The following interesting article appeared in today's (Wednesday's)
electronic version of the NY Times.
Writing About Trauma Is Seen to Ease
Illness in Some
By ERICA GOODE
In a powerful demonstration of how intimately mind and
body are linked,
researchers have shown that writing about traumatic
experiences
measurably improves the health of some patients suffering
from
chronic asthma or rheumatoid arthritis.
Asthma patients who wrote about "the most stressful event
they had ever
undergone" for 20 minutes on three consecutive days, the
researchers
found, showed significant improvements in lung function four
months later,
compared with patients who spent the same amount of time
writing about
neutral topics. Similarly, four months after finishing the
writing exercise,
rheumatoid arthritis patients showed less overall severity
in their disease.
The study, which appears in
Wednesday's
issue of the Journal of the American
Medical
Association, is notable both for its
size and its
scientific rigor. It included 107
patients with
mild to moderately severe asthma or
rheumatoid arthritis, and the health
of the
patients was monitored using objective
physiological measures. Doctors who
took
part in the study did not know whether or not the patients
they were
examining had received the writing "treatment."
The findings add to increasing evidence that attention to
patients'
psychological needs can play an important role in the
treatment of many
physical illnesses, a view shared by many doctors and nurses
but one that
has only recently begun to draw the attention of the medical
establishment.
In an editorial accompanying the journal report, Dr. David
Spiegel,
professor and associate chairman of psychiatry and
behavioral sciences at
Stanford University, wrote, "We have been closet Cartesians
in modern
medicine, treating the mind as though it were reactive to
but otherwise
disconnected from disease in the body."
The patients in the "treatment" group were instructed to
write down their
"deepest thoughts and feelings" about the traumatic
experience, while
control subjects wrote about their plans for the day.
Subjects in both groups
were instructed to write continuously for 20 minutes.
"This is not an easy task," said Dr. Joshua Smyth, an
assistant professor of
psychology at North Dakota State University and the lead
author of the
study. "The time goes very quickly and you feel there's a
lot more to say."
The patients who wrote about traumatic experiences became
very involved
in the task, Smyth said. Some cried or showed other signs of
emotional
distress while writing. Few chose to write about their
illnesses. Instead,
most wrote about the death of a loved one, problems in a
close relationship
or disturbing events in childhood. A few wrote of witnessing
or being
involved in a disastrous incident like a train wreck or an
automobile
accident.
The researchers found that of the 70 patients who wrote
about traumatic
events, 47.1 percent showed significant improvement in their
health at the
end of four months, 48.6 percent showed no change and 4.3
percent got
worse. In the control group, 24.3 percent showed
improvement, 54.1
percent showed no change and 21.6 percent got worse.
Smyth, who conducted the research with colleagues while at
the State
University of New York at Stony Brook School of Medicine,
said the
results were meaningful not only because significantly more
patients who
wrote about stressful experiences improved but also because
many
patients whose conditions might have been expected to worsen
instead
showed no change.
Why writing about traumatic experiences works remains
unclear, Smyth
said. Nor is it known how long-lasting the improvement is,
or what factors
make it more likely that an individual will improve.
But Smyth and others suspect that the writing task may be
effective
because it lets patients synthesize and make sense of their
experiences.
Like psychotherapy, Smyth said, the writing allows patients
to alter the
way they think about an event, giving it order and
structure. This process,
he noted, is very different from the intrusive and upsetting
rumination that
often follows traumatic events, a process that has been
shown to have
physiological effects, among them increases in heart rate
and in the levels
of stress hormones.
Previous work by other researchers has shown that in healthy
subjects the
writing exercise can reduce visits to doctors, improve
subjective well-being
and increase some indicators of immune-system functioning.
The new
study is the first to test the effects on medical conditions
of the writing
exercise, which was developed by Dr. James Pennebaker, a
psychologist
at the University of Texas at Austin, and his colleagues.
Spiegel, author of the journal's editorial, said he was
surprised "by the vigor
of the biomedical outcome" in the new study, "given the
truly minimalist
intervention." But he said it was increasingly clear that
the way patients
responded to being sick often affected the course of their
illnesses. For
some patients, he said, illness may trigger associations to
past traumatic
events that were beyond their control, causing the body to
respond "as if
you're being assaulted rather than just being sick."
For example, he said, Holocaust survivors who develop cancer
sometimes
find that the disease revives the feelings of helplessness,
loss of control and
physical intrusion they experienced earlier in their lives.
The new study underlines the role of stress in both asthma
and rheumatoid
arthritis and alerts doctors to their patients' emotional
needs. But Smyth
cautioned against generalizing the findings too broadly. "I
really do believe
that it's premature to advocate this as a part of therapy,"
Smyth said.
Dr. Mary Klinnert, an associate faculty member in pediatrics
at the
National Jewish Medical and Research Center in Denver, who
studies the
relationship of stress to the onset of asthma, said she
welcomed the
findings because they confirmed her clinical observations.
"It's exciting that
someone could document it," Klinnert said.
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