Expressing gratitude, blessing, and joy promotes post traumatic growth* and puts an emphasis on moving beyond trauma to thriving.  In this practice, rather than looking back on what happened, those afflicted with PTSD or TBI are encouraged to look at the present and future following a prescribed sequence of writing experiences in the form of letters or notes that express gratitude, blessing, and joy.  Engaging in this experience has the potential to change the brain to process information more mindfully, fostering awareness, attention, acceptance, appreciation, affection, and affirmation. 
When Darkness Falls
If you have recently been touched by a life-changing event, diagnosed with cancer, diabetes, heart disease, job loss, divorce, separation, death of spouse, death of a parent, you know the mind/body connection first hand.  The mind/body connection is never more apparent than when we experience a significant emotional event in the form of such traumas.  We don't sleep well, we stop eating or we sleep all the time or we eat everything in sight.  Such is common knowledge anecdotally and it is demonstrated widely in studies. 
Letting the Light In
Thankfully, rather than looking only at effects of stress, some research looks for healing, for remedies, for moving beyond the effects of stress to growth.  One of the fruits of such research about healing from the negative effects of stress is the role that written expression can play in alleviating symptoms such as high blood pressure, stressed- induced asthma, rheumatoid arthritis. Expressive Writing heals through a process focusing  on feelings related to a trauma, imagining a fresh perspective about that trauma, and creating a meaningful narrative about the trauma.  Other ways of writing can promote healing as well.  While expressive writing focuses on trauma, Transactional Writing focuses on expressing appreciation, affection, and affirmation.  
Other Sources of Light
Transactional Writing  often takes the form of letters and notes, sent or unsent.  Try writing one or all of these letters and see how you feel.
Gratitude Letter (write for twenty minutes)
Write a letter to someone in your life that you would like to thank for something they gave you, or something they taught you, or something they have inspired in you. Get right to the point and don’t apologize for not writing before now. Imagine how the recipient may feel when they read your letter. Describe your relationship with the person you are thanking and the context for this occasion. Describe the gift that you received, the skill you learned, or the inspiration you received from knowing them.
* Tell them what their gift meant to you when you received it.
* Tell them how you felt about it then and how you feel about it now.
* Tell them how you have been able to use this gift or the skill or the inspiration you received from them.
* Tell them how your life has been enriched by what you received from them and for their presence in your life.
Blessing Letter (write for twenty minutes)
Write a blessing for someone that promotes their happiness, well-being, and prosperity. Get right to the point and don’t apologize for not writing before now. Imagine how the recipient may feel when they read your letter.  Name or describe your relationship with the person you are blessing and the context for this occasion.  
In your writing, affirm their gifts and talents. Write at least six words that name their best attributes.  Consider the milestones they will encounter in their life and offer your wisdomand support. Give permission for them to love themselves, love others, and to enjoy life when you are no longer with them. Let the receiver know how they have blessed you and what they mean to you.
 Joy Letter (write for twenty minutes)
Write an expression of joy about a person. Write for twenty minutes. Describe your relationship with the person you are celebrating and the context for this occasion. In your writing describe a joyous, wonderful, exquisite experience with this person.  Recall how you felt, what you thought, what you said, what others said to you, who was with you, and where you were. How you feel about them now?  How you wish to feel about them in the future.
Do not worry about sending the letters you write. In fact, it might be smart to not send the letters you write. They are ultimately for your mental health and not the intended recipient’s. If, after finishing your writing and taking a few days off, go back and look at your letters and reconsider if sending the letters would ultimately be beneficial for others and for you.


* Post-traumatic growth courtesy of Irene Hayden

“What is writing to heal, writing for health?” is one of the most frequent questions I am asked when I explain why healthcare providers may wish to lead their patients in writing for health.  

For the purposes of our retreat, Leading Patients in Writing for Health, my colleague, Karen Jooste, MD and I use the terms writing to heal, writing for health, and writing for wellness interchangeably.   How wellness and writing are connected is usually described under an umbrella term like writing to heal or writing for health and sometimes simply as expressive writing (EW) We make a distinction between these terms and casual journaling or journal writing in general because writing to heal practices are marked mostly by their carefully designed writing prompts, prompts that may point to specific health challenges or the wellness goals of individual patients or clients.  A further distinction between casual journaling and writing to heal is how writing to heal practices are grounded in expressive writing research and techniques that encourage patients or clients to write in accordance with a progression of exercises from simple but deep emotional expression to an affirmation of strengths and intentional living.  

Many of our distinctions between journaling and writing to heal practices are suggested in the wonderful synthesis of research and practices that Louise DeSalvo provides in her work, Writing as a Way of Healing: How Telling Our Stories Transforms Our Lives.  DeSalvo suggests that writing about trauma benefits health when it is rich in detail, balanced with feelings of the past, present, and future; and when it looks for linkage in the present and for meaning.  Journaling that is simply keeping track of events or free-writing about those events has not been shown to improve health.   Here is what DeSalvo describes are the qualities of a healing narrative:

1. Renders our experiences concretely, authentically, explicitly, with a richness of detail;
2. Links feelings to events;
3. Is balanced in its use of positive language and negative language;
4. Reveals insights we’ve achieved from our painful experience;
5. Tells a complete, complex, coherent story (57-61).

The literature of several healthcare professions suggests that for many people writing to heal is beneficial and useful for obtaining and sustaining emotional, physical, and spiritual health. In fact since the early 1980s, a growing body of research shows that the heart rate lowers and people are more equipped to fight off infections when they release their worries in writing. In addition to coping better with stressful situations, this research shows that writing can have a positive impact on self-esteem and result in work that can help people overcome their own obstacles. 

We propose in Leading Patients in Writing for Health that writing is one tool in a toolbox of integrative medicine or complimentary medicine and that it may be a useful tool for you in your practice, but it is certainly not a one-size-fits-all prescription.  Writing to heal may take many forms because therapeutic value is found when literary genres such as memoirs, essays, fiction, poetry, drama are framed in such a way to build on the writer’s life experience, health challenges and goals for well-being.  Whether you ever read what your client or patient writes is not as important or as necessary as how they reflect on their writing.  In fact sharing does not improve the positive affect writing can have on the writer.   

Writing to heal is safe, inexpensive, and accessible to almost everyone.  It only has one rule: The three-day rule.  Advise your patients to watch out for writing themselves into a rut.  Please explain to them that if they find themselves covering the same ground over and over with the same emotion, it may be time to move on.  Either write about the topic in an entirely different way or leave the topic alone for a while.

In further articles in this series, we will explain the principles and defining characteristics of five types of writing to heal known as Expressive, Transactional, Poetic, Affirmative and Legacy, and we will demonstrate how writing and mindfulness are connected through Six As of Mindful Writing: awareness, attention, acceptance, affection, appreciation, and affirmation.

Combining the new brain science discoveries and writing to heal.
by John Evans
Reprinted from his original blog posting on Psychology Today.

“Think not lightly of good, saying,
“It will not come to me.”
Drop by drop is the pot filled.
Likewise, the wise one, gathering it little by little,
Fills oneself with good.”

In the beginning of Rick Hanson’s, Hardwiring Happiness (1), I find this ancient wisdom provides a doorway for my understanding of recent discoveries about how the brain responds to applications from the science of happiness. Hanson suggests that overcoming the brain’s inclination to focus on bad experiences is possible through learning to focus on good experiences or “taking in the good.”

Hanson describes Four Steps of Taking in the Good:

1.Have a positive experience.
2.Enrich it.
3.Absorb it.
4.Link positive and negative material in a generative way

I believe writing can play a significant part in taking these steps and rewiring your brain for happiness.   Be your own scientist and see for yourself.  Set aside a time each day for three or four days to write following the guidelines Hanson suggests. Or just try it today and see how it feels. Set aside twenty minutes and do the following:

First, take five minutes to Have a positive experience or remember one and describe in writing this recent positive experience. Any positive experience will do, a pleasant physical sensation, a sense of purpose, a relationship with a close friend or being in a satisfying environment. Recall your feelings as you write. Describe the sensations that make writing in this way, about these things rewarding for you. 

Second, take a few minutes to Enrich the positive experience you wrote about in Step One. Enjoy the experience from a different perspective by writing about your experience using third or second person point of view, using pronouns like, he or she, or you. Write about the positive experience from the point of view of another person who shared in enjoying the experience with you. Write about how this experience was deeply satisfying for you, and how you link it to making a difference in your life or the life of someone you love.

Third, take five minutes to write in a way that will help you Absorb the healthful benefits of remembering and enriching this pleasant experience. Do this by visualizing this experience warming you like a comforter or blanket that covers you with good feelings. Or visualize immersing yourself into this good experience like entering a warm bath. Write about how you keep this experience as you might a precious stone or other valuable safely where you may retrieve it easily.

Fourth, take five minutes to Link positive and negative experiences in a generative way.  Be open to negative issues or feelings that may have arisen as you wrote about your positive and pleasant experience. Acknowledge those feelings in writing with compassion and nonjudgment. If you are ready, begin to write about any relationship you are aware of coming to the surface when you have an unpleasant or negative experience competing for your attention with something positive and pleasant. Imagine any negative material being overwhelmed with positive energy or light filling in the darkness. If you find yourself writing more about the negative feeling than is comfortable let it go and focus again on only the positive feelings or pleasant experience you wrote about in Step One. The challenge is being able to hold the positive experiences in the forefront while acknowledging that it may have been otherwise. 

While Hanson provides these steps as thought exercises, I believe writing provides a generative tool that makes an implicit process explicit, so that through writing we can see things we do not see if we reflect on pure thought. Writing makes the abstract concrete.

The long-term implications for writing our life story as we wish it to be written, are only now being investigated. I find useful what neuropsychologist, Hanson suggests: "By learning how your brain was built over time, you'll understand yourself and others better." Our brain was built by remembering what caused us pain, what to be afraid of for future reference, what mistakes we have made in order to avoid them in the future. Our responsivity bias has run toward "bad" for so long that we have forgotten how to internalize the "good." Internalizing the good over time builds up an inner strength to meet life challenges, without fear, frustration, or heartache. 

Our positive story shapes our neuro-pathways when we begin to write a new story for ourselves with a different perspective and in self-compassionate affirming language. Through writing in this way I suggest that we are setting down new pathways, affirming ourselves in the future in the manner in which we wish to live. 

Writing about your positive emotional experience in this way may become such a positive experience in itself that you begin to keep a journal of positive experiences.

(1) Hanson, R. (2013) Hardwiring Happiness: The new brain science of contentment, calm, and confidence. Harmony Books. NY. 

by John F. Evans

Wellness and writing are connected in ways we are only beginning to understand and use.  The literature of several healthcare professions suggests that for many people wellness and writing can be closely connected, and that writing is useful for obtaining and sustaining emotional, physical, and spiritual health. In fact since the early 1980s, a growing body of research about the physical affects of writing shows that the heart rate lowers and people are more equipped to fight off infections when they release their worries in writing. In addition to coping better with stressful situations, this research shows that writing can have a positive impact on self-esteem and result in work that can help people overcome their own obstacles.Much of the research about writing and healing was pioneered by James Pennebaker, Ph.D., and is now sustained by others who work in the disciplines of writing, psychology, medicine, counseling, nursing, coaching, hospice and  education.  The biological underpinnings of writing for health are currently found in such highly sophisticated and overlapping scientific areas such as: applied psychoneuorimmunology[i], psychobiology[ii], applied psychophysiology[iii] and recent findings in epigenetics[iv].  However daunting these terms may be, gratefully, no one needs to be an expert in these fields, and no one needs to be a professional writer to benefit from writing.  Moreover the writing does not even have to be grammatical or follow any particular form; it only needs to be expressive.  Writing-to-heal is even for people who don’t like to write.

Research about expressive writing, the kind of writing that is deeply personal and is written for one’s own eyes only, demonstrates that writing:

• Boosts thinking ability
• Increases working memory
• Reduces pain, tension, and fatigue
• Enhances mood and sleep quality
• Positively influences immune system function

Other studies suggest that significant mental and physical health benefits occurred in cancer patients who wrote their deepest feelings and thoughts for thirty minutes daily for five days.  Writing about “your best possible self” resulted in a significant boost in mood along with a drop in illness when compared to those who wrote about neutral topics.

Writing is one tool in a toolbox of self-care, and it may be a useful tool for you, but it is certainly not a one-size-fits-all prescription.  Writing for wellness may take many forms.  Therapeutic value is found in literary genres such as memoirs, essays, fiction, poetry, drama.  Whether they are published or not does not negate the positive affect they can have on the writer.  Other forms of writing for wellness are unsent letters, lists, logs, journals, and exercises designed to specific health or behavioral concerns.   A very popular form of writing for wellness is writing in a personal journal.

Here are a few suggestions:

• Write whenever you want - daily or weekly or only when you have strong emotions to express about something that happened or something someone said or did.

• Write in any way you want without regard to punctuation or spelling or any convention.
• Write about yourself and your activities in the third person to see a change in perspective.

Writing for wellness only has one rule: the three day rule.  Watch out for writing yourself into a rut.  If you find yourself covering the same ground over and over with the same emotion for three days straight, it may be time to move on.  Either write about the topic in an entirely different way or leave the topic alone for a while.

[i] Psychoneuroimmunology (PNI) is the study of the interaction between psychological processes and the nervous and immune systems of the human body.
[ii] Psychobiology is the application of the principles of biology (in particular neurobiology), to the study of physiological, genetic, and developmental mechanisms of behavior in human and non-human animals.
[iii] Applied psychophysiology is the application of interventions such as mindfulness or biofeedback to change the physical response we usually have to something our mind tells us.
[iv] Epigenetics is the study of inherited changes in phenotype (appearance) or gene expression caused by mechanisms other than changes in the underlying DNA sequence, hence the name epi- (Greek: επί- over, above) -genetics.