'Narrative expressive writing' might protect against harmful health effects of divorce-related stress

Narrative expressive writing led to improvements in heart rate and an index of the heart's responses to stress, according to the research by psychology doctoral student Kyle J. Bourassa and colleagues of University of Arizona, Tucson. "The results suggest that the ability to create a structured narrative -- not just re-experiencing emotions but making meaning out of them -- allows people to process their feelings in a more adaptive way, which may in turn help improve their cardiovascular health," said Kyle Bourassa.

The study included 109 adults (70 women and 39 men) with a recent marital separation. Participants were randomly assigned to one of three writing exercises, performed on three occasions over several days.

One group performed a traditional expressive writing task, with instructions to write freely about their "strongest and deepest emotions." In a prior study by principal investigator Dr. David Sbarra, this approach seemed to increase separation-related emotional distress, particularly among participants with high psychological rumination -- the tendency to persistently think about one's mood.

Another group performed a narrative expressive writing task, in which they created a "coherent and organized narrative" of their separation experience -- culminating in describing an end of their "divorce story." The third group was given an emotionally neutral writing task. Indicators of the body's cardiovascular responses to stress were compared before and after the writing tasks (up to 9 months after the writing).

Participants assigned to narrative expressive writing had a reduction in heart rate as well as an increase in heart rate variability (HRV), which measures beat-to-beat variations in heart rate. Higher HRV reflects better functioning of the body's parasympathetic nervous system reactions to stimuli, including stress.

These effects were moderate in size -- heart rate in the narrative expressive writing group was about seven beats per minute lower than the other two groups -- and were consistent across some stressful and non-stressful laboratory tasks (such as doing mental math). Blood pressure was unaffected. There was no evidence that expressive writing increased physical stress responses in people with a high degree of psychological rumination.

Dr. Sbarra noted, "From this work, we can make two specific conclusions. First, relative to the two other conditions, narrative expressive writing caused the changes we observed in the cardiovascular biomarkers. This is a pretty striking result for just 60 minutes of writing over three days. Second, the effects of narrative writing on these health-relevant biomarkers is independent of adults' self-reported emotional responses about their separation. Creating narrative may be good for the heart, so to speak, but this does not mean there a corresponding improvement in psychological wellbeing."

Divorce is a common stressor linked to increased risk for poor long-term physical and mental health. Yet few studies have evaluated interventions to lessen the health impact of divorce. Since both higher heart rate and lower HRV are linked to increased health risks, narrative expressive writing might be one way to reduce the long-term health impact of divorce.

Dr. Sbarra also suggested caution in interpreting these findings. "To be clear, this study points to causal changes in health-relevant cardiovascular responding, not health outcomes per se. Further research will be needed to clarify the links between these biomarkers and the long-term health outcomes of people after divorce."