Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-25T12:40:51.470Z Has data issue: false hasContentIssue false
  • English
  • Français

Does emotional disclosure have any effects? A systematic review of the literature with meta-analyses

Published online by Cambridge University Press:  26 April 2005

Catherine Meads  and
Arie Nouwen
Catherine Meads
Affiliation:
University of Birmingham
Arie Nouwen
Affiliation:
University of Birmingham
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Emotional disclosure has been widely publicized as having beneficial effects on physical and psychological health. A full systematic review was undertaken, with standard health technology appraisal methods, with the aim to assess the effects of emotional disclosure on healthy participants and those with pre-existing morbidity, particularly on longer-term physical health, performance, and psychological outcomes.

Methods: Randomized controlled trials of emotional disclosure were obtained from database searches (Medline (1966–2003), Embase (1980–2003), Cochrane Library (2002, issue 4), Web of Science (1981–2003), Cinahl (1982–2003), and Theses (March 2003), Internet sites (including Professor J.W. Pennebaker's home pages), and personal contacts. Quality was assessed qualitatively and by Jadad score. Meta-analysis was conducted, using Revman 4.1 software, where more than two trials reported the same outcome.

Results: Sixty-one trials were found meeting the inclusion criteria. Most had less than 100 participants and the median Jadad score was 0. A wide variety of physical, physiological, immunological, performance, and psychological outcomes were measured, but fewer were reported. There was no clear improvement for emotional disclosure compared with controls in objectively measured physical health and most other outcomes assessed.

Conclusions: The opinion that this intervention is beneficial needs to be reassessed in light of the totality of evidence available.

Keywords

Systematic reviewMeta-analysisEmotional disclosureHealth technology assessment
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 21 , Issue 2 , April 2005 , pp. 153 - 164
Copyright
© 2005 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychological Association. 1994. Publication manual of the American Psychological Association. 4th ed. Washington, DC: American Psychological Association
Barry LM. 2000. The benefits of journal writing: Reducing maternal psychological distress levels after the neonatal intensive care unit. PhD Thesis. Santa Barbara, CA: University of California
Batten SV, Follette VM, Hall ML, Palm KM. 2002 Physical and psychological effects of written disclosure among sexual abuse survivors. Behav Ther. 33: 107– 122.Google Scholar
Booth RJ, Petrie KJ, Pennebaker JW. 1997 Changes in circulating lymphocyte numbers following emotional disclosure: Evidence of buffering? Stress Med. 13: 23– 29.Google Scholar
Bootzin RR. 1997 Examining the theory and clinical utility of writing about emotional experiences. Psychol Sci. 8: 167– 169.Google Scholar
Cameron LD, Nicholls G. 1998 Expression of stressful experiences through writing: Effects of a self-regulation manipulation for pessimists and optimists. Health Psychol. 17: 84– 92.Google Scholar
Clarke M, Oxman A, eds. 2003. Cochrane Reviewers' Handbook 4.2.0. Oxford: The Cochrane Library, Update Software
Czajka JA. 1987. Behavioral inhibition and short-term physiological responses. MA Thesis. Southern Methodist University, Dallas, TX, USA
D'Souza P, Lumley MA, Kraft C, et al. 2003. Emotional disclosure and relaxation training for migraine and tension headaches: A randomised trial. Phoenix, AZ. Presentation to 61st Annual Scientific Meeting of the American Psychosomatic Society
de Moor C, Sterner J, Hall ML, et al. 2002 A pilot study of the effects of expressive writing on psychological and behavioural adjustment in patients enrolled in a phase II trial of vaccine therapy for metastatic renal cell carcinoma. Health Psychology. 21: 615– 619.Google Scholar
de Moor C, Warneke C, Sterner J, et al. 2001 Emotional expression writing program for cancer patients. Psychosom Med. 63: 1143.Google Scholar
Derogatis LR, Rickels K, Rock AF. 1976 The SCL-90 and the MMPI: A step in the validation of a new self-report scale. Br J Psychiatry. 128: 280– 289.Google Scholar
Dickerson SS, Kemeny ME, Aziz N, Kim KH, Fahey JL. 2001 Immunological effects of induced shame and guilt. Psychosom Med. 63: 159.Google Scholar
Donnelly DA, Murray EJ. 1991 Cognitive and emotional changes in written essays and therapy interviews. J Soc Clin Psychol. 10: 334– 350.Google Scholar
Esterling BA, Antoni MH, Fletcher MA, Margulies S, Schneiderman N. 1994 Emotional disclosure through writing or speaking modulates latent Epstein-Barr virus antibody titres. J Consult Clin Psychol. 62: 130– 140.Google Scholar
Esterling BA, L'Abate L, Murray EJ, Pennebaker JW. 1999 Empirical foundations for writing in prevention and psychotherapy: Mental and physical health outcomes. Clin Psychol Rev. 19: 79– 96.Google Scholar
Francis ME, Pennebaker JW. 1992 Putting stress into words: The impact of writing on physiological, absentee and self-reported emotional well-being measures. Stress Manag. 6: 280– 287.Google Scholar
Freemantle N, Calvert M, Woods J, Eastaugh J, Griffin C. 2003 Composite outcomes in clinical trials. Greater precision but with greater uncertainty? JAMA. 289: 2554– 2559.Google Scholar
Gallagher P, Maclachlan M. 2002 Evaluating a written emotional disclosure homework intervention for lower-limb amputees. Arch Phys Med Rehabil. 83: 1464– 1466.Google Scholar
Gidron Y, Duncan E, Lazar A, et al. 2002 Effects of guided written disclosure of stressful experiences on clinic visits and symptoms in frequent clinic attenders. Fam Pract. 19: 161– 166.Google Scholar
Gidron Y, Peri T, Connolly JF, Shalev AY. 1996 Written disclosure in posttraumatic stress disorder: Is it beneficial for the patient? J Nerv Ment Dis. 184: 505– 507.Google Scholar
Gillis ME, Lumley MA, Koch H, et al. 2002 Written emotional disclosure in fibromyalgia: Effects on sleep quality and fatigue. Sleep. 25: 538.Google Scholar
Greenberg MA, Stone AA. 1992 Emotional disclosure about traumas and its relation to health: Effects of previous disclosure and trauma severity. J Pers Soc Psychol. 63: 75– 84.Google Scholar
Greenberg MA, Wortman CB, Stone AA. 1996 Emotional expression and physical health: Revising traumatic memories or fostering self regulation? J Pers Soc Psychol. 71: 588– 602.Google Scholar
Greenhalgh T. 1999 Writing as therapy, effects on immune mediated illness need substantiation in independent studies. BMJ. 319: 270– 271.Google Scholar
Hannay D, Bolton G. 1999 Therapeutic writing in primary care: A feasibility study. Prim Care Psychiatry. 5: 157– 160.Google Scholar
Horowitz MJ, Wilner N, Alvarez W. 1979 Impact of events scale: A measure of subjective stress. Psychosom Med. 41: 209– 218.Google Scholar
Hughes CF. 1993. Effects of expressing negative and positive emotions and insight on health and adjustment to college. PhD Thesis. Southern Methodist University, Dallas, TX, USA
Hughes CF, Uhlmann C, Pennebaker JW. 1994 The body's response to processing emotional trauma: Linking verbal text with autonomic activity. J Personality. 62: 565– 585.Google Scholar
Jadad A, Moore R, Carroll D. 1996 Assessing the quality of reports of randomised clinical trials: Is blinding necessary? Control Clin Trials. 17: 1– 12.Google Scholar
Kelley JE, Lumley MA, Leisen JC. 1997 Health effects of emotional disclosure in rheumatoid arthritis patients. Health Psychol. 16: 331– 340.Google Scholar
King LA. 2001 The health benefits of writing about life goals. Pers Soc Psychol Bull. 27: 798– 807.Google Scholar
King LA, Miner KN. 2000 Writing about the perceived benefits of traumatic events: Implications for physical health. Pers Soc Psychol Bull. 26: 220– 230.Google Scholar
Klapow JC, Schmidt SM, Taylor LA, et al. 2001 Symptom management in older primary care patients: Feasibility of an experimental, written self-disclosure protocol. Ann Intern Med. 134: 905– 911.Google Scholar
Klein DJ, Cacioppo JT. 1996 The effects of emotional disclosure and traumatic life event history on blood pressure and heart rate in college-aged females. Psychophysiology. 33: S51.Google Scholar
Klein K, Boals A. 2001 Expressive writing can increase working memory capacity. J Exp Psychol Gen. 130: 520– 533.Google Scholar
Kloss JD, Lisman SA. 2002 An exposure based examination of the effects of written emotional expression. Br J Health Psychol. 7: 31– 46.Google Scholar
Kovac SH, Range L. 2000 Writing projects: Lessening undergraduates' unique suicidal bereavement. Suicide Life Threat Behav. 30: 50– 60.Google Scholar
Lepore SJ. 1997 Expressive writing moderates the relation between intrusive thoughts and depressive symptoms. J Pers Soc Psychol. 73: 1030– 1037.Google Scholar
Lepore SJ, Greenberg MA. 2002 Mending broken hearts: Effects of expressive writing on mood, cognitive processing, social adjustment and health following a relationship breakup. Psychol Health. 17: 547– 560.Google Scholar
Littrell J. 1998 Is the Re-experience of painful emotion therapeutic? Clin Psychol Rev. 18: 71– 102.Google Scholar
Lumley M, Leegstra S, Provenzano K, Warren V. 1999 The health effects of writing about emotional stress on physically symptomatic young adults. Psychosom Med. 61: 84–130: 89.Google Scholar
Lumley MA, Provenzano K. 2003 Stress management through written emotional disclosure improves academic performance among college students with physical symptoms. J Educ Psychol. 95: 641– 649.Google Scholar
Mann T. 2001 Effects of future writing and optimism on health behaviors in HIV-infected women. Ann Behav Med. 23: 26– 33.Google Scholar
Marlo H, Wagner MK. 1999 Expression of negative and positive events through writing: Implications for psychotherapy and health. Psychol Health. 14: 193– 215.Google Scholar
Meads CA, Lyons A, Carroll D. 2003. The impact of the emotional disclosure intervention on physical and psychological health—a systematic review. Birmingham, UK: WMTAC, Department of Public Health and Epidemiology, University of Birmingham; Report number 43.
Meyer T, Lumley MA, Markowitz A, et al. 2003. Written and verbal emotional disclosure about stress in patients with rheumatoid arthritis. Phoenix, AZ. Presentation to 61st Annual Scientific Meeting of the American Psychosomatic Society, March 5-8,
Moher D, Schulz KF, Altman DG. 2001 The CONSORT Statement: Revised recommendations for improving the quality of reports of parallel-group randomised trials. Lancet. 357: 1191– 1194.Google Scholar
Murray EJ, Lamnin AD, Carver CC. 1989 Emotional expression in written essays and psychotherapy. J Soc Clin Psychol. 8: 414– 429.Google Scholar
Murray EJ, Segal DL. 1994 Emotional processing in vocal and written expression of feelings about traumatic experiences. J Trauma Stress. 7: 391– 405.Google Scholar
O'Neill HK, Smyth JM. 2002. Effects of written disclosure on post-disaster psychological adjustment and symptomatology. Available at: http://www.colorado.edu/hazards/qr/qr138/qr138.htm.. Accessed: November 7,
Pennebaker JW. 1982. The psychology of physical symptoms. New York: Springer
Pennebaker JW. 1993 Putting stress into words: Health, linguistic, and therapeutic implications. Behav Res Ther. 31: 539– 548.Google Scholar
Pennebaker JW. 1997 Writing About emotional experiences as a therapeutic process. Psychol Sci. 8: 162– 166.Google Scholar
Pennebaker JW. 2002. Reference list of writing/disclosure studies. Available at: http://homepage.psy.utexas.edu/homepage/faculty/Pennebaker/Reprints/writingrefs.html. Accessed
Pennebaker JW, Barger SD, Tiebout J. 1989 Disclosure of traumas and health among holocaust survivors. Psychosom Med. 51: 577– 589.Google Scholar
Pennebaker JW, Beall SK. 1986 Confronting a traumatic event: Toward an understanding of inhibition and disease. J Abnorm Psychol. 95: 274– 281.Google Scholar
Pennebaker JW, Colder M, Sharp LK. 1990 Accelerating the coping process. J Pers Soc Psychol. 58: 528– 537.Google Scholar
Pennebaker JW, Francis ME. 1996 Cognitive, emotional and language processes in disclosure. Cogn Emotion. 10: 601– 626.Google Scholar
Pennebaker JW, Hughes CF, O'Heeron RE. 1987 The psychophysiology of confession: Linking inhibitory and psychosomatic processes. J Pers Soc Psychol. 52: 781– 793.Google Scholar
Pennebaker JW, Kiecolt-Glaser JK, Glaser R. 1988 Disclosure of traumas and immune function: Health implications for psychotherapy. J Consult Clin Psychol. 56: 239– 245.Google Scholar
Pennebaker JW, Seagal JD. 1999 Forming a story: The health benefits of narrative. J Clin Psychol. 55: 1243– 1254.Google Scholar
Petrie KJ, Booth RJ, Pennebaker JW. 1998 The immunological effects of thought suppression. J Pers Soc Psychol. 75: 1264– 1272.Google Scholar
Petrie KJ, Booth RJ, Pennebaker JW, Davison KP, Thomas MG. 1995 Disclosure of trauma and immune response to a hepatitis B vaccination program. J Consult Clin Psychol. 63: 787– 792.Google Scholar
Range L, Kovac SH. 2002 Can writing autobiographical essays lessen suicidal thinking? Arch Suicide Res. 6: 373– 382.Google Scholar
Range L, Kovac SH, Marion MS. 2000 Does writing about the bereavement lessen grief following sudden, unintentional death? Death Studies. 24: 115– 134.Google Scholar
Reynolds M, Brewin CR, Saxton M. 2000 Emotional disclosure in school children. J Child Psychol Psychiatry. 41: 151– 159.Google Scholar
Richards JM, Beal WE, Seagal JD, Pennebaker JW. 2000 Effects of disclosure of traumatic events on illness behavior among psychiatric prison inmates. J Abnorm Psychol. 109: 156– 160.Google Scholar
Rosenberg HJ, Rosenberg SD, Ernstoff MS, et al. 2002 Expressive disclosure and health outcomes in a prostate cancer population. Int J Psychiatr Med. 32: 37– 53.Google Scholar
Schoutrop M, Brosschot JF, Lange AJ. 1999 Writing assignments after trauma: Decreased re-experiencing and within/across session physiological habituation. Psychosom Med. 61: 84–130: 95.Google Scholar
Schoutrop M, Lange A, Hanewald G, Davidovich U. 2002 Structured writing and processing major stressful events: A controlled trial. Psychother Psychosom. 71: 151– 157.Google Scholar
Sheffield D, Duncan E, Thomson K, Johal SS. 2002 Written emotional expression and well-being: Result from a home-based study. Aust J Disaster Trauma Studies. 1: 1– 13.Google Scholar
Sloan DM, Marx BP, Soler-Baillo J. 2002 Physiological correlates of emotional processing through written disclosure. Psychophysiology. 39: S77.Google Scholar
Smyth JM. 1998 Written emotional expression: Effect sizes, outcome types and moderating variables. J Consult Clin Psychol. 66: 174– 184.Google Scholar
Smyth JM, Anderson C, Hockemeyer J, Stone AA. 2002 Does emotional non-expressiveness or avoidance interfere with writing about stressful life events? An analysis in patients with chronic illness. Psychol Health. 17: 561– 569.Google Scholar
Smyth JM, Hockemeyer J, Anderson C, et al. 2002 Structured writing about a natural disaster buffers the effect of intrusive thoughts on negative affect and physical symptoms. Aust J Disaster Trauma Studies. 1: 1– 10.Google Scholar
Smyth JM, Stone AA, Hurewitz A, Kaell A. 1999 Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis. JAMA. 281: 1304– 1309.Google Scholar
Smyth JM, True N, Souto J. 2001 Effects of writing about traumatic experiences: The necessity for narrative structuring. J Soc Clin Psychol. 20: 161– 172.Google Scholar
Spera SP, Buhrfeind ED, Pennebaker JW. 1994 Expressive writing and coping with job loss. Acad Manag J. 37: 722– 733.Google Scholar
Spiegel D. 1999 Healing words: Emotional expression and disease outcome. JAMA. 281: 1328– 1329.Google Scholar
Spiegel D. 2002. Minding the body. Available at: http://whyfiles.org/039emotion/spiegel2.htm. Accessed: November 7
Stanton AL, Danoff-Burg S, Sworowski LA, et al. 2002 Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients. J Clin Oncol. 20: 4160– 4168.Google Scholar
Stephens C. 2002 Health benefits of the disclosure of emotions about traumatic experiences: What is the evidence and potential for therapeutic benefits? Aust J Disaster Trauma Studies. 1: 1– 6.Google Scholar
Stroebe M, Stroebe W, Schut H, Zech E, van den Bout J. 2002 Does disclosure of emotions facilitate recovery from bereavement? Evidence from two prospective studies. J Consult Clin Psychol. 70: 169– 178.Google Scholar
Strough HC. 1998. The effects of disclosive writing on psychological responses and subjective and objective outcomes following anterior cruciate ligament (ACL) rehabilitation. PhD Thesis. West Lafayette, IN: Purdue University
Ullrich PM, Lutgendorf SK. 2002 Journaling about stressful events: Effects of cognitive processing and emotional expression. Ann Behav Med. 24: 244– 250.Google Scholar
Walker BL, Nail LM, Croyle RT. 1999 Does emotional expression make a difference in reactions to breast cancer? Oncol Nurs Forum. 26: 1025– 1032.Google Scholar
Watson D, Pennebaker JW. 1989 Health complaints, stress and distress: Exploring the central role of negative affectivity. Psychol Rev. 96: 234– 254.Google Scholar
Zuckerman M, Lubin B. 1985. Manual for the MAACL-R: The multiple affect adjective checklist—revised. San Diego: Education and Industrial Testing Service
90. 1965 Zung WWK. A self-rating depression scale. Arch Gen Med. 12: 63– 70.