Journal of Personality and Social Psychology
1997, Vol. 73, No. 5, 1030-1037
Copyright 1997 by the American Psychological Association, Inc.
0022-3514/97/$3.00
Expressive Writing Moderates the Relation Between
Intrusive Thoughts and Depressive Symptoms
Stephen J. Lepore
Carnegie Mellon University
The author investigatedwhether expressive writing enhancesemotionaladaptationto a stressful event
(graduate entrance exams) by reducing event-related intrusive thoughts or by desensitizingpeople
to such thoughts. Participants in the experimentalgroup, who were instructed to write their deepest
thoughts and feelings about the exam, exhibited a significant decline in depressive symptoms from
1 month (Time 1) to 3 days (Time 2) before the exam. Participants in the control group, who wrote
about a trivial topic, maintaineda relativelyhigh level of depressive symptomsover this same period.
Expressive writing did not affect the frequency of intrusive thoughts, but it moderated the impact of
intrusivethoughts on depressive symptoms. Specifically,intrusive thoughts at Time 1 were positively
related to depressive symptoms at Time 2 in the control group and were unrelated to symptoms in
the expressive writing group.
present study attempted to evaluate aspects of this theory in
people taking graduate and professional school entrance exams.
People taking these exams can experience a high degree of
emotional distress, because their exam performance can be a
critical determinant of their professional training and ultimate
career choices. Using an emotional expression paradigm, this
study tested whether expressive writing diminishes psychological distress in examinees. In addition, the study investigates the
mediating role of intrusive thoughts in this process. As discussed
below, intrusive thoughts may reflect incomplete or failed processing of stressful events. Thus, examining the influence of
expressive writing on intrusive thoughts may shed some light
on whether expressive writing facilitates emotional adjustment
by means of its influence on cognitive processing mechanisms.
During aversive events, many people have a strong urge to
express their thoughts and feelings related to the events (Rime,
1995). This urge may be motivated by the comfort associated
with ventilation or it may reflect an attempt to make sense of a
negative event or validate one's feelings through social sharing.
Whatever the motive, it appears that disclosure about stressful
events is associated with improvements in physical and psychologica! well-being (see Pennebaker, 1989, 1993; Smyth, 1996,
for reviews). Emotional expression, or disinhibition, is also a
central feature of many psychotherapeutic interventions (Stiles,
1995). There is suggestive evidence that inhibition in general,
which can be defined as the tendency to conceal or not express
significant experiences to others, may have dramatic effects on
health. For instance, in a study of HIV-seropositive men, HIV
infection advanced more rapidly in men who concealed their
homosexual identity than in men who were more open about
their identity (Cole, Kemeny, Taylor, Visscher, & Fahey, 1996).
Despite the cumulative evidence that emotional expression may
be adaptive when coping with stress, researchers have gained
little insight into the mechanisms underlying this phenomenon.
Recently, however, there have been attempts to connect expression-based benefits to cognitive processes of adjustment (e.g.,
Clark, 1993; Gold & Wegner, 1995; Greenberg, Wortman, &
Stone, 1996; Lepore, Silver, Wortman, & Wayment, 1996; Pennebaker, 1993, 1995; Tait & Silver, 1989).
Independent of social reactions to disclosures, emotional expression might facilitate cognitive processing of stressful experiences by forcing individuals to confront (i.e., contemplate and
evaluate) the stressful stimulus and their responses to it. The
Intrusive Thoughts in the Context
of Cognitive-Processing Theories
I thank Martha Francis and James Pennebakerfor sharing the Linguistic Inquiry and Word Count program, which was used for content analyses in this study.
Correspondence concerning this article should be addressed to Stephen J. Lepore, Departmentof Psychology,Carnegie Mellon University,
Pittsburgh, Pennsylvania 15213-3890. Electronic mail may be sent via
the Internet to [email protected].
People under stress exhibit a great deal of variability in their
emotional responses. Even following extremely traumatic
events, such as the loss of a loved one or paralyzing accidents,
some people may enter a state of intense and prolonged depression, whereas others appear to be emotionally unscathed (Wortman & Silver, 1989). Several investigators have shown a consistent positive relation between repetitive and unbidden thoughts
about stressful events and negative mood (e.g., Horowitz, 1975;
Lutgendorf et al., 1997; Parkinson & Rachman, 1981a, 1981b;
Rachman, 1980; Silver, Boon, & Stones, 1983; Tait & Silver,
1989). For example, 6 years after the nuclear accident at Three
Mile Island, chronic distress was evident only in those area
residents who had intrusive thoughts about the incident (see
Baum, 1990). The association between ruminative thought and
negative affect appears to be a general one: It has been observed
across a variety of nonclinical populations and in a host of
stressful situations, including contrived laboratory manipulations (see Horowitz, 1986, 1993). This pattern of associations
between intrusive thoughts and negative emotional states sug-
1030
EXPRESSION, INTRUSIONS, AND DEPRESSIVE SYMPTOMS
gests that intrusive thoughts may have some causal role in the
development or maintenance of negative emotions during stress.
Intrusive thoughts may be a product of the mental struggle
involved in cognitively assimilating stressful events. Events that
challenge people's basic expectations and beliefs about themselves and the world can cause intense and prolonged psychological distress (Janoff-Bulman, 1992; Parkes, 1975). Cognitive
processing theorists contend that negative emotions may arise
when information inherent in external events is discrepant with
individuals' established self-views and worldviews (Epstein,
1985, 1990; Marris, 1986; Wilson, 1989) or thwarts valued
goals (Mandler, 1984; Martin & Tesser, 1989). The generalized
assumptions that people hold about themselves and their world
can be referred to as high-order schemata (Janoff-Bulman,
1992). Intrusions may occur as a result of incomplete assimilation of trauma-related information into preexisting schemata or
from incomplete accommodation of the preexisting schemata to
the new information. Successful assimilation and accommodation of trauma-related information may depend on repeated exposure to traumatic stimuli, including the unresolved thoughts
and feelings one has about the stressor. Horowitz (1975, 1986)
has argued that emotionally disturbing, intrusive thoughts subside once an individual has successfully assimilated or accommodated stressful information. Others have argued that repeated
exposure to stressful material dampens negative emotional responses to the material (Creamer, Burgess, & Pattison, 1990;
Rachman, 1980).
Although exposure to stressful material may facilitate longterm emotional adaptation, the interim process of contemplating
and evaluating the negative material can be aversive. Thus, it is
not uncommon for people experiencing intrusive thoughts about
stressors to engage in avoidant thinking and behaviors (Horowitz, Wilner, & Alvarez, 1979). The problem with avoiding
stressor-related material, including intrusive thoughts, is that it
may impede assimilation processes or, worse yet, prolong intrusive ideation and instigate new intrusions (Gold & Wegner,
1995). It has been suggested that one way to get people to
confront rather than to avoid stressor-related thoughts and feelings is to make them engage in tasks that foster emotional expression (e.g., Pennebaker, 1989). However, emotional expression, per se, may facilitate cognitive processing and emotional
adjustment only when it occurs in a safe or supportive context.
In a study of mothers who had lost a child to sudden infant
death syndrome (SIDS), level of intrusive thoughts at 3 weeks
postloss was negatively associated with amount of talking about
the loss months later in mothers who felt socially constrained
(i.e., felt others were uncomfortable, unwilling to listen, or not
fully supportive when they talked about the death; Lepore et ai.,
1996). In contrast, a positive association was found between
intrusive thoughts and amount of talking about the loss in mothers who felt relatively unconstrained in talking about the loss.
In addition, level of intrusive thoughts in the early bereavement
period was positively related to subsequent depressive symptoms
only in mothers who felt constrained in talking about the loss.
Recently, this same pattern of results was found in research on
men with prostate cancer (Lepore & Helgeson, in press),
women with breast or colon cancer (Lepore, 1997), and children
exposed to inner-city violence (Kliewer, Lepore, Oskin, & Johnson, in press).
1031
Two Explanations o f the Mediating Role o f Intrusive
Thoughts in the Relation Between Emotional
E x p r e s s i o n and Psychological Adjustment to Stressors
The studies by Lepore and his colleagues on bereaved mothers
(Lepore et al., 1996), cancer survivors (Lepore, 1997; Lepore &
Helgeson, in press), and violence-exposed children (Kliewer
et al., in press) suggest that expressing one's stressor-related
thoughts to supportive others can attenuate the negative association between intrusive thoughts and mental health. These studies
further suggest that expression in a nonsupportive social context
may lead trauma survivors to inhibit themselves from talking
and thinking about their traumatic experiences. Lepore and colleagues have argued that these inhibitory behaviors may interfere with assimilation and accommodation of traumatic material,
resulting in prolonged or increased emotional distress. The interactive effects of intrusive thoughts and social constraints on
inhibition and mental health also suggest that intrusive thoughts
are more tolerable, or less aversive, when they occur in a supportive context.
A complementary theory has been proposed by Pennebaker
(1989; also Harber & Pennebaker, 1992), who argued that providing people with an opportunity to express their stressor-related thoughts and feelings facilitates adjustment by diminishing
the frequency of intrusive thoughts. According to Pennebaker, emotional expression, either verbal or written, involves
confronting (e.g., contemplating, evaluating) stressor-related
thoughts and feelings. This process may help people to assimilate the stressor or to restructure their cognitions about it.
Through this assimilation process, people may be able to resolve
the discrepancy between preexisting schemas and information
inherent in stressful events. By working through, or resolving,
the discrepancy, emotional expression should free people of
their distressing, intrusive thoughts. Resolution of the stressful
thoughts and the concomitant decline in intrusions are believed
to account for adjustment following emotional expression.
Like Lepore, Pennebaker (1989) maintained that emotional
expression should occur in a " s a f e " context (for a related
perspective, see Meichenbaum & Fitzpatrick, 1993). The primary difference between Pennebaker's model and the one proposed by Lepore (1997; Lepore & Helgeson, in press; Lepore
et al., 1996) is the role of intrusive thoughts in the link between
expression and psychological adjustment. From Pennebaker's
perspective, emotional expression facilitates adjustment by diminishing the frequency of intrusive thoughts. Findings from
Lepore's research have suggested that emotional expression, in
a supportive context, facilitates adjustment by diminishing the
impact of intrusive thoughts. From this latter perspective, stressor-related intrusive thoughts lose their emotional sting when
individuals are able to express themselves in a supportive context. Of course, it is possible that emotional expression diminishes both the frequency and the impact of intrusive thoughts
on mental health. However, to date no studies have tested these
two possibilities. In the present study, I examined whether emotional expression about a stressful event diminishes psychological distress by reducing the frequency with which individuals
experience intrusive thoughts or by attenuating the effects of
intrusive thoughts on psychological distress.
1032
LEPORE
Hypotheses
T h e first h y p o t h e s i s is that e m o t i o n a l e x p r e s s i o n will d i m i n i s h
p s y c h o l o g i c a l distress s y m p t o m s in p e o p l e taking stressful examinations. T h e s e c o n d h y p o t h e s i s is m o r e exploratory: E m o tional e x p r e s s i o n will d i m i n i s h p s y c h o l o g i c a l distress by ( a )
r e d u c i n g the f r e q u e n c y o f intrusive thoughts or ( b ) e m o t i o n a l l y
desensitizing p e o p l e to their intrusive thoughts.
Method
Participants
Seventy-four examinees (44 men, 30 women) were recruited into the
study through advertisements on electronic bulletin boards and newspapers at two metropolitan universities. Only 4 recruits did not complete
the entire study, of whom 3 refused to continue for undisclosed reasons
and 1 could not be reached for his follow-up interview. All participants
were paid $10 at the end of the study. The average age of participants
was 22 years (SD = 6.48 ); 57% were Caucasian, 30% were Asian, 12%
were African American, and 1% were other races. Most of the participants were enrolled in a 4-yr college degree program (61%); however,
a minority of the participants had higher degrees, including bachelor's
(24%), master' s (8%), and professional degrees ( 1% ).
To be eligible for the study, participants had to be taking either the
Medical College Entrance Examination (MCAT; 50%), Graduate Record Examination (GRE; 23%), Law School Admissions Test (LSAT;
10%), or Graduate Management Admissions Test (GMAT; 3%). Two
other individuals (3 %), who responded to the advertisements were taking
the National Council Licensing Exam (NCLEX) for nursing, also were
allowed to participate. Most of the participants were first-time test takers
(80%), although some were second-time test takers (20%). Many of
the participants had prepared for the examinations through a preparatory
course (31%) or study guides (45%).
Procedures
Data were collected through three structured telephone interviews
conducted approximately 1 month (28.18 ___5.77 days) before the exam,
Time 1 (T1); 3 days (3.11 ± 1.13 days) before the exam, Time 2
(T2); and 1 week (7.32 ± 1.93 days) after the exam, Time 3 (T3).
Demographic and background variables were assessed in the first interview; the remaining variables, which are described below, were measured in all three interviews. Between the first and the second measurement, or approximately 10 days before the examination (9.27 ± 3.05),
participants came into the laboratory to write an essay for 25 min.
Participants were randomly assigned (within gender) to an experimental
or a control essay condition, both of which are described below.
Writing Manipulation
The writing manipulation followed the standard protocol established
by Pennebaker (1989), except that participants wrote on only one occasion rather than multiple occasions. Although Pennebaker recommended
3 to 4 days of writing, the high level of demands of the study (three
interviews and a laboratory visit), as well as the high constraints on
participants' time as the exam date approached, precluded more frequent
writing sessions. Participants wrote their essays in a private, comfortable
laboratory room with a low level of lighting. They were assured of
confidentiality and given 25 min to write.
Experimental participants were given the following instructions verbally and in writing:
During today's writing session, I want you to let go and write about
your very deepest thoughts and feelings about the exam. In your
essay, you may want to write about your thoughts and feelings
regarding the exam itself, the effect of the exam on your life in the
present, the exam's implications for your future goals, and alternate
plans you may have. The important thing is that you dig down into
your deepest emotions and explore them in your writing.
Control participants were given the following instructions verbally and
in writing:
Since we are interested in the day-to-day activities of people who
are taking the exam, please describe in detail what you have done
in the last 24 hours. Please include who you met with, how much
time you spent on meals, socializing, studying, etc. It is important
that you describe things exactly as they occurred. Do not mention
your own emotions, feelings, or opinions. Your descriptions should
be as detailed and objective as possible.
Measures
Manipulation check. Immediately after the writing task, participants
completed a questionnaire designed to test the manipulation. Using a 7point scale ( 1 = not at all, 7 = a great deal), they indicated the extent
to which their essay was "meaningful," "personal," and "revealing of
your emotions." In addition, objective measures of essay content were
derived using the Linguistic Inquiry and Word Count (LIWC; Francis &
Pennebaker, 1993; also see Pennebaker, 1993) text analysis program.
The program analyzes text on a word-by-word basis and classifies words
into several high-level categories, including negative emotionality terms
(e.g., sad, hurt, guilty), positive emotionality terms (e.g., happy, joy,
peaceful), and terms reflecting cognitive insight or self-reflection (e.g.,
realize, understand, thought, knew).
Depressive symptoms. Level of depressive symptoms was measured
during each of the telephone interviews using the 13-item depressive
symptoms subscale of the SCL-90-R (Derogatis, 1983). Participants
indicated on a 5-point scale (0 = not at all, 4 = extremely) how distressed they were by different depressive symptoms (e.g., feeling blue,
hopeless, worthless) in the prior week. Item scores were summed and
averaged; higher scores indicate greater psychological distress. In the
present study, internal consistency of the scale was good, with Cronbach's alphas ranging from .87 (T1) to .93 (T2 and T3).
Intrusive thoughts. A 10-item scale was used to assess intrusive
thoughts about the examination during each interview. Seven items with
high factor loadings were adapted from the Impact of Events Scale (IES;
Horowitz, Wilner, & Alvarez, 1979). The IES can apply to any event,
referred to in the items as it. In the present study, the exam was substituted for it (e.g., things you saw or heard suddenly reminded you of the
exam; images related to the exam popped into your mind; you had bad
dreams related to the exam). Three additional items were adapted from
Lepore et al.'s (1996) Intrusive Thoughts Scale (difficult to get the
exam off your mind; thoughts about the exam interfered with your ability
to concentrate on other things; it was easy to forget about the exam
[reverse coded[). Participants indicated on a 5-point scale (0 = never,
4 = very often) how often in the prior week they had these undesirable,
unwanted, or uncontrollable thoughts about the exam. The scale has
high face validity. Item scores were summed and averaged; higher scores
indicate more frequent intrusive thoughts. In the present study, the scale
had excellent internal consistency, with Cronbach's alphas ranging from
.92 (T1 and T2) to .95 (T3).
Results
Manipulation
Check
C o m p a r i s o n s were m a d e b e t w e e n participants in the control
( n o d i s c l o s u r e ) and e x p e r i m e n t a l ( d i s c l o s u r e ) groups. As s h o w n
EXPRESSION, INTRUSIONS, AND DEPRESSIVE SYMPTOMS
in Table 1, participants in the experimental group perceived their
essays to be more personal, meaningful, and revealing of their
emotions than participants in the control group. Results from
the LIWC text analysis also are shown in Table 1. Participants
in the experimental group expressed more negative and positive
emotionality and cognitive insight in their essays than did control group participants. These results indicate that the expressive
writing manipulation was engaging to participants and successful at getting them to contemplate their thoughts and feelings
related to this significant event.
Changes in Depressive S y m p t o m s A s s o c i a t e d With
Writing
Figure 1 shows participants' mean level of depressive symptoms over the course of the study as a function of writing condition. Change scores (T2 - T1 and T3 - T1 ) were calculated
to analyze the change in depressive symptoms over time as a
function of writing condition. The change scores were subjected
to a 2 (condition) x 2 (period) repeated measures analysis of
variance (ANOVA). There was a significant main effect of time,
F( 1, 72) = 19.76, p < .001, no significant main effect of
condition, F( 1, 72) = 1.67, ns, and a significant Condition x
Period interaction, F( 1, 72) = 5.22, p < .05. Between-groups
simple effect analyses revealed significant group differences in
the mean change scores from T1 to T2, F( 1, 112) = 5.01, p <
.05, but not from T1 to T3, F( 1, 112) = .001, ns. Within-group
simple effect analyses revealed a significant difference in the
mean change scores over time (T2 - T1 vs. T3 - T1) in the
control group, F(1, 72) = 22.64, p < .001, but not in the
experimental group, F( 1, 72) = 2.33, ns. These analyses, along
with the means shown in Figure 1, indicate that the expressive
writing condition attenuated depressive symptoms prior to the
exam. In contrast, the control group did not experience a decline
in symptoms until after the exam was over.
Role o f Intrusive Thoughts
The writing manipulation was hypothesized to moderate depressive symptoms in one of two ways: (a) by lowering the
level of exam-related intrusive thoughts or (b) by mitigating
the distress associated with exam-related intrusive thoughts. If
1033
the first hypothesis is correct, the level of intrusive thoughts
over time should depend on the writing condition, as did the
level of depressive symptoms. Specifically, participants writing
about their exam-related thoughts and feelings would exhibit a
decline in intrusive thoughts as the exam approached (T1 to
T2), whereas control participants would exhibit no change or
an increase in intrusive thoughts as the exam approached. If the
second hypothesis is correct, level of intrusive thoughts would
not be affected by the writing condition. However, participants in
the expressive-writing condition would have less psychological
distress associated with their intrusive thoughts than controls.
I tested the first hypothesis by subjecting the intrusive
thoughts change scores (T2 - T1 and T3 - T1) to a 2 (condition) x 2 (period) repeated measures ANOVA. There was no
significant interaction, F( 1, 72) = .01, ns, indicating that the
level of intrusive thoughts did not vary over time as a function
of writing condition. There also was no significant main effect
of condition, F( 1, 72) = 1.24, ns. However, there was a change
in level of intrusive thoughts as a function of time, F( 1, 72) =
82.42, p < .001. The mean level of intrusive thoughts for the
sample as a whole at T1, T2, and T3, respectively, was 1.32
(SD = 0.77), 1.66 (SD = 0.83), and .95 (SD = 0.74). Thus,
participants had an increase (0.34) in their level of intrusive
thoughts from T1 to T2 but a decrease ( - . 3 7 ) in intrusive
thoughts from T1 to T3. These analyses suggest that the writing
manipulation did not reduce depressive symptoms by reducing
level of intrusive thoughts.
I tested the second hypothesis using moderated regression
analyses (Aiken & West, 1991 ). According to the second hypothesis, the positive association between intrusive thoughts and
depressive symptoms should be attenuated in the group writing
about the exam, but not in the control group. The simple zeroorder correlations between intrusive thoughts and depressive
symptoms are shown in Table 2. The regression analyses focused on the change in depressive symptoms from T1 to T2,
which was the period prior to the exam and when individuals had
the highest level of intrusive thoughts and depressive symptoms.
Depressive symptoms scores at T2 were first regressed onto
depressive symptoms scores at T1, resulting in a residualized
depressive symptoms scores as the outcome. The residualized
score can be conceived of as change in depressive symptoms.
Table 1
Manipulation Check on Essay Content (n = 74)
Control group
Experimental
group
Variable
M
SE
M
Rating of essay as personala
Rating of essay as revealing of emotionsa
Rating of essay as meaningfula
Number of words in essay
Number of negative emotion terms
Number of positive emotion terms
Number of cognitive insight terms
4.11
2.91
3.73
473.65
5.68
7.00
42.38
0.27
0.25
0.26
22.09
0.75
0.82
3.74
5.27
5.41
5.57
467.51
18.24
23.76
88.14
Rating scales ranged from 1 (not at all) to 7 (a great deal).
**p < .01. ***p < .001.
a
SE
0.25
0.21
1.17
15.07
10.62
1.42
3.31
t(72)
3.15"*
7.57***
5.70***
0.16
6.61"**
10.23"**
9.17"**
1034
LEPORE
1.3-
T
1.2
I~
Control
Experimental
A
1.1
e~
1.0
¢/i
t..
g~
0.9
0.8
0.7
0.6
i
i
Time I
f
Time 2
Writing
i
f
Time 3
Exam
Figure 1. Mean depressive symptoms as a function of writing condition
and epoch. The experimental group expressed their deepest thoughts and
feelings about the exam in their writing, whereas the control group wrote
about their daily activities. Bars represent the standard error of the mean.
Time 1 measurement occurred 1 month before the exam, Time 2 occurred
3 days before the exam, and Time 3 occurred 7 days after the exam.
The writing manipulation was administered 10 days before the exam.
This procedure also controls for spurious associations between
T 1 intrusive thoughts and T2 depressive symptoms that could be
driven by T1 depressive symptoms. Next, the centered predictor
variables, condition and intrusive thoughts, were entered into
the regression equation, followed by their cross-product, Condition x Intrusive Thoughts.
The regression results are presented in Table 3. There was a
significant positive association between T1 intrusive thoughts
and T2 depressive symptoms after we controlled for T1 depressive symptoms. There also was a significant negative association between condition and depressive symptoms at T2 after I
controlled for T1 depressive symptoms. Thus, people with fewer
intrusive thoughts and people who were able to express themselves during the writing task had a lower level of symptoms
from T1 to T2. More important, there was a significant interaction between T1 intrusive thoughts and condition. The plot of
this interaction (Figure 2) shows that an extreme level of intrusive thoughts at T1 was associated with increases in depressive
symptoms from T1 to T2 in the control group, but not in the
experimental group.
Discussion
The present findings indicate that expressive writing can reduce psychological distress associated with an impending stressful event. Examinees who wrote expressive essays had a lower
level of depressive symptoms as the exam date approached than
did examinees who wrote about a trivial control topic. The
present analyses suggest that expressive writing reduced depressive symptoms by attenuating the negative emotional effects
of intrusive thoughts rather than by reducing the number of
intrusive thoughts. There was no effect of expressive writing on
the number of intrusive thoughts reported. However, there was
a strong association between intrusive thoughts at 1 month before the exam and depressive symptoms 3 days before the exam
among examinees in the control group, but not among examinees in the expressive writing group. This interactive effect of
intrusions by condition on depressive symptoms was observed
even with a statistical control for prior depressive symptoms.
The present results are consistent with the social-cognitive
processing model proposed by Lepore and colleagues (Kliewer
et al., in press; Lepore, 1997; Lepore et al., 1996; Lepore &
Helgeson, in press). Specifically, it appears that being able to
express one's stressor-related thoughts and feelings promotes
emotional adaptation to stressors by blunting the emotional impact of intrusive thoughts. Exactly why or how this emotional
blunting occurs is not yet clear. It is possible that people become
habituated to intrusive thoughts because of the repeated exposure to the stressful stimuli when they write or talk about stressors (cf. Bootzin, 1997). Alternatively, through the process of
contemplating one's thoughts and feelings during expression
tasks, people may reappraise intrusive thoughts as nonthreatening entities. Finally, people who engage in thinking about
and expressing their stress-related thoughts and feelings may
gain some insight into the stressor, which in turn renders any
reminders or memories of the stressor comprehensible and
nonthreatening.
Data from the present study and previous ones (e.g., Pennebaker, 1993 ) are not adequate to distinguish between these competing explanations. However, it appears from the present results
that expressive tasks do not facilitate emotional recovery simply
by resolving and removing intrusive thoughts. Instead, it appears
that expression enables people to experience intrusive thoughts
with less residual distress. Perhaps among people who are processing traumatic experiences that have already occurred, such
as the death of a loved one, emotional expression may facilitate
cognitive integration of the experience and reduce the number
of intrusive thoughts. In the present study, because the stressor
was anticipatory there might have been so many situational cues
about the exam that it was virtually impossible for people not
to have thoughts about the exam.
Per one reviewer's suggestion, I conducted a number of additional
exploratory analyses. To test whether the expressive writing specifically
diminished aversive thoughts, I computed two subscales from the original Intrusive Thoughts Scale and examined the effect of the manipulation
on these subscales. One subscale included items that were relatively
neutral, or affect-free (e.g., thought about the exam when you didn't
want to), and one included items that reflected both intrusive thoughts
and distress (e.g., difficulty falling asleep because of images or thoughts
related to the exam). Analyses conducted with these subscales produced
the same pattern of results found with the original scale. Next, 1 conducted an internal analysis on the expressive writing group's data. Specifically, I examined whether the variables generated by the LIWC analysis of the writing (see Table 1, bottom), as well as participants' ratings
of the extent to which their essays were personal, meaningful, and emotionally revealing, would predict changes in depressive symptoms from
T1 to T2. The linguistic characteristics of the essays and the extent to
which they were revealing of the person's thoughts and feelings did not
significantly predict depressive symptoms at T2 or changes from T1 to
T2. It is possible that the small sample size in the internal analysis, as
well as the relatively uniform responses of participants, accounted for
these null effects.
EXPRESSION, INTRUSIONS, AND DEPRESSIVE SYMPTOMS
1035
Table 2
Pearson Product-Moment Correlations Between Intrusive Thoughts and Depressive
Symptoms at T1, 72, and T3 (n = 74)
Intrusive thoughts
Variable
Intrusivethoughts
T1
T2
T3
Depressive symptoms
T1
T2
T3
Depressive symptoms
T1
T2
T3
.70***
.50***
-.64***
--
.41"**
.44***
.32**
.24"
.44***
.37***
.14
.33**
.56***
T1
T2
T3
.60"**
.60***
.66***
Note. T1 = Time 1, 1 month prior to the exam and 20 days prior to the writing manipulation; T2 = Time
2, 3 days prior to the exam and 7 days after the writing manipulation; T3 = Time 3, 1 week after the exam.
*p < .05. **p < .01. ***p < .001.
Lepore et al. (1996) have argued that sharing stress-related
thoughts and feelings with supportive others also may facilitate
cognitive assimilation and emotional adjustment by lowering
arousal. This is consistent with Pennebaker's model (e.g., Pennebaker, t 989). If people have a lower level of arousal following
expression, they may be better able to tolerate intrusive thoughts
because they will not be overaroused by them. This may allow
individuals to confront the thoughts and feelings associated with
intrusive thoughts instead of attempting to avoid the thoughts
and feelings as a method of reducing arousal. The ability to
confront the intrusions may allow people to make sense of, or
to accept, their situation, thus regaining a sense of well-being
and mastery.
One limitation of the present study is that the stressor was not
as grave as those typically associated with chronic and clinically
significant levels of distress or posttraumatic-stress disorders. It
is unclear whether the present findings would generalize to other
samples, such as the bereaved or people facing life-threatening
illnesses. It is probable that a single writing session would not
moderate the effects of intrusive thoughts on depressive symptoms under such severe stress. However, there is no reason to
believe that the same general method would not be beneficial
if administered over multiple days and in a safe, controlled
environment. Either expressive writing or verbal disclosures in
a protected or empathic social context may allow people to
successfully confront and adapt to even highly traumatic events.
A final caution in interpreting the present findings is that the
effect of the manipulation on exam performance is unknown.
Although the writing task was effective in reducing distress
around the time of the exam, there is no way of knowing whether
this had an impact on exam performance. In test-taking situations, a modest amount of arousal, which could be induced by a
moderate amount of distress, can enhance performance, whereas
inadequate or excessive levels of arousal can undermine performance. At several days before the exam (T2), the experimental
group had less distress than they did 1 month before the exam
( T I ) and more distress than they did 1 week after the exam
( T 3 ) , which suggests that their level of distress was neither
excessively high nor excessively low. Nevertheless, one can infer
nothing about exam performance from these data.
In summary, people taking stressful examinations reported a
lower level of depressive symptoms after engaging in an expressive writing task than examinees writing about a control topic.
The expressive writing task seemed to reduce depressive symptoms by attenuating the examinees' negative emotional reactions
to exam-related intrusive thoughts. Future research should examine how this emotional blunting occurs and whether this effect is obtained for people confronting major traumas. The pres-
Table 3
Regression o f T2 Depressive Symptoms on Intrusions, Condition, and Intrusions ×
Condition, Controlling f o r T1 Depressive Symptoms (n = 74)
Variable
Total R 2
Increment
in R 2
B (last in)
SE B
~ (last in)
Depressive symptoms at TI
Intrusive thoughts at TI
Condition
Intrusive thoughts at TI × Condition
.36
.44
.47
.50
.36***
.08**
.03*
.03*
0.63
0.23
-0.25
-0.31
0.12
0.08
0.12
0.16
.50***
.26**
- . 18*
-.17"
Note. T1 = Time t, 1 month prior to the exam and 20 days prior to the writing manipulation; T2 = Time
2, 3 days prior to the exam and 7 days after the writing manipulation. Condition: 0 = control (no disclose);
1 = experimental (disclose). Intrusive Thoughts Scale ranges from 0 (never) to 4 (often).
*p < .05. **p < .01. ***p < .001.
/7
1036
0.8
°
0.70.6
0.5
0.4
•~
o.3
•~
0.2
_/._ ......
.
LEPORE
x..eLmenZl.
0.1
!
Low
High
Level of Intrusive Thoughts
at Time 1
Figure 2. Slope of the relation between intrusive thoughts and changes
in depression from Time 1 to Time 2 (residualized) as a function of
writing condition. The experimental group expressed their deepest
thoughts and feelings about the exam in their writing, whereas the control
group wrote about their daily activities. Time 1 measurement occurred
1 month before the exam and Time 2 occurred 3 days before the exam.
The writing manipulation was administered 10 days before the exam.
High = +1 SD;low = - 1 SD.
ent findings not only indicate how expressive writing might
enhance adjustment to a stressor, but they reveal that intrusive
thoughts are not just a by-product of depressive symptoms or
confounded with depressive symptoms. If intrusive thoughts and
depressive symptoms were confounded, then everyone with intrusive thoughts would have had higher depressive symptoms.
Clearly this was not the case. Therefore, the door is wide open
for additional research into the causal role of intrusive thoughts
in processes of emotional adjustment to stressors.
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Received June 10, 1996
Revision received November 10, 1996
Accepted November 13, 1996 •
Dannemiller Appointed Editor of
Developmental Psychology, 1999-2004
The Publications and Communications Board of the American Psychological Association
announces the appointment of James L. Dannemiller, PhD, University of Wisconsin, as
editor of D e v e l o p m e n t a l P s y c h o l o g y for a 6-year term beginning in 1999.
Effective January 1, 1998, manuscripts should be directed to
James L. Dannemiller, PhD
Developmental Psychology Journal Office
Room 555 Waisman Center
University of W i s c o n s i n - - M a d i s o n
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email: j l d a n n e m @ facstaff, wisc.edu