Practice Profile: Expressive Writing Interventions for Adolescents

This is a brief psychosocial intervention, also called written emotional disclosure. Expressive writing interventions are individually focused and designed to improve emotional expression and processing during adaptation to stressful situations. The goal is to improve psychological and physical health. The practice is rated Effective for improving adolescents’ problem behaviors, internalizing behaviors, and school participation, and rated Ineffective for school performance.

Practice Goals/Target Population

Expressive writing is a brief psychosocial intervention, also called written emotional disclosure. Expressive writing interventions are individually focused and designed to improve emotional expression and processing during adaptation to stressful situations. The goal is to improve psychological and physical health. For this iteration of expressive writing interventions, the target population was adolescents ages 10 to 18.

Practice Components

The length, spacing of sessions, and focus of the writing assignment can vary by intervention. Expressive writing interventions are usually three or four sessions, 15 to 20 minutes each, spaced 1 to 7 days apart. The focus of the writing task can also differ by intervention. Some expressive writing interventions instruct adolescents to write about a general topic (such as an upsetting or stressful event); others instruct them to write about something specific (such as the trauma of a death or an ongoing physical illness).

A writing protocol described by Pennebaker (1997) provides an example of the types of instructions that might be given to adolescents during an expressive writing intervention. The protocol is as follows: “For the next 3 days, I would like you to write about your very deepest thoughts and feelings about an extremely important emotional issue that has affected you and your life. In your writing I’d like you to really let go and explore your very deepest emotions and thoughts. You might tie your topic to your relationships with others, including parents, friends, or relatives, to your past, your present, or your future, or to whom you have been, whom you would like to be, or whom you are now. You may write about the same general issues or experiences on all days of writing or on different topics each day. All of your writing will be completely confidential. Don’t worry about spelling, sentence structure, or grammar. The only rule is that once you begin writing, continue to do so until your time is up” (Pennebaker 1997:162).

Practice Theory

There are several theories (including attentional processing, habituation, and cognitive processing) to explain how expressive writing interventions could affect adolescents and initiate emotion regulation. With attentional processing, expressive writing interventions allow adolescents to focus their attention on memories of upsetting or traumatic events (that they’re writing about) and redirect that attention toward more positive aspects of the event that may have been disregarded or forgotten. Habituation involves reducing the magnitude of a response to a specific stimulus (such as an upsetting or traumatic event) with repeated exposure to that stimulus. Writing repeatedly about a traumatic event may produce the reactivation, the habituation, and the eventual diminishing and loss of the stress-related physiological and emotional states that were brought about by the event. Finally, expressive writing interventions may help in the cognitive processing of upsetting or traumatic events, in terms of search for a meaning for the event and reappraising the situation. Writing about the event allows adolescents to look for causal explanations and interpretations about the event that can help process what happened (Travagin, Margola, and Revenson 2015).

It is believed that expressive writing can improve adolescents’ psychological and behavioral response to upsetting or traumatic events because it facilitates emotion- and self-regulation by encouraging adolescents to write about those events and their associated emotions. Adolescents can learn to regulate their emotions by directing their attention to different aspects of the event and develop alternative ways to respond (Kliewer et al. 2011; Travagin, Margola, and Revenson 2015).

Travagin, Margola, and Revenson (2015) conducted moderator analyses, to see whether any factors strengthened the likelihood that expressive writing interventions improved outcomes (specifically, school performance and somatic complaints).

For participant characteristics, expressive writing interventions that included participants at risk for psychological problems had a statistically significant larger effect than interventions with healthy participants on measures of somatic complaints (meaning adolescents at risk for psychological problems saw a larger decrease in somatic complaints than healthy adolescents did). There were no other statistically significant effect sizes for somatic complaints related to other participant characteristics (such as gender and age). There were no statistically significant effect sizes for school performance related to any participant characteristics.

For intervention characteristics, expressive writing interventions with more than three sessions had a statistically significant larger effect than interventions with a maximum of three sessions on measures of somatic complaints (meaning adolescents who participated in interventions with more than three sessions saw a larger decrease in somatic complaints than did adolescents who participated in interventions with three or fewer sessions). Similarly, interventions that had writing sessions spaced more than 1 day apart had a statistically significant larger effect for somatic complaints than interventions with writing sessions on consecutive days. There were no statistically significant effects for somatic complaints pertaining to other intervention characteristics (such as focus of the writing or length of sessions). There was no statistically significant effect for school performance related to any intervention characteristics.

These sources were used in the development of the practice profile:

These sources were used in the development of the practice profile:

Pennebaker, James W. 1997. “Writing About Emotional Experiences as a Therapeutic Process.” Psychological Science 8(3):162–66.

Kliewer, Wendy, Stephen J. Lepore, Albert D. Farrell, Kevin W. Allison, Aleta L. Meyer, Terri N. Sullivan, and Anne Y. Greene. 2011. “A School-Based Expressive Writing Intervention for At-Risk Urban Adolescents’ Aggressive Behavior and Emotional Lability.” Journal of Clinical Child & Adolescent Psychology 40(5):693–705.

Following are CrimeSolutions-rated programs that are related to this practice:

School-Based Expressive Writing Intervention for At-Risk Urban Adolescents

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?