Expressive Writing & Narrative Medicine: Evidence Overview (with Citations)

Part 1: Evidence by Strength

Strong Evidence

– Mental health (depression, anxiety, stress): significant improvements in many studies, especially postpartum, trauma survivors, students (Creswell et al., 2007; Krpan et al., 2013; Cohn et al., 2023).
– Wound healing: faster recovery shown in controlled studies (Koschwanez et al., 2013).
– Empathy, reflection, and trust in medical education and practice via narrative medicine (Charon, 2001; Fioretti et al., 2016).

Moderate Evidence

– Quality of life in chronic illness (cancer, asthma, rheumatoid arthritis, heart failure) (Henry et al., 2010; Liao et al., 2023).
– Self-efficacy and self-care improvements in patients (Zhou et al., 2022).
– Reduction of PTSD symptoms in trauma survivors (Smyth et al., 2008; Sloan et al., 2015).
– Improved immune function (e.g. HIV, asthma) in some studies (Pennebaker & Seagal, 1999; Petrie et al., 2004).

Mixed or Limited Evidence

– Long-term depression or anxiety reduction: effects often diminish after 4–6 months (Krpan et al., 2013).
– Some meta-analyses show small or non-significant overall effects (Frattaroli, 2006; Mogk et al., 2006).
– Not equally effective for all populations (Baikie & Wilhelm, 2005; Harvard Health, 2017).

Part 2: Evidence by Condition

Condition / Area	Effects Found	Key Citations
Depression & Anxiety	Reduced symptoms, especially postpartum and in students; effects may fade after months.	Krpan et al., 2013; Cohn et al., 2023; Frattaroli, 2006
Trauma / PTSD	Fewer intrusive thoughts, reduced PTSD symptoms short-term.	Smyth et al., 2008; Sloan et al., 2015
Cancer (esp. breast cancer)	Improved quality of life, self-care self-efficacy.	Zhou et al., 2022
Chronic illness (asthma, arthritis, heart failure)	Better symptom management, adherence, fewer ER visits, improved QoL.	Liao et al., 2023
Wound Healing	Faster recovery of skin wounds in older adults after expressive writing.	Koschwanez et al., 2013
Immune Function	Improved immune markers in HIV; better lung function in asthma.	Pennebaker & Seagal, 1999; Petrie et al., 2004
Medical/Nursing Education	Increased empathy, professionalism, reflective practice.	Charon, 2001; Fioretti et al., 2016

References

Baikie, K. A., & Wilhelm, K. (2005). Emotional and physical health benefits of expressive writing. Advances in Psychiatric Treatment, 11(5), 338–346.

Charon, R. (2001). Narrative Medicine: A Model for Empathy, Reflection, Profession, and Trust. JAMA, 286(15), 1897–1902.

Cohn, M. A., et al. (2023). Expressive writing for postpartum depression and distress: A meta-analysis. Journal of Affective Disorders.

Creswell, J. D., et al. (2007). Expressive writing effects on health: Moderators and mechanisms. Journal of Consulting and Clinical Psychology, 75(4), 639–649.

Fioretti, C., et al. (2016). Research on narratives in health care: A review of the literature. Patient Education and Counseling, 99(3), 239–249.

Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132(6), 823–865.

Harvard Health Publishing. (2017). Writing about emotions may ease stress and trauma.

Henry, E. A., et al. (2010). Writing about stressful experiences: Effects on health outcomes. Anxiety, Stress, & Coping, 23(3), 263–281.

Koschwanez, H. E., et al. (2013). Expressive writing and wound healing in older adults. Psychosomatic Medicine, 75(6), 581–590.

Krpan, K. M., et al. (2013). An everyday activity as a treatment for depression: The benefits of expressive writing for people diagnosed with major depressive disorder. Emotion, 13(2), 354–364.

Liao, H., et al. (2023). Narrative medicine interventions in chronic illness: A review. The Permanente Journal.

Mogk, C., et al. (2006). Meta-analysis of expressive writing on health outcomes. British Journal of Health Psychology, 11(2), 173–186.

Pennebaker, J. W., & Seagal, J. D. (1999). Forming a story: The health benefits of narrative. Journal of Clinical Psychology, 55(10), 1243–1254.

Petrie, K. J., et al. (2004). Disclosure of trauma and immune response: A randomized trial. Psychosomatic Medicine, 66(2), 271–277.

Sloan, D. M., et al. (2015). Written exposure therapy for PTSD: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 83(6), 1023–1032.

Smyth, J. M., et al. (2008). Effects of writing about stressful experiences on symptom reduction: A meta-analysis. Journal of Clinical Psychology, 64(2), 167–184.

Zhou, X., et al. (2022). Expressive writing for breast cancer patients: A randomized controlled trial. Healthcare, 10(9), 1762.