How Writing Heals Wounds — Of Both the Mind and Body

2013-07-16

By Maia Szalavitz

Talking about difficult experiences can be a way of easing the emotional pain of trauma, but the latest research shows that expressing emotions in words can also speed physical healing.

The study is the latest delving into the mind-body connection to suggest that expressing emotions about a traumatic experience in a coherent way may be important to not just mental but physical health as well. It showed that the calming effect of writing can cut physical wound healing time nearly in half.

Researchers led by Elizabeth Broadbent, a senior lecturer in health psychology at the University of Auckland in New Zealand, studied 49 healthy senior citizens, aged 64 to 97.  For three days, half were assigned to write for 20 minutes a day about the most traumatic event they had experienced, and were encouraged to be as open and candid as they could about exactly what they felt and thought at the time. If possible, they were also asked to share thoughts or emotions that they had never expressed to others about what they had undergone.

The other participants wrote for the same duration about their plans for the next day, avoiding mentioning their feelings, opinions or beliefs. Two weeks after the first day of writing, researchers took small skin biopsies, under local anesthesia, that left a wound on the arms of all participants.  The skin tissue was used for another study.

A week later, Broadbent and her colleagues started photographing the wounds every three to five days until they were completely healed.  Eleven days after the biopsy, 76% of the group that had written about trauma had fully healed while only 42% of the other group had.

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“This is the first study to show that writing about personally distressing events can speed wound healing in [an older] population that is at risk of poor healing,” says Broadbent.

It’s not the first, however, to reveal the intriguing connection between state-of-mind and physical health. In previous studies, this type of emotionally expressive writing, as opposed to writing on neutral topics, reduced viral load in HIV-positive patients and increased their levels of virus-fighting immune cells. The practice also increased the effectiveness of the hepatitis B vaccination by increasing antibody levels generated by the vaccine and speeding wound healing in young men.

But in terms of psychological health, the results are more conflicting. A recent study found that writing about disturbing combat experiences may improve marital satisfaction among soldiers returning home from war zones while another paper in which patients with post-traumatic stress disorder (PTSD) wrote about their difficult experiences did not find that the practice reduced symptoms. Putting emotions down in words did, however, improve mood and reduce levels of stress hormone  in these patients.

One way that writing about distressing events could give the body a boost is by promoting sleep. “We found that people who got at least seven hours of sleep most nights had faster healing than those who got less sleep,” Broadbent says. Sleep deprivation can lower levels of growth hormone, which is important for repairing injuries. And writing about their traumatic experiences also seemed to help participants to actually get more sleep.  “Many people who have written about their negative experiences report that it allowed them to gain greater insight into what happened and to put the event into perspective,” says Koschwanez, “This might reduce the extent to which the event troubles them and possibly improve their sleep.”

The writing may also help the body by reducing stress; less anxiety means fewer stress hormones, which can interfere with chemicals needed for wound healing. While Broadbent’s study did not find such a link, it’s possible the researchers were not evaluating the right anxiety measures.  “It might be that our perceived stress questionnaire was not assessing the right type or duration of stress,” says Heidi Koschwanez, a study co-author and postdoctoral fellow at the University of Auckland.

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It’s also possible that emotional writing is not helpful for everyone. In one study published last month, when people who typically are stoic wrote about their worst trauma, their anxiety actually increased.  Those who were accustomed to being emotionally open, however, showed a drop in worry measures. That suggests that different people may have different ways of coping with traumatic events, and that writing may be an effective outlet for those who are normally more expressive, while pushing people to express feelings when they are not inclined to do so can actually increase risk for PTSD.

For those who do experience relief from expressing their emotions, however, writing may become an important part of helping them to recover —both in mind and in body— from difficult situations.

To Avoid Dementia, Stay Mentally Active Throughout Lifetime

2013-07-09

By Maia Szalavitz

The key to staying sharp in old age is to exercise your brain throughout life. Now the latest research shows that such activity may actually slow cognitive decline and, if you do develop dementia, shorten the time you spend living with it.

The new study, which was published in Neurology, involved nearly 300 older people, about half of whom developed dementia or mild cognitive impairment (often a precursor to dementia), over the course of six years. At the start of the study, participants reported on how frequently they engaged in mentally stimulating experiences throughout life such as extracurricular activities while in school and, more generally, reading books, writing letters, reading the newspaper and visiting libraries. (Because the research started over 20 years ago, internet related activity was not common.)

By studying brain autopsies after the participants died, the scientists found that 14% of the variability in mental decline could be attributed to the amount of intellectual activity in which people participated, both early and late in life. And that effect was seen even after the researchers accounted for other factors that influence dementia like age and education.

They also adjusted for the effect of brain changes due to diseases such as Alzheimer’s, stroke and Parkinson’s disease, which the research team said accounted for about a third of the differences in people’s cognitive decline before death. By comparison, cognitive activity accounted for nearly half as much as such pathology.

The people who were most active in late life showed a 32% slower rate of decline compared to those who maintained an average level of mental activity. And those who were the least active had a 48% faster fall into dementia.

“The beauty of this study is that they tested people at different points and followed them [through to] autopsy,” says Prashanthi Vemuri, an Alzheimer’s researcher at the Mayo Clinic who wrote an editorial accompanying the study, but was not otherwise associated with the trial. “People need to know [this] and be aware that it is possible to slow down the decline of dementia,” Vemuri says.

That’s important knowledge, given that nearly half of people over age 85 develop Alzheimer’s and the baby boom generation is rapidly approaching the age at which risk starts to increase; the lifetime risk of Alzheimer’s for women is 17% and for men is one in ten. By 2050, the Alzheimer’s Association estimates that the prevalence of dementia will double due to the increased proportion of the elderly in the population.

“Anything having to do with reading and writing counts in spades,” says the study’s lead author Robert Wilson, senior neuropsychologist at the Rush Alzheimer’s Disease Center at Rush University in Chicago. Sending emails or reading news online, he suspects, would have similar effects. “There’s no reason to think they wouldn’t be as mentally stimulating.”

How early does the mental activity have to start? Earlier research found that childhood intelligence can account for some of the differences in the brain once attributed to later-life cognitive activity. But whether it does so by increasing lifetime cognitive activity— people who grow up reading, for example, tend to be life time learners— or through some other means is not clear. The new study found that both early childhood cognitive activity and such activity in middle age were linked with slowing mental decline.

Vemuri says brain aging is similar to having money in the bank— people who are intelligent are cognitively “richer” and therefore have more reserves upon which to draw when brain function starts to decline. Consequently, it takes longer to “bankrupt” these resources. And cognitive activity throughout a lifetime can increase this “wealth.” But this study shows that greater cognitive activity not only adds funds, but actually slows the rate at which you lose intellectual resources— and that helps no matter how much you start out with.

Research also shows that engaging in more intellectual activity shortens the time during which someone is actually demented if they do get ill— meaning that it not only delays active disease, but shortens the worst part of it. “Reading, writing playing music, playing games [all of these] could be good,” says Vemuri, “I don’t want to pinpoint specific activities: keeping your brain mentally stimulated and active is what is primary.”

And it’s not just intellectual stimulation that may be important. Social engagement also seems to be crucial. “We’re finding in our studies that social interactions and group activities seem to help,” she says.

“The more, the better,” Wilson says. “But it’s not like physical exercise, [where it’s] ‘no pain, no gain.’ The metaphor should be ‘a hobby.’ In order to change structure and function, the activity needs to be sustained and to be sustained, it needs to be enjoyable. Hobbies like quilting or photography, acting and theatre, book clubs: those sorts of things. There’s no product that needs to be bought and one size won’t fit all.” What is important, he says, is that the activity is intellectually stimulating, and interesting enough to keep you occupied for more than one or two sessions.

When does your mental health become a problem?

2013-07-03

People often experience sadness in response to difficult life events, but when does this become a mental health problem?

One in four people are expected to experience a mental health problem, yet stigma and discrimination are still very common. Myths such as assuming mental illness is somehow down to a ‘personal weakness’ still exist.

How do we define mental health?

A person who is considered ‘mentally healthy’ is someone who can cope with the normal stresses of life and carry out the usual activities they need to in order to look after themselves; can realise their potential; and make a contribution to their community. However, your mental health or sense of ‘wellbeing’ doesn’t always stay the same and can change in response to circumstances and stages of life.

Everyone will go through periods when they feel emotions such as stress and grief, but symptoms of mental illnesses last longer than normal and are often not a reaction to daily events. When these symptoms become severe enough to interfere with a person’s ability to function, they may be considered to have a significant psychological or mental illness.

Someone with clinical depression, for example, will feel persistent and intense sadness, making them withdrawn and unmotivated. These symptoms usually develop over several weeks or months, although occasionally can come on much more rapidly.

Mental health problems are defined and classified to help experts refer people for the right care and treatment. The symptoms are grouped in two broad categories – neurotic and psychotic.

Neurotic conditions are extreme forms of ‘normal’ emotional experiences such as depression, anxiety or obsessive compulsive disorder (OCD). Around one person in 10 experiences these mood disorders at any one time. Psychotic symptoms affect around one in 100 and these interfere with a person’s perception of reality, impairing their thoughts and judgments. Conditions include schizophrenia and bipolar disorder.

Mental illness is common but fortunately most people recover or learn to live with the problem, especially if diagnosed early.

What causes mental illness?

The exact cause of most mental illnesses is not known but a combination of physical, psychological and environmental factors are thought to play a role.

Many mental illnesses such as bipolar disorder can run in families, which suggests a genetic link. Experts believe many mental illnesses are linked to abnormalities in several genes that predispose people to problems, but don’t on their own directly cause them. So a person can inherit a susceptibility to a condition but may not go on to develop it.

Psychological risk factors that make a person more vulnerable include suffering, neglect, loss of a parent, or experiencing abuse.

Difficult life events can then trigger a mental illness in a person who is susceptible. These stressors include illness, divorce, death of a loved one, losing a job, substance abuse, social expectations and a dysfunctional family life.

When is someone thought to be mentally ill?

A mental illness can not be ‘tested’ by checking blood or body fluids. Instead it is diagnosed, usually by an experienced psychiatrist or clinical psychologist, after studying a patient’s symptoms and monitoring them over a period of time.

Many different mental illnesses can have overlapping symptoms, so it can be difficult to tell the conditions apart.

To diagnose a mental health condition, psychiatrists in the UK may refer to the World Health Organisation’s International Classification of Diseases (ICD) system. This lists known mental health problems and their symptoms under various sub-categories. It is updated around every 15 years.

Some experts argue that the current system relies too strongly on medical approaches for mental health problems. They say it implies the roots of emotional distress are simply in brain abnormalities and underplay the social and psychological causes of distress.

They argue that this leads to a reliance on anti-depressants and anti-psychotic drugs despite known significant side-effects and poor evidence of their effectiveness.