Effectiveness of expressive writing interventions with adolescents: A meta-analysis and exploration of mechanisms.

Expressive Writing (EW) is a brief, minimal cost intervention designed to improve health and psychological well being through cognitive and emotional elaboration of stressful experiences. EW involves writing about one’s deepest thoughts and feelings several times for a short period. Writing repeatedly in an emotional way may affect health cognitive reappraisal and completion of a narrative. These mechanisms are hypothesized to lead to less rumination, a greater sense of meaning, and physiological changes, e.g., immune system improvements. Most studies of EW have been conducted with adults, but its simplicity suggests that it might help adolescents facing major stress. We present a meta-analysis of EW studies with adolescents that examined whether EW is effective for adolescents. We examined six outcome domains and conducted analyses for the whole sample and for specific subgroups (e.g., gender; those with high depressive symptoms). Combining 22 studies (25 effect sizes) of adolescents aged 10-18, we found a positive but small effect size adjusted for publication bias (g = 0.126, p <. 01). Students with high levels of emotional problems benefitted more; EW was most effective in outcome domains that required emotional regulation. A small study of 20 adolescents who wrote expressively for three days after the sudden death of a classmate provides additional evidence for this emotional regulation process. However, adolescents may not have the cognitive processes necessary to create narratives on their own and emotional issues may be left open. Although our findings are encouraging, we conclude that EW alone is not an effective intervention for adolescents, as they may need scaffolding from parents or counselors to aid them in cognitively processing stressful or traumatic events. More generally, our data suggest that EW may operate differently with vulnerable or younger populations.