WEBVTT 00:00:05.663 --> 00:00:09.093 >> Hi, welcome back. We are here with Dr. Jamie Pennebaker, 00:00:09.093 --> 00:00:13.390 and we're talking about expressive writing and welcome to our second hour. 00:00:14.080 --> 00:00:17.803 We talked a lot about the research base and the history of kind of discovering 00:00:17.803 --> 00:00:21.457 and figuring out that expressive writing works, especially to help people with 00:00:21.457 --> 00:00:25.622 a variety of objective outcomes, including health measures, 00:00:25.622 --> 00:00:29.579 job measures, and things related to that, and then we're going to go back 00:00:29.579 --> 00:00:34.113 and talk more about how it is that we can think about expressive writing 00:00:34.113 --> 00:00:35.493 most productively. 00:00:36.024 --> 00:00:38.449 Well, welcome back Jamie. >> It's good to be back. 00:00:38.449 --> 00:00:39.613 >> (laughing) Indeed. 00:00:40.493 --> 00:00:43.953 So, when we're thinking about expressive writing, you know, one of the things 00:00:43.953 --> 00:00:46.997 that I think about a lot here is sort of what's the magic ingredient, 00:00:46.997 --> 00:00:50.539 what's the mechanism of treatment effect, do you think, for this process? 00:00:51.632 --> 00:00:58.280 >> When the first studies were done, there were all of these hypotheses on 00:00:58.280 --> 00:01:02.635 what it must be, and one of them, people were-- felt that 00:01:02.635 --> 00:01:05.372 "Well, this must be some kind of catharsis or venting." 00:01:05.372 --> 00:01:10.312 And all of our analyses and various studies showed that's not it at all, 00:01:10.312 --> 00:01:13.320 it's a much more-- there are many things going on. 00:01:13.320 --> 00:01:20.223 And the other thing-- science hates this, science wants a nice simple answer, 00:01:20.223 --> 00:01:23.877 but spoilers-- >> What clinicians are (crosstalk)? 00:01:23.877 --> 00:01:29.880 >> Spoiler alert! There is not a silver bullet that explains it, that there are 00:01:29.880 --> 00:01:32.617 multiple, multiple factors involved. 00:01:32.617 --> 00:01:37.418 So for example, with expressive writing, we-- there have now been these 00:01:37.418 --> 00:01:43.855 various studies that show first of all just labeling an upsetting experience 00:01:44.444 --> 00:01:45.374 is important. 00:01:45.374 --> 00:01:48.619 So there have been these studies looking at brain activity, 00:01:48.619 --> 00:01:53.362 and if you can just label what happens, or just label your emotions, 00:01:53.822 --> 00:01:55.009 that's beneficial. 00:01:55.662 --> 00:02:00.413 A second is that writing about an experience helps to give it some 00:02:00.413 --> 00:02:01.959 structure and organization. 00:02:02.534 --> 00:02:04.705 So that too is really valuable. 00:02:05.224 --> 00:02:10.361 Another related one is that expressive writing also helps to provide meaning 00:02:10.361 --> 00:02:11.448 for a person. 00:02:12.350 --> 00:02:15.912 And then-- and creating a narrative seems to be beneficial. 00:02:16.779 --> 00:02:22.335 But another thing that I think is really central is that-- think about what happens 00:02:22.335 --> 00:02:25.557 when you don't write, or you don't talk about an upsetting experience. 00:02:26.961 --> 00:02:31.386 You're walking down the street, and you've had, just had a terrible interaction 00:02:31.386 --> 00:02:32.113 with somebody. 00:02:32.747 --> 00:02:37.770 What happens is in your mind, you think about "Ooh, I shouldn't have said that", 00:02:37.770 --> 00:02:42.085 "Ooh, I can't believe that they said that" and then you go off in another direction. 00:02:42.085 --> 00:02:46.481 Your thought patterns, very often after a trauma, in the days and weeks afterwards, 00:02:46.821 --> 00:02:49.920 are random, they're just-- they are-- >> Destroying you. 00:02:50.630 --> 00:02:52.314 >> Destroying-- exactly. >> (inaudible). 00:02:52.314 --> 00:03:00.097 >> And so what writing does, it forces you to bring together all of these aspects, 00:03:00.097 --> 00:03:04.731 so you start to realize "Wow, this upsetting experience is associated 00:03:04.731 --> 00:03:09.270 "with why I'm having problems with my spouse, this is associated with 00:03:09.270 --> 00:03:13.574 "why I'm having sleep problems, this explains why I don't 00:03:13.574 --> 00:03:16.203 "have any money in the bank right now, this..." And so you start putting-- 00:03:16.203 --> 00:03:17.684 >> Think of those connections we were talking about-- 00:03:17.684 --> 00:03:19.994 >> You're making connections that's right. >> You want people to be indicating, yeah. 00:03:19.994 --> 00:03:24.187 >> So it's all of this. But then there have been all of these other studies 00:03:24.187 --> 00:03:28.006 looking at expressive writing, and one was one that I particularly loved 00:03:28.006 --> 00:03:32.261 that was looking at essentially working memory or executive function. 00:03:33.114 --> 00:03:39.829 And working memory, as you'll remember, is this-- the idea of your ability to 00:03:40.509 --> 00:03:45.490 keep multiple ideas in your head at once, it's a frontal lobe phenomenon. 00:03:46.196 --> 00:03:49.921 And what this research found was that when people did expressive writing, 00:03:49.921 --> 00:03:53.872 that they found enhancements, improved working memory, 00:03:53.872 --> 00:03:56.500 in the days and weeks afterwards. >> Oh, yeah. 00:03:56.500 --> 00:04:01.418 >> Now, having more working memory does a lot of things, and it's also 00:04:01.418 --> 00:04:07.490 associated with... that's one reason I think, by the way, people do better 00:04:07.490 --> 00:04:09.304 in school after writing. >> Sure, yeah, 00:04:09.304 --> 00:04:10.847 better focus and concentration. >> That's right. 00:04:10.847 --> 00:04:12.528 >> They can direct their thinking more effectively. 00:04:12.528 --> 00:04:14.594 >> That's right. And there have been some studies showing that people 00:04:14.594 --> 00:04:19.966 who are taking the SATs, or college boards of some kind, that if they do expressive 00:04:19.966 --> 00:04:22.712 writing beforehand, they do actually better than if they don't. 00:04:23.269 --> 00:04:25.870 And again, I think it's the working memory issue. 00:04:26.630 --> 00:04:29.867 And there's another thing that's also relevant to working memory, 00:04:29.867 --> 00:04:34.423 and a lot of other things, is after people write, they also sleep better. 00:04:34.908 --> 00:04:36.759 >> Ah. Good. >> And think about 00:04:36.759 --> 00:04:38.246 what we not know about sleep. 00:04:38.246 --> 00:04:42.262 We know sleep is associated with reduction in depression, we know 00:04:42.262 --> 00:04:44.870 that it's associated with enhanced immune functions, many of the things 00:04:44.870 --> 00:04:47.351 that we know expressive writing is beneficial for. 00:04:47.351 --> 00:04:49.805 >> Sure, it's the quality and quantity are related to these things, yeah. 00:04:49.805 --> 00:04:51.011 >> That's exactly right. 00:04:51.011 --> 00:04:54.341 So that's another factor that feeds into this. 00:04:54.341 --> 00:04:58.717 But then there's one that I found also quite compelling. Years ago, 00:04:58.717 --> 00:05:08.036 we did a study with college students, and what we were interested in was 00:05:08.036 --> 00:05:12.305 does expressive writing change your daily behaviors? 00:05:12.305 --> 00:05:15.792 Now, we had done studies and we gave people questionnaires, 00:05:15.792 --> 00:05:18.916 and one thing in my research is I'm very suspicious of questionnaries, 00:05:18.916 --> 00:05:21.674 and one of the questionnaire items we asked was, you know, 00:05:21.674 --> 00:05:24.660 "To what degree over the last few weeks have you been able to 00:05:24.660 --> 00:05:25.958 "connect with others?" 00:05:26.912 --> 00:05:30.110 Nobody could answer that question, it's a stupid question. 00:05:30.960 --> 00:05:35.762 I wanted, though, to find out can we get at that? So what we devised was a-- 00:05:36.602 --> 00:05:42.001 it's a method called the electronically activated reporter, the EAR, or the ear. 00:05:42.616 --> 00:05:46.865 And it was essentially a glorified tape recorder that would come on for 00:05:46.865 --> 00:05:51.172 30 seconds and go off for 12 minutes, and we had people wear this for two days 00:05:51.172 --> 00:05:53.074 before they came in to a writing study. 00:05:53.884 --> 00:05:58.549 And then we had them wear this again one month later, and what it does is 00:05:58.549 --> 00:06:01.062 it just captures how much of the time you're talking with others, 00:06:01.062 --> 00:06:03.828 the degree to which you are laughing, the kind of language that you are 00:06:03.828 --> 00:06:04.837 using, so forth. 00:06:05.533 --> 00:06:09.102 What we found was that people in the experimental conditions, people who 00:06:09.102 --> 00:06:11.355 wrote about their deepest thoughts and feelings about something 00:06:11.355 --> 00:06:15.513 ended up talking more with others, laughing more with others, 00:06:15.513 --> 00:06:17.875 they were more connected with others. 00:06:18.548 --> 00:06:23.446 And I think this gets back to executive function, or working memory, 00:06:23.446 --> 00:06:28.533 that when you have an upsetting experience, you are thinking about it 00:06:28.533 --> 00:06:29.609 all the time. 00:06:29.609 --> 00:06:33.868 You are a worse friend, because you're just not paying attention to your friends, 00:06:33.868 --> 00:06:37.028 you're not sleeping as well, you're not doing as well at school, 00:06:37.028 --> 00:06:38.628 because you're distracted-- >> You're distracted by all your thoughts. 00:06:38.628 --> 00:06:39.483 >> That's exactly right. 00:06:39.483 --> 00:06:44.363 And then what expressive writing does is it helps to put this upsetting experience 00:06:44.363 --> 00:06:47.973 into some kind of context, and you just don't think about it as much. 00:06:47.973 --> 00:06:50.398 And if you do think about it, it's not as upsetting. 00:06:50.821 --> 00:06:54.761 And you sleep better, and you can connect with others better. 00:06:54.761 --> 00:06:56.284 So why does it work? 00:06:56.651 --> 00:07:00.186 I think all of those things in this cascade of things, all of those things 00:07:00.186 --> 00:07:02.220 help to explain the effect. >> It's basically a form of 00:07:02.220 --> 00:07:05.391 cognitive processing, clearly. >> It very much is. It is. 00:07:05.391 --> 00:07:08.265 >> And that obviously has been shown in a lot of ways to be 00:07:08.265 --> 00:07:11.255 beneficial to people in terms of putting traumating experiences 00:07:11.255 --> 00:07:13.658 and other past experiences sort of in their place, right? 00:07:13.658 --> 00:07:14.677 >> Yes, that's right. >> It kind of helps to 00:07:14.677 --> 00:07:16.814 actually put them in the past, and they don't have to be 00:07:16.814 --> 00:07:19.070 thinking about them so actively all the time anymore. 00:07:19.070 --> 00:07:20.860 >> That's right, that's right, and a cognitive experience 00:07:20.860 --> 00:07:23.777 is also an emotional experience, and this distinction between 00:07:23.777 --> 00:07:26.496 cognition and emotion, I think, is somewhat false, 00:07:26.496 --> 00:07:31.596 because the two are-- they're all part of the same phenomenon. 00:07:31.596 --> 00:07:33.830 >> Yeah, clinically we end up making those distinctions a lot, 00:07:33.830 --> 00:07:36.999 I think just mostly as a shorthand way to kind of make life easier 00:07:36.999 --> 00:07:39.854 for us as clinicians sometimes, and kind of looking at 00:07:39.854 --> 00:07:42.062 someone's emotional functioning and their cognitive functioning. 00:07:42.506 --> 00:07:45.987 Obviously those are very intertwined in this way, and especially-- 00:07:45.987 --> 00:07:49.984 obviously, this is the primary basis of all CBT, cognitive behavioral therapy, 00:07:49.984 --> 00:07:52.505 is that those things are very closely linked that way. 00:07:52.868 --> 00:07:56.317 So this discussion about working memory kind of makes me wonder about 00:07:56.317 --> 00:08:01.075 the timing of these interventions, and whether we have any kind of 00:08:01.075 --> 00:08:04.191 indication of boundary conditions, having to do with when we would 00:08:04.191 --> 00:08:06.890 recommend that we not use these techniques-- 00:08:06.890 --> 00:08:14.972 >> This is a critical question. And... so there are interventions, 00:08:14.972 --> 00:08:19.559 and I think clinicians worry about this as well, if there is a major 00:08:19.559 --> 00:08:24.864 trauma for a person, should you jump right in and start doing some kind of 00:08:24.864 --> 00:08:26.450 therapy immediately? 00:08:26.450 --> 00:08:28.603 >> Yes, this is very dicey to us. >> It is. 00:08:28.603 --> 00:08:31.641 >> Given the evidence base these days. >> That's right, and the data shows 00:08:31.641 --> 00:08:38.500 pretty clearly, therapy-- at least deep therapy immediately after trauma's 00:08:38.500 --> 00:08:39.674 probably a bad idea. 00:08:39.674 --> 00:08:42.780 And I think that includes writing. >> We want much more naturalistic 00:08:42.780 --> 00:08:44.889 social support and that kind of thing during that time. 00:08:44.889 --> 00:08:46.219 >> Yeah, that's exactly right. 00:08:46.231 --> 00:08:51.706 And, you know, if you look at the data, and this is since I started 00:08:51.706 --> 00:08:54.657 doing expressive writing, I've since moved into another world 00:08:54.657 --> 00:08:56.649 doing analysis of language. 00:08:56.649 --> 00:08:58.134 And look-- >> We'll have to have you back 00:08:58.134 --> 00:08:59.408 to talk about it. >> Exactly. 00:08:59.408 --> 00:09:03.562 But looking at how people write in blogs after, say, 9/11, 00:09:03.562 --> 00:09:06.080 or other traumas. 00:09:06.080 --> 00:09:11.787 And what you find is that people who are able to distract themselves 00:09:12.454 --> 00:09:15.922 actually do much better than people who are really obsessing about 00:09:15.922 --> 00:09:18.803 this trauma immediately afterwards. >> Digging into it right away. 00:09:18.803 --> 00:09:23.408 >> But the rule I have for expressive writing is you should write when you 00:09:23.408 --> 00:09:25.993 find that you're thinking about a trauma too much. 00:09:26.943 --> 00:09:31.510 Now, if your spouse died last week and you're thinking about it all the time. 00:09:32.790 --> 00:09:34.289 >> How would we define when that's too much? 00:09:34.289 --> 00:09:37.168 >> That's not too much, that's completely normal. 00:09:37.793 --> 00:09:40.363 If, two years later, you're thinking about the spouse all the time, 00:09:40.363 --> 00:09:42.013 that's too much. >> Not so acceptable. 00:09:42.013 --> 00:09:47.509 >> So I think you have to weigh when-- at what point do your friends 00:09:47.509 --> 00:09:49.346 not want to talk about this anymore? 00:09:50.024 --> 00:09:54.045 At what point do you realize that nobody wants to hear this, 00:09:54.045 --> 00:09:56.248 or that your friends are avoiding you? 00:09:56.248 --> 00:09:59.139 That's a sign you're thinking about it too much, and that's where 00:09:59.139 --> 00:10:01.350 expressive writing can be really beneficial. 00:10:03.027 --> 00:10:08.294 Now, I should also say, there are some people immediately after trauma, 00:10:08.294 --> 00:10:10.558 they need to start writing immediately. 00:10:11.294 --> 00:10:11.920 Fine! 00:10:11.920 --> 00:10:13.431 >> Do we know who these people are-- >> No. 00:10:13.431 --> 00:10:15.141 >> I mean from a clinical perspective-- >> No, no. 00:10:15.141 --> 00:10:18.292 >> So, you know, if we're doing a crisis intervention kind of a-- 00:10:18.892 --> 00:10:20.856 an intervention for example, you know, if somebody 00:10:20.856 --> 00:10:24.566 runs a practice, for example, who is very centered around crisis intervention, 00:10:24.566 --> 00:10:28.392 this might not be the place where we would suggest using this type of technique 00:10:28.392 --> 00:10:32.147 as much, I'm not sure we have a way to test who would benefit from it 00:10:32.147 --> 00:10:33.610 and who wouldn't. 00:10:33.610 --> 00:10:37.680 >> Well, I'll tell you what I have done, and that is when I dealt with 00:10:38.120 --> 00:10:39.229 a group like that. 00:10:39.229 --> 00:10:44.839 I'll say "look, I don't recommend writing right now, but there might be 00:10:44.839 --> 00:10:48.659 "some of you here who feel as though you would benefit from it. Try it." 00:10:49.309 --> 00:10:55.075 You know-- but if you're finding that it's not helping, try something else. 00:10:55.075 --> 00:10:57.861 >> Yeah, there's that autonomy piece again, and that sort of self-reflective 00:10:57.861 --> 00:11:00.263 piece that we want people to be engaging in. 00:11:00.263 --> 00:11:01.884 That makes total sense. 00:11:01.884 --> 00:11:05.884 So when we think about the ways that this gets implemented, are there 00:11:05.884 --> 00:11:09.640 any other sort of really negative effects that can come off of this? 00:11:09.640 --> 00:11:12.744 Iatrogenic effects, you know, effects that are actually harmful to people 00:11:12.744 --> 00:11:15.887 when we're attempting to help them, other ways in which you would consider 00:11:15.887 --> 00:11:17.655 this technique to be dangerous? 00:11:18.388 --> 00:11:20.889 >> I've never seen it to be dangerous. 00:11:20.889 --> 00:11:25.886 I've seen some people who got quite distressed when they were writing. 00:11:26.757 --> 00:11:34.021 Now in the laboratory studies, of the, I don't know, let's say 2,000 people 00:11:34.021 --> 00:11:38.738 that I've been involved with, I've probably seen cases of 00:11:38.738 --> 00:11:41.409 maybe three cases that were problematic. 00:11:42.631 --> 00:11:50.838 One was a project-- we were dealing with people who were self-harmers. 00:11:51.828 --> 00:11:58.553 And this was-- actually, this was a pivotal study for me, because 00:12:00.333 --> 00:12:06.644 we were not reading people's writings, and I-- but we were vague, 00:12:06.650 --> 00:12:11.226 a little bit vague about it, and one person was essentially writing, 00:12:11.226 --> 00:12:13.938 you know, "I have my life, I'm going to commit suicide" and so forth. 00:12:14.382 --> 00:12:16.171 And weren't reading it-- >> And we didn't see that. 00:12:16.171 --> 00:12:23.382 >> They then... she made a half-hearted attempt in the sense that she 00:12:24.152 --> 00:12:26.116 took a lot of antidepressants. 00:12:27.798 --> 00:12:29.977 And then told somebody immediately. 00:12:30.490 --> 00:12:31.631 So that was-- >> A cry for help attempt. 00:12:31.637 --> 00:12:36.309 >> That's right, and, you know, I look at that thinking just how stupid I was 00:12:36.309 --> 00:12:43.450 not to be much more clear that we weren't reading this, and that if she were 00:12:43.450 --> 00:12:47.476 distressed, she should tell us. >> Take to the usual things 00:12:47.476 --> 00:12:50.781 that you would need to do to communicate that type of distress. 00:12:50.781 --> 00:12:54.749 But we haven't seen this to have any sort of systematic negative effect-- 00:12:54.749 --> 00:12:56.090 >> Not at all. >> On people's mood, 00:12:56.090 --> 00:13:00.056 or to produce suicidal ideation where that isn't already what the person 00:13:00.056 --> 00:13:02.408 is expressing or anything along that line certainly. 00:13:02.408 --> 00:13:06.816 >> In fact, that's what's been the most intriguing thing about this, 00:13:06.816 --> 00:13:12.384 'cause in our early days, this was the big concern for every, you know, 00:13:12.384 --> 00:13:16.513 review board, and others, which was "Oh my god, people are-- 00:13:17.323 --> 00:13:19.719 "You can't let someone talk about their feelings." 00:13:19.719 --> 00:13:23.879 And this was the biggest, our biggest problem was in the medical IRBs. 00:13:23.879 --> 00:13:27.590 The medical IRBs would-- you could basically submit saying 00:13:27.590 --> 00:13:30.249 "I'm doing a project, I want to saw off people's arms," 00:13:30.249 --> 00:13:31.163 and they go "Okay." 00:13:31.629 --> 00:13:34.786 And then we would say "We want people to write about that", and they go 00:13:34.786 --> 00:13:40.996 "Oh no, that might make people really..." >> Mental health does make people 00:13:40.996 --> 00:13:44.272 uncomfortable. >> But I would say 00:13:44.272 --> 00:13:47.302 looking across all of the studies that have been done, 00:13:47.302 --> 00:13:52.675 there are no major-- I've not seen any particular people who are at risk, 00:13:53.805 --> 00:13:56.729 except those people who-- >> Already at high risk. 00:13:56.729 --> 00:13:59.269 >> Who are in crisis at the time. 00:13:59.862 --> 00:14:02.311 >> Well these are people that obviously from a clinical perspective, 00:14:02.311 --> 00:14:06.565 if you have a client who's at high risk of suicial ideation, other kinds of 00:14:06.565 --> 00:14:09.855 similar problems, obviously we would expect for that to be being monitored 00:14:09.855 --> 00:14:13.466 in other ways that are independent of the expressive writing technique, 00:14:13.466 --> 00:14:15.966 since one of the keys I think that Dr. Pennebaker is really 00:14:15.966 --> 00:14:20.095 bringing forward to us here is that we really don't want to review this writing. 00:14:20.095 --> 00:14:22.884 And in fact, we don't want them to be encouraged, people to be encouraged 00:14:22.884 --> 00:14:25.147 to share this writing with others either. 00:14:25.147 --> 00:14:28.544 So for example, if we have a group setting in which we're actually doing 00:14:28.544 --> 00:14:33.641 group therapy, and we might assign this technique as an individual tool 00:14:33.641 --> 00:14:37.184 for people to use, I don't think we would want to encourage them to share 00:14:37.184 --> 00:14:38.914 their writing with each other, would we? 00:14:39.736 --> 00:14:45.546 >> Probably not. And, you know, it's-- again, I always get nervous about 00:14:45.546 --> 00:14:48.727 being too, you know, because-- >> Directive. 00:14:48.727 --> 00:14:55.171 >> Too directive. But one of the early studies showed that 00:14:55.171 --> 00:14:57.926 expressive writing was bad, and I was so upset 00:14:57.926 --> 00:15:02.140 by this experiment, but the project was-- turned out to be an odd one, 00:15:02.140 --> 00:15:06.798 what happened was it was done in a situation where they-- 00:15:06.798 --> 00:15:10.541 these were standing groups, and in one group, 00:15:10.541 --> 00:15:14.871 they wrote-- and then afterwards, they got up and had to share-- 00:15:14.871 --> 00:15:15.988 read what they had written. 00:15:16.414 --> 00:15:19.932 And I was thinking "Geez, that's a terrible thing," because what 00:15:19.932 --> 00:15:26.717 what writing is doing is you're writing-- think about how we share an upsetting 00:15:26.717 --> 00:15:28.846 experience with another person. 00:15:28.846 --> 00:15:32.789 So for example, all of us had this experience, you know, you start to 00:15:32.789 --> 00:15:36.087 tell a friend about something that was really distressing, and you're starting 00:15:36.087 --> 00:15:39.498 to talk, and you're looking at their face, and their face is going "ahh!" 00:15:39.875 --> 00:15:44.226 And so what you do is you change the topic and you move it off in some-- 00:15:45.396 --> 00:15:48.172 >> Make social adjustments in terms of what you're trying to say. 00:15:48.182 --> 00:15:53.097 >> But if you're reading your writing, you can't do that, and so therein's 00:15:53.097 --> 00:15:59.245 the issue. So I often-- what I have done, some people would call it therapy, 00:15:59.245 --> 00:16:02.875 I don't call it therapy, but when I've done work with someone who 00:16:02.875 --> 00:16:07.711 wants to write, I say "I want you to write about this, and if you want to 00:16:07.711 --> 00:16:10.408 "talk to me about it, that's great, but, you know, I don't need to 00:16:10.408 --> 00:16:12.988 "read it, I don't-- and you don't need to read it to me. 00:16:12.988 --> 00:16:14.475 "You can just tell me about it." 00:16:14.952 --> 00:16:17.703 >> Yeah, there you go. So obviously, I think we're saying that our 00:16:17.703 --> 00:16:20.405 patients are welcome to talk to us about their expressive writing, 00:16:20.405 --> 00:16:22.624 that it's not that we would say "Ah, I don't want to hear about that," 00:16:22.624 --> 00:16:25.498 obviously we do, and we want to encourage that communicative 00:16:25.498 --> 00:16:28.797 relationship, but we also want to make it clear that this writing is private, 00:16:28.797 --> 00:16:32.554 so that they are able to fully unload and to, you know, kind of engage 00:16:32.554 --> 00:16:35.851 in that process the best way that they can subjectively, 00:16:35.851 --> 00:16:38.217 without truncating it for them in some way that would 00:16:38.217 --> 00:16:42.112 involve them trying to manage us, really, and our feelings that way. 00:16:42.484 --> 00:16:43.187 Fantastic. 00:16:43.700 --> 00:16:47.888 So, when we think about the effect that expressive writing has on, 00:16:47.888 --> 00:16:50.904 you know, sort of-- sounds very powerful, it sounds like something that I would 00:16:50.904 --> 00:16:53.377 be very tempted to start to use and to really encourage, 00:16:53.377 --> 00:16:56.837 myself potentially as a practice, and then also with my clients. 00:16:56.837 --> 00:17:00.064 But I also know that there's only so much change we can make 00:17:00.064 --> 00:17:02.866 for people, and change is often incremental and happens 00:17:02.866 --> 00:17:04.864 in small and kind of subtle ways. 00:17:04.864 --> 00:17:08.405 What would you say is sort of the powerfulness of this technique 00:17:08.405 --> 00:17:10.889 or the effect size, if you will, if we're going to speak 00:17:10.889 --> 00:17:12.010 in research terms. >> Right. 00:17:12.434 --> 00:17:20.635 So this is a-- I would call this a major question. So it's important to remember 00:17:20.635 --> 00:17:24.004 that expressive writing-- it's free. 00:17:25.137 --> 00:17:31.955 You know-- so as techniques go, this is a really low-impact 00:17:31.955 --> 00:17:35.667 from a clinician's perspective, and also from the client's perspective, 00:17:35.667 --> 00:17:38.270 this is something anybody can do in any context. 00:17:39.193 --> 00:17:40.445 How effective is it? 00:17:41.110 --> 00:17:45.997 I would-- in the grand effect sizes, it's a modest effect size. 00:17:46.592 --> 00:17:49.670 It doesn't work for everybody, it's doesn't work for any one person 00:17:49.670 --> 00:17:50.507 all the time. 00:17:51.904 --> 00:17:59.370 It's something that you can do any way in all-- and in different methods. 00:17:59.370 --> 00:18:03.347 But don't think of this as a panacea for everything. 00:18:03.347 --> 00:18:07.898 So I guess that would be my-- for those of you out in TV land, 00:18:07.898 --> 00:18:13.208 who are into statistics, the average effect size is about 0.16. 00:18:13.208 --> 00:18:18.953 And it's also important to appreciate, there have now been, I'm guessing 00:18:18.953 --> 00:18:22.530 1,000 studies done on expressive writing. >> Or more. Or more. 00:18:22.530 --> 00:18:28.196 >> And they have been-- they've been done all over the world in every-- with every 00:18:28.196 --> 00:18:30.299 kind of group you could imagine. >> Interesting. 00:18:30.299 --> 00:18:33.360 >> And sometimes it works, sometimes it doesn't. 00:18:33.360 --> 00:18:38.036 And sometimes it-- you know, it depends a lot on the kind of measures they have. 00:18:38.036 --> 00:18:42.555 But there have been five that I know of, meta analyses, so these are 00:18:42.555 --> 00:18:44.921 analyses of large groups of studies. 00:18:45.518 --> 00:18:50.612 And still, this effect size of about 0.16, it bounces around a little bit. 00:18:50.612 --> 00:18:54.444 But it's generally beneficial. >> Yeah, got it. 00:18:54.444 --> 00:18:58.061 And it sounds like there's no systematic group that we would say 00:18:58.061 --> 00:19:01.338 "This never works for them, this is not a group that we want to use 00:19:01.338 --> 00:19:02.395 "this technique with." 00:19:02.855 --> 00:19:05.288 We've talked about the complexities, I think, of using this technique 00:19:05.288 --> 00:19:09.158 with children and their developmental status being the main issue there. 00:19:09.158 --> 00:19:13.516 Obviously, it looks like literacy would be involved here, can you address that 00:19:13.516 --> 00:19:14.808 a little bit for us? 00:19:14.808 --> 00:19:16.350 >> You know, it's funny. 00:19:17.170 --> 00:19:21.356 One of our early studies looked at the maximum security prisoners. 00:19:21.356 --> 00:19:22.504 >> Interesting, yeah. 00:19:22.504 --> 00:19:26.372 >> And-- you know, some of these guys couldn't write worth a damn. 00:19:26.372 --> 00:19:28.724 >> Yeah, low education level-- >> Low education level. 00:19:28.724 --> 00:19:30.323 >> Low (inaudible) or writing ability. 00:19:30.831 --> 00:19:38.643 >> But they-- it did work, an even though they couldn't spell or write well, 00:19:39.453 --> 00:19:43.968 they wrote incredibly powerful stories that were beneficial. 00:19:44.584 --> 00:19:50.886 And we-- occasionally in our research, we come across groups or individuals 00:19:50.886 --> 00:19:52.635 who are essentially not literate. 00:19:53.464 --> 00:19:57.972 And what we have done with them is have them just talk into 00:19:57.972 --> 00:20:02.441 a tape recorder, or we've had them try other kinds of methods. 00:20:02.961 --> 00:20:08.399 So they may have had a little bit of training with writing, but they 00:20:08.399 --> 00:20:09.500 just can't write. 00:20:10.102 --> 00:20:13.029 Or some, they just physically can't write. >> Right. 00:20:13.029 --> 00:20:17.366 >> And some of the methods that had been used, one of my colleagues 00:20:17.366 --> 00:20:23.836 in Mexico, for example, worked with a Mayan group, and one of their 00:20:23.836 --> 00:20:28.106 cultural traditions there are worry dolls, and what he did was have them, 00:20:28.106 --> 00:20:31.270 gave them essentially the writing instructions, but instead of 00:20:31.270 --> 00:20:35.446 writing, they talked to these little worry dolls, and found beneficial 00:20:35.446 --> 00:20:36.240 effects there. 00:20:36.672 --> 00:20:41.092 >> Fascinating, so obviously the writing in and of itself may not be the sort of 00:20:41.092 --> 00:20:43.689 crucial mechanism that we were talking about, but instead 00:20:43.689 --> 00:20:46.868 is something that prompts the thinking-- >> It's the translation into words. 00:20:46.868 --> 00:20:50.663 >> And relates what's happening. >> In fact, another study that 00:20:50.663 --> 00:20:54.830 I'm really proud of, this was done by Anne Krantz, she's a dance therapist 00:20:54.830 --> 00:20:59.858 in San Francisco who was getting her PhD, and came-- and worked 00:20:59.858 --> 00:21:01.240 with me for her PhD. 00:21:01.851 --> 00:21:08.216 And we had people do expressive movement in a room by themselves, you know, 00:21:08.216 --> 00:21:11.781 express your most traumatic experience, or they would do this, and then 00:21:11.781 --> 00:21:13.335 they would write afterwards. 00:21:13.919 --> 00:21:15.895 And then there was a control group. 00:21:15.895 --> 00:21:20.056 And what we found was with the expressive movement, people found this 00:21:20.056 --> 00:21:23.332 to be wonderful, and on their questionnaires, they say 00:21:23.332 --> 00:21:25.261 "It was valuable, meaningful, it changed my life." 00:21:25.895 --> 00:21:29.108 But it had no effect on their physical health, nor on their grades. 00:21:29.108 --> 00:21:32.213 The group that changed were the ones who did the expressive movement 00:21:32.213 --> 00:21:33.732 and they also wrote. 00:21:34.551 --> 00:21:40.253 And if you think of how dance therapy works, or art therapy, 00:21:40.253 --> 00:21:43.909 what happens is the person does this expressive movement, or they 00:21:43.909 --> 00:21:48.559 draw or whatever, but then afterwards, the clinician says 00:21:48.559 --> 00:21:50.195 "Tell me about that." >> "Let's talk about this." 00:21:50.195 --> 00:21:54.555 >> That's right. And I think what happens is that therapy works-- 00:21:54.555 --> 00:22:00.640 that the expression is valuable, it makes you think, but it's the words 00:22:00.640 --> 00:22:02.286 that cement the changes. 00:22:02.286 --> 00:22:05.419 >> That verbalizing, and whatever mechanism of verbalizing 00:22:05.419 --> 00:22:08.502 we're talking about, but the verbalizing is sort of the key in this way. 00:22:08.502 --> 00:22:13.637 >> That's right. And another issue that I think is also important, 00:22:13.637 --> 00:22:19.505 is when we put things into words, there are different ways that 00:22:19.505 --> 00:22:20.435 we can do it. 00:22:20.435 --> 00:22:25.946 So talking is a good one, but there's also-- there's the feedback. 00:22:26.674 --> 00:22:31.039 And one of the things that's always is a high risk for a person is 00:22:31.039 --> 00:22:34.022 "I'm going to tell you something so profoundly personal, 00:22:35.092 --> 00:22:37.074 "and you're not going to validate me." >> Right. 00:22:37.074 --> 00:22:39.341 >> And I think people are nervous even in therapy. 00:22:39.341 --> 00:22:41.383 >> Oh, I know they're nervous even in therapy of that, 00:22:41.383 --> 00:22:43.228 and I think they even have the experience in therapy, 00:22:43.228 --> 00:22:44.592 >> That's right. >> Sometimes, of being invalidated. 00:22:44.592 --> 00:22:47.879 >> That's right. And I think all of us have had that experience sometimes. 00:22:49.015 --> 00:22:51.376 And this is where writing is good. 00:22:51.977 --> 00:22:56.183 But speaking also fast, you know, words just explode out of our mouths. 00:22:56.183 --> 00:22:57.367 >> It is, it's very quick, yeah. 00:22:57.367 --> 00:23:01.131 >> So you can compare, say, typing with writing by hand. 00:23:01.706 --> 00:23:04.113 Or another method that I call finger writing. 00:23:04.460 --> 00:23:08.191 And all of these-- these are kind of different types. Expressive writing 00:23:08.191 --> 00:23:10.597 with typing, so there have been several studies comparing 00:23:10.597 --> 00:23:15.030 expressive writing to typing versus with handwriting. 00:23:15.030 --> 00:23:15.956 >> Versus handwriting, yeah. 00:23:15.956 --> 00:23:20.453 >> And by and large the studies don't show much difference, 00:23:20.453 --> 00:23:23.550 but if you stand back and kind of squint at the data, 00:23:24.320 --> 00:23:25.678 this is called the squint method. 00:23:26.209 --> 00:23:30.195 And you kind of look and you see some slight benefit for handwriting 00:23:30.195 --> 00:23:32.234 over typing, but it's not pretty big. 00:23:33.368 --> 00:23:35.327 And if you're more comfortable just typing... 00:23:35.327 --> 00:23:36.458 >> Just do it, yeah. 00:23:37.958 --> 00:23:41.754 >> I think handwriting might work a little bit better, because it's slower. 00:23:42.081 --> 00:23:46.836 And I think how quickly you write makes a big difference. 00:23:47.981 --> 00:23:50.680 >> I wonder if people slow down over time in the process, 00:23:50.680 --> 00:23:52.829 with themselves, even, as they go. 00:23:52.829 --> 00:23:54.583 >> It could be. 00:23:54.583 --> 00:23:56.991 I've often wondered, actually, if you had a typewriter, 00:23:56.991 --> 00:23:59.625 you had people come in, they write either on their computer, 00:23:59.625 --> 00:24:02.092 on a typewriter, you know, the old manuals where you have to push-- 00:24:02.092 --> 00:24:04.672 >> Boom, boom, boom, yeah, it's more efffort, slower there. 00:24:04.672 --> 00:24:06.479 >> That that might be more beneficial. 00:24:06.771 --> 00:24:09.107 >> What is finger writing, define this for our audience. 00:24:09.107 --> 00:24:11.504 >> I'm the inventor of finger writing. 00:24:11.504 --> 00:24:13.348 >> (laughing) Congratulations. 00:24:13.348 --> 00:24:19.592 >> No, no. So many years ago, my wife and I were travelling in another country, 00:24:19.592 --> 00:24:25.568 we were in some hotel, and I can't remember even what the issue was, 00:24:25.568 --> 00:24:28.519 but I was tossing and turning about some issue that I was dealing with. 00:24:29.154 --> 00:24:33.801 And I didn't want to get up and turn on the light and so forth, so I just 00:24:33.801 --> 00:24:38.817 got up and sat in the chair, and just started writing in the air. 00:24:38.817 --> 00:24:41.476 >> Like as though you were writing and your finger was the pen? 00:24:41.476 --> 00:24:42.430 >> That's right, that's right. 00:24:42.866 --> 00:24:45.279 And I, you know, I'd go like this, and... 00:24:47.049 --> 00:24:51.412 And then I started noticing that "Wow, this works really well." 00:24:51.412 --> 00:24:53.872 And then I tried writing in much bigger letters, which I did-- 00:24:53.872 --> 00:24:54.925 >> Big, loopy letters. 00:24:54.925 --> 00:24:57.699 >> And when you do that, you're slowing it down even more. 00:24:57.699 --> 00:25:00.494 >> Yes you are, that's the connection here between that verbal and movement 00:25:00.494 --> 00:25:01.998 and all. That's interesting. >> That's right. 00:25:02.683 --> 00:25:06.730 And so I then started doing this in workshop, so I would have people 00:25:07.770 --> 00:25:11.426 write by hand, versus they would have one period for you to just 00:25:11.426 --> 00:25:12.702 write by fingers. 00:25:13.369 --> 00:25:16.877 And what I find is a lot of people actually prefer finger writing 00:25:16.877 --> 00:25:18.027 to writing by hand. 00:25:18.495 --> 00:25:21.410 And I would ask people, "Well, what was the difference?" And many people would say 00:25:21.870 --> 00:25:25.891 "Well, I swear more when I'm writing with my fingers," 'cause you know, 00:25:25.891 --> 00:25:27.302 they don't want to leave-- >> More open, they're 00:25:27.302 --> 00:25:29.692 leaving no trace. >> There's no trace, exactly. 00:25:30.007 --> 00:25:33.044 >> Interesting. It's like another level of privacy, almost, 00:25:33.044 --> 00:25:35.658 on the product that you're creating. >> That's exactly right. 00:25:36.408 --> 00:25:37.585 >> That's really neat (laughing). 00:25:37.585 --> 00:25:43.434 >> So-- but all of these, the ultimate goal is translating an emotional 00:25:43.434 --> 00:25:45.375 experience into words. 00:25:45.375 --> 00:25:49.180 And I think that is really a critical dimension. Well in many ways, 00:25:49.180 --> 00:25:51.548 I'm sure that that's a commonality that underlies a lot of 00:25:51.548 --> 00:25:53.911 effective therapies, actually. >> Effective therapies, 00:25:53.911 --> 00:25:56.928 social support. >> Anything that helps us. 00:25:56.928 --> 00:26:02.406 >> Just like religion and prayers, all of these are is that translation process. 00:26:02.685 --> 00:26:05.649 >> Often many I think meditative, and contemplative practices 00:26:05.649 --> 00:26:09.266 also involve that same type of process, that's why it's interesting to 00:26:09.266 --> 00:26:10.549 see that it's there. 00:26:10.549 --> 00:26:15.644 So I wonder-- you know, we talked a lot about sort of the, a bit of the 00:26:15.644 --> 00:26:20.382 symptomatology that people might find is eased through this process, 00:26:20.382 --> 00:26:22.363 sleep problems, for example. 00:26:22.363 --> 00:26:25.067 Obviously frontal lobe-related things, if you're having a cluttered 00:26:25.067 --> 00:26:26.829 working memory, that kind of thing. 00:26:27.159 --> 00:26:30.654 And in my experience of this, those symptoms overlap 00:26:30.654 --> 00:26:33.355 through a lot of different kinds of disorders that we might see 00:26:33.355 --> 00:26:34.328 in clinical practice. 00:26:35.025 --> 00:26:38.061 I don't think that this-- this hasn't really been done, experimenting, 00:26:38.061 --> 00:26:41.104 looking at specific diagnostic groups so much. 00:26:41.421 --> 00:26:44.681 >> Well it kind of has. >> Yeah, so I've talked (inaudible). 00:26:44.681 --> 00:26:50.427 >> In a sense-- and this is so intersting looking at expressive writing 00:26:50.427 --> 00:26:57.545 versus other methods like kind of the official ones, CVT, ACT, 00:26:57.545 --> 00:26:59.750 you know, they all have three letters. (laughter) 00:26:59.750 --> 00:27:03.136 >> Yes, DBT, we've got lots of them. >> Expressive writing is just EW, 00:27:03.136 --> 00:27:05.311 just for... >> 'Cause you're a rebel, 00:27:05.311 --> 00:27:07.260 through and through, there it is. >> (laughing) That's right. 00:27:07.823 --> 00:27:13.578 But expressive writing, because it's, you know, because it's, there's no 00:27:13.578 --> 00:27:17.516 license for it, you don't need a certificate, you just do it. 00:27:18.019 --> 00:27:22.305 And there's no money that changes hands, there haven't been these 00:27:22.305 --> 00:27:27.215 giant RCTs of 10,000 people. >> Yes, indeed. 00:27:27.685 --> 00:27:30.294 Sort of safety and efficacy studies in that way. 00:27:30.294 --> 00:27:34.513 >> That's right. And my approach is, well, why would you want to do it? 00:27:35.266 --> 00:27:38.266 I certainly-- I'm not going to do it. >> Sure. 00:27:38.266 --> 00:27:43.329 >> So what this means is it's been a-- it's kind of been a ground swell of 00:27:43.329 --> 00:27:48.488 small researchers in clinical psychology, social psychology, cognitive psychology, 00:27:48.488 --> 00:27:52.670 and frankly, in anthropology, sociology, and other areas. 00:27:53.610 --> 00:27:58.749 And so you have this giant community that has done this expressive writing, 00:27:59.359 --> 00:28:03.471 and so now we have to look, so this person-- so it's been done with 00:28:03.471 --> 00:28:05.538 people awaiting surgery. 00:28:06.041 --> 00:28:09.765 This is chronic pain, this one has been done on this kind of cancer, 00:28:09.765 --> 00:28:13.736 this one's been done on-- you name a disorder, 00:28:14.126 --> 00:28:16.090 there are studies that have been done. 00:28:17.644 --> 00:28:21.900 Does it work better for some diseases, some people more than others? 00:28:22.462 --> 00:28:28.958 You know, if you stand back and look at it, there's just not a clear answer. 00:28:29.356 --> 00:28:31.978 It seems to be generally beneficial. 00:28:31.978 --> 00:28:34.978 >> Yeah. But it's not so much that we would say this is an empirically 00:28:34.978 --> 00:28:39.150 supported treatment for depression, or for anxiety, or anything 00:28:39.150 --> 00:28:41.863 along that line, but instead that this is much more of a general technique 00:28:41.863 --> 00:28:45.158 that would expect to be potentially beneficial to anyone that's 00:28:45.158 --> 00:28:47.195 carrying something around, really. 00:28:47.195 --> 00:28:51.046 >> That's right. That's right, and so depression would be the obvious one. 00:28:52.122 --> 00:28:54.198 And-- >> But PTSD also, 00:28:54.198 --> 00:28:56.262 and other kinds of anxiety experiences. >> And PTSD is another one. 00:28:56.262 --> 00:29:02.290 And what you see when you look at this is it seems to work, but it's not, 00:29:02.820 --> 00:29:05.485 they're not huge effect sizes, it's very modest, 00:29:05.485 --> 00:29:11.192 and I think people right in the midst of it, so if one of these PTSD studies 00:29:11.192 --> 00:29:15.740 was done right after trauma, which means its really not PTSD, 00:29:15.740 --> 00:29:19.206 it's probably not going to work. >> You know, that's acute stress disorder. 00:29:19.206 --> 00:29:22.905 >> And I think also a person in the-- right in the depths of a 00:29:22.905 --> 00:29:25.538 depressive episode, I would not recommend that. 00:29:25.979 --> 00:29:28.547 >> I doubt they'd be willing to engage in it or able to engage in it. 00:29:28.547 --> 00:29:31.551 >> You know, and I wouldn't even recommend it. 00:29:31.551 --> 00:29:34.472 >> Yeah, yeah. And so this is also something that we would think of 00:29:34.472 --> 00:29:38.002 as being kind of relevant to the therapists as well, right? 00:29:38.002 --> 00:29:40.850 I mean it sounds to me like it's probably, you know, appropriate 00:29:40.850 --> 00:29:44.780 for a general population that would also include the worriers among us, 00:29:44.780 --> 00:29:48.230 the clinicians who are carrying client data around potentially. 00:29:48.825 --> 00:29:51.271 I know you and I had talked about this separately, that there are 00:29:51.271 --> 00:29:53.947 some ways that we might think about this as a tool, possibly, also 00:29:53.947 --> 00:29:59.808 for sort of processing information as a therapist, case conceptualization, 00:29:59.808 --> 00:30:03.553 thinking about how it is that a particular patient is managing things, 00:30:03.553 --> 00:30:07.847 perhaps you would write your deepest thoughts and feelings about a patient. 00:30:07.847 --> 00:30:11.267 >> I think something like that can be really beneficial.