Emotional writing and wound healing

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Research has found that stress has a negative impact on wound healing (Ebrecht et al., 2004; Marucha, Kiecolt-Glaser & Favagehi, 1998). A meta-analysis of research conducted by Walburn and colleagues (2009) found that stress impacted the healing both acute and chronic wounds as well as experimentally inflicted wounds, such as punch biopsy and tape stripping. The research cites a high effect size (r=0.42) and emphasises that a focus should now shift to determining why stress detrimentally effects healing. Research is now looking at stress reduction interventions to help promote faster healing. At present only a few studies have measured the relationship between stress reduction techniques and wound healing (Broadbent et al. 2012; Emery, Hextall, Kirtley, Taylor, Dyson & Weinman, 2005). If such interventions can be proven to have a positive effect there are very important implications for clinical and surgical populations. Emotional writing is one intervention that researchers are currently trialling to investigate the stress-reducing effects on wound healing. The intervention involves participants writing about a traumatic or upsetting event over three consecutive days for 20 minutes per session. The intervention is not only easy to administer but also very cost effective. Emotional writing has been found to have a number of positive effects on mood and well-being for different populations. For example, Smyth (1998) conducted a review of 13 studies reporting benefits in physical health, psychological well-being, physiological functioning, and general functioning. Furthermore, emotional disclosure has been linked to decreased pain, better mood and shorter hospital stays in surgical patients (Francis & Pennebaker, 1992; Greenberg & Stone, 1992). The benefits of emotional writing are not fully understood but it is thought that writing about traumatic events or upsetting emotions can help process the event or issue, which can decrease the stress and prevent rumination (Pennebaker, 1997). Two studies to date have found that emotional writing has an impact on wound healing. Weinman, Ebrecht, Scott, Walburn and Dyson (2008) conducted a randomised control trial with young men who received punch biopsy wounds. They found that those who completed emotional writing healed significantly faster than the control group. More recently Koschwanez et al., (2013) found a similar effect with older adults. Those assigned to write expressively, rather than about daily life events, had a greater proportion of fully healed wounds at day 11 after receiving a standardized biopsy. Despite the amount of research that has been done looking at the effects of emotional disclosure there is still more research to be conducted to ensure that the intervention has the best effect. In the two studies previously discussed (Koschwanez et al., 2013; Weinman et al., 2008), the intervention was administered prior to wounding. The research aims to understand if the timing can play a role in improving wound healing. Timing may be a very important factor in understanding exactly how the emotional disclosure intervention works and may be particularly relevant for injured populations, for whom which this intervention may be particularly helpful and may be more practical to administer after the injury or post-surgery.