James W.

Pennebaker 3

Telling Stories: The Health

Benefits of Narrative*
James W. Pennebaker

Much of literature derives from authors writing about significant

emotional experiences from their own lives. Elements of Eugene O’Neill’s
and Maya Angelou’s tortured childhoods, Elie Wiesel’s concentration
camp experiences, and the painful death of Edgar Allen Poe’s mother
can be seen in much of their work. Publishing houses are inundated
with authors’ first (and, usually, only) manuscripts telling their personal
stories. Although many authors may be motivated to publish their work
for the imagined fame, glory, and wealth associated with having a best-
seller, the majority have been guided more by a need to tell their
stories.
I come to this essay not as an expert in literature but as a
psychologist who was initially interested in the use of writing as a way
to affect people’s health. Through a series of experiments, my colleagues
and I discovered that when people put their emotional upheavals into
words, their physical and mental health improved markedly. Further,
the act of constructing stories appeared to be a natural human process
that helped individuals understand their experiences and themselves.
This work started over a decade ago when I asked students to write
their deepest thoughts and feelings about traumatic experiences as part
of a laboratory experiment. Much more happened than just a recording
of traumatic experiences, however. The writing exercise often changed
their lives. There was something remarkable about their expressing
themselves in words.
The basic technique we used was straightforward. Students were
brought into the laboratory and told that they would be participating
in a study wherein they would write about an assigned topic for four
consecutive days for fifteen minutes each day. They were assured that
their writing would be anonymous and that they would not receive any
feedback on it. As far as they knew, the purpose of the project was to

*Preparation of this manuscript was aided by a grant from the National

Institutes of Health (MH52391).

Literature and Medicine 19, no. 1 (Spring 2000) 3–18

© 2000 by The Johns Hopkins University Press
4 HEALTH BENEFITS OF NARRATIVE

learn more about writing and psychology. The only rule about the
writing assignment was that once they began writing, they were to
continue to do so without stopping and without regard to spelling,
grammar, or sentence structure. Participants were then randomly as-
signed to either an experimental group or a control group.
Those who, by a flip of the coin, ended up in the experimental
group were asked to spend each session writing about one or more
traumatic experiences in their lives. In the words of the investigator,

For the next four days, I would like for you to write about your very
deepest thoughts and feelings about the most traumatic experience of
your entire 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,
lovers, friends, or relatives, to your past, your present, or your
future, or to who you have been, who you would like to be, or who
you are now. You may write about the same general issues or
experiences on all days of writing or on different traumas each day.
All of your writing will be completely confidential.

Those who were assigned to the control condition were asked to

write about non-emotional topics for fifteen minutes on all four days of
the study. Examples of their assigned writing topics included describing
the laboratory room in which they were seated or their own living
room. One group, then, was encouraged to delve into their emotions
and the other was to describe objects and events dispassionately.
The first writing study that Sandra Beall and I conducted yielded
astounding results.1 Most striking was that beginning college students
immediately took to the task of writing. Those in the experimental
condition averaged writing 340 words during each fifteen-minute ses-
sion. Although many cried, the vast majority reported that they found
the writing to be extremely valuable and meaningful. Indeed, 98 percent
of the experimental participants said that, if given the choice, they
would participate in the study again. Most surprising to us was the
nature of the writing itself. The students, who tended to come from
upper-middle class backgrounds, described a painful array of tragic and
depressing stories. Rape, family violence, suicide attempts, drug prob-
lems, and other horrors were common topics. Indeed, approximately
half of the people wrote about experiences that any clinician would
agree were truly traumatic.
James W. Pennebaker 5

Even the ways the participants wrote was remarkable. The same
students who would turn in sloppy, poorly constructed, appallingly
spelled term papers or essay exams would write eloquently about their
own personal tragedies. When given the opportunity in the study, the
participants intuitively knew how to put their life experiences into
remarkably coherent narratives with few spelling or grammatical errors.
What made this first experiment so compelling for us, however,
was not just the narratives themselves. Rather, we were primarily
interested in how the writing exercise influenced physical health. Dur-
ing the school year, we followed the students’ illness visits to the
university health center in the months before and after the experiment.
To our amazement and delight, we discovered that those who had
written about their thoughts and feelings drastically reduced their
doctor visit rates after the study compared to our control participants
who had written about trivial topics. Confronting traumatic experiences
had a salutary effect on physical health.

Writing and Health

Over the last decade, several dozen studies from multiple labora-
tories around the world have confirmed and extended the basic find-
ings. Some of the general results include the following:

• Writing benefits a variety of groups of individuals beyond under-

graduate college students. Positive health and behavioral effects have
been found with maximum security prisoners, medical students,
community-based samples of distressed crime victims, arthritis and
chronic pain sufferers, men laid off from their jobs, and women who
have recently given birth to their first child. These effects have been
found in all social classes and major racial/ethnic groups in the
United States, and in samples in Mexico City, New Zealand, French-
speaking Belgium, and the Netherlands.2

• Writing influences more than just physician visits. At least six

different laboratories report that writing produces positive effects on
blood markers of immune function. Other studies indicate that
writing is associated with lower pain and medication use among
arthritis sufferers and, in a sample of asthmatics, improvements in
markers of lung function. Among students taking professional-level
exams, such as the Graduate Record Exam, researchers report finding
6 HEALTH BENEFITS OF NARRATIVE

lower levels of depression in the weeks after writing. Additional

experiments have demonstrated that writing is linked to higher
grades in college and faster times in getting new jobs among senior-
level engineers who have been laid off from their jobs.3

• Despite the clear health and behavioral effects, writing about trau-
matic experiences tends to make people feel more unhappy and
distressed in the hours after writing. These emotions, in many ways,
can be viewed as appropriate to the topics the individuals are
confronting. When questionnaires are administered to participants at
least two weeks after the studies, however, experimental volunteers
report being as happy or happier than controls. Interestingly, among
highly distressed samples, such as the unemployed engineers men-
tioned above, writing about losing their jobs produced immediate
improvements in moods compared to controls. Emotional state after
writing depends on how participants are feeling prior to writing: the
better they feel before writing, the worse they feel afterwards and
vice versa.4

• There are not strong indications that some personality types benefit
more from writing than others. A recent analysis of several writing
studies by Joshua Smyth suggests that men may benefit somewhat
more than women.5 This effect, however, still must be tested in
future studies. Although traditional measures of neuroticism, depres-
sion-proneness, and extraversion are unrelated to the benefits of
writing, a recent experiment by Alan Christensen and Timothy Smith
indicates that individuals who are particularly hostile and suspicious
benefited more from writing than people who were low in these
traits.6

• The effects of the writing are not related to the presumed audience.
In most studies, participants turn in their writing samples with the
understanding that only the experimenters will examine what they
have written. Other experiments, however, have allowed participants
to keep their writing samples, or, in one masters thesis by Jeanne
Czajka, students wrote on a child’s magic pad where their writing
was erased as soon as they lifted the plastic sheet on the writing
tablet.7

• Although the original studies required participants to write on four

consecutive days for fifteen minutes each day, later studies have
James W. Pennebaker 7

varied the number of sessions from one to five days and from fifteen
minutes to thirty minutes each session. The summary project by
Smyth hints that the longer time the study lasts, the better.8 Again,
this effect needs to be examined experimentally.

• A variety of writing topics produces comparable health benefits.

Although the earlier studies asked volunteers to write about traumas,
more recent experiments have had new students write about their
thoughts and feelings about coming to college or, in the case of the
unemployed engineers, about the experience of getting laid off.9 Most
impressive is a recent study by Melanie Greenberg and her col-
leagues at the State University of New York at Stony Brook wherein
previously traumatized students were asked to write about an imagi-
nary trauma rather than something they had experienced directly.10
Their results indicated that writing about someone else’s trauma as
though they had lived through it produced health benefits compa-
rable to a separate group who wrote about their own traumas. What
is critical in all of these studies, however, is that people are encour-
aged to explore their emotions and thoughts no matter what the
content might be. Although most experiments have focused primarily
on writing, a few studies have compared writing with talking into
a tape recorder. Overall, writing and talking have produced compa-
rable effects. Additional experiments by Edward Murray and his
colleagues at the University of Miami suggest that writing about
traumatic experiences brings about changes comparable to talking to
a psychotherapist—at least among a psychologically healthy sample.11

While hard and fast conclusions are rare in our line of work, the
evidence of dozens of studies over a decade of research strongly
suggests that there are significant, positive, consistent, and identifiable
relationships between writing and speaking about difficult or emotional
experiences and physical health.

Language and Emotional Experiences

Why does writing or talking about emotional experiences influ-

ence health? This has been the central question that has guided our
research over the last several years. Three general research directions
have provided a number of answers.
8 HEALTH BENEFITS OF NARRATIVE

One possibility is that by writing about emotional experiences,

people simply become more health conscious and change their behav-
iors accordingly. Very little evidence supports this. As indicated by the
Smyth review, most experiments find that after writing about emotional
topics, participants continue to smoke, exercise, diet, and socialize in
ways similar to those in the control conditions.12 The one exception may
be alcohol intake. In two studies with adults, people who wrote about
emotional topics later reported a drop in the amount of alcohol they
were drinking each day. This pattern has not held up for college
students or prisoners.
A second possible explanation for the value of writing is that it
allows people to express themselves. If the driving process is self-
expression, one could argue that both verbal and nonverbal forms of
expression would provide comparable benefits. Dance, music, and art
therapists, for example, assume that the expression of emotion through
nonverbal means is therapeutic. It should be noted, however, that
traditional research on catharsis or the venting of emotions has failed
to support the clinical value of emotional expression in the absence of
cognitive processing.13 In our own lab, we have attempted to determine
the degree to which language is necessary for physical and mental
health improvement. A recent experiment by Anne Krantz and me
sought to learn if the disclosure of a trauma through dance or bodily
movement would bring about health improvements in ways comparable
to writing.14 In the study, students were asked to express a traumatic
experience using bodily movement, to express an experience using
movement and then write about it, or to exercise in a prescribed
manner for three days, ten minutes per day. Whereas the two move-
ment expression groups reported that they felt happier and mentally
healthier in the months after the study, only the movement plus writing
group evidenced significant improvements in physical health and grade
point average. The mere expression of a trauma is not sufficient to bring
about long-term physiological changes. Health gains appear to require
translating experiences into language.
A third broad explanation for the effects of writing is that the act
of converting emotions and images into words changes the way the
person organizes and thinks about the trauma. Further, part of the
distress caused by the trauma lies not just in the events but in the
person’s emotional reactions to them. By integrating thoughts and
feelings, then, the person can more easily construct a coherent narrative
of the experience. Once formed, the event can be summarized, stored,
James W. Pennebaker 9

and forgotten more efficiently. Tests of this general idea are still in
progress. However, preliminary findings are encouraging.
One of our first systematic approaches to understanding the
potential cognitive benefits of writing was to examine the essays
themselves. Independent raters initially compared the writing samples
of people whose health subsequently improved after the experiment
with those whose health remained unchanged. Essays from those who
improved were judged to be more self-reflective, emotionally open, and
thoughtful. Not being content with clinical evaluations, we decided to
subject the essays to computer text analyses to learn if language use
could predict improvements in health among people who had written
about emotional topics.
Unbeknownst to me at the time this decision was made, no
standard computer programs existed that specifically measured emo-
tional and cognitive categories of word usage. Conceptually, such a
program was very easy to write. Practically, Martha Francis and I spent
over three years doing it. The result was a computer program called
LIWC (Linguistic Inquiry and Word Count) that analyzed essays in text
format.15 LIWC was developed by having groups of judges evaluate the
degree to which over 2,000 words or word stems were related to each
of several dozen categories. Although there are now over seventy word
categories in the most recent version of the LIWC program, only four
were of primary interest to us. Two of the categories were emotion
dimensions and the other two were cognitive. The emotion categories
included negative-emotion words (e.g., sad, angry) and positive-emo-
tion words (e.g., happy, laugh). The two cognitive categories, causal and
insight words, were intended to capture the degree to which partici-
pants were actively thinking in their writing. The causal words (e.g.,
because, reason) were included because they implied people were
attempting to put together causes and reasons for the events and
emotions that they were describing. The insight words (e.g., understand,
realize) reflected the degree to which individuals were specifically
referring to cognitive processes associated with thinking. For each essay
that a person wrote, we were able to quickly compute the percentage
of total words that these and other linguistic categories represented.
The beauty of the LIWC program is that it allowed us to go back
to previous writing studies and link word usage among individuals in
the experimental conditions with various health and behavioral out-
comes. To date, the most extensive re-analysis of data concerns six
writing studies: two studies involving college students writing about
traumas where blood immune measures were collected; two studies
10 HEALTH BENEFITS OF NARRATIVE

where first-year college students wrote about their deepest thoughts

and feelings about coming to college; one study by maximum-security
prisoners in a state penitentiary; and one study using professionals who
had unexpectedly been laid off from their jobs after over twenty years
of employment.
Analyzing the use of negative- and positive-emotion words, Tracy
Mayne, Martha Francis, and I uncovered two important findings.16 First,
the more people used positive-emotion words, the more their health
improved. Negative-emotion word use also predicted health changes
but in an unexpected way. Individuals who used a moderate number
of negative emotions in their writing about upsetting topics evidenced
the greatest drops in physician visits in the months after writing. That
is, those people who used a very high rate of negative-emotion words
and those who used very few were the most likely to have continuing
health problems after participating in the study. In many ways, these
findings are consistent with other literatures. Individuals who tend to
use very few negative-emotion words are undoubtedly most likely to be
characterized as repressive copers—people whom Dan Weinberger, Gary
Schwartz, and Richard Davidson have defined as poor at being able to
identify and label their emotional states.17 Those who overuse negative-
emotion words may well be the classic high neurotic or, as David
Watson and his colleagues call them, high Negative Affect individuals.18
These individuals are people who ponder their negative emotions in
exhaustive detail and who may simply be in a recursive loop of
complaining without attaining closure. Indeed, this may be exacerbated
by the inability of these individuals to develop a story or narrative.
Although the findings concerning emotion word use were intrigu-
ing, they paled in comparison to the robust results surrounding the
cognitive word categories. Remember that in our studies, people wrote
for three to five days, fifteen to thirty minutes per day. As they wrote,
they gradually changed what they said and how they said it. The LIWC
analyses showed strong and consistent effects for changes in insight and
causal words over the course of writing. Specifically, people whose
health improved, who got higher grades, and who found jobs after
writing went from using relatively few causal and insight words to
using a high rate of them by the last day of writing. In reading the
essays of people who showed this pattern of language use, it became
apparent that they were constructing a story over time. Building a
narrative, then, seemed to be critical in reaching understanding. Inter-
estingly, those people who started the study with a coherent story that
explained some past experience did not benefit from writing.19
James W. Pennebaker 11

These findings are consistent with current views on narrative and

psychotherapy in suggesting that it is critical for the client to confront
anxieties and problems by creating a story to explain and understand
past and current life concerns. The story can be in the form of an
autobiography or even a third-person narrative. Interestingly, our data
indicate that merely having a story may not be sufficient to assure good
health. A story that may have been constructed when the person was
young or in the midst of a trauma may be insufficient later in life when
new information is discovered or broader perspectives are adopted. In
our studies, as in narrative therapies, then, the act of constructing
stories is associated with mental and physical health improvement. A
constructed story, then, is a type of knowledge that helps to organize
the emotional effects of an experience as well as the experience itself.

Narrative and the Search for Meaning

Within the psychological literature, there is a broadly accepted

belief that humans—and perhaps most organisms with at least a
moderately complex nervous system—seek to understand the worlds
around them. If we feel pain or hear a strange noise, we try to learn
the cause of it. Once we understand how and why an event has
occurred, we are more prepared to deal with it should it happen again.
By definition, then, we will be far more motivated to learn about events
that have powerful consequences—either positive or negative—than
about common or predictable events that don’t affect us. Similarly,
events with large and significant personal consequences will be exam-
ined to a greater degree than relatively superficial events.20
Over the course of a normal day, we are constantly surveying and
analyzing our worlds. The person in the car behind us honks his horn
while we sit at a stoplight. Automatically, we ask questions such as, “Is
the person honking at me?” “Is the light green?” “Do I know this
person?” As soon as we come to some understanding as to the meaning
of the horn honk, we adjust our behavior (we go if the light is green,
wave if it is a friend) or return to our private world if the honk was
not relevant to us. As soon as this brief episode is over, we will
probably put it out of our mind forever.
Whereas the search for the meaning of a honking horn is a brief,
relatively automatic process, major life events are far more difficult to
comprehend. If our lover leaves us, a close friend dies, or we face a
significant career set-back, we generally mull the event over in our
12 HEALTH BENEFITS OF NARRATIVE

mind, trying to understand the causes and consequences of it. To

complicate matters, a major life event usually consists of many events
and experiences. If our lover has gone, it will affect our relationships
with others, our finances, how we view ourselves, and even our daily
eating, sleeping, talking, and sexual habits. In trying to understand this
experience, we will naturally attempt to ask ourselves why it happened
and how we can cope with it. To the degree that the event is
unresolved, we will think, dream, obsess, and talk about it for days,
weeks, or years.
Exactly what constitutes meaning or understanding is far less
clear. Philosophers, psychologists, poets, and novelists have noted that
a single event can have completely different meaning for different
individuals. Following the death of a very close friend, some may find
meaning in religion (“God has a plan”), others in understanding the
cause of the death (“He smoked, what can you expect?”), yet others in
exploring the implications for their own lives (“He would have wanted
me to change my life”). Simple analyses relying on a single causal
explanation may be useful in explaining some aspects of the death but
will probably not be helpful in all aspects. We may have a straightfor-
ward explanation of why the friend died, but we still must deal with
a change in our friendship network, our daily routine of talking with
our friend, etc. The beauty of a narrative is that it allows us to tie all
of the changes in our life into a broad comprehensive story. That is, in
the same story we can talk both about the cause of the event and its
many implications. Much as in any story, there can be overarching
themes, plots, and subplots—many of them arranged logically and/or
hierarchically. Through this process, then, the many facets of the pre-
sumed single event are organized into a more coherent whole.
Drawing on research on conversation and language, Leslie Clark
points out that conveying a story to another person requires that the
speech act be coherent.21 Linguistic coherence subsumes several charac-
teristics, including structure, use of causal explanation, repetition of
themes, and an appreciation of the listener’s perspective. Referring to
the work of William Labov and David Fanshel, Clark emphasizes that
conversations virtually demand the conveying of stories or narratives
that require an ordered sequence of events.22
Once a complex event is put into a story format, it is simplified.
The mind doesn’t need to work as hard to bring structure and meaning
to it. As the story is told over and over again, it becomes shorter with
some of the finer detail gradually leveled. The information that is
recalled in the story is that which is congruent with the story. Whereas
James W. Pennebaker 13

the data (or raw experience) was initially used to create the story, once
the story is fixed in the person’s mind only story-relevant data is
conjured up. Further, as time passes, we have the tendency to fill in
gaps in our story to make the story more cohesive and complete. The
net effect of constructing a good narrative is that our recollection of
emotional events is efficient—we have a relatively short, compact
story—and undoubtedly biased.
A common example can be seen in talking to people who have
recently undergone a divorce. In the first weeks following the separa-
tion, individuals often talk (or, in our studies, write) about the many
facets of the break up. Often the accounts are long-winded, inconsistent,
yet highly emotional. Over time, however, the explanations become
simpler, even simplistic, such as “the reason our marriage fell apart was
because he was a self-centered philanderer.” With such one-dimensional
summations of the end of their relationship, individuals overlook the
nuances—both positive and negative—of the marriage.
Ironically, then, good narratives can be beneficial in making our
complex experiences simpler and more understandable but, at the same
time, they distort our recollection of them. Translating distress into
language ultimately allows us to forget or, perhaps a better phrase,
move beyond the experience. As an indirect test of this, Michael Crow
and I studied how people thought and talked about the Persian Gulf
War during the time it was ongoing and in the months following its
completion.23 Once a week, over 200 students in each of several classes
were asked how many times in the previous twenty-four hours they
had talked, thought, and heard about the war. We also asked the
participants how worried, upset, and angry they were about the war
during each questionnaire administration.
Approximately two-and-a-half years later, we were able to track
down seventy-six students who had completed the majority of the war
questionnaires. At the beginning of the follow-up telephone interview,
we asked people to tell us about the war, and then we asked them a
series of objective questions about it (e.g., who were we fighting, who
was their leader, on what day did the war start). Among those people
who were most upset about the war, the more they talked about it
during the war, the poorer their memory about it two-and-a-half years
later. Our sense is that they constructed a coherent narrative about the
event and, once the war was over, they were easily able to move
beyond it. By the time we interviewed them, they simply couldn’t recall
much about the war since they had had no reason to rehearse or relive
the experience. It was a story that had resolved itself in the distant past.
14 HEALTH BENEFITS OF NARRATIVE

In many ways, the war project was more titillating than definitive.
We don’t know how or why they talked about the war. We suspect that
those who were most emotional about it were expressing their concerns
and fears as well as mulling over the daily reports through the media.
They may not have been focusing on the facts of the war at all—which
is what we tested them on over two years later. However, the fact that
these same people had the greatest difficulty in remembering who their
own country was fighting in the first place suggests that the act of
talking may have been instrumental in putting the war behind them.
Because of these findings, we are now exploring how people talk about
emotional events in their daily lives. In the future, we hope to be able
to tie naturally occurring discussions about distressing experiences to
our long-term memories of them.24

The Social Dynamics of Disclosure

Telling a story implies that there are other people who can listen
to it. Until recently, our studies ignored the social dynamics of writing
and of telling stories. This is ironic given that our earliest research was
motivated by the observation that traumatic experiences often isolated
individuals because they were unable to talk to others. Is it possible that
writing, or even orally telling a story, can bring about a richer connec-
tion between the storytellers and their social networks? Does the child
who writes about a traumatic experience in the classroom subsequently
make more friends?
These questions are at the heart of our current research agenda.
We are discovering, for example, that keeping an important secret can
create a psychological divide between the secret-keepers and their
friends. If I can’t tell you about some deeply disturbing events in my
life, you will not be able to interpret many of my actions or emotions.
By the same token, I will probably be too consumed with my own
problems to be a good listener or friend during your times of need.
In a recent series of studies, we asked participants to wear
computer-controlled tape recorders for several days both before and
after writing about emotional topics. What we are finding is that after
writing about traumatic experiences, unlike writing about superficial
topics, individuals begin talking more to their friends, laughing more,
and using more positive emotions in their daily language. Interestingly,
the effects are not readily apparent to the research participants. That is,
people don’t say their lives have changed in any discernible way.
James W. Pennebaker 15

However, we are capturing these impressive changes on the tape

recorders.25 These changes would seem to support the idea that writing
about emotional topics has an immediate positive impact upon the
subsequent social interactions of those who write with others in their
community.
In an ideal world, upsetting experiences are transformed into
stories that are shared with others. This process helps us to understand
the events and, at the same time, alerts our friends to our emotional
and psychological state. Such storytelling ultimately helps us maintain
a stable social and emotional life. In our less-than-ideal existence,
however, we often keep important personal experiences to ourselves.
Holding these secrets can be biologically taxing, can block the natural
cognitive work of coming to terms with the secrets, and can distance
the secret-keeper from friends and family. Translating personally upset-
ting experiences into language in a story format, even when the story
is written rather than spoken, may accomplish for us what oral
storytelling must have accomplished for our ancestors—improvements
in physical and mental health as well as the development of closer
social bonds.

NOTES

1. James W. Pennebaker and Sandra K. Beall, “Confronting a Traumatic Event:

Toward an Understanding of Inhibition and Disease,” Journal of Abnormal Psychology
95 (1986): 274–81.
2. Within the United States, the disclosure paradigm has benefited senior
professionals with advanced degrees at rates comparable to maximum security
prisoners with sixth grade educations (see Stefanie P. Spera, Eric D. Buhrfeind, and
James W. Pennebaker, “Expressive Writing and Coping with Job Loss,” Academy of
Management Journal 37 [1994]: 722–33; and Jane M. Richards et al., “The Effects of
Disclosure of Traumatic Events on Illness Behavior among Psychiatric Prison In-
mates,” Journal of Abnormal Psychology [in press]).
Among college students, we have not found differences as a function of the
students’ ethnicity or native language. The disclosure paradigm has produced con-
sistently positive results among French-speaking Belgians (Bernard Rimé, “Mental
Rumination, Social Sharing, and the Recovery from Emotional Exposure,” in Emotion,
Disclosure, and Health, ed. James W. Pennebaker [Washington, D.C.: American Psycho-
logical Association, 1995]), Spanish-speaking residents of Mexico City (Benjamin
Dominguez et al., “The Roles of Emotional Reversal and Disclosure in Clinical
Practice,” in Emotion, Disclosure, and Health), multiple samples of adults and students
in The Netherlands (Mirjam J. A. Schoutrop et al., “The Effects of Writing Assign-
ments on Reprocessing Traumatic Events: Three Experimental Studies” [paper pre-
sented at The (Non) Expression of Emotions and Health and Disease Conference,
Tilburg, The Netherlands, 1996]), and even English-speaking New Zealand medical
students (Keith J. Petrie et al., “Disclosure of Trauma and Immune Response to
Hepatitis B Vaccination Program,” Journal of Consulting and Clinical Psychology 63
[1995]: 787–92).
16 HEALTH BENEFITS OF NARRATIVE

There is some evidence that writing may not always work by itself in samples
that may have disordered cognitive processing or relatively severe depression. For
instance, in a study conducted in Israel among a group of fourteen post-traumatic
stress disorder (PTSD) patients, the half assigned to write and orally expand about
their traumas seemed to get worse compared to controls. The authors suggest that
writing may not benefit PTSD patients in the absence of cognitive and/or coping
skills training (Yori Gidron et al., “Written Disclosure in Posttraumatic Stress Disor-
der: Is It Beneficial for the Patient?” Journal of Nervous & Mental Disease 184 [1996]:
505–7). Further, severe cases of PTSD may be associated with the inability to
cognitively organize traumatic experiences despite the continuous ruminating and
emotional responses to thoughts of the precipitating traumas.
3. Writing or talking about emotional experiences relative to writing about
superficial control topics has been found to be associated with significant drops in
physician visits from before to after writing among relatively healthy samples
(Pennebaker and Beall; Melanie A. Greenberg, Arthur A. Stone, and Camille B.
Wortman, “Emotional Expression and Physical Health: Revising Traumatic Memories
or Fostering Self-Regulation?” Journal of Personality and Social Psychology 71 [1996]: 588–
602; and James W. Pennebaker, Michelle Colder, and Lisa K. Sharp, “Accelerating the
Coping Process,” Journal of Personality and Social Psychology 58 [1990]: 528–37).
Writing and/or talking about emotional topics has also been found to influ-
ence immune function in beneficial ways, including t-helper cell growth using a
blastogenesis procedure with the mitogen PHA (James W. Pennebaker, Janice K.
Kiecolt-Glaser, and Ron Glaser, “Disclosure of Traumas and Immune Function:
Health Implications for Psychotherapy,” Journal of Consulting and Clinical Psychology
56 [1988]: 239–45), antibody response to Epstein-Barr virus (Brian A. Esterling et al.,
“Emotional Disclosure through Writing or Speaking Modulates Latent Epstein-Barr
Virus Reactivation,” Journal of Consulting and Clinical Psychology 62 [1994]: 130–40),
and antibody response to hepatitis B vaccinations (Petrie et al., 787–92).
Particularly exciting is that a recent group of studies is now providing
convincing evidence that emotional disclosure is associated with objective improve-
ments in health among chronically ill populations, including those with asthma and
arthritis (Joshua M. Smyth et al., “Effects of Writing About Stressful Experiences on
Symptom Reduction in Patients with Asthma or Rheumatoid Arthritis: A Random-
ized Trial,” Journal of the American Medical Association 281 [1999]: 1304–9) and children
with AIDS (Becky F. Sherman, George A. Bonnano, Lori S. Wiener, and Haven B.
Battles, “When Children Tell Their Friends They Have AIDS: Possible Consequences
for Psychological Well-Being and Disease Progression,” Psychosomatic Medicine, in
press).
Behavioral changes have also been found. Students who write about emotional
topics evidence improvements in grades in the months following the study (Linda
D. Cameron and Gregory Nicholls, “Expression of Stressful Experiences through
Writing: Effects of a Self-Regulation Manipulation for Pessimists and Optimists,”
Health Psychology 17 [1998]: 84–92; and James W. Pennebaker and Martha Francis,
“Cognitive, Emotional, and Language Processes in Disclosure,” Cognition and Emotion
10 [1996]: 601–26). Senior professionals who have been laid off from their jobs get
new jobs more quickly after writing (Spera et al., 722–23). Consistent with the direct
health measures, university staff members who write about emotional topics are
subsequently absent from their work at lower rates than controls (Pennebaker and
Francis, 601–26). Interestingly, relatively few reliable changes emerge using self-
reports of health-related behaviors. That is, after writing, experimental participants do
not exercise more or smoke less (James W. Pennebaker, “Putting Stress into Words:
Health, Linguistic, and Therapeutic Implications,” Behaviour Research and Therapy 31
[1993]: 539–48). The one exception is that the study with laid-off professionals found
that writing reduced self-reported alcohol intake.
James W. Pennebaker 17

4. For general summary of mood and health effects, see James W. Pennebaker,
Opening Up: The Healing Power of Emotional Expression (New York: Guilford Press,
1997).
5. Joshua M. Smyth, “Written Emotional Expression: Effect Sizes, Outcome
Types, and Moderating Variables,” Journal of Consulting and Clinical Psychology 66
(1998): 174–84.
6. Alan J. Christensen and Timothy W. Smith, “Cynical Hostility and Cardio-
vascular Reactivity during Self-Disclosure,” Psychomatic Medicine 55 (1993): 193–202.
7. Jeanne A. Czajka, “Behavioral Inhibition and Short Term Physiological
Responses,” Southern Methodist University (1987).
8. Smyth, 174–84.
9. Spera, Buhrfeind, and Pennebaker, 722–33.
10. Greenberg, Stone, and Wortman, 588–602.
11. Most studies comparing writing alone (e.g., Esterling et al., 130–40) versus
talking either into a tape recorder or to a therapist find comparable biological, mood,
and cognitive effects (see Daniel A. Donnelly and Edward J. Murray, “Cognitive and
Emotional Changes in Written Essays and Therapy Interviews,” Journal of Social and
Clinical Psychology 10 [1991]: 334–50; and Edward J. Murray, Alisa D. Lamnin, and
Charles S. Carver, “Emotional Expression in Written Essays and Psychotherapy,”
Journal of Social and Clinical Psychology 8 [1989]: 414–29). Talking and writing about
emotional experiences are both superior to writing about superficial topics.
12. Smyth, 174–84.
13. Most claims concerning the effectiveness of nonverbal therapies have not
been tested experimentally. Note that the term catharsis has changed significantly
from Josef Breuer and Sigmund Freud’s description of the talking cure. Their original
use of catharsis was a method whereby the patient verbally described her or his
emotions and thoughts surrounding anxiety-laden topics. More recently, the term has
come to mean the venting of emotions without cognitive processing. Multiple studies
on venting (or abreaction) have failed to demonstrate that it is an effective technique
to reduce emotional arousal. Indeed, most studies indicate that venting increases
emotional experience (see William A. Lewis and Amy M. Bucher, “Anger, Catharsis,
the Reformulated Frustration-Aggression Hypothesis, and Health Consequences,”
Psychotherapy 29 [1992]: 385–92).
14. Anne Krantz and James W. Pennebaker, “Bodily Versus Written Expression
of Traumatic Experience,” University of Texas, Austin (1995).
15. James W. Pennebaker and Martha E. Francis, Linguistic Inquiry and Word
Count (LIWC): A Computerized Text Analysis Program (Mahwah, N.J.: Lawerence
Erlbaum Associates, 1999).
16. James W. Pennebaker, Tracy J. Mayne, and Martha E. Francis, “Linguistic
Predictors of Adaptive Bereavement,” Journal of Personality and Social Psychology 72
(1997): 863–71.
17. Daniel Weinberger, Gary E. Schwartz, and Richard J. Davidson, “Low-
Anxious, High-Anxious, and Repressive Coping Styles: Psychometric Patterns and
Behavioral and Physiological Responses to Stress,” Journal of Abnormal Psychology 88
(1979): 369–80.
18. David Watson and Lee Anna Clark, “Negative Affectivity: The Disposition
to Experience Aversive Emotional States,” Psychological Bulletin 96 (1984): 465–90.
19. For more information on current views on narrative and psychotherapy,
see Michael J. Mahoney, ed., Cognitive and Constructive Psychotherapies: Theory, Re-
search, and Practice (New York: Springer Publishing, 1995); Donald Meichenbaum and
Geoffrey T. Fong, “How Individuals Control Their Own Minds: A Constructive
Narrative Perspective,” in Handbook of Mental Control, ed. Dan M. Wegner and James
W. Pennebaker (Englewood Cliffs, N.J.: Prentice Hall, 1993), 473–90; and Kenneth J.
Gergen and Mary M. Gergen, “Narrative and the Self as Relationship,” in Advances
18 HEALTH BENEFITS OF NARRATIVE

in Experimental Social Psychology vol. 21, ed. Leonard Berkowitz (New York: Academic
Press, 1988), 17–56.
20. That individuals attempt to understand their worlds is explicitly or
implicitly acknowledged by virtually all schools of thought within psychology.
Although Freud argued that people often distorted or represses negative experiences,
the mere fact that they sought psychoanalysis suggested that oftentimes people
wanted and needed to understand themselves. Gestalt psychologists were more
explicit in stating that a basic need was to attain closure. Even at the perceptual level,
organisms are motivated to see a complete circle even if part of the circle is erased
or obscured (see Wolfgang Kohler, Gestalt Psychology [New York: Liveright, 1947]).
More recently, cognitive psychologists and therapists indicate that monkeys and
humans actively seek to understand the causes of unexpected events and emotions
(e.g., Harold H. Kelley, “Attribution Theory in Social Psychology,” in Nebraska
Symposium on Motivation, ed. David Levine [Lincoln: Univ. of Nebraska Press, 1967],
192–238; see also Aaron T. Beck, Cognitive Therapy and Emotional Disorders [New York:
International Universities Press, 1976]). Even radical behaviorists suggest that indi-
viduals seek understanding—even though it may be a futile and naive urge (see B.
F. Skinner, Beyond Freedom and Dignity [New York: Alfred A. Knopf, 1971]).
21. Leslie F. Clark, “Stress and the Cognitive-Conversational Benefits of Social
Interaction,” Journal of Social and Clinical Psychology 12 (1993): 25–55.
22. In particular, Clark cites William Labov and David Fanshel, Therapeutic
Discourse: Psychotherapy as Conversation (Orlando: Academic Press, 1977).
23. D. Michael Crow and James W. Pennebaker, “The Persian Gulf War: The
Forgetting of an Emotionally Important Event,” University of Texas, Austin (1997).
24. Talking about an event can be examined on the cultural level as well as
individual. Entire societies, for example, may collectively “forget” important events
(e.g., the Korean War or Persian Gulf War) and remember and/or repeatedly
commemorate others (e.g., World War II). The processes surrounding collective
memories of large-scale experiences are discussed in James W. Pennebaker, Dario
Paez, and Bernard Rimé, Collective Memories of Political Events: Social Psychological
Perspectives (Mahwah, N.J.: Lawerence Erlbaum Associates, 1997).
25. From James W. Pennebaker and Matthias Mehl, “The Effects of Emotional
Writing on Social and Linguistic Behaviors” (paper presented at the Japanese Society
for Research on Emotion, Tokyo, 27 May 1999).
134 CONTRIBUTORS

Marian Mesrobian MacCurdy, a writer, teacher, and singer, is currently

Associate Professor and Chair of the Writing Program at Ithaca College
where she teaches both creative and expository writing. She has published
scholarly articles as well as personal essays and poetry. An article, “The
Four Women of the Apocalypse: Polarized Feminine Images in Magazine
Advertisements,” is included in Utopia and Gender in Advertising, A Critical
Reader. Her essay, “From Image to Narrative: the Politics of the Personal,”
was published in the Journal of Teaching Writing, and she is the co-editor,
with Charles Anderson, of the book Writing and Healing: Toward and
Informed Practice (National Council of Teachers of English Press, 2000). She
is a frequent speaker at national conferences including the Conference on
College Composition and Communication, the National Association for
Poetry Therapy, and the Associated Writing Programs. She holds a Ph.D.
from Syracuse University.
Peggy Munson is the editor of the forthcoming book, Stricken: Voices from a
Hidden Epidemic (The Haworth Press). She has published poetry, fiction, and
essays in anthologies by Cleis Press, Faber & Faber, and Creative Arts Book
Company, as well as in magazines and journals such as The Spoon River
Poetry Review, the San Francisco Bay Guardian, and 13th Moon. She has won
grants, awards, and fellowships, including numerous residencies at the
Ragdale Foundation and Cottages at Hedgebrook. She holds a B.A. in
Creative Writing from Oberlin College and has been on disability due to
her illness for several years.
JoAnn O’Reilly is Director of the Rush University Program in Healthcare and
Humanities, a supervisor of Clinical Pastoral Education, and a chaplain. As
a doctoral candidate in Humanities at The Union Institute she is working
on her project demonstrating excellence, which examines the relationship
between suffering and narrative.
James W. Pennebaker is Professor of Psychology in the social and clinical
areas of the Department of Psychology at the University of Texas at Austin,
where he received his Ph.D. in 1977. He has been on the faculty at the
University of Virginia, Southern Methodist University, and, since 1997, The
University of Texas. He and his students are exploring the links between
traumatic experiences and physical and mental health. His studies find that
physician use, medical costs, and alcohol use can be reduced and work
performance increased by simple writing and talking exercises. His most
recent research focuses on the nature of language and emotion in the real
world. Author or editor of seven books and over one hundred articles,
Pennebaker has received numerous awards and honors.
Mediha F. Saliba was born in Indonesia and immigrated to the United States
in 1955. She graduated from the San Fernando Valley School of Nursing in
1971 and worked coronary and intensive care, until retiring to motherhood.
From 1994–1998 she was Associate Editor of the Santa Barbara Review, a
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