Writing as Healing: Reduces Symptoms of Asthma and Rheumatoid Arthritis

Writing about stressful experiences can reduce symptoms in people with asthma or rheumatoid arthritis, according to a study published last month in the Journal of the American Medical Association (JAMA, 4/14/99). It involved 107 people who had mild to moderately severe asthma or rheumatoid arthritis. The investigators, Joshua M. Smyth, Ph.D., North Dakota State University, and colleagues said they chose asthma and rheumatoid arthritis for this study "because they are common, cause substantial personal and economic burden, and are chronic conditions affecting daily life."

The participants were randomly assigned to write about the most stressful events of their lives or about an emotionally neutral topic. (People assigned to the latter formed the control group.) All were told to write for 20 minutes a day, three times a week for the four-month duration of the study. The study participants' disease symptoms were assessed by physicians at two weeks, two months, and four months. Physicians who examined the participants at these intervals did not know who had the emotionally charged writing assignment and who did not.

At the end of the study, the people with asthma who wrote about emotionally charged issues demonstrated a 19% improvement in lung function that did not occur in the control group. The people with rheumatoid arthritis showed a 28% reduction in symptoms, as compared to no change in the control group. While these improvements are modest, they are comparable to those shown in many drug trials. Dr. Smyth and colleague stated, "This is the first study to demonstrate that writing about stressful life experiences improves physician ratings of disease severity and objective indices of disease severity in chronically ill patients." Earlier studies showed that writing about a stressful life experience improves well-being and immune function.

In an editorial that accompanied the study, David Spiegel, M.D., Stanford University School of Medicine, wrote, "We are closet Cartesians in modern medicine, treating the mind as though it were reactive to but otherwise disconnected from disease in the body." Noting that a self-administered non-pharmacologic therapy usually generates less enthusiasm, Dr. Spiegel continued, "Were the authors to have provided similar outcome evidence about a new drug, it likely would be in widespread use within a short time. Why? We would think we understood the `mechanism' (whether we did or not) and there would be a mediating industry to promote its use."

No doubt, JAMA editors chose Dr. Spiegel to provide this commentary because he had conducted a 1989 landmark study of women with advanced breast cancer. Those who attended a weekly support group and were taught coping skills like self-hypnosis lived 18 months longer than their counterparts who received only the standard cancer treatments. This is a more impressive effect than most chemotherapy drugs can offer to cancer patients with metastatic disease.

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