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February 20, 2018
by Tracey Block

The power of the pen in mental health therapy

February 20, 2018 01:17 by Tracey Block

The variety of tech-friendly options currently available to assist people with their mental health and wellness challenges is almost overwhelming. Computers and smart phone technology provide opportunities for tele-therapy, avatar communication and mental health apps. Yet, regardless of the ever-changing technological advances in therapy, many researchers and mental health professionals are recognizing the importance of an old-fashioned medium. Some are even calling it groundbreaking. The technology? A pen or pencil and paper.

More specifically, expressive writing.

In his article last week for the National Alliance on Mental Health (NAMI), counseling psychologist Steven Swink discussed the recent renewed interest in longer-form writing. “In 1985, psychologist James W. Pennebaker theorized that the effort it takes to hold back our thoughts and feelings serves as a stressor on our bodies,” wrote Swink. Pennebaker believed that facing the thoughts and recognizing one’s emotions may lessen their negative effects on the mind and body.

Karyn Hall, Ph.D., in her 2012 article for, further explained Pennebaker’s work. “[He] discovered that most people who write in a certain way about upsetting events in their past gain an improved mood and health,” she added. “The writing technique is not about reliving the event, but about gaining a better understanding or finding meaning in the event.”

Referring to the years of research into the topic, Swink continued: “One of the best ways to confront our feelings is through writing, . . . [and] expressive writing can help improve mood, increase psychological well-being, reduce depressive symptoms, decrease PTSD avoidance symptoms, reduce days spent in a hospital and improve immune system functioning (to name a few).”

The concepts of journaling or letter writing are not new, Swink explained, but in this 21st century technology-reliant society, more and more it has become a “fading art”. He referred to the more common, ubiquitous use of social media sites as the places people are turning to for expression of ideas and tip of the iceberg emotions—that is, expressing only limited messages or superficial information sharing.

“For someone with mental illness, taking time beyond a social media post to write expressively can be very helpful,” said Swink. He pointed to a 2014 psychology study directed by Andrea N. Niles et al at the University of Los Angeles. Results of the study found “that participants who wrote in detail about [one] particular stressor showed the most improvement versus writing about general facts of a stressful event,” Swink wrote. “Participants who did not just recount events but rather wrote about how they felt about the event had marked improvement in their health.”

According to researchers Niles et al, asking study participants to label the content of distressing images presented to them resulted in reports of lower overall mental stress. “Affect labelling, or ‘putting feelings into words’, is the verbal labelling of emotional stimuli or one’s reaction to them,” the researchers explained.

The reduction in mental distress from writing or verbalizing “can be attributed to activation of an area of the prefrontal cortex . . .which reduces activity in the amygdala, an area associated with emotional processing,” they wrote.

Based on this evidence, Swink interpreted Pennebaker’s concept of expressive writing to mean: You should write about a specific experience and all its features—how it made you feel, and any thoughts or ideas you had as result. Don’t just rehash what happened.”

In addition to this advice, Swink interpreted additional studies based on Pennebaker’s work and suggested expressive writing should be done in a consistent manner—for two or three days in a row, for example. And, Swink supported Pennebaker’s recommendation to allow oneself at least 15-20 minutes a day for more in-depth writing.

According to Swink’s research, shorter writing sessions provide less improvement to an individual’s long-term mental health. “By dedicating a set amount of time to write, you can dive deeper into your feelings and experiences rather than just brush the surface,” he wrote. “[And] giving yourself a focused time, day and schedule to write improves the ability for your mind to dive deeper into processing your feelings.”

In keeping with Pennebaker’s advice, Swink suggested that when using expressive writing, one should be less concerned with grammar, spelling and editing, but more focused on allowing the mind to relax, to write freely, and explore the experiences and emotions invoked.

“The art of expressive writing has been researched and studied for decades, and the findings demonstrate that it has a positive impact on symptom reduction and overall well-being for participants who use the process as it was intended,” Swink explained.

Nevertheless, he tempered his enthusiasm for expressive writing, recognizing that although testing of the method has been extensive, “there is still much to learn about the implications of writing about emotional topics such as PTSD, anxiety or depression”.

As a result, Swink suggested that for anyone interested in using expressive writing, it would be wise to “seek support from a mental health professional to help you through any challenges that may arise during these exercises.”

The importance of having professional resources available for support while experiencing new or difficult reactions, feelings and emotions cannot be over-emphasized, he concluded



Hall, K., Ph.D., (February 2012). Expressive Writing.

Murray, B., (June 2002). American Psychological Association. Writing to heal.

Niles, A.N., Byrne Haltom, K.E., Lieberman, M.D., Hur, C., & Stanton, A.L., (January 14, 2016). University of California. Writing content predicts benefit from written expressive disclosure: Evidence for repeated exposure and self-affirmation.

Swink, S., (February 16, 2018). National Alliance on Mental Illness. Writing Tips That Can Reduce Symptoms.


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