Journaling as trauma therapy - New research validates the effectiveness of expressive writing

By: Tom Cloyd - 4 min. read (Published: 2023-08-23; reviewed: 2023-11-08:2154 Pacific Time (USA))

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NOTE: The page contains a brief comment concerning an article recently published in The New York Times on August 23, 2023: A Novel Therapy, Using Writing, Shows Promise for PTSD.” . (for link, see note 2 in the Notes section below.)

Originally intended as a post to the Facebook Trauma and Dissociation Education and Advocacy page, limitations of the Facebook posting editor made impossible the inclusion of essential footnotes. My comment is therefore posted here instead. As mentioned below, a longer article on this general subject is in preparation.

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Writing expressively (detailing events, thoughts, and feelings) about what troubles you, when well-focused on the experience that is the origin of your present distress, has been shown by considerable research to effectively reduce and even eliminate distress associated with memory of the experience. (James W. Pennebaker has authored an excellent summary of this research, readable by the public as well as professionals.¹)

In the research reported below², an expressive writing procedure was experimentally compared to an established, well-researched trauma therapy - “prolonged exposure” (PE) - which has received considerable support from the Department of Defense. The writing procedure was as effective as PE, but had the advantage of having fewer individuals drop out of the process. Client dropouts have long been a major problem with PE.

This New York Times article has several major problems. At first glance, these are what struck me immediately:

“Recommended therapies” referred to omits a very major one. Paragraph one of the article refers to “the therapies most recommended by federal agencies”. Later in the article, these agencies are specified: the US Departments of Veterans Affairs and Defense. What is not mentioned is that the Department of Veterans Affairs also recommends EMDR³, as does the U.S. Substance Abuse and Mental Health Services Administration, and the American Psychiatric Association, among other notable professional groups.

The journalist-author seems unaware of the long-standing major effort made by Edna Foa PhD, originator of prolonged exposure therapy for trauma, to keep EMDR out of the military. She has received multiple large funding grants to validate her method, and clearly wants no competition. This does not well serve the psychotherapy community or people needing trauma therapy, the majority of whom are NOT related to military institutions in any way.

Prolonged exposure therapy itself has major problems, of which only one is mentioned. It is not to be preferred to EMDR and related therapies, which are not a part of the reported research. The latter use memory reconsolidation (see note⁴) to bring about permanent resolution of trauma memories, while PE and related therapies train an alternative response to a trauma memory, leaving the memory unaltered and still capable of causing flashbacks and emotional flooding.

What this means for a trauma therapy client is that PE-type therapy is not permanent. The created alternative response must be repeatedly rehearsed, else the therapy must be repeated to recreate the alternative response. This unfortunate fact, coupled with the much higher client dropout rate, means PE is NOT what an informed client, military or not, should seek.

Therapy dropout rates for the researched therapies are high compared to other well-regarded therapies not mentioned in the article. Mention is made (see paragraph 2 of the “Why It Matters” section in the Times article) of the 20 to 50 percent client dropout rate of the two supposedly “most recommended” trauma therapies. I have read a lot of research on trauma psychotherapies, and alone among them all is the high dropout rate for PE. Memory consolidation therapies, EMDR included, do not have such a dramatic loss of clients.

An apology, concerning this brief note: Severe time limitations, plus a strong focus on writing production at this time in my life, prevent me from providing full source documentation for all the major claims I have made here. However, this general topic of exposure therapy versus memory reconsolidation therapy is so important that it is definitely on my shortlist for a major article in which full source documentation will be provided.

Notes ^{^}

 

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