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October 1, 2020

Research Matters / A "Write" Way to Address Trauma

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    Social-emotional learning
      Missing friends, teachers, and learning. Worrying about families, resources, and food. The coronavirus pandemic has taken a heavy toll on the mental health of our students. A survey of 1,500 teens in May found that 7 in 10 are grappling with mental health issues: 55 percent reported having anxiety, 45 percent excessive stress, 43 percent depression, and 27 percent said they were worried about running out of basic necessities (4-H / The Harris Poll, 2020). In short, many students are in a fragile emotional state that's likely to make it difficult for them to immerse themselves in learning.

      So, what can educators do? One solution may lie in a strategy that remains accessible to every student whether they're learning at home or in school: Writing.

      Writing and Well-being
      For years, studies have linked frequent writing (such as journaling) with better mental health, better sleep patterns, greater self-confidence, and even stronger immune systems (Pennebaker & Smyth, 2016). For more than a century, dating as far back as Sigmund Freud, psychologists have encouraged patients to engage in various forms of writing therapy.

      In recent years, a particular form of writing therapy called expressive writing has gone under the microscope of rigorous study. Expressive writing encourages people of all ages to share their deepest personal thoughts and feelings about a negative life experience. A closer look at this type of writing reveals some important insights about how it can help students process traumatic events—and where it may fall flat or backfire.

      Making Sense of Experiences
      Psychologists have long observed that people tend to remember traumatic events as disjointed "sensory perceptions, obsessional ruminations, or behavioral reenactments," which we emotionally rehash with little cognitive mental processing (Smyth, True, & Souto, 2001, p. 162). Writing can help students process and convert this swirl of emotions into a coherent narrative—but only when prompted to do so. A study of 116 high school students, for example, found those prompted to construct a narrative of past traumatic events demonstrated better mental health outcomes than those who simply engaged in freewriting or wrote how they felt about the event (Smyth et al., 2001).

      Asking students to write about stressful events can stir up raw emotions, but without proper guidance these exercises can prove unhelpful. This may explain why a meta-analysis of 21 studies (Travagin, Margola, & Revenson, 2015) found limited effects of using expressive writing exercises to help 10–18-year-olds develop coherent narratives. Young people, researchers noted, often need support from adults to "finish the narrative" and draw insights from their experiences (p. 53). For example, teachers may need to prompt students to consider what they've learned from a stressful experience so they might emerge from it as a stronger, wiser person. (Of course, we must also be sensitive to privacy and not push students to reveal anything.)

      Writing Out of "Stinking Thinking"
      Perhaps the most important benefit of writing is when it helps students put their feelings into words and identify "cognitive distortions"—exaggerated ways of thinking that can spiral into depression, such as catastrophizing (focusing on the worst possible outcome), filtering (dwelling on negative events and ignoring positive ones), or emotional reasoning (assuming one's negative feelings reflect reality) (Burns, 1989).

      Cognitive behavior therapy helps teens re-examine and diffuse negative beliefs by identifying the event that triggered those beliefs and putting it into words ("My friends aren't texting me, so I feel depressed"). Next, they surface faulty beliefs that led to those feelings ("My friends are ditching me"), dispute those beliefs by calling out the cognitive distortions at work ("I'm catastrophizing and filtering") and develop alternative explanations ("Maybe my friends are just spending more time with their families, too"). Finally, they identify how to change their negative thoughts ("I'll focus on positive things, like my new puppy").

      Rigorous studies have found that incorporating cognitive behavior therapy into expressive writing can have significant mental health benefits for youth experiencing psychological trauma. In one such study, 8–18-year-olds wrote narratives of a traumatic experience, including their emotions and thoughts about the experience, then identified and dispelled cognitive distortions before concluding their stories with how they feel now and what they will do to cope in the future (Van der Oord et. al, 2010).

      Writing Therapy in the Classroom
      Although classroom teachers are not licensed therapists, writing assignments like the ones suggested below can serve as a first-tier intervention to help students work through their negative experiences and thoughts—and uncover when they might need professional mental health services:
      • Construct a narrative. Help students turn their experiences and thoughts into a narrative ("What were your first thoughts when you learned schools were closing because of COVID?" "What changed in your life?") that includes their response ("What things did you do during quarantine to lift your spirits? How did they help you?").
      • Reflect on emotions. Recalling these events may surface powerful emotions for students, which you can help them process through expression. ("How did you feel when you heard school would be closed longer than expected or the pandemic might have a negative impact on your family's finances?" "What worries keep you awake at night?")
      • Re-examine negative beliefs. Help students see and dispel cognitive distortions in their thinking. ("Do any of your anxieties or beliefs reflect exaggerated thinking?")
      • Be the helper. Students often arrive at personal insights by first advising others. (Example assignment: "Write a letter to a peer who feels anxious or depressed, showing you understand their feelings. Then share what coping strategies work for you.")
      Studies of cognitive behavioral writing therapy suggest that this final step—giving advice to others—is often key to coming to terms with trauma, as it helps youth crystallize their insights and feel agency in overcoming their adverse experiences. Therapeutic writing is no cure-all, but for many students, it may offer preventative medicine and self-care and help them turn their adverse experiences into opportunities to grow as individuals.
      References

      Burns, D. D. (1989). The feeling good handbook: Using the new mood therapy in everyday life. New York: William Morrow & Co.

      4-H / The Harris Poll (2020). Teen mental health. Washington, D.C.: Author.

      Pennebaker, J. W., & Smyth, J. M. (2016). Opening up by writing it down: How expressive writing improves health and eases emotional pain. New York: Guilford Publications.

      Smyth, J., True, N., & Souto, J. (2001). Effects of writing about traumatic experiences: The necessity for narrative structuring. Journal of Social and Clinical Psychology20(2), 161–172.

      Travagin, G., Margola, D., & Revenson, T. A. (2015). How effective are expressive writing interventions for adolescents? A meta-analytic review. Clinical Psychology Review36, 42–55.

      Van der Oord, S., Lucassen, S., Van Emmerik, A. A. P., & Emmelkamp, P. M. (2010). Treatment of post-traumatic stress disorder in children using cognitive behavioural writing therapy. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice17(3), 240–249.



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