writingtherapy

Chronic Stress & Memory Erosion

The Bright Side of Stress?

Stress is a necessary human experience that keeps us alive.[1] It can be defined by the physical and mental responses we use to combat stressors experienced in our lives, such as threatening situations, insecurity, a tumultuous relationship or academic and work responsibilities.[2] We learn from previous stressors (e.g., avoiding sketchy alleyways we know of, or the signs of “red flags” in a relationship.) These adaptations are how short-term stress can beneficially inform our memory and subsequent learning. Stress-induced fears, anxieties and physiological signals cause us to react to danger or threats so that we know how to avoid a stressor again.

When the brain processes an imminent stressor, the sympathetic nervous system and hypothalamic-pituitary-adrenocortical (HPA) axis react to release adrenaline and glucocorticoids.[3] The sympathetic nervous system activates physiological responses for a fight or flight response. For example, pupils dilate and heart rate increases. The HPA axis regulates the stress response through structures such as the hypothalamus and hippocampus, an important structure for memory, via steroid hormones like cortisol.[4] By a negative feedback loop, the hippocampus’ cortical receptors are activated for the memory and biological learning of a stressful event.[5] As a result, memory is improved following an acute stress response so that our learning is improved for future similar stressful situations.[6,7] 

When Stress Becomes Problematic

While research indicates that short-term or acute stress can promote behavioral adaptations and improve spatial memory, in the same study by Lin et al. (2022), prolonged durations of stress led to behavioral and cognitive impairment in animal models.[8] Relatedly, in humans, long periods of stressful life events lead to cognitive and memory declines in older adults.[9] Additionally, prolonged (i.e., chronic) stress can increase risk of disease and mortality.[10,11] 

Chronic stress causes the body to be constantly out of balance (i.e., allostasis) in response to trying to restore balance (i.e., homeostasis) through energy expenditure.[12] The cumulatively created effect of chronic stress is referred to as allostatic load (when allostasis is repeatedly activated with a lack of adaptation or conclusion of the stress response.)[13] These chronic and repeated stress responses increase cortisol, which negatively affect components of memory (like navigation and long-term memory retention), and structurally damages neurons necessary for memory.[14,15] This leads the human body to be in a constant state of neurological disruption that is not restored, resulting in negative impacts on one’s memory.[16-22]  

Despite these negative health impacts, chronic stress remains an extremely common experience. According to the American Institute of Stress (2022), 94% of American workers say they are stressed at work while 55% of Americans report that they are stressed during any given day.[23] While some degree of stress in life is vital, an allostatic load can decrease well-being and cognition, and should be reduced to promote one’s health and overall life.

What Chronic Stress Looks Like

Chronic stress has particularly negative effects on the hippocampus (related to forming and sustaining memory), amygdala (related to emotional regulation) and neurons in the prefrontal cortex (related to problem-solving and planning).[24] Duman (2004) notes that by using physical restraints on rats, chronic stress was found to decrease neuron length and branching in the hippocampus.[25] Furthermore, increased glucocorticoid circulation leads to decreased neural plasticity (i.e., when neurons adapt and connect to process or establish information), and decreased growth of neurons in the hippocampus.[26] Brain-derived neurotrophic factor (BDNF) signaling, a marker of neural plasticity, is also reduced in the prefrontal cortex and hippocampus following chronic stress.[27] 

Chronic stress essentially impairs memory consolidation and retrieval, making reactivating and forming new information more difficult and less frequent.[28] Memory for spatial and navigating information was found to be impaired due to chronic stress, as well.[29] The body’s homeostatic regulation in response to a prolonged stressor additionally causes chronic neuroinflammation.[30] For these reasons, allostatic load leads to an increased risk of developing certain disorders such as post-traumatic stress disorder (PTSD), depression and neurodegeneration; these risks increase with age and cortisol levels.[31] 

Signs of chronic stress include:[32-34]

  • Emotional dysregulation

  • Decreased memory for events, general knowledge and navigation

  • Social withdrawal

  • Depressive symptoms

  • Increased anxiety and constant worrying

  • Fatigue or low energy

  • Immune system dysregulation and impaired disease resistance

  • High blood pressure

  • Digestive problems

 When chronic stress becomes persistently life-impairing, it can be a significant factor in several disorders, such as those involving anxiety, emotional disruption and cognitive problems. Stress-related cognitive impairment is found in several conditions and disorders:

  • PTSD symptom severity is associated with cognitive decline.[35] 

  • Chronic stress is a risk factor for dementia.[36]

  • In middle age, those with depression and high allostatic load have a higher risk of cognitive decline.[37] 

  • Childhood psychological stress (i.e., childhood poverty) is associated with a greater risk for anxiety-related symptoms and allostatic load in adolescence and adulthood with intensity relating to the duration of the allostatic load.[38] 

  • Impaired memory in depressed individuals is often attributed to chronic stress and its duration.[39]

Those with anxiety and mood disorders tend to experience psychological stress for lengthy periods. This is why high allostatic load is a factor for memory problems as the brain’s hippocampal neurons atrophy or degenerate and plasticity is disrupted by exhausted homeostatic energy expenditure. 

Perceptive Differences 

While individuals with mood or anxiety disorders are more vulnerable to chronic stress and memory impairment, stress responses can still vary by person and are not exclusive to those who experience such disorders. Chronic stress itself is also not a disorder, but a comorbid risk factor for memory impairment that can look different for everyone.

Internal beliefs vary per individual and are subjective, causing certain situations to be stressful to some and not to others, and leading to varied effects on memory. For example, students’ perceived high stress is found to be partially reliant on low self-efficacy (i.e., belief in self-success) and high emotional attention.[40] Additionally, high stress and cortisol levels lead to worsened memory performance such as declarative memory (i.e., memory for general knowledge and events), and cortisol is found to be in higher levels in females than males.[41,42] This is because cortisol levels are impacted by ovarian hormones such as estrogen.[43] Therefore, higher baseline cortisol levels may lead to high cortisol release when responding to stress.[44] For such reasons, cortisol administration is a way of inducing depression in animal models in addition to physical and social stressors due to chronic exposure. Other individual differences (such as age) may impact perceived stress as in older adults; egocentric stressors (e.g., self-health and financial stressors) were found to be detrimental to cognitive functioning as opposed to non-egocentric stressors.[45] 

Societal stressors may also impact the rate and intensity of the stressors that different groups face. For example, individuals of a sexual minority often experience increased impairment in psychosocial adaptation and overall quality of life likely due to negative stereotyping or stigma consciousness.[46] Menhinick & Sanders (2023) note that fear of violence is also an imminent physical stressor that many LGBTQ+ individuals and racial minorities experience, which can induce chronic stress, depression and PTSD.[47] 

Solutions to Mitigate and Overcome Chronic Stress

Several methods can be employed to tackle chronic stress. A social-psychological approach may look at the stressors that arise from social norms. From such a perspective, effortful social change can alleviate minority stress and threats, which removes the fault from the individual experiencing the neurological effects of stressors and targets the creation of the stressors themselves, such as violence and microaggressions arising from biases.[48] 

In terms of regenerating neurological functioning, Hernandez & Brinton (2022) found that allopregnanolone (a neurosteroid) may activate the GABA-chloride complex and can help to promote neurogenesis or the formation of neurons in the brain.[49] Relating to diet, Szala-Rycaj et al. (2023) found that chicory root insulin and topinambur powder, when supplemented long-term, can alleviate anxiety and cognitive disorder-like symptoms that were induced through chronic stress in animal models.[50] Additionally, Duman (2004) notes that antidepressants such as selective serotonin reuptake inhibitors (SSRIs) have been shown to reflect a reversal of neuron atrophy in the hippocampus and promote neural plasticity as well.[51] Note: it is important not to start or stop taking any medications or supplements without first discussing them with your physician and/or pharmacist.

Several evidence-based psychotherapies are effective at preventing and overcoming the effects of chronic stress. Acceptance and Commitment Therapy (ACT) is an approach that focuses on the awareness of mental states and thoughts with particular effectiveness for mood and anxiety disorders.[52] Mindfulness-Based Therapy (MBT) additionally reduces stress through attention to physical experiences and meditation.[53] This modality directly targets psychological stress reduction by promoting relaxation and building mindfulness skills. Cognitive Behavioral Therapy (CBT) is effective in treating stress-related disorders such as PTSD, anxiety, and depression by utilizing cognitive-restructuring of negatively-formed or maladaptive thoughts and behaviors that cause stress.[54] 

Due to the variety of potential stressors that one can experience and the individuality of perceived stress responses, it is possible that a combination of stressor-targeting and personal psychological support is necessary for both avoiding chronic stress and memory impairment, in addition to recovering from chronic stress. In everyday life, acute stress is beneficial for memory and the body, but chronic stress that takes both physical and psychological forms should be avoided as much as possible. Lowering chronic stress may further be promoted through prioritizing safety, relaxation, nutrition, time in nature, engaging in therapy to find ways to cope with stressors, and decreasing time on social media.[55] 

Moreover, this responsibility to avoid chronic stress is not always carried solely by the individual but is also held by a network of people that socially impact each other’s lives every day. In order to reduce the negative memory and health effects of chronic stress, both the individual and the environment by which they interact should be addressed. Stress and memory research continues to rapidly evolve, and may eventually be able to determine how to quantify, possibly by time and neural information, dangerous amounts of allostatic load on the brain and the processes of memory.  

If one is experiencing prolonged or chronic stress that is impacting daily life and overall well-being, please reach out to a licensed mental health professional (e.g., a psychotherapist, psychologist or psychiatrist) for guidance and support.

Contributed by: Phoebe Elliott

Editor: Jennifer (Ghahari) Smith, Ph.D.

References

1 Hadany, L., Beker, T., Eshel, I., & Feldman, M. W. (2006). Why is stress so deadly? An evolutionary perspective. Proceedings. Biological sciences, 273(1588), 881–885. https://doi.org/10.1098/rspb.2005.3384

2 American Psychological Association. (2023). Stress. In APA Dictionary of Psychology. https://dictionary.apa.org/stress?amp=1 

3 Lenart-Bugla, M., Szcześniak, D., Bugla, B., Kowalski, K., Niwa, S., Rymaszewska, J., & Misiak, B. (2022). The association between allostatic load and brain: A systematic review. Psychoneuroendocrinology, 145, 105917. https://doi.org/10.1016/j.psyneuen.2022.105917

4 Peavy, G. M., Salmon, D. P., Jacobson, M. W., Hervey, A., Gamst, A. C., Wolfson, T., Patterson, T. L., Goldman, S., Mills, P. J., Khandrika, S., & Galasko, D. (2009). Effects of chronic stress on memory decline in cognitively normal and mildly impaired older adults. The American journal of psychiatry, 166(12), 1384–1391. https://doi.org/10.1176/appi.ajp.2009.09040461

5 Ibid.

6 Lenart-Bugla et al. (2022)

7 Peavy et al. (2009)

8 Lin, L., Zhang, J., Dai, X., Xiao, N., Ye, Q., & Chen, X. (2022). A moderate duration of stress promotes behavioral adaptation and spatial memory in young C57BL/6J mice. Brain Sciences, 12(8) doi:10.3390/brainsci12081081

9 Peavy et al. (2009)

10 Bobba-Alves, N., Juster, R. -., & Picard, M. (2022). The energetic cost of allostasis and allostatic load. Psychoneuroendocrinology, 146 doi:10.1016/j.psyneuen.2022.105951

11 Selye, H. (1950). Stress and the general adaptation syndrome. British medical journal, 1(4667), 1383–1392. https://doi.org/10.1136/bmj.1.4667.1383

12 Bobba-Alves et al. (2022)

13 Lenart-Bugla et al. (2022)

14 Akan, O., Bierbrauer, A., Kunz, L., Gajewski, P. D., Getzmann, S., Hengstler, J. G., Wascher, E., Axmacher, N., & Wolf, O. T. (2023). Chronic stress is associated with specific path integration deficits. Behavioural brain research, 442, 114305. https://doi.org/10.1016/j.bbr.2023.114305

15 Kirschbaum, C., Wolf, O. T., May, M., Wippich, W., & Hellhammer, D. H. (1996). Stress- and treatment-induced elevations of cortisol levels associated with impaired declarative memory in healthy adults. Life sciences, 58(17), 1475–1483. https://doi.org/10.1016/0024-3205(96)00118-x

16 Peavy et al. (2009)

17  Bobba-Alves et al. (2022)

18 Lenart-Bugla et al. (2022)

19 Prieto, S., Nolan, K. E., Moody, J. N., Hayes, S. M., Hayes, J. P., & Department of Defense Alzheimer’s Disease Neuroimaging Initiative (2023). Posttraumatic stress symptom severity predicts cognitive decline beyond the effect of Alzheimer's disease biomarkers in Veterans. Translational psychiatry, 13(1), 102. https://doi.org/10.1038/s41398-023-02354-0

20 Perlman, G., Cogo-Moreira, H., Wu, C. -., Herrmann, N., & Swardfager, W. (2022). Depression interacts with allostatic load to predict cognitive decline in middle age. Psychoneuroendocrinology, 146 doi:10.1016/j.psyneuen.2022.105922

21 Duman R. S. (2004). Neural plasticity: consequences of stress and actions of antidepressant treatment. Dialogues in clinical neuroscience, 6(2), 157–169. https://doi.org/10.31887/DCNS.2004.6.2/rduman

22 Kirschbaum et al. (1996)

23 The American Institute of Stress. (2022). What is Stress? https://www.stress.org/daily-life 

24 Lenart-Bugla et al. (2022)

25 Duman (2004)

26 Ibid.

27 Ibid. 

28 Lenart-Bugla et al. (2022)

29 Akan et al. (2023)

30 Craddock, T. J. A., Michalovicz, L. T., Kelly, K. A., Rice, M. A., Jr., Miller, D. B., Klimas, N. G., . . . Broderick, G. (2018). A logic model of neuronal-glial interaction suggests altered homeostatic regulation in the perpetuation of neuroinflammation. Frontiers in Cellular Neuroscience, 12 doi:10.3389/fncel.2018.00336 

31 Palego, L., Giannaccini, G., & Betti, L. (2021). Neuroendocrine response to psychosocial stressors, inflammation mediators and brain-periphery pathways of adaptation. Central Nervous System Agents in Medicinal Chemistry, 21(1), 2-19. doi:10.2174/1871524920999201214231243 

32 National Institutes of Health. (2022). Stress. In The National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/stress 

33 Mariotti A. (2015). The effects of chronic stress on health: new insights into the molecular mechanisms of brain-body communication. Future science OA, 1(3), FSO23. https://doi.org/10.4155/fso.15.21

34 Yaribeygi, H., Panahi, Y., Sahraei, H., Johnston, T. P., & Sahebkar, A. (2017). The impact of stress on body function: A review. EXCLI journal, 16, 1057–1072. https://doi.org/10.17179/excli2017-480

35 Prieto et al. (2023)

36 Ibid.

37 Perlman et al. (2022)

38 De France, K., Evans, G. W., Brody, G. H., & Doan, S. N. (2022). Cost of resilience: Childhood poverty, mental health, and chronic physiological stress. Psychoneuroendocrinology, 144 doi:10.1016/j.psyneuen.2022.105872 

39 Dillon, D. G., & Pizzagalli, D. A. (2018). Mechanisms of Memory Disruption in Depression. Trends in neurosciences, 41(3), 137–149. https://doi.org/10.1016/j.tins.2017.12.006

40 Navarro-Mateu, D., Alonso-Larza, L., Gómez-Domínguez, M. T., Prado-Gascó, V., & Valero-Moreno, S. (2020). I’m not good for anything and That’s why I’m stressed: Analysis of the effect of self-efficacy and emotional intelligence on student stress using SEM and QCA. Frontiers in Psychology, 11 doi:10.3389/fpsyg.2020.00295

41 Kirschbaum et al. (1996)

42 Wolf, O. T., Schommer, N. C., Hellhammer, D. H., McEwen, B. S., & Kirschbaum, C. (2001). The relationship between stress induced cortisol levels and memory differs between men and women. Psychoneuroendocrinology, 26(7), 711–720. https://doi.org/10.1016/s0306-4530(01)00025-7

43 Edwards, K. M., & Mills, P. J. (2008). Effects of estrogen versus estrogen and progesterone on cortisol and interleukin-6. Maturitas, 61(4), 330–333. https://doi.org/10.1016/j.maturitas.2008.09.024

44 Wolf et al. (2001)

45 De France et al. (2022)

46 Dispenza, F. (2023). Chronic illness and disability among sexual minority persons: Exploring the roles of proximal minority stress, adaptation, and quality of life. Psychology of Sexual Orientation and Gender Diversity, doi:10.1037/sgd0000642

47 Menhinick, K. A., & Sanders, C. J. (2023). LGBTQ+ stress, trauma, time, and care. Pastoral Psychology, doi:10.1007/s11089-023-01073-z

48 Riggs, D. W., & Treharne, G. J. (2017). Decompensation: A novel approach to accounting for stress arising from the effects of ideology and social norms. Journal of Homosexuality, 64(5), 592-605. doi:10.1080/00918369.2016.1194116

49 Hernandez, G. D., & Brinton, R. D. (2022). Allopregnanolone: Regenerative therapeutic to restore neurological health. Neurobiology of Stress, 21 doi:10.1016/j.ynstr.2022.100502

50 Szala-Rycaj, J., Szewczyk, A., Zagaja, M., Kaczmarczyk-Ziemba, A., Maj, M., & Andres-Mach, M. (2023). The influence of topinambur and inulin preventive supplementation on microbiota, anxious behavior, cognitive functions and neurogenesis in mice exposed to the chronic unpredictable mild stress. Nutrients, 15(9) doi:10.3390/nu15092041

51  Duman (2004)

52 Wersebe, H., Lieb, R., Meyer, A. H., Hofer, P., & Gloster, A. T. (2018). The link between stress, well-being, and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention. International journal of clinical and health psychology : IJCHP, 18(1), 60–68. https://doi.org/10.1016/j.ijchp.2017.09.002

53 Hofmann, S. G., Sawyer, A. T., Witt, A. A., & Oh, D. (2010). The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review. Journal of consulting and clinical psychology, 78(2), 169–183. https://doi.org/10.1037/a0018555

54 Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive therapy and research, 36(5), 427–440. https://doi.org/10.1007/s10608-012-9476-1

55 National Institutes of Health. (2022). Stress. In The National Center for Complementary and Integrative Health. https://www.nccih.nih.gov/health/stress

Writing to Heal

A Basis in Bibliotherapy

The use of writing as a tool in the health field is not a new concept; it has roots in bibliotherapy, a form of therapy that began in the 5th century BCE. This therapy was based on the belief that literature could help people face the challenges that would arise in their daily lives, and was often used to treat melancholia (a condition of profound sadness and despair). It wasn’t until the 20th century that writing in therapy began to truly gain traction in the psychological world.[1]

Sigmund Freud, the founding father of psychoanalysis, is largely responsible for the growth of writing in therapy as a result of his 1907 presentation “Creative Writers and Day Dreaming” (which was eventually written and published). His speech bolstered the concept of writing as a therapy tool and it only continued to grow throughout the 1930s and 1940s, during which time the use of creative arts in therapy became popularized.[2] Currently, writing is one of the most commonly-used tools with patients in psychotherapy, even if it isn’t the focus of the therapy nor the core tool used.[3]

TYPES OF WRITING IN THERAPY

Writing can take several forms within a therapeutic setting. The first is free writing, which often comes in the form of journaling. When free writing, the client’s only instruction is to write what is on their mind; to put their thoughts on paper in whatever form they come in, without censoring or altering them.[4] Though this may seem basic, it’s entirely common for people to try and reject thoughts that they don’t find appealing. They often worry that, by acknowledging these thoughts, they’ll also be giving them credibility, or making them true.[5] However, repressing or denying thoughts instead of addressing them will only do more harm than good in the long run; thus, giving the client a space where they can express all of their thoughts (and easily reflect on them later) can be incredibly beneficial. 

Writing poetry is another often recommended outlet, for similar reasons. It provides a creative, positive avenue for a client to express their thoughts and emotions, and helps them channel even negative feelings into something productive.[6]

Letter writing is another common tool used in therapy. Essentially, the client is tasked with writing a letter; the recipient of the letter varies. It may be to themselves, to someone in their life they have unresolved issues with, or to a concept or issue that they’ve personified for the sake of the exercise. However, the letter will never actually be sent to anyone. Its purpose is to allow the client to communicate their feelings (on a given issue or person) to themselves more than to anyone else. By writing them down and expressing them in a way that would help the other person (whether they’re real or imaginary) understand their emotions and perspective, the client can gain a better understanding of their emotions on the matter.[7]

While it does not technically include writing, storytelling can also be used with young children in therapy in a manner very similar to (or even crossing over with) play therapy. One particularly famous example involves the use of dolls. In this exercise, the therapist gives their child client one or two dolls, and instructs them to tell the therapist a story using the dolls. In theory, the story the child tells using the dolls would be reflective of their own experiences, giving the therapist insight into the child’s understanding of and perspective on what they have gone through.

DISORDERS MOST-BENEFITED

Writing is commonly used to treat PTSD, anxiety and depression.[8] For all three psychological disorders, writing is helpful because it allows the patient to externalize their mental processes and emotions in a way that is productive and generally isn’t harmful to themselves or to others. Regarding PTSD, an example of writing therapy is demonstrated in a 2013 study by Lorenz et al.; they invited 70 women who experienced childhood sexual abuse to participate in five weekly 30-minute sessions that included writing therapy. In these sessions, participants would write about their traumas and sexual schemas. Then, at three different intervals—two weeks, one month and six months (post study) they were asked to complete questionnaires centered around their PTSD symptoms, depression, and sexual functioning. Not only did participants report fewer PTSD symptoms post-treatment, but those who wrote about their sexual schemas reported experiencing less sexual dysfunction.[9]

Writing can also be beneficial in treating anxiety. In 2020, the Tabriz University of Medical Sciences in Iran performed a study in which they administered three writing therapy sessions to pregnant women. Each week, they utilized writing therapy in different ways. In the first, the women were tasked with writing about concerns they had about their pregnancy and possible solutions. In the second, they were asked to write a story about their concerns, in which they applied the solutions they had brainstormed in the previous section. Finally, in the third, participants were led through a group discussion about their previous assignments. At the end of the study, the research team concluded that the women who had participated in writing therapy had much lower anxiety levels than the control group, despite having only experienced three sessions.[10]

Patients with depression can also benefit from writing therapy. In a 2014 study published in Cognitive Therapy and Research, two groups of undergraduate students were gathered and given separate tasks. The first was asked to engage in non-emotional writing (i.e., writing that does not focus on complicated emotions or traumatizing experiences). The second was asked to participate in emotional writing, with a special focus on emotional acceptance of traumatic experiences. At the end of the study, those who had engaged in emotional writing saw a reduction in their depressive symptoms, while those who had conducted non-emotional writing saw no change.[11]

Writing can also be used to treat issues that are not fully-fledged psychological disorders. When a person is looking to improve their self-esteem, process bereavement, find perspective or avoid relapses, their mental health provider may recommend incorporating writing into their treatment plan.[12] Writing is also frequently used with patients who have terminal or life-threatening illnesses. In addition to providing clients with an outlet for the undoubtedly complex, intense emotions they have about their condition, Murray (2002) notes that writing about one’s emotions and stress has been shown to improve immune functioning.[13]

ADDITIONAL BENEFITS OF WRITING THERAPY

There are numerous benefits to writing in therapy, including physical benefits. In addition to increasing immune function (though the exact explanation as to how has not yet been discovered),[14] Moy (2017) notes that writing has also been shown to lessen stress, lower blood pressure and can even improve liver function.[15] 

The benefits of writing extend beyond physical advantages. Students who engage in writing therapy often experience an improvement in their grades, likely in part because writing also strengthens a person’s memory (both in the sense of making them more apt to remember specific information and by improving their recall abilities). Writing also generally results in decreased symptoms of depression and reduced emotional distress, which can result in fewer missed days of work or school compared to those who don’t utilize writing therapy.[16]

Further, writing is a versatile tool that can be used in a variety of therapies, in one form or another. It also requires few resources, making it easily and readily available to clients.

LIMITATIONS

There are few disadvantages to writing therapy. Some patients will benefit with writing therapy more than others and some forms of writing will prove to be more effective than others, based on the individual. Therefore, it’s important to utilize different forms of writing until the one with greatest efficacy is determined. 

The biggest points of contention among psychologists regarding writing include: the discussion of venting vs. healing; and the risk of retraumatizing patients. Depending on the manner in which writing is utilized, a mental health provider may ask the patient to write about a traumatic experience that they endured. In doing so, the patient must, to some degree, relive the experience, and some psychologists worry that the process of reliving the trauma will only do the patient more harm than good.[17] Others argue that avoiding acknowledgment of the trauma is the real danger, and while the process of reliving the experience may be difficult or painful in the moment, the long-term relief will be worth the short-term struggle.[18]

If you’re interested in pursuing writing in therapy and exploring the psychological benefits of this modality, please reach out to a licensed mental health professional to discuss options and plan a course of action.

Contributed by: Jordan Rich

Editor: Jennifer (Ghahari) Smith, Ph.D.

1  Moy, J.D. (2017). Reading and writing one’s way to wellness: The history of bibliotherapy and scriptotherapy. New Directions in Literature and Medicine Studies, 15-30.  https://doi.org/10.1057/978-1-137-51988-7_2

2 Ibid.

3 Exploring Your Mind. (2018). Writing as a Therapeutic Tool.  https://exploringyourmind.com/writing-therapeutic-tool/

4 Tartakovsky, M. (2015). The Power of Writing: 3 Types of Therapeutic Writing. Psych Central. https://psychcentral.com/blog/the-power-of-writing-3-types-of-therapeutic-writing#1

5 Ibid.

6 Ibid.

7 Ibid.

8  Anderson, B. L., & Cyranowski, J. M. (1994). Women’s sexual self-schema. Journal of Personality and Social Psychology, 67(6), 1079–1100. https://doi.org/10.1037/0022-3514.67.6.1079

9  Lorenz, T. A., Meston, C. M., & Stephenson, K. R. (2013). Effects of expressive writing on sexual dysfunction, depression, and PTSD in women with a history of childhood sexual abuse: Results from a randomized clinical trial. The Journal of Sexual Medicine, 10(9), 2177–2189. https://doi.org/10.1111/jsm.12247

10  Esmaeilpour, K., Golizadeh, S., Mirghafourvand, M., Mohammad-Alizadeh-Charandabi, S., & Montazeri, M. (2020). The effect of writing therapy on anxiety in pregnant women: A randomized controlled trial. Iranian Journal of Psychiatry and Behavioral Sciences, 14(2). https://doi.org/10.5812/ijpbs.98256

11  Baum, E. S., & Rude, S. S. (2013). Acceptance-enhanced expressive writing prevents 

symptoms in participants with low initial depression. Cognitive Therapy and Research, 

37. 35-42. https://doi.org/10.1007/s10608-012-9435-x

12 Exploring Your Mind (2018)

13 Murray, B. (2002). Writing to Heal. Monitor on Psychology, 33(6), 54. 

https://www.apa.org/monitor/jun02/writing

14 Ibid.

15 Moy (2017)

16 Ibid.

17 Capozzi, B. (2021). The Benefits and Drawbacks of Therapeutic Writing. Step Up for Mental Health. 

https://www.stepupformentalhealth.org/benefits-and-drawbacks-of-therapeutic-writing/

18 Ibid.