An Examination of Productive Processing Activities in the Expressive Writing Intervention

Expressive Writing (EW) is a therapeutic intervention that involves writing about stressful experiences over several sessions using as much detail and references to emotion as possible. For individuals experiencing a wide range of psychological and physical symptoms, in response to an array of stressors, EW has been repeatedly shown to lead to positive outcomes. Not all participants experience these positive outcomes, however, and the questions of how EW works and why it can lead to disparate outcomes across participants remain. In an effort to address these questions, the present study turned to psychotherapy process research, which has revealed several in-session client cognitive and affective processes that are consistently linked with positive therapeutic change. The purpose of the present study was to examine whether these processes are also relevant to EW and can provide insight into how and why EW works. Twenty-eight individuals who experienced psychological trauma participated in an EW intervention. Measures of psychological and physical health were administered at baseline and one month follow-up. The Measure of Clients' Productive Processing (MCPP; Watson McMullen, 2008), an observer-rated measure, was used to assess participants' engagement in several processing activities believed to be productive. The Linguistic Inquiry and Word Count (LIWC; Pennebaker, Booth, Francis, 2007) was also used to examine word use related to affective processes and cognitive mechanisms. Partial correlations calculated between the MCPP, LIWC and outcome provided some support for the notion that the expression of emotions at a moderate level of arousal, as well as actively exploring and developing new understanding, are productive processes in EW. These processes were most prominently linked with improvements in depressive symptoms, though some improvements in other psychological and physical symptoms were also revealed. Phase of the intervention emerged as important, with the most notable effects occurring in the mid and late phases. Productive descriptions of external experience, expressions of need, and evaluations were not found to be related to positive outcome following EW. Results are discussed in the context of the previous research, with consideration given to limitations, future directions and clinical implications.Ph.D