Some Current Research Evidence For Therapeutic Uses Of Reading & Writing

by James Hawkins

initial comments:

There are very many ways that people use reading and writing to reduce suffering and increase well-being. So someone studying to gain an education is likely to benefit both themselves and others (Loucks, Gilman et al. 2014). Similarly, reading around a subject in order to tackle it more effectively (for example, cooking, DIY, or raising babies) is also likely to be helpful. At a more psychological level, reading stories can deepen our understanding and connection with others (Gabriel and Young 2011, Kidd and Castano 2013) and help change behaviours for the better (Houston, Allison et al. 2011, Lee, Talwar et al. 2014). In the following couple of sections however – on reading and on writing – I will keep a narrower focus, looking at evidence supporting more directly “therapeutic” methods. Although numerous research studies have explored this narrower therapeutic territory, there are still many claimed therapeutic uses of reading and writing that, as yet, have not been tested in any rigorous way. As Ralph Sockman put it “The larger the island of knowledge, the longer the shoreline of wonder.”

therapeutic benefits from reading

A particularly well-researched approach to “therapeutic reading” is a rapidly growing set of studies using a mix of education, self-monitoring & skills development (typically cognitive behavioural) for a widening variety of psychological problems (Kilbourne 2012). Studies have looked at the value of simply reading relevant books (Lancee, van den Bout et al. 2012), at reading more carefully designed “work books”, and at computer and internet delivered materials. Although it is likely that – with increasing sophistication of both programmes and target audiences (Wuthrich, Rapee et al. 2012, Anderson, Price et al. 2013) – computer & smart phone delivery will become dominant, at present simple printed materials are often as helpful as other more hi-tech options (Wagner, Penelo et al. 2013). Currently, improved outcomes seem less dependent on how reading material is delivered and more dependent on how much additional person-to-person support is provided. Typically, unsupported reading of evidence-based material is more helpful than no intervention at all. However, even quite simple forms of additional person-to person support (via email, discussion groups, online interaction, messaging, email, and face-to-face) often significantly boosts outcomes (Hilvert-Bruce, Rossouw et al. 2012, Lancee, van den Bout et al. 2013).
The value of other kinds of reading intervention is currently less well supported by research. This is usually because adequate investigations simply haven’t been done, not because studies have shown the interventions to be ineffective. It can be helpful here to remember Irvin Yalom’s listing of therapeutic mechanisms that can operate in groups: cohesiveness, altruism, universality, interpersonal learning (input & output), catharsis, instillation of hope, identification, family re-enactment, self-understanding, guidance, and existential factors (Yalom and Leszcz 2005). Yalom’s model would benefit from being updated with further research, but it nicely illustrates the varying mix of therapeutic mechanisms that can operate in reading and writing groups. Such groups may take so many diverse forms – consider the differences & overlaps between, for example, library-based reading groups in the UK (Whelan 2013), trauma story telling groups for child soldiers in Africa (Ertl, Pfeiffer et al. 2011), and reminiscence-based groups for depressed older people (Hallford and Mellor 2013). It’s very likely that most of these and other approaches do some good. Why bother to try analysing how much benefit a particular intervention achieves and what mechanisms are particularly helpful in producing the benefit? Well, as the famous social psychologist Kurt Lewin put it “There’s nothing so practical as a good theory”. If we have a pretty clear idea of key mechanisms that help to make a particular reading approach useful, then we can adapt the intervention to boost or add to these central mechanisms and then check that this increases the value of what we’re doing.

therapeutic benefits from writing

Quite often “therapeutic” approaches that primarily involve reading also include writing components and vice-versa. Probably the most extensively studied form of therapeutic writing is the large body of research that has grown from Jamie Pennebaker’s work on expressive writing. On his website Pennebaker lists over 300 research articles published on writing & disclosure in the last 30 years (Pennebaker 2015). His recent book, “Expressive writing: Words that heal” (Pennebaker and Evans 2014), provides a good practical overview of this method. Oscar Wilde wrote “The truth is rarely pure and never simple” and this apparently straightforward writing approach is a good illustration of this warning – see, for example the article “Exploring the boundary conditions of expressive writing: In search of the right recipe” and the 19 research papers in the special section of the British Journal of Health Psychology devoted to this issue (Smyth and Pennebaker 2008). A particularly interesting extension of expressive writing is the recent work by Sloan & colleagues successfully using a 30 minute x 5 intervention for full syndrome PTSD (Sloan, Marx et al. 2012). Meston et al. have also shown benefits from this extended form of expressive writing with the particular subject area suggested to participants making a further difference to success rates (Meston, Lorenz et al. 2013). It’s important though to use expressive writing cautiously. Like all effective interventions it can also do harm (Sbarra, Boals et al. 2013, Niles, Haltom et al. 2014), so be informed before trying it out (for example by reading Pennebaker’s recent book) and monitor responses so that one can adapt or stop using the approach if it seems contra-indicated.
As expressive writing has become better established as an interesting and often worthwhile intervention, a whole series of other writing approaches have also sprung up. Quite a few of them are backed up by at least some research. Examples include writing about positive futures (Harrist, Carlozzi et al. 2007, Layous, Katherine Nelson et al. 2013), positive experiences (Burton and King 2004, Burton and King 2009), writing “counterfactually” (Koo, Algoe et al. 2008, Heintzelman, Christopher et al. 2013), working with dissonance (Stice, Marti et al. 2008, Stice, Rohde et al. 2009), blogging (Tan 2008, Ko and Kuo 2009), using self-affirmation (Yeager and Walton 2011, Creswell, Dutcher et al. 2013), looking for learning opportunities (Watkins, Cruz et al. 2008, North, Pai et al. 2011), practising gratitude (Sergeant and Mongrain 2011, Toepfer, Cichy et al. 2012), physically disposing of written thoughts (Li, Wei et al. 2010, Briñol, Gascó et al. 2012), reminding oneself about important relationships (Slatcher and Pennebaker 2006, Twenge, Zhang et al. 2007), and self-transcendence & values-affirmation (Crocker, Niiya et al. 2008, Burson, Crocker et al. 2012).
There are so many worthwhile approaches in these complex, intertwined fields of therapeutic reading and writing. Exciting times. As has been said “It’s important that we keep open minds, but not so open that our brains fall out”.
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