Journaling Can Reduce the Impact of Trauma and Stress

JournalingIt doesn’t surprise anyone in my life when I pull out a pen and notebook. I write everything down. I love books with blank pages, beautiful paper, and pens that are comfortable in my hand and are nicely balanced. I hand write. A lot.

In particular, journaling has been a part of my life ever since I could remember. I write about the good, the bad and the ugly of my life. In many ways, my life is recorded in thousands and thousands of words. I do it because it is good for me. The research says so. That’s why, in my practice, I recommend journaling to a lot of my clients.

Why?

Because writing, even about difficult and traumatic experiences, is good for your health, your emotional well-being and for improving life functioning in general. It improves mood, objective and subjective health, and the ability to function well in an otherwise very stressful world.

Here’s what the research says.

1) A 1988 study done by psychologist Dr. James W. Pennebaker and his colleagues have proved the value of deep personal disclosure that comes with journaling. The study involved 50 undergraduates who were instructed to write about either their traumatic experiences or superficial topics for four days in a row. After six weeks, the students in the trauma group reported more positive mood and fewer illnesses than those writing about everyday experiences. They reported fewer visits to the student health center and reported that confronting their trauma was physically and psychologically beneficial.

2) In a follow-up study, Pennebaker and his research group categorized 60 Holocaust survivors as low, midlevel or high disclosure while being interviewed. Those who disclosed at high or midlevel disclosures were significantly healthier a year later when compared to low disclosures.

3) In 1994, an outplacement firm (Drake Beam Morin) followed 63 professionals who had been laid off from their jobs over an eight-month period. The experimental group was asked to write about their deepest thoughts and feelings about the layoff and about how their professional and personal lives had been affected. They were instructed to write for five consecutive days for 30 minutes at a time while researchers tracked their employment status. Those who wrote about losing their job were much more likely to find a new one in the months following the study.

4) Joshua Smyth and Arthur Stone extended the research to medical patients who suffered from asthma and rheumatoid arthritis. They were instructed to write about the most stressful event of their lives or about a neutral topic. Four months later, patients with asthma showed improvements in lung function while arthritis patients showed a reduction in the severity of their disease. A total of 47% of patients who disclosed stressful events show marked physical improvement.

What does this all mean?

Writing works.

Writing is easy, inexpensive and independent. It is a simple way to be resilient in the face of stress and disease. It is worth the time and effort to disclose your innermost thoughts and feelings because it is good for your health and your psychological well-being.

I encourage journaling for three main reasons.

1. Journaling reduces mental scatter and increases focus.

Difficult life events can create a scatter-brained experience like no other. Thoughts become overwhelming and can race out of control. You can become bombarded with everything that needs to get done, that you didn’t get done, and everything in between; leading to no rhyme or reason. Everything becomes tangled together in one big mess.

Writing it down can help to sort things out and keep you focused and grounded in processing one thing at a time and in a thorough manner.

Journaling assists in holding thoughts still so they can be changed and integrated.

Many times, I have clients complain about how frustrating it is for them to hang on to their thoughts while in the grip of crisis or emotional upheaval. During these times, thoughts can be powerful, fleeting and elusive – like hanging on to water with a tight fist. When thoughts move quickly, they are only processed on the surface – at the place of physiological experience and emotions.

Writing helps to hold thoughts still long enough to examine them on a deeper level where change becomes possible.

2. Journaling releases pent-up thoughts and emotions.

It can be tempting to hold everything in. Some do it because they feel, if they start, they may never be able to stop. Others, because it is just plain overwhelming and hard. It’s easier to avoid and not deal with difficult stuff.

But, it’s worse when you hold it all in. Those who hang on their emotions – holding them in, skimming over them, minimizing them – tend to build up a reservoir of unresolved issues. Eventually, the reservoir becomes too small, explodes and spills out in a big mess.

Writing helps to process things as they happen…as you have time. The alternative is to not address things and eventually, your issues will force you to take the time. Eventually, your body will say “no” in whatever way it can to make you hear and stop.

Writing can be like a valve that releases the pressure to keep things manageable.

And, most importantly….

3. Journaling allows you to re-experience the past with today’s adult mind.

When a trauma happened in your childhood, it gets coded at that age. This is why sometimes, when someone gets triggered, they tend to become that age again. For example, if you were abused as a six-year-old, as an adult, when this memory gets triggered, you become that six-year-old – behaving, thinking and feeling the emotions of your six-year-old self. As a consequence, you use the strategies that worked for you as a child, but which are unhelpful in your adult life because you have other options available to you as a response.

In essence, you have a child driving the bus. And, they can’t even see out over the steering wheel.

The goal of trauma work and therapy is to help you process your trauma so it “grows” up from childhood to adult ways of thinking and behaving in relation to the trauma. Journaling, like therapy, helps you process the disturbing event to it’s logical, healthy and most helpful resolution.

The 3 most popular objections to journaling.

“I don’t have enough time.”

My short answer to this: you don’t have the time not to. Like I said earlier if you don’t make the time, your body and your emotions will do something drastic to force you to make the time.

Journaling does not require a lot of time and you don’t have to do it every day. You do, however, need to have the courage to do it consistently.

Everything worth doing takes time and effort.

“I’m not a writer.”

You don’t have to be a writer. And, you don’t have to write in full paragraphs or even in complete sentences. Write in bullet form. Draw with words and quotes. Just get your feelings down and process your experience. There is no word or page quota. Do enough to keep your life moving forward.

Here are some questions to get you started:

  • What happened?
  • How did you feel when it was happening? After? Now?
  • How do you wish it had been different?
  • In what ways did you manage the situation well?
  • What did you learn about yourself as you look back on your experience?
  • How can these new learnings move your life forward?
  • Where do you want to go from here?
  • What are your hopes for yourself and your life moving forward?
  • If the crisis/trauma could speak, what would it want for your life?
  • Is what the trauma wants for you the same as what you want for you…your life?
  • As an adult, how can you see or think about your trauma in a different way?

“I’m afraid I won’t be able to stop.”

Trauma and crisis can be overwhelming sometimes. So overwhelming it can derail you if you spend too much time thinking and writing about it. This is when you may need some additional support to get past the initial overwhelm. Therapy can be helpful in these situations to move you from overwhelm to managing while you process. Therapy can be a place where you learn self-soothing and coping skills you can apply to all areas of your life. There is also great power in having someone else non-judgmentally bear witness to your story, help you give language to your experience (naming things can be powerful) and guiding you through the process of overcoming your past.

So grab a pen (pencil, marker, crayon…), set the timer and choose an event.

Calm out of chaos.

It is (as Martha would say) a very good thing.

Research

Pennebaker, J.W. (1997). Opening Up: The Healing Power of Expressing Emotion. New York: Guilford Press.

Pennebaker, J. W., Kiecolt-Glaser, J. K., & Glaser, R. (1988). Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, Vol. 56, pp. 239-245.

Smyth, J. M., Stone, A. A., Hurewitz, A., & Kaell, A. (1999). Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis. Journal of the American Medical Association, Vol. 281, pp. 1304-9.

Spera, S. P., Buhrfeind, E. D. & J.W. Pennebaker, (1994). Expressive writing and coping with job loss. Academy of Management Journal, Vol. 37, pp. 722-733.

Journaling not quite helping you to move in the direction you would like? Therapy (EMDR therapy in particular) can get you moving faster and with the support you need. Ready to have your six-year-old ride in the back where they belong? Give me a call at 610-551-8203 for a free 30-minute phone or in-office consult to see how we can make that happen.

Because I’m Your Therapist, I Can’t Also Be Your Friend

a Dining tableI really enjoy my job as a therapist.

As a therapist, I am in a very privileged position because I get to know my clients in a way that, most likely, no-one else in the world knows them. I get invited into the most raw and vulnerable places of a person’s soul, heart and mind. And, under all the uncertainties, the pain, and everything else clients bring into therapy; there are amazing individuals who have so much to offer the world. My clients are caring, thoughtful, driven, creative, brilliant and gifted in ways I am not, and have a sense of humor that brings tears to my eyes.

As I get to know my clients, I often find myself thinking, “Why did I have to meet you in therapy? Why couldn’t I have met you at the grocery store? You are such a cool person. Now that you are my client, I can’t be your friend!” And, when clients ask me if we can just “hang out” over a cup of coffee, I have to say “no” for a number of reasons.

The differences between therapy and friendship.

1. Ideally, a therapist’s office is a neutral place; the therapist has no agenda aside from supporting your agenda for change in your life. There should be no pressure for you to behave in a particular way – the only expectation is that you will be yourself and be open to possibilities you had not considered for your life. Friends generally want what they want for you often because it is what they think is the “best” for you

2. Friends do not listen without expecting that they will be listened to in return. A relationship with a therapist is one sided – we listen; clients talk. And, when we do talk, it’s to help you be clear in your thinking.

3. You pay your therapist. The exchange is one of money for knowledge, support and direction. Payment relieves a client from the responsibility of the reciprocity necessary in a friendship. In therapy, there is no give and take on an emotional level. Because there is payment, the situation is and is supposed to be imbalanced in your favor – clients are freed up to talk about themselves and not worry about the therapist’s well-being.

4. In therapy, you are the recipient of a particular knowledge base of how certain psychological issues tend to look and play out in your life. At its best, therapy is a combination of art, intuition, intellect, and science. Sometimes, it’s not done so well. Although running into the “wrong” therapist can be discouraging, don’t give up in the pursuit of finding a therapist who is a good fit for you. A good therapist will be one who can take your experiences, help you name and understand them, help you come up with your own solutions, and cheer you on as you meet your goals for your life.

5. Therapists often talk about therapy as a “holding environment” where the therapist is someone who is strong, loving and understanding when you are going through some turbulence in life. In short, we are like the good parental figure that can hold whatever you bring into the room and be able to sit calmly in the presence of your strong feelings. Therapists are (or should) be able to think about your situation rationally and see it objectively for the purpose of pointing out that which you may not be able to see. Therapists are people whose primary job is to listen without reaction and judgment – to take in and gently mirror back to clients what they have a hard time accepting about themselves.

Okay, so the above list is pretty thorough in explaining the differences between therapy and friendship. In theory, a therapeutic relationship can be turned into a friendship, but this move would be fraught with a high level of risk to the client. (“Danger, Will Robinson! Danger!”) Generally, most of us therapists will not make this move in an effort to protect both ourselves and our clients.

A few weeks ago, a client and I were finishing the work we were doing together. In our last conversation, we were discussing how difficult it is to end a therapeutic relationship that has been a constant for a long time. My client asked, “Are you allowed to just have coffee and hang out?” I pretty much told my client that a friendship would be impossible because she would never be able to win an argument with me. I joked that getting into a fight with me would never be a fair fight.

“I would decimate you! I know everything about you; especially those things in your life that are the most painful. You, on the other hand, know nothing about me.”

She pondered this for a couple of seconds.

“Yeah. That would be weird…and unfair. I never thought of it that way.”

We then proceeded to seriously discuss the imbalance in a therapeutic relationship – an imbalance that is necessary for me to do as objective work as is possible for me, for her benefit and in her best interests.

Because of the lack of reciprocity in therapy, I have a great deal of power as a therapist. If you think about what I do for a living, it becomes clear I have been extensively trained to help people change the way they think, feel, behave, and what they believe. It’s like having a superpower! Thankfully, I have chosen to use my powers for good (mainly because I have a very low threshold for the kind of stress and guilt that comes from living on the dark side).

If you really think about it, a superhero has a secret identity, not because they don’t want relationships, but because they value them. They have secret identities because they want to protect the people they love. Therefore, they keep their private and personal lives separate from their work. Things can get very confusing for both parties if there is what is called a “dual relationship”. When Clark Kent told Lois Lane that he was Superman, ugly things happened. Clark badly wanted to share his life and everything that he was with Lois, but to do so would mean that her life would be in danger.

Okay, so I am not Wonder Woman (no matter how badly I wanted to be when I was a little girl). In the real world, a dual relationship (being therapist-client and friends at the same time) means there would need to be mutual vulnerability and, as a result, all manner of confusing things are introduced into a place that should (and needs to) be as neutral and safe as possible for you. Safety in therapy is established by keeping the boundaries very clear as to the purpose of the therapeutic relationship. This is why therapy is framed by your goals and the expectation is that I will help you accomplish them. It never goes in the other direction. It’s all about you, baby!

So, please don’t be offended if I say I can’t be your friend when you are or have been my client or if I seem a little standoffish when you reach out to me outside of the therapeutic context. It’s because I am protecting both your safe experience of therapy and the role you have asked me to play in your life as your therapist.

The truth is, as difficult as it is for clients to hear “no”, it is just as difficult for me to say.

Depression and Hypothyroidism

Sadness(Note: The following is not medical advice. It is simply what I have learned in my research to understand my personal experience with hypothyroid, Hashimoto’s thyroiditis, thyroid cancer, a complete thyroidectomy, and living without a thyroid gland. For medical advice, please discuss your concerns with your doctor.)
 

A physical, including a full blood panel can signal nutrient deficits in your body that may be contributing to mood swings, depression, fatigue, and so much more. Because a lot of my practice is focused on depression, I will ask my clients when they had their last physical and if their blood panel includes tests for hypothyroid (in addition to iron and Vitamin D). I stress blood work because clients with depression tend to have higher rates of hypothyroidism than those of the general population and women seem more likely to be affected than men.

Hypothyroidism is more common than many think it is. The 2000 Colorado Disease Prevalence Study, with over 25,000 participants, found that almost 10% of those in the study were hypothyroid. This 10% included people already on thyroid hormone replacement, 40% of whom were still hypothyroid indicating they were under-treated. That means that, potentially, over 30 million Americans are hypothyroid. In addition, the study used outdated measures so the real numbers are actually much higher.

This is a really important finding because normal and healthy thyroid hormone levels are essential for optimum brain and body health.  In fact, many of the body’s systems are impacted by the thyroid hormone levels. As a result, hypothyroidism (low thyroid function) can lead to many physical and mental problems.

Some signs and symptoms of hypothyroidism include:

  • Fatigue
  • Depression
  • Impaired memory
  • Increased sensitivity to cold
  • Constipation
  • Dry skin
  • Unexplained weight gain
  • Puffy face
  • Hoarseness
  • Muscle weakness
  • Elevated blood cholesterol level
  • Muscle aches, tenderness and stiffness
  • Pain, stiffness or swelling in your joints
  • Heavier than normal or irregular menstrual periods
  • Thinning hair
  • Slowed heart rate
  • Mood swings
  • “Foggy” thinking
  • Inability to feel alert until late in the day
  • Inability to lose weight
  • Brittle nails

There are a number of reasons that thyroid issues get missed and undiagnosed. Blood work can be very helpful in signaling that there is a problem, but it is really dependent on the numbers of tests that are conducted and how the results are interpreted.

Often, when testing for thyroid issues, doctors normally do a TSH (Thyroid Stimulating Hormone) test when what is needed is a TSH, free-T3 and free-T4 tests at a minimum. If your doctor wants to be more comprehensive, this number can rise to five or more tests.

When my clients come back with their thyroid hormone test results, they normally tell me that the levels are off or that their doctor reported that their results were “normal”. The normal range for thyroid is big and it can range anywhere from .3 to 5.  These limits can vary even more depending on who you talk to.

My clients are often told their levels fall into the “normal” range and I make a point of instructing them to ask where in the range their results fall – low normal, right in the middle, or high normal. If the number is low normal, there is a very real possibility that you may be struggling with what is known as “sub-clinical hypothyroid”. So, talk to your doctor about your options and whether sub-clinical hypothyroid is a possibility. Patients with low thyroid function, even if it’s not severe, can also have problems with mood, cognitive function, fatigue, and memory loss.

Before you consider antidepressants, you may want to try a few things first:

  • Get an appointment with your doctor for a full physical including blood tests for hypothyroid and vitamin deficiencies.
  • Start exercising. Exercise has been shown, in some cases, to be more effective than antidepressants.
  • Eat well and stay hydrated – your brain needs adequate levels of nutrients and water to stay healthy and function optimally.
  • Get outside and get some sunshine. This will promote the production of Vitamin D in your body as well as increase the production of serotonin (a feel good neurotransmitter).
  • There is a large body of research that shows that a combination of medication and therapy in the treatment of depression is more powerful and effective than medication alone.
  • See a therapist for other areas of your life that you could change to lift your mood – stress management, self-soothing skills, mindfulness practices, journaling, and self-care strategies.
  • Seriously consider tackling your trauma history with a therapist. Past events can and do negatively impact you in later life, but they don’t have to. There are treatments that are very efficient – such as Eye Movement Desensitization and Reprocessing (EMDR) – which have been shown to be very effective in the treatment of trauma or difficult life experiences.

When you suspect depression, checking out what is going on in your body is a good place to start regardless of whether you see a doctor or a therapist as your first course of action.

The Potholes of Life

potholeI have to tell you, there are a lot of potholes in Pennsylvania where I live. They are all over the place, seem to keep coming back regardless of how often they are patched up, are the bane of my driving existence, and have done a number on my beloved VW Bug.

Life’s problems are the equivalent of potholes in the road of life. (Yup, “…life is a highway….”) And, ultimately, therapy is about change. As a colleague once told me, therapy is about “more… better… different….”

Change is never easy. And, most of the time, things get worse before they get better.

However, life’s challenges, like potholes and holes in the sidewalk, need to be addressed. Here’s a lovely poem written by Portia Nelson to help you consider the process of change – it is slow, progressive, and a process during which there are slow improvements.

Be encouraged. And, safe travels!

(Great. Now that song is stuck in my head!)

 Autobiography in Five Short Chapters

By Portia Nelson

 Chapter I

 I walk down the street.

There is a deep hole in the sidewalk.

I fall in

I am lost…I am helpless

It isn’t my fault,

It takes forever to find a way out.

 Chapter II

I walk down the same street.

There is a deep hole in the sidewalk.

I pretend I don’t see it.

I fall in again.

I can’t believe I am in the same place.

But, it isn’t my fault.

It still takes a long time to get out.

 Chapter III

I walk down the same street.

There is a deep hole in the sidewalk.

I see it is there.

I still fall in…it’s a habit.

My eyes are open.

I know where I am.

It is my fault.

I get out immediately.

 Chapter IV

 I walk down the same street.

There is a deep hole in the sidewalk.

I walk around it.

Chapter V

I walk down another street.