Writing therapy

Question 1

Pennebaker writing paradigm

Answer 1

1986, origin of writing therapy. Demonstrated that writing about trauma reduced illness-related doctor visits

• Short writing sessions where students wrote down feelings and thoughts about distressing/traumatic memory of event
• did not receive feedback or discuss it with clinician
• was not meant as a therapy

Question 2

WT Phase 1

Answer 2

Imaginal exposure;

Goal: exposure to memory for habituation and extinction of fear response

Task: write detailed script in first person and present tense, as if its happening again emphasizing on most painful details

Clinician: Read and discuss w patient, see if anythings been left out/avoided, determine what is most painful

Question 3

WT Phase 2

Answer 3

Cognitive restructuring and coping:

Goal: targeting maladaptive thoughts and coping

Task: Write an advice letter to imaginal close friend who experienced the same. Focus on how they can cope, other perspective, reflection of meaning and positive insights

Clinician: identifies and challenges dysfunctional aspects, and instruct to apply advice to themselves

Question 4

WT phase 3

Answer 4

Social sharing and closure

Goal: Foster social support and help achieve sense of closure

Task: write a letter to a SO. Write imporant aspects about event and effect on their life. State reason why its addresses to that person an what reaction is expected.

Closure task: devise symbolic closure ritual, eg burning object, visiting a place etc.

Clinician: check letter for content, grammer etc. Decide whether it a good idea to actually send the letter. Help plan and decide the symbolic ritual

Question 5

Phasing of the model

Answer 5

Strictly adhered to in outcome studies. However, in clinical setting might be more flexible (extending/shortening phases based on effect)

Question 6

Psychoeducation

Answer 6

One of the main focus points. Increases patients enthusiasm and involvement: allows for understanding the purpose

Question 7

Writing Guidelines

Answer 7

1. Try finish 3 45-minute sessions each week
2. Utilize first 5 minutes to orient self and recollect memory
3. Sessions are planed and not executed before bedtime
4. Plan calming activity right after writing
5. Writing is done alone and distractions are minimised (turn of phone, make sure you’re not disturbed)
6. Use 1 notebook and only use it for sessions. Keep it safe
7. Grammer is not important except for last task
8. Send it in well before the session to optimize therapy session

Question 8

Writing therapy in relation to models explaining PTSD

Answer 8

Cognitive model:
- Writing exposure and restructuring in line with cognitive model (Clark & Ehlers). 1. elaboration into autobiographical memory through imagined exposure, 2. Modification of problematic appraisal through advice letter, 3. hindering/abandoning maladaptive strategies

Actual working partially unclear, yet proven effective in multiple studies.

Results seen after 5 weeks