Lucini, 2001;Radtke et al., 2016;Rossi et al., 2015;Taylor et al., 2003;Thayer et al., 2010;Van de Borne et al., 1994;Ziegler et al., 1992), but there is a dearth of studies that measure many of the remaining signals simultaneously and during controlled autonomic perturbations. The approach to ANS measurement taken in this work shows that parallel expansion of the modalities of raw physiological signals measured broadens the analysis from simple vitals to numerous measures that include temporal measures of HRV, pupillometry, respiration, and EDA. ...
Background
The autonomic nervous system (ANS) maintains physiological homeostasis in various organ systems via parasympathetic and sympathetic branches. ANS function is altered in common diffuse and focal conditions and heralds the beginning of environmental and disease stresses. Reliable, sensitive, and quantitative biomarkers, first defined in healthy participants, could discriminate among clinically useful changes in ANS function. This framework combines controlled autonomic testing with feature extraction during physiological responses.
Methods
Twenty-one individuals were assessed in two morning and two afternoon sessions over two weeks. Each session included five standard clinical tests probing autonomic function: squat test, cold pressor test, diving reflex test, deep breathing, and Valsalva maneuver. Noninvasive sensors captured continuous electrocardiography, blood pressure, breathing, electrodermal activity, and pupil diameter. Heart rate, heart rate variability, mean arterial pressure, electrodermal activity, and pupil diameter responses to the perturbations were extracted, and averages across participants were computed. A template matching algorithm calculated scaling and stretching features that optimally fit the average to an individual response. These features were grouped based on test and modality to derive sympathetic and parasympathetic indices for this healthy population.
Results
A significant positive correlation ( p = 0.000377) was found between sympathetic amplitude response and body mass index. Additionally, longer duration and larger amplitude sympathetic and longer duration parasympathetic responses occurred in afternoon testing sessions; larger amplitude parasympathetic responses occurred in morning sessions.
Conclusions
These results demonstrate the robustness and sensitivity of an algorithmic approach to extract multimodal responses from standard tests. This novel method of quantifying ANS function can be used for early diagnosis, measurement of disease progression, or treatment evaluation.
Trial registration
This study registered with Clinicaltrials.gov , identifier NCT04100486 . Registered September 24, 2019, https://www.clinicaltrials.gov/ct2/show/NCT04100486 .
... Research has connected expressive writing to a number of positive physical and mental health outcomes. In terms of physical health, researchers have observed improved immune functioning (Esterling et al., 1994;Petrie et al., 1995;Smyth et al., 2011), reduced symptoms of asthma and arthritis (Smyth et al., 2011, Smyth et al., 1999, improved sleep (Smyth et al., 2011), and improved cardiovascular functioning (McGuire et al., 2005). Across multiple studies, researchers have observed significant decreases in physician visits in the months following the expressive writing intervention (Baikie & Wilhelm, 2005;Pennebaker & Chung, 2012). ...
Interactive Journaling is a structured writing process that motivates and guides individuals toward positive change and greater well-being in target life areas. This paper maps the properties of Interactive Journaling to core properties and criteria of positive interventions – activities within the field of positive psychology that are empirically validated and strive to promote well-being. These properties include underpinnings in the evidence-based paradigm of expressive writing, an emphasis on participant agency and person-activity fit, and other evidence-based norms within the practice of Interactive Journaling. Based on this alignment, Interactive Journaling can be considered a positive intervention. Existing positive interventions may also be enhanced when integrated into the Interactive Journaling framework. Researchers are invited to examine Interactive Journaling more closely using validated well-being measures and new populations.
... In the broader context, studies in the last three decades showed that the practice of expressive writing can lead to improvement in lung and liver functioning [4], [5], decreased blood pressure [6] and even enhanced immune system functioning [7]. In addition, expressive writing also results in significant improvement in non-health related outcomes such as better academic performance [8], reduced absenteeism from work [4] and enhanced working memory [9]. ...
This experimental study examined the effect of expressive writing on depressive symptoms. 86 undergraduate students were recruited from a private university to perform online positive experience writing (PEW) (n=31), negative experience (NEW) (n=32) and control topic (CW) (n=23) for three sessions in three consecutive weeks. The depressive symptoms of participants were measured at pre-treatment and post-treatment. It was hypothesized that PEW has significant greater reduction in depressive symptoms compared to NEW and CW based on broaden and build model. Nevertheless, results showed that PEW had significantly greater symptoms reduction than CW, yet there was no significant difference between PEW and NEW. The findings suggested that PEW might be potentially useful in reducing depressive symptoms among undergraduates.
... Although EW interventions have been associated with multiple benefits in the short-term, most effects faded after a few months, 13,28 or changed over time. 14,[37][38][39] We, however, found that many of the original 3MMM study participants continued to use EW to deal with stress after this single intervention. ...
Background:
An expressive writing intervention, the Three-minute Mental Makeover (3MMM), was previously associated with reduced stress for practitioners, patients, and families. The goal of this follow-up study was to evaluate long-term use of writing and perspectives after participation in the 3MMM.
Methods:
The original study involved patients and families in the neonatal and pediatric Intensive Care Units, inpatient units, and outpatient clinics of a children's hospital. Health-care practitioners led the intervention, writing concurrently with patients and families using the 3MMM intervention. Follow-up contact by phone was attempted for all original patient/family participants 12 to 18 months after completing the exercise. Practitioners were contacted via email 24 months after the original study. Participants were surveyed about the 3MMM and continued use of writing to cope with stressful situations. Original and follow-up survey responses were compared using the Mann-Whitney test.
Results:
Of the 96 original patient/family members, 61 individuals were reached, remembered the 3MMM, and agreed to participate in the follow-up study. Among the 61 participants, 52 (85%) agreed that the 3MMM had been helpful. Thirty-six (59%) reported using writing to help cope with stress at follow-up, compared to only 23 (38%) at baseline (P = 0.005). The majority of clinicians (87%) also continued to use the 3MMM in clinical practice following the original 3MMM study period and ranked it as both feasible (75%) and worth the time investment (75%).
Conclusion:
The 3MMM demonstrated long-term perceived benefits and behavior changes. Findings provide preliminary support for using the 3MMM in routine clinical practice.
... tests(Ziegler et al., 1992;Van de Borne et al., 1994; Pagani & Lucini, 2001;Taylor et al., 2003;McGuire et al., 2005; Freeman, 2006; Borresen & Lambert, 2008; Martinez et al., 2010;Thayer et al., 2010; Castiglioni et al., 2011; Rossi et al. 2015;Bellenger et al., 2016;Radtke et al., 2016;Gonzaga et al. 2017;Michael et al., 2017), but there is a dearth of studies that measure many of the remaining signals simultaneously and during controlled autonomic perturbations. The approach to ANS measurement taken in this work shows that parallel expansion of the modalities of raw physiological signals measured broadens the analysis from simple vitals to numerous measures that include temporal measures of HRV, pupillometry, respiration, and EDA. ...
The autonomic nervous system (ANS), which maintains physiological homeostasis in various organ systems via parasympathetic and sympathetic branches, is altered in common diffuse and focal conditions. Sensitive, quantitative biomarkers could detect changes in ANS function, first here in healthy participants and eventually in patients displaying dysautonomia. This framework combines controlled autonomic testing with feature extraction from physiological responses. Twenty-one individuals were assessed in two morning and two afternoon sessions over two weeks. Each session included five standard clinical tests probing autonomic function: squat test, cold pressor test, diving reflex test, deep breathing, and Valsalva maneuver. Noninvasive sensors captured continuous electrocardiography, blood pressure, breathing, electrodermal activity, and pupil diameter. Heart rate, heart rate variability, mean arterial pressure, electrodermal activity, and pupil diameter responses to the perturbations were extracted, and averages across participants were computed. A template matching algorithm calculated scaling and stretching features that optimally fit the average to an individual response. These features were grouped based on test and modality to derive sympathetic and parasympathetic indices for this healthy population. A significant positive correlation ( p = 0.000377) was found between sympathetic amplitude response and body mass index. Additionally, longer duration and larger amplitude sympathetic and longer duration parasympathetic responses occurred in afternoon testing sessions; larger amplitude parasympathetic responses occurred in morning sessions. These results demonstrate the robustness and sensitivity of an algorithmic approach to extract multimodal responses from standard tests. This novel method of quantifying ANS function can be used for early diagnosis, measurement of disease progression, or treatment evaluation.
Background
Software agents are computer-programs that conduct conversations with a human. The present study evaluates the feasibility of the software agent “SISU” aiming to uplift psychological wellbeing. Methods: Within a one-group pretest-posttest trial, N = 30 German-speaking participants were recruited. Assessments took place before (t1), during (t2) and after (t3) the intervention. The ability of SISU to guide participants through the intervention, acceptability, and negative effects were investigated. Data analyses are based on intention-to-treat principles. Linear mixed models will be used to investigate short-term changes over time in mood, depression, anxiety.
Intervention.
The intervention consists of two sessions. Each session comprises writing tasks on autobiographical negative life events and an Acceptance- and Commitment Therapy-based exercise respectively. Participants interact with the software agent on two consecutive days for about 30 min each.
Results
All participants completed all sessions within two days. User experience was positive, with all subscales of the user experience questionnaire (UEQ) M > 0.8. Participants experienced their writings as highly self-relevant and personal. However, 57% of the participants reported at least one negative effect attributed to the intervention. Results on linear mixed models indicate an increase in anxiety over time (β = 1.33, p = .001). Qualitative User Feedback revealed that the best thing about SISU was its innovativeness (13%) and anonymity (13%). As worst thing about SISU participants indicated that the conversational style of SISU often felt unnatural (73%).
Conclusion
SISU successfully guided participants through the two-day intervention. Moreover, SISU has the potential to enter the inner world of participants. However, intervention contents have the potential to evoke negative effects in individuals. Expectable short-term symptom deterioration due to writing about negative autobiographical life events could not be prevented by acceptance and commitment therapy-based exercises. Hence, results suggest a revision of intervention contents as well as of the conversational style of SISU. The good adherence rate indicates the useful and acceptable format of SISU as a mental health chatbot. Overall, little is known about the effectiveness of software agents in the context of psychological wellbeing. Results of the present trial underline that the innovative technology bears the potential of SISU to act as therapeutic agent but should not be used with its current intervention content.
Trial-Registration.
The Trial is registered at the WHO International Clinical Trials Registry Platform via the German Clinical Studies Register (DRKS): DRKS00014933 (date of registration: 20.06.2018). Link:https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014933).
In this research, the effect of written self-disclosure's, on the positive and negative emotions of individuals has been investigated. The research was carried out with 8 people (1 woman, 7 men) residing in Giresun (Turkey) who agreed to participate in the research voluntarily. Participants first filled in the personal information forms provided by the researcher (in the researcher's office) and Positive and Negative Affect Schedule was used as the pretest. Immediately after these, the participants were left alone for the first written self-disclosure activity. The next 7 written self-disclosure activities were carried out by the researcher via phone calls while the participants were at their homes. After conducting 8 written self-disclosure activities in total, the participants were subjected to the Positive and Negative Affect Schedule once more as the post-test. The same schedule was reapplied as a follow-up test one month after the application was completed and the results were evaluated. The research was conducted in a pretest-posttest semi-experimental pattern (without any control group), and frequency, percentage and Wilcoxon Signed-Rank Test were used for the analysis of the data. In this research, where the effect of written self-disclosure on the positive and negative emotions of individuals who have personal, emotional or physical problems that they have not been able to talk about with anyone for a long time, has been investigated, three main results have been obtained. The first result is that written self-disclosure has an effect on the negative emotions of individuals and "reduces the negative emotions". In addition, as the second result, it was observed that written self-disclosure has no effect on positive emotions. Lastly, based on the follow-up tests conducted one month after the study was completed, it was seen that the effect of written self-disclosure on negative emotions remained one month later as well, which was the third main conclusion of the research.
THE PURPOSE of the "Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure" (JNC VI) is to provide guidance for primary care clinicians. The committee recognizes that the responsible clinician's judgment of the individual patient's needs remains paramount. Therefore, this national guideline should serve as a tool to be adapted and implemented in local and individual situations. Using evidence-based medicine and consensus, the report updates contemporary approaches to hypertension control. Among the issues covered are the important need for prevention of high blood pressure by improving lifestyles, the cost of health care, the use of self-measurement of blood pressure, the role of managed care in the treatment of high blood pressure, the introduction of new combination antihypertensive medications and angiotensin II receptor blockers, and strategies for improving adherence to treatment. The JNC VI report places more emphasis than earlier reports on absolute
We examined how the social environment influences men's ability to cognitively process and recover psychologically from the trauma associated with prostate cancer. We hypothesized that men who judge others to be unreceptive to their attempts to talk about their cancer-related concerns would have poorer mental health than men with more receptive social networks. In a survey with 178 prostate cancer survivors, we measured intrusive thoughts about cancer, social constraints in talking about cancer, avoidance in thinking and talking about cancer, and mental health. There were significant interactive effects of Family/Friend Social Constraints × Intrusive Thoughts and Wife Social Constraints × Intrusive Thoughts on mental health. Plots of the interactions showed a stronger negative relation between intrusive thoughts and mental health among men who felt socially constrained in talking about their cancer than among men who felt unconstrained. In addition, level of constraints from family and friends was positively associated with level of avoidance in thinking and talking about cancer which, in turn, was associated with poorer mental health. These results suggest that supportive social networks may promote psychological adjustment by facilitating cognitive processing of the cancer experience.
Attempting to understand the body’s signals is similar to trying to interpret the noises and sensations of the automobile that we drive. We do not have a computer printout of either the current physiological status of our body or the condition of the various systems of our car. Given this, we are in the position of attempting to understand a large array of ambiguous sensations about which we have at best a modicum of knowledge. Whether we are dealing with human bodies or inanimate cars, the awareness and reporting of symptoms are dependent on psychological or perceptual processes. Throughout this book, a large number of studies have outlined some of the parameters that determine when and why symptoms are reported. Before discussing some of the implications of symptom research, we present the following brief review of our current knowledge about the perception of physical symptoms.
Physical symptoms are fascinating phenomena to examine. We all experience them, use them as signals to guide our behavior, and usually assume that they accurately represent underlying physiological activity. At the same time, we implicitly know that bodily sensations are often vague, ambiguous, and subject to a variety of interpretations. It is not surprising, then, that there is often a disparity between what we think is going on in our bodies and what is objectively occurring. In short, phenomena such as physical symptoms are the stuff of psychology. My own research into physical symptoms started by accident several years ago. In a hastily devised experiment dealing with the effects of noise on behavior, I had to write a post-experimental questionnaire that would be long enough to allow the experimenter time to calibrate some equipment for a later portion of the study. I included some physical symptoms on the questionnaire as fillers. The experiment was a total failure, with the exception of the symptom reports. People's perceptions of symptoms were easily influenced by our manipulations, even though their actual physiological state had not changed. And so began the present inquiry. Despite the pervasiveness, importance, and sheer amount of time and money devoted to discussing and curing common physical symptoms and sensations, very little empirical work has been devoted to examining the psychological and perceptual factors related to sensory experience. Occa sional papers have tested a specific theory, such as cognitive dissonance, wherein physical symptoms served as an interesting dependent measure."