Effects of writing about emotions versus goals on hostility, depressive symptoms and physical health parameters: The moderating role of emotional approach coping

Abstract

A randomized, controlled trial compared emotionally disclosive writing (EMO; Pennebaker & Beall, 1986; n = 24), writing about long-term goals as the "best possible self" (BPS; after King, 2001; n = 17), and a control writing condition (CTL; n = 22); the trial evaluated emotional approach coping, i.e., efforts to cope through emotional processing (EP) and emotional expression (EE), as a moderator of writing effects on hostility, depressive symptoms, and physical health parameters in 63 undergraduate students. Emotional processing and emotional expression moderated the effects of writing condition on hostility at 1-month follow-up. Low EP participants reported less hostility in the BPS condition relative to the EMO condition, whereas high EP participants reported less hostility in EMO relative to BPS. Low EE participants reported less hostility in BPS, and high EE participants reported more hostility in BPS, relative to the EMO and CTL conditions. A moderating effect of EP on cynicism at 1 month also was identified, such that low EP participants reported more cynicism in EMO, and those high in EP reported less cynicism in EMO, compared to the other two conditions. Emotional processing moderated the effects of condition on the number of health care visits at 1-month follow-up. Low EP participants had fewer visits in BPS whereas high EP participants had more visits in BPS relative to the other two conditions. No main or moderated effects of condition were identified at 1-month follow-up on depressive symptoms, self-reported physical symptoms, or blood pressure.

Experimental studies using a paradigm developed by Pennebaker and Beall (1986) have demonstrated that emotional disclosure through writing produces physical and psychological health benefits across differing populations and stressors (e.g., Smyth, 1998; Frisina, Borod, & Lepore, 2004; Frattaroli, 2006). Findings, however, are not uniform, and extensions of the original paradigm have raised new questions regarding both mechanisms and moderators of writing benefits. As writing is developed as an intervention strategy, it is critically important to establish what individual difference variables and environmental contexts moderate physical and psychological health outcomes. Austenfeld, Paolo, and Stanton (2006) compared emotional writing about current stress to optimistic writing about future goals and accomplishments as the "best possible self" (King, 2001) in a group of third-year medical students. This study yielded several novel findings. Students with high baseline hostility evidenced reduced hostility at 3-month follow-up in the emotional disclosure writing condition, but hostility increased in students high in hostility at baseline who were assigned to write about goals or a control topic. Effects of writing condition on depressive symptoms were moderated by emotional approach coping (EAC; see Austenfeld & Stanton, 2004, for a review), a construct encompassing efforts to cope through emotional processing (EP), i.e., acknowledging and understanding emotion, and emotional expression (EE). In the medical student study, participants high in EP or EE reported lower levels of depressive symptoms when writing about emotion relative to the goal-writing and control conditions. For students low in EP or EE, writing about goals resulted in lower levels of depressive symptoms compared to the other two conditions. Emotional processing also moderated the effects of writing condition on number of health care visits at 3-month follow-up; low EP participants had fewer visits in the goals condition compared to the emotional disclosure and control conditions (the number of visits did not appear to be affected by condition for high EP participants). The effects of writing on hostility are of particular interest, considering recent long-term prospective studies suggesting that hostility is a major risk factor for development of cardiovascular disease. The current study compared emotional versus goal-oriented writing in a sample of undergraduates, in an attempt to replicate the moderator effects of EAC and to further evaluate effects of writing on hostility, using a hostility measure that is employed in studies of cardiovascular disease.