Summary: A new study reports that for those who wrote emotionally about previous stressful events prior to having a skin biopsy healed faster than those who wrote about factual events.
Source: University of Auckland.
People who wrote emotionally about past stressful events two weeks before having a biopsy had their wound heal faster than people who wrote about factual day to day activities, a study has found.
The study, “The effects of expressive writing before or after punch biopsy on wound healing”, was published in the journal Brain, Behaviour and Immunity.
The research was conducted by Doctoral Candidate Hayley Robinson and Associate Professor Elizabeth Broadbent of the University of Auckland’s Faculty of Medical and Health Sciences. They were joined by Professor Kavita Vedhara of the University of Nottingham and dermatologist Dr Paul Jarrett of Counties Manukau DHB.
The aim of the study was to investigate whether expressive writing could speed the healing of punch biopsy wounds if writing was performed either before or after wounds were made compared to writing about neutral topics.
The study recruited 122 participants from Auckland aged between 18 and 55 years that were randomly allocated to one of four groups, expressive writing pre biopsy or expressive writing post biopsy, or control writing pre biopsy, or control writing post biopsy.
The expressive writing groups were asked to write about their “deepest thoughts and feelings about a traumatic, upsetting experience of your entire life”. Ideally participants were to write about something they had not discussed in great detail with anyone else.
The control groups were asked to write factually about their daily activities.
A dermatologist performed a 4mm punch biopsy to each participant’s inner upper arm.
After 10 days the results showed that 52 percent of the people who had written expressively before the biopsy were healed, while only 27 percent of people who wrote expressively afterward the biopsy had healed.
The results were worse for the two groups that wrote facts without emotion. Only 15 percent in the controlled writing before the biopsy had healed. And for those who wrote about the control topic after the biopsy, only 23 percent had healed.
Hayley says the results suggest that expressive writing has its greatest effects when it occurs prior to an acute wound.
“This is because the writing initially makes you feel worse before you feel better,” she says.
“So ideally you have finished writing and are starting to feel better during the period when your wound is healing. The results are important because they suggest that when you write is important, not just what you write about.
“Future research needs to look at the effects of expressive writing on the healing of chronic wounds, when writing can only be done after the wound has occurred,” Dr Broadbent says.
Source: Anna Kellett – University of Auckland
Image Source: NeuroscienceNews.com image is in the public domain.
Original Research: Full open access research for “The effects of expressive writing before or after punch biopsy on wound healing” by Hayley Robinson, Paul Jarrett, Kavita Vedhara, Elizabeth Broadbent in Brain, Behaviour and Immunity. Published online March 2017 doi:10.1016/j.bbi.2016.11.025
The effects of expressive writing before or after punch biopsy on wound healing
Recent studies have shown that written emotional disclosure (expressive writing) performed in the two weeks prior to wounding improves healing of punch biopsy wounds. In many clinical settings, it would be more practical for patients to perform this intervention after wounding. The aim of this study was to investigate whether expressive writing could speed the healing of punch biopsy wounds if writing was performed after wounds were made.
One hundred and twenty-two healthy participants aged between 18 and 55 years were randomly allocated to one of four groups in a 2 (intervention) by 2 (timing) design. Participants performed either expressive writing or neutral writing, either before or after receiving a 4 mm punch biopsy wound. Wounds were photographed on day 10 (primary endpoint) and day 14 after the biopsy to measure epithelisation. Participants also completed questionnaires on stress and affect two weeks prior to the biopsy, on the day of biopsy and two weeks after biopsy.
There was a significant difference in healing at day 10 between groups, χ2(3, N = 97) = 8.84, p = 0.032. A significantly greater proportion of participants who performed expressive writing before the biopsy had fully reepithelialised wounds on day 10 compared to participants who performed neutral writing either before or after wounding, with no other significant differences between groups. Amongst people who wrote expressively after wounding, those who finished writing over the first 6 days were significantly more likely to be healed at 14 days than those who finished writing later. There were significant differences in positive and negative affect over the healing period between the pre and post expressive writing groups.
Expressive writing can improve healing if it is performed prior to wounding. Performing expressive writing after wounding may be able to improve healing depending on the timing of writing and wound assessment. Expressive writing causes affect to worsen followed by subsequent improvement and it is important to consider this in the timing of intervention delivery. Further research with patient groups is required to determine the clinical relevance of these findings.
“The effects of expressive writing before or after punch biopsy on wound healing” by Hayley Robinson, Paul Jarrett, Kavita Vedhara, Elizabeth Broadbent in Brain, Behaviour and Immunity. Published online March 2017 doi:10.1016/j.bbi.2016.11.025