Disclosing Trauma Through Writing: Testing the Meaning-Making Hypothesis

Abstract

Salutary effects of writing about trauma on health are well documented, but little research has directly examined the underlying mechanisms by which these effects occur. The principal study in this article assessed the potential underlying mechanism of meaning-making, defined as changing situational meaning (appraisals of the traumatic experience) and global meaning (world views, personality, and coping styles) in order to reduce the discrepancy between global and situational meaning. Forty-one trauma-writing participants and 21 nontrauma-writing control participants completed 4 days of writing and a 4 month follow-up. Decrements in health were noted for the control group but not for the trauma-writing group. Over time, the trauma-writing group's appraisals changed to reflect less aversive situational meaning (e.g., less stressful, less threatening), and their cognitive processing, reflected by intrusions and avoidance, decreased. Less stressful appraisals and reduced cognitive processing were related to improved health outcomes. Results indicate that writing about trauma facilitates the making of meaning. A second study examined whether scores on several measures used in the first study changed across 4 months without a writing intervention. It was found that these measures did not change across time.

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REFERENCES

  1. Bootzin, R. R. (1997). Examining the theory and clinical utility of writing about emotional experiences. Psychological Science, 8, 167–169.

    Google Scholar 

  2. Bower, J. E., Kemeny, M. E., Taylor, S. E., & Fahey, J. L. (1998). Cognitive processing, discovery of meaning, CD4 decline, and AIDS-related mortality among bereaved HIV-seropositive men. Journal of Consulting and Clinical Psychology, 66, 979–986.

    Google Scholar 

  3. Carver, C. S. (1997). You want to measure coping but your protocol's too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4, 92–100.

    Google Scholar 

  4. Carver, C. S., Scheier, M. G., & eintraub, J. G. (1989). Assessing coping strategies:Atheoretically-based approach. Journal of Personality and Social Psychology, 56, 267–283.

    Google Scholar 

  5. Costa, P. T., Jr., & McCrae, R. R. (1991). The NEO-Personality Inventory manual. Odessa, FL: Psychological Assessment Resources.

    Google Scholar 

  6. Creamer, M., Burgess, P., & Pattison, P. (1992). Reaction to trauma:Acognitive processing model. Journal of Abnormal Psychology, 101, 452–459.

    Google Scholar 

  7. Epstein, S. (1993). Bereavement from the perspective of cognitive-experiential self-theory. In M. S. Stroebe, W. Stroebe, & R. O. Hansson (Eds.), Handbook of bereavement: Theory, research, and intervention (pp. 112–125). New York: Cambridge University Press.

    Google Scholar 

  8. Esterling, B. A., Antoni, M. H., Kumar, M., & Schneiderman, N. (1990). Emotional repression, stress disclosure responses, and Epstein-Barr viral capsid antigen titers. Psychosomatic Medicine, 52, 397–410.

    Google Scholar 

  9. Foa, E. B. (1997). Psychobiology of post-traumatic stress disorder. Annals of the New York Academy of Sciences, 821, 410–424.

    Google Scholar 

  10. Foa, E. B., Molnar, C., & Cashman, L. (1995). Change in rape narratives during exposure therapy for posttraumatic stress disorder. Journal of Traumatic Stress, 8, (Special Issue), 675–690.

    Google Scholar 

  11. Gorsuch, R. L., & McPherson, S. E. (1989). Intrinsic/Extrinsic measurement: I/E-Revised and single item scales. Journal for the Scientific Study of Religion, 28, 348–354.

    Google Scholar 

  12. Greenberg, M. A. (1995). Cognitive processing of traumas: The role of intrusive thoughts and reappraisals. Journal of Applied Social Psychology, 25, 1262–1296.

    Google Scholar 

  13. Greenberg, M. A., & Stone, A. A. (1992). Emotional disclosure about traumas and its relation to health: Effects of previous disclosure and trauma severity. Journal of Personality and Social Psychology, 63, 74–85.

    Google Scholar 

  14. Greenberg, M. A., Wortman, C. B., & Stone, A. A. (1996). Emotional expression and physical health: Revising traumatic memories or fostering self-regulation? Journal of Personality and Social Psychology, 71, 588–602.

    Google Scholar 

  15. Horowitz, M. J. (1991). Person schemas. In M. Horowitz (Ed.), Person schemas and maladaptive interpersonal patterns (pp. 13–31). Chicago: University of Chicago Press.

    Google Scholar 

  16. Horowitz, M. J. (1997). Cognitive psychodynamics:The clinical use of states, person schemas, and defensive control process theories. In D. J. Stein (Ed.), Cognitive science and the unconscious (pp. 189–205). Washington, DC: American Psychiatric Press.

    Google Scholar 

  17. Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Event Scale: A measure of subjective distress. Psychosomatic Medicine, 41, 209–218.

    Google Scholar 

  18. Janoff-Bulman, R. (1989). Assumptive worlds and the stress of traumatic events: Applications of the schema construct. Social Cognition, 7, 113–136.

    Google Scholar 

  19. Janoff-Bulman, R. (1992). Shattered Assumptions: Towards a new psychology of trauma. New York: Free Press.

    Google Scholar 

  20. Klein, K., & Boals, A. (2001). Expressive writing can increase working memory capacity. Journal of Experimental Psychology: General, 130, 520–533.

    Google Scholar 

  21. King, L. A. (2001). The health benefits of writing about life goals. Personality and Social Psychology Bulletin, 27, 798–807.

    Google Scholar 

  22. Lazarus, R. S. (1999). The cognition-emotion debate:Abit of history. In T. Dalgleish & M. J. Power (Eds.), Handbook of cognition and emotion (pp. 3–19). Chichester, England: Wiley.

    Google Scholar 

  23. Lepore, S. J., & Greenberg, M. (in press). Mending broken hearts: Effects of expressive writing on mood, cognitive processing, social adjustment, and health following a relationship breakup. Psychology and Health.

  24. Lepore, S. J., & Helgeson, V. S. (1998). Social constraints, intrusive thoughts, and mental health after prostate cancer. Journal of Social & Clinical Psychology, 17, 89–106.

    Google Scholar 

  25. Lepore, S. J., Ragan, J.D., & Jones, S. (2000). Talking facilitates cognitive-emotional processes of adaptation to an acute stressor. Journal of Personality & Social Psychology, 78, 499–508.

    Google Scholar 

  26. Lutgendorf, S. K., & Antoni, M. H. (1999). Emotional and cognitive processing in a trauma disclosure paradigm. Cognitive Therapy and Research, 23, 423–440.

    Google Scholar 

  27. McCann, I. L., Sakheim, D. K., & Abrahamson, D. J. (1988). Trauma and victimization: A model of psychological adaptation. Counseling Psychologist, 16, 531–594.

    Google Scholar 

  28. McIntosh,D.N., Silver, R., & Wortman, C. B. (1993). Religion's role in adjustment to a negative life event: Coping with the loss of a child. Journal of Personality and Social Psychology, 65, 812–821.

    Google Scholar 

  29. Murray, E., Lamnin, A., & Carver, C. S. (1989). Emotional expression in written essays and psychotherapy. Journal of Social and Clinical Psychology, 8, 414–419.

    Google Scholar 

  30. Murray, E., & Segal, D. (1994). Emotional processing in vocal and written expression of feelings about traumatic experiences. Journal of Traumatic Stress, 7, 391–405.

    Google Scholar 

  31. Pargament, K. I. (1997). The psychology of religion and coping. New York: Guilford.

    Google Scholar 

  32. Park, C. L., Cohen, L. H., & Murch, R. (1996). Assessment and prediction of stress related growth. Journal of Personality, 64, 71–105.

    Google Scholar 

  33. Park, C. L., & Folkman, S. (1997). Meaning in the context of stress and coping. General Review of Psychology, 1, 115–144.

    Google Scholar 

  34. Peacock, E., & Wong, P. (1990). The stress appraisal measure (SAM): A multidimensional approach to cognitive appraisal. Stress Medicine, 6, 227–236.

    Google Scholar 

  35. Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2–21.

    Google Scholar 

  36. Pennebaker, J. W. (1993). Putting stress into words: Health, linguistics, and therapeutic implications. Behavior Research and Therapy, 31, 539–548.

    Google Scholar 

  37. Pennebaker, J. W. (1997). Writing about emotional experiences as a therapeutic process. Psychological Science, 8, 162–166.

    Google Scholar 

  38. Pennebaker, J. W., Colder, M., & Sharp, L. K. (1990). Accelerating the coping process. Journal of Personality and Social Psychology, 58, 528–537.

    Google Scholar 

  39. Pennebaker, J. W., & Francis, M. E. (1996). Cognitive, emotional, and language processes in disclosure. Cognition & Emotion, 10, 601–626

    Google Scholar 

  40. Pennebaker, J.W., Kiecolt-Glaser, J. K., & Glaser, R. (1988). Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56, 239–245.

    Google Scholar 

  41. Pennebaker, J. W., Mayne, T. J., & Francis, M. E. (1997). Linguistic predictors of adaptive bereavement. Journal of Personality & Social Psychology, 72, 863–871.

    Google Scholar 

  42. Sansone, R. A., Sansone L. A., & Wiederman, M. W. (1997). Increased health care utilization as a function of participation in trauma research. American Journal of Psychiatry, 154, 1025–1027.

    Google Scholar 

  43. Schwartzberg, S. S., & Janoff-Bulman, R. (1991). Grief and the search for meaning: Exploring the assumptive worlds of bereaved college students. Journal of Social and Clinical Psychology, 10, 270–288.

    Google Scholar 

  44. Scheier, M. F., Carver, C. S., & Bridges, M. W. (1994). Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test. Journal of Personality and Social Psychology, 67, 1063–1078.

    Google Scholar 

  45. Segal, D., & Murray, E. J. (1994). Emotional processing in cognitive therapy and vocal expression of feeling. Journal of Social & Clinical Psychology, 3, 189–206.

    Google Scholar 

  46. Smyth, J. M. (1998). Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66, 174–184.

    Google Scholar 

  47. Tennen, H., & Affleck, G. (1998). Personality and transformation in the face of adversity. In R. G. Tedeschi, C. L. Park, & L. G. Calhoun (Eds.), Posttraumatic growth: Positive changes in the aftermath of crisis (pp. 65–98). Mahwah, NJ: Erlbaum.

    Google Scholar 

  48. Vitaliano, P. P., Maiuro, R.D., Mitchell, E., & Russo, J. (1989). Perceived stress in medical school: Persistors, adaptors, and maladaptors. Social Science and Medicine, 28, 1321–1329.

    Google Scholar 

  49. Ware, J. E. (1993). SF-36 Health Survey Manual and Interpretation Guide. Boston: The Health Institute, New England Medical Center.

    Google Scholar 

  50. Zilberg, N. J., Weiss, D. S., & Horowitz, M. J. (1982). Impact of Event Scale: A cross-validation study and some empirical evidence supporting a conceptual model of stress response syndromes. Journal of Consulting and Clinical Psychology, 50, 407–414.

    Google Scholar 

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Park, C.L., Blumberg, C.J. Disclosing Trauma Through Writing: Testing the Meaning-Making Hypothesis. Cognitive Therapy and Research 26, 597–616 (2002). https://doi.org/10.1023/A:1020353109229

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  • disclosure
  • meaning-making
  • cognitive processing
  • emotional processing