Addressing Trauma by Changing Your Inner Narrative

June 7th, 2016

Awake Goy

The best way to deal with significant trauma such as PTSD is to engage in post-trauma counselling immediately after the event with a qualified therapist, right? After all, it should only help to talk about the event and get all of that weight off your chest, shouldn’t it?

Wrong. In most cases, post-trauma counselling (particularly within the framework of CISD – Critical Incident Stress Debriefing) immediately following a significantly traumatic event can be the very worst thing that one can do, the growing consensus shows (Wilson, 2011; Bledsoe, 2003).

Researchers believe the reason for this seeming paradox is that the memory of a highly traumatic event can actually become reinforced and crystallized if post-trauma counselling is undertaken immediately following the event, thereby making it much more problematic to deal with in the future.

One of the key mechanisms believed to be at play in PTSD and significant trauma is the mind’s inability to rationalize and make sense of an event, sometimes even moreso than the actual event itself (Wilson, 2011).

Thus any reinforcement of a traumatic memory engendered by post-trauma counselling such as CISD may simply serve to strengthen a person’s inability to rationalize and make sense of the traumatic event from that point on.

Researchers and clinicians are beginning to accept an alternate approach in dealing with PTSD and stressful events in general, known as Expressive Writing, a technique pioneered by social psychologist James Pennebaker in the late 1980s. A steady flow of research papers since then has shown clear evidence of the benefits of this technique (Pennebaker & Evans, 2014).

Despite what sounds like a promising approach for a serious mental health issue, a caveat must be issued at this point that I am not a psychologist, nor am I formerly educated in the behavioural sciences. Should you feel that you require intervention for such a serious issue, then I would advise you to seek advice from a qualified mental health professional. It would, however, appear prudent to discuss the Expressive Writing strategy with your doctor, and to even bring along information about the technique to show them.

The Expressive Writing method

The Expressive Writing approach involves no active participation from the subject for the first two weeks following the traumatic event. This reprieve is believed to give the mind some breathing space in order to allow natural thoughts and feelings to surface in addition to some degree of memory healing to take place. Following this, the subject is directed to write about the incident for approximately 20 minutes per day over a four-day period, with no consideration given to style, spelling, punctuation, sentence structure, or grammar. It is irrelevant whether the patient chooses pen and paper or sits in front of a keyboard. Furthermore, poor writing skills has shown to be an irrelevant factor in the outcome of intervention (an outline of instructions for the Expressive Writing method is given in the appendix section at the end of this article).

Although this method may not sound like much in the way of intervention, the approach has been demonstrated to allow the patient to begin to articulate and analyze their perspective of the traumatic event, with more sense of the incident being made over the course of the four days.

Aside from highly traumatic events such as those which can lead to PTSD however, Pennebaker’s Expressive Writing method can also be quite helpful in the context of moderate or even low-key emotional upheavals from a person’s past.

The psychology behind Expressive Writing

So what is happening here? What is it that explains the success of Pennebaker’s Expressive Writing method? The key word is narrative.

Unlike a computer or a human version of Mr. Spock, we humans do not naturally process the world around us in terms of separate events and facts in a purely objective, logical manner, but instead in terms of a connected, flowing narrative that we expect to make sense. This occurs via a mental editing process which enabled our ancestors to survive by priming them to detect causal relationships between meaningful events in the environment (McRaney, 2013).

With this mental software in place, it is no surprise then that we tend to absorb information best when it is put into narrative format. This is one reason why Expressive Writing is so effective.

We see our lives, the lives of others, in addition to contemporary and historical events in terms of narrative: a beginning, a middle and an end, with a plot, sub-plots, and characters, and crucially, a seemingly logical framework by which we can explain and make coherent sense of our lives and the world around us.

It is a breakdown of the latter aspect of this narrative process which appears to be one of the key mechanisms underlying PTSD – i.e. the failure of the traumatic event to make coherent sense within the context of the person’s life story.

By writing about the event in question, the patient involved in Expressive Writing intervention is changing the way in which their brain is organizing the information about the traumatic event and its connections to other beliefs, events and areas of their lives. This is absolutely critical, because the person is literally changing the way in which the traumatic event fits into their own life story, allowing them to make better sense of the event and to rationalize it with greater clarity (Wilson, 2011). In essence, the person is making a crucial adjustment to their inner narrative.

In basic lay terms, this could be thought of as a restructuring of the person’s perspective. However, in reality it is a much more profound change than this.

Although Pennebaker suggests an intervention period of four days of writing, a longer period beyond this is permissible if it helps the subject. The four-day rule of thumb is merely suggested in order to avoid the subject from becoming fixated on the traumatic memory, which may tend to reinforce and magnify it. Pennebaker instead suggests that once the person has achieved a reasonable degree of clarity and resolution of the event, they should move on with their life. But of course this is not possible for some people after a mere four days of writing. Provided the patient continues to build on the restructuring of their perspective of the traumatic event in a positive and useful direction, exceeding four days of writing is quite acceptable.

The implications of Expressive Writing for journal writing

The above discussion naturally begs the question whether or not regular journal writing is beneficial. The answer as Pennebaker asserts is “yes”, provided that the past events written about restructure the author’s perspective in a positive and healthy direction. One trap which journal writers can fall into, Pennebaker warns, is to ruminate about past events to the point of fixation and obsession, which is not merely useless, but downright harmful to mental health.

Appendix section: instructions for Expressive Writing

Note – the following is merely a short excerpt from Pennebaker’s book, Expressive Writing: Words that Heal. Should you wish to engage in Expressive Writing, it would be advisable to purchase Pennebaker’s book (listed in the references section below).

General Instructions

“For the next four days, you will write about a trauma or emotional upheaval that has profoundly affected your life. A few simple guidelines to keep in mind while you are writing:”

Write for twenty minutes a day. If you end up writing for more than twenty minutes, that’s great. However, the following day, you still need to write for at least twenty minutes.

Writing topic. You can write about the same event on all four days or about different events each day. Not everyone has had a major trauma they want to write about. However, all of us have had major conflicts or stressors in our lives — you can write about those as well. What you choose to write about should be something that is extremely personal and important for you.

Write continuously. Once you begin writing, write without stopping. Don’t worry about spelling or grammar. Your high school English teacher will never see it. If you run out of things to say, simply repeat what you have already written.

Write only for yourself. You are writing for yourself and no one else. Plan on destroying or hiding what you have written when you are finished. Do not make this a letter to someone. If, after you finish writing, you want to write a letter, then do it. But this exercise is for your eyes only.

The Flip-Out Rule. If you feel as though you cannot write about a particular event because it will push you over the edge, then don’t write about it. Deal only with those events or situations that you can handle now. If you have additional traumatic topics that you can’t get to now, you can deal with them in the future.

What to expect after writing. Many people often feel somewhat sad or depressed after writing, especially on the first day or two. If this happens to you, it is completely normal. These feelings usually last only a few minutes and, in some cases, hours — much like the way you feel after seeing a sad movie. If possible, plan to have some time to yourself after writing to reflect on the issues you have been dealing with.

More information can be found at the following sites:

The Expressive Writing method: https://www.youtube.com/watch?v=XsHIV9PxAV4

James W Pennebaker – University of Texas at Austin: https://www.utexas.edu/cola/psychology/faculty/pennebak#writing-health