A Science-Supported Journaling Protocol to Improve Mental & Physical Health

welcome to the huberman Lab podcast

where we discuss science and

science-based tools for everyday

[Music]

life I'm Andrew huberman and I'm a

professor of neurobiology and

Opthalmology at Stanford school of

medicine today we are discussing

journaling for mental and physical

health I want to emphasize that today's

discussion is not a general discussion

about the value of journaling rather it

is a discussion about a particular form

of journaling that the scientific

peerreview data says is especially

powerful for improving our mental and

physical health in fact what I will

describe today is a journaling method

that is supported by over 200

peer-reviewed studies in quality

journals and I frankly was not aware of

this journaling practice prior to

researching this episode but in

researching this episode have come to

discover that this practice should

easily be placed among some of the other

critical so-called foundational pillar

practices

in terms of its impact on improving

mental and physical health including

things like lowering anxiety improving

sleep improving immunity to things like

colds flu Etc as well as reducing the

symptoms of autoimmune disorders such as

arthritis lupus and also providing some

relief for fibromyalgia which is a

condition of excessive pain the

particular journaling method and

protocol that I will describe has also

been shown to improve various metric Tri

of everyday living including improved

memory decision- making and on and on

and on so much so that again I was very

surprised that I had not heard of this

particular journaling method one would

think that if such a powerful method

existed that everyone would know about

it but it turns out that this particular

journaling method has been somewhat

cloistered within the fields of

psychology and Psychiatry it's not that

nobody was aware of it in fact I learned

about it for the first time from our

associate chair of Psychiatry at

Stanford for University School of

Medicine my colleague and collaborator

Dr David Spiegel who as some of you may

know has been featured as a guest on

this podcast previously and upon hearing

about it I decided to explore the

primary research that is the studies

that demonstrate the power of this

particular journaling method and was

absolutely Blown Away by the positive

impact this particular journaling method

can have what's wonderful about it

you'll soon discover is that it takes a

relatively small amount of time in fact

it's something that you could do during

the the course of one week or even

across one month and then never do again

and the data say that it would still

have lasting positive benefits both for

body and mind so while it's rare to

feature one particular protocol as an

entire huberman Lab podcast that is

indeed what I will do today it is

important that we go into some depth

about the specific protocol because

there are some important details that

everyone should know if they want to

apply it and make it as effective as it

can be and in addition to that we'll

talk about some of the underlying

science that that's been published

explaining why and how this protocol is

so effective for mental and physical

health before we begin I'd like to

emphasize that this podcast is separate

from my teaching and research roles at

Stanford it is however part of my desire

and effort to bring zero cost to

Consumer information about science and

science related tools to the general

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access a free 30-day trial okay let's

talk about this particularly

transformative form of journaling that

initially was researched by Dr James

pennebaker James pennebaker was a

professor of psychology at Southern

Methodist University when he first

started researching this form of

journaling and its positive impacts on

the body and mind but he has since moved

to the University of Texas Austin where

he still runs a laboratory and has

continued his studies on the role of

journaling and other forms of language

both spoken and written in terms of

their impact on one's mental and

physical health so the origins of the

research into this particular form of

journaling started in the mid 80s and it

was really in 1986 that the first

published manuscript about this form of

journaling was published now I want to

be clear that prior to James penay Baker

studying this form of journaling clearly

others had used the form of journaling

that I'm about to describe however it

was pen aaker that really started

attaching measurements of the specific

types of changes that occurred in people

when they did this journaling in a

particular way and indeed came up with

the precise protocol that we'll talk

about today so pennebaker and colleagues

and James pennebaker in particular

really deserves credit for the discovery

of this method as you'll soon learn

pennebaker was absolutely meticulous in

figuring out exactly how long the method

should be carried out what exact forms

of change occurred in the body and mind

he was careful to explore the method in

the context of students as well as in

the general population in veterans in

elderly in kids and on and on so it's

really that incredible attention to

detail and that scientific rigor that

makes the protocol so incredibly

powerful so that first scientific study

of this particular form of journaling as

I mentioned was published in 1986 and I

provided a link to that study in the

show note captions but what that study

essentially consisted of was inviting

undergraduate students into the

university laboratory one at a time and

they were to spend 15 to 30 minutes

writing about the most difficult even

traumatic or possibly non-traumatic but

still very difficult experience that

they can recall from their entire life

the instruction included that they

should write for the entire time that is

because they were writing by hand in

that particular particular experiment

that they were to not stop moving their

hand for the entire duration of the 15

to 30 minutes and in addition to that

that no one besides them the person

writing would see what was written at

the beginning middle or even after the

experiment in fact the students were

invited to tear up the paper at the end

of the writing exercise if they so chose

okay so the first key instruction is

that they take a moment to think about

what is the most difficult perhaps even

traumatic experience of their entire

life the second instruction was that

they were supposed to write for 15 to 30

minutes and the third instruction was

that they were supposed to write for the

entire time that it no point would they

take a pause Unless somehow emotionally

or physically they were unable to keep

moving their hand on the paper in fact

they were told to not pay attention to

Accurate grammar to not pay attention to

reread ability they were told in fact

that their writing could be replete with

spelling errors or grammatical errors

that didn't matter what was most

important is that they tap into a

particularly negatively charge memory of

their prior life experience now of

course because this was an experiment

carried out in a university laboratory

there was a quiet place where the

students could write undisturbed but

since we're taking this particular

protocol and we're exporting it to the

real world through this podcast so it's

important that if you decide to

implement this protocol in your own life

that you carry out the writing in a

place where you will not be disturbed

for that entire 15 to 30 minute duration

it's also important that you know that

even though that first 1986 study was

done having students write out these

memories by hand with a pen and paper or

a pencil and paper there have been many

subsequent studies that have explored

whether or not the pen and paper was

particularly important it turns out it's

not the exact same magnitude of positive

effects are observed regardless of

whether or not people write out their

passage of words by hand or type it out

on a word processor or any other form of

writing now just to make sure that

everyone gets the exact same protocol

that was provided in that first initial

study from pennebaker and colleagues and

that has been used really over and over

and over again for more than 200

peer-reviewed studies that demonstrate

the power of this protocol I'm going to

read to you some of the specific

instructions from that first study so

the subjects were instructed to quote

write about something that you are

thinking about or worrying about way too

much or if you're not thinking about or

worrying about something way too much

perhaps you've deliberately tried to not

think about this series of events or

event something that you've been

dreaming about at night perhaps in

disturbing dreams or something that you

feel is affecting your life in an

unhealthy way either internally or

externally so it could be in your

emotional state your inability to calm

down when you want to be calm maybe

you're ruminating maybe even compulsive

thought maybe it's leading to addictive

or compulsive or habitual behaviors or

perhaps you can identify by a specific

trauma or set of traumas that you know

are really plaguing your body and mind

The Specific Instructions that were

given to the subjects in those

experiments are The Specific

Instructions that I'm going to give to

you now should you decide to implement

this journaling protocol and those

instructions are as follows I want you

to write down your deepest emotions and

thoughts as they relate to the most

upsetting experience in your life really

let go and explore your feelings and

thoughts about it as you write you might

tie this experience to your childhood

your relationship with your parents or

siblings people you have loved or love

now or even your career or

schooling how has this experience

related to who you have now become who

you have been in the past and who you

would like to become the instructions

then continue to say many people have

not had a truly traumatic experience in

their lives but everyone has had major

conflicts or stressors and you can write

about the most dramatic or stressful

experience you've ever had okay so those

are some of the key instructions that

subjects in these experiments were given

before they do the exercise and of

course they were given a few minutes to

think about what they wanted to write

but once they selected what they wanted

to write they started writing there was

a timer going in the background for 15

to 30 minutes and the Reason by the way

I keep saying 15 to 30 minutes is that

some experiments employed a 30-minute

period other experiments employed a

20-minute period others employed a

15minute period turns out there were no

major differences between the 15minute

and the 30 minute writing blocks in

terms of the positive impact that they

had on mental and physical health but

for some people and their particular

experience that they're writing about 15

minutes is simply going to be too brief

a time in order to capture the entire

experience and as many thoughts and

feelings about that experience as one

would perhaps put down onto paper or

type out if they had a full 30 minutes

so you can allow yourself 15 to 30

minutes and feel welcome to stop before

the 30 minute period is over over or

perhaps you're going to restrict

yourself to 15 minutes and you're going

to force yourself to get out as much as

possible in that time it really doesn't

matter or so say the data okay so before

I continue to detail the specifics of

this writing protocol you've probably

already noticed that what I'm describing

is a very different form of journaling

than say morning notes which is a form

of journaling that writers often use in

order to quote unquote clear out the

Clutter this is a process of sitting

down and writing down in stream of

consciousness whatever's on your mind

for the first 5 to 15 maybe even 30

minutes every morning as a way to sort

of clear out your mental processes and

get ready for the day perhaps a day of

other forms of writing or other

activities entirely what I'm describing

is also distinctly different from

so-called gratitude journaling in fact

it's quite the opposite it's not writing

about things that you're grateful for

necessarily it's writing about things

that are extremely unfortunate that

happened to you and that you have very

charged negative emotions about in

addition the form of journaling that

we're talking about today is distinctly

different from the form of journaling

that I and many others have undertaken

perhaps not on a daily basis but perhaps

on a daily basis where you essentially

are writing out the contents of your

daily life a so-called diary and I

mention that because I think many people

do journal and some do so on a

consistent basis I would put myself into

that category although the last few

years I have not been journaling too

much I have literally Stacks and stacks

of Journal journals dating back to uh

the early 90s I brought a few of them

along today and no I'm not going to read

them to any of you in fact um when I was

looking at these last night uh and by

the way these are from the late so this

is Summer of 1997 so I would have been

uh late in my uh undergraduate career

this is um fall of 96

1992 uh always done on the same

composition notebook at that time and

always done by hand um I'm surprised

that my handwriting was as legible as it

was it's gotten worse over the years I

don't know what neural process that

reflects but in any event in Reading

over these journal entries um it was

clear to me that just as I had recalled

that each and every one of them was

essentially an update about what was

happening lately what I was hoping for

some challenges you know basically a

diary of sorts and um these are kept in

the second drawer of the second no I'm

just kidding uh the idea for me is also

that no one will ever read these besides

me it was uh quite an interesting

exercise to to go back and and read

those and uh yeah there were a few

cringe moments but there were also a few

moments where I found myself smiling

because um in certain ways uh so little

has changed between the person I was

then and the person I am now and

fortunately uh in so many ways certain

things have changed between the person I

was then and the person I am now now I

mention all of that simply because I

think the form of journaling that I've

been doing for some years the sort of

autobiographical approach to daily

entries or pseudo daily ENT R is far and

a way different than the type of

journaling that we're talking about for

sake of improving mental and physical

health during today's episode which is

not to say that gratitude journaling or

autobiographical daily entries AK diary

type journaling is not useful in fact

there are data to support that gratitude

journaling in particular can be very

beneficial for both body and mind

everything from improving General states

of Happiness to reducing anxiety

improving relationships and and on and

on but to get back to the protocol that

we're talking about today you probably

noticed that it is not a protocol that's

likely to feel very good at least not at

first and indeed that's what the

research shows and this is something

that you really need to be aware of that

when subjects are given this research

assignment during the assignment they

are often quite distraught often times

they cry often times they find

themselves holding their breath and

anxiety often times they'll finish that

15 to 30 minute writing block and

they'll feel as if they had run a mental

marathon and therefore the subjects were

given a period of 5 to 15 minutes post-

writing to settle down and transition

back into their day so I highly

recommend that you incorporate that into

your protocol as well so if you're going

to allow yourself say 20 minutes to

write you want to give yourself probably

10 minutes of quiet time to you know

bring your composure back and reset

yourself so that you can re-enter daily

living because the writing that you're

going to do for this particular protocol

is designed to tap into very negative if

not the most negative experiences of

your life and so that's something to be

taken seriously and it's an entirely

unreasonable expectation that you could

write about something as difficult as

the most difficult experience in your

life and then simply pivot and go back

into everyday life right away so you'll

want to designate a time of day or night

perhaps when you can do this writing and

still allow yourself some time to you

know settle down your autonomic system

you know return your breathing to normal

perhaps you know wash your face with

some cool water remind yourself that the

rest of the day continues that you're

doing great in fact you made it through

this first installment of the journaling

exercise so you're probably starting to

get the impression that this form of

journaling that Penna Baker and

colleagues really researched and

pioneered the evolution of is quite

different than other forms of journaling

and in fact it's very different I've

already told you that the idea is to sit

down and write for 15 to 30 minutes

right continuously write about something

that really to you is one of the most if

not the most difficult experiences of

your life in addition to that for this

form of journaling to be most effective

that is to bring about the greatest

positive shifts in mental and physical

health you're actually going to write

about that exact same thing four times

now the way that that was initially

researched by penne Baker and others was

to have the same person of course write

about the same experience four times on

four consecutive days for 15 to 30

minutes each so students or people from

the general population or veterans were

literally coming into the laboratory and

sitting down and writing about the most

difficult experience of their life that

they could recall for 15 to 30 minutes

on one day and then again on the next

day and then the next day and the next

day so much of the data on this

particular journaling method reflects

that four consecutive days of 15 to 30

minute writing bouts of the most

difficult experience that you can

recall however there have been

variations on this protocol such that

people selected one day per week and it

doesn't even have to be the same day

like every Monday it could be Monday of

one week and then Wednesday of the next

week and so on such that you write only

one day per week about the most

difficult experience you can recall and

then you write about that same difficult

experience one week later and then again

one week later and then again one week

later across the course of a month or

any 4-we period for that matter now I

don't know about you but when I hear

that that I'm going to need to write

about the most difficult experience of

my entire life that I can recall for

even 15 minutes let alone 30 minutes let

alone two times and here we're talking

about four times perhaps even on four

consecutive days that actually speaks to

some intensity some demand in fact I

find myself kind of leaning away from

that experience a little bit but as

we'll talk about later that's exactly

the point of this type of exercise which

is that we are harboring these stories

these experiences and in some cases

partial Recollections and in other case

detailed Recollections of the difficult

thing that happened to us perhaps even

the most difficult thing that happened

to us and those narratives exist in our

nervous system these are not necessarily

traumas as we talked about before

although they can be traumas now we hear

a lot about trauma and these days people

call all sorts of things trauma and

traumatizing and say that they've been

traumatized by this or traumatized by

that there's actually a specific

definition of trauma that was provided

by Dr Paul kti who is some of you know

is a medical doctor and psychiatrist

he's been a guest on this podcast first

to talk about trauma he wrote a

excellent book about trauma I provide a

link to that book in the show note

captions by the way and he and I did

four episodes of The hubman Lab podcast

a So-Cal guest series specifically aimed

at mental health what it is how to build

mental health specific protocols and Dr

Paul kti is really truly a world expert

in trauma and he defines trauma as any

experience or experiences plural that

modify our brain and neural circuitry so

it could be brain or body or both such

that we do not function as well

emotionally

behaviorally or cognitively going

forward from that experience okay so not

everything constitutes a trauma but many

things do so applying that definition I

think it's fair to say that many if not

most people have some form of trauma

stored in their nervous system and other

people perhaps don't have such traumas

but everyone has had stressors in fact I

think it's fair to say that everyone has

had major stressors in their life

provided that they've lived it all

that's just part of life unfortunately

or maybe fortunately maybe it makes us

who we are in positive ways if we are

able to transmute those negative

experiences and stressors or traumas

into particular forms of learning that

allow us to do better and indeed that's

possible and that was discussed with

Paul kti in that four episode series on

Mental Health but the particular form of

journaling that we're talking about

today was really designed to have people

focus on those difficult experiences and

then for four episodes total yes total

there's no ongoing every week or you

know it's not like having to seek out

sunlight every morning and getting

sunlight in your eyes or trying to get

the best possible night sleep at night

like I'm always encouraging people to do

this is really a short-term protocol but

it's one that is indeed very intense

okay so along those lines that

deliberately journaling about a

particularly distressing experience or

set of experiences is likely to bring

some degree of you know sadness anxiety

frustration anger perhaps other emotions

as well it's important that you know

some some of the data that have been

collected about this journaling protocol

one of the more important features of

this protocol is that when people do it

they tend to bin out into two different

groups and these two groups have been

described as low expressors and high

expressors now low expressors and high

expressors have nothing to do with

introversion and extroversion that's

actually been looked at and they have no

relationship okay so some people who are

very talkative and very

extroverted they could be a low

expressor somebody who's very

introverted tends to only you know share

when they really have something to say

and maybe doesn't have a lot of interest

in social interactions or as some of you

who heard the episode on relationships

know an actual introvert is somebody who

really enjoys social interactions but

they are very sated they are very

satisfied by less social interaction

than our extroverts okay if you want to

learn more about that check out the

episode I did on relationships but in

any event when people sit down to do

this exercise and and when they consent

to having their writing analyzed and

when they undergo a number of other

different tests turns out there are two

different groups that segment out the

first are these low expressors the low

expressors tend to use less descriptive

language in their writing they tend to

get less emotional during the first bout

of writing that first day of 15 to 30

minute writing whereas the high

expressors tend to be people that use a

lot of negative language to describe

their negative emotions about the

negative experience so that means more

negative descriptor words were used at

higher frequency these people when they

have their physiology measured also tend

to have higher amounts of distress and

upset in the first bout of writing that

first 15 to 30 minute episode so we've

got two different groups the low

expressors and the high expressors the

low expressors on day one are sharing a

bit less they're expressing Less on

paper of their particular emotions that

they can recall from that traumatic or

very distressing event and overall based

on physiological measures as well so

cortisol increases as well as Skin

conductance changes in heart rate and

blood pressure the lower expressors are

effectively relatively more calm less

distressed as they write about this very

stressful event in their lives relative

to the high expressors who have higher

blood pressure higher heart rate they

tend to be the ones that cry more or

hold their breath more or SOB more have

higher levels of ctis all during that

first round of writing now for the

protocol to be effective it doesn't

matter if you're in the low expressor or

high expressor group here's what's

interesting I just mentioned that on day

one the low expressors are less

distressed physiologically and

psychologically as they write about this

for them very distressful event whereas

the high expressors are much more

distressed significantly more so in fact

when these are measured in laboratory

studies on both mental and physical

dimensions of of stress now that's on

day one but then what's observed is an

opposite pattern of progression such

that the low

expressors become more and more

distressed as the writing exercise

continues from day two 3 and four

whereas the high expressors these people

that use a lot of language to

communicate their distress and are

experiencing a lot of physiological and

emotional distress as they're writing on

day one their amount of distress

from day 1 to two to 3 to four actually

goes down more dramatically so you can

expect that you fall into one or the

other group this was truly a binary

distribution where people bend out into

one or the other based on a number of

different measurements but here's the

good news turns out it doesn't matter

whether or not you're a low expressor or

a high expressor you want to use the

form of writing that's most natural for

you and that for you communicates what

that negative experience was like and

how it has affected you and perhaps how

it's affected others as well the

important thing to know is that both

groups both the low expressors and the

high expressors benefit from this

journaling protocol such that three

weeks later and even three months later

and even years later both groups are

experiencing far less distress and

Baseline levels of stress than they did

prior to embarking on the journaling

protocol at the very beginning now the

reason I mention these two groups the

low expressors and the high expressors

is that it's a non-trivial detail of

this writing protocol because some

people are very familiar with

communicating their emotions both in

writing and perhaps in speech as well

and this actually has been looked at uh

there's a wonderful study also by penne

Baker and colleagues and I should

mention that even though he studied

these journaling protocol for a good

number of years his laboratory has

evolved now to studying all sorts of

things related to how the particular

language usage patterns that people use

in everyday speech as well as in their

writing how that reflects their

underlying psychological tone and

emotions but also and I find this so

interesting how the particular words

that we use in writing and speech

actually shape in a causal way our

emotional state so I'll talk a little

bit about that later but the important

thing to focus on now is the results of

this study entitled natural emotion

vocabularies as Windows on stress and

well-being and this again is a study

that was done by pen Baker and

colleagues I've linked to it in the show

note captions and it essentially

examines people's natural language usage

patterns now what do I mean by natural

and why is that important well there

have been many many studies of people's

vocabulary and assessing whether or not

people have more knowledge of negative

words to describe negative emotions or

positive emotions these studies are

varying in their form but generally

consist of having people Circle words

they recognize or maybe writing out the

definitions to and it turns out that

people that have more extensive

knowledge of words that describe

negative emotions themselves tend to

have a lower affect or negative

emotional state as compared to people

who have more extensive knowledge of

vocabulary words that pertain to

positive emotions so a crude example of

what I just described is somebody that

has fairly limited knowledge of words

that describe positive emotional states

so perhaps they recognize the word happy

they recognize the word ecstatic they

recognize the word joyful but they have

a fairly limited word set that pertains

to positive emotions whereas by

comparison this is always relative

within the same person right by

comparison the person knows four times

more words that pertain to a negative

emotional state okay in general those

people tend to be more depressive tend

to have higher levels of anxiety and so

forth as compared to somebody where the

reverse pattern is true where they have

knowledge of far more words that pertain

to positive emotional states as compared

to negative emotional states now on the

face of it that result probably seems

straightforward right people that have a

lot of words to describe happiness are

more happy people that have a lot of

words to describe sadness and negative

emotions are more sad but it didn't

necessarily have to be that way and it

turns out that it's not always that way

what do I mean by that well the

particular study that I've been

describing here this natural emotion

vocabularies as Windows on distress and

well-being is an important paper because

it explored not the words that people

have knowledge of but the word patterns

that people tend to use in their natural

speech either spoken or written and what

pen Baker and others showed is that

people that tend to use a lot of

negative words tend to have more

negative emotional states whereas people

that naturally tend to use words that

describe positive emotional states have

more positive emotions and this related

to both mental and and physical metrics

of negative emotions and positive

emotions so this is a significant result

because what it says is that our

knowledge of vocabulary words is while

interesting and perhaps important for

other things is not nearly as important

as which particular words we use on a

frequent basis and so whereas before I

said okay if you're going to embark on

this protocol of four writing sessions

15 to 30 minutes each that you should

not monitor your writing that you want

to sit down start writing and just don't

stop you don't want to pay attention to

grammar or spelling or anything else and

then after the fourth writing session

you don't look at what you've written

for at least a week but then a week or

more later you go back and you read what

you've written paying careful attention

to the number of words that you use that

reflect a negative emotional or affect

as it's sometimes called state in the

first versus the second versus the third

versus the fourth journal entry now this

might seem a little bit uh detailed and

reductionist for a protocol that we

would discuss on this podcast here we're

really talking about you doing your own

data analysis of self but if you think

about it a practice like this both can

be very quick and highly informative so

for instance you can go back and simply

Circle all the words that at first blush

to you appear to reflect a negative

State and put a square around all the

words that just by your read seem to

reflect a positive State and then

compare them across those four journal

entries and of course you can opt to not

do any of this but what people find that

is what was discovered in the research

literature is that on average the

patterns of language use from the 1 to

the 4th entury shift dramatically such

that by the 4th entury people even

though they're still writing about the

same negative experience are writing

about that experience in a very

different way not only are they

naturally using fewer negative words to

describe their recollection and

experience experience of that negative

event but the number of positive words

is also increasing now this is important

because when pen Baker and colleagues

gave the instruction to people to do

this protocol they encouraged them to

think about three things before they

ever start writing the first is of

course to write about facts about that

difficult experience I think that's sort

of obvious that when people are going to

recall a difficult experience they're

likely to write down facts about that

experience the second thing that they

want to remind them to include were

emotions that they felt at the time of

the experience as well as emotions that

they happen to feel now about that

experience and third that people include

writing about any and all links that

come to mind about the negative

experience and things that may be

happening today or plans for the future

people from the past present or future

really any link no matter how distant it

might seem or how random it might seem

to include that in the the writing okay

so just to repeat the three things that

they were instructed to include before

they ever set their pens to paper or

started typing out their negative

experience first facts about the hard

experience so whatever they can recall

that happened in that hard experience or

perhaps it was something that didn't

happen and that was why it was a hard

experience but facts related to that

hard experience facts of the hard

experience second that they include

writing about emotions felt at the time

of the experience as well as emotions

felt now while writing about that prior

experience and third to include any

writing about any links that spring to

mind about the negative experience and

anything that's happening now or perhaps

happened in the past or things that you

have plan for the future now that third

category of links between the experience

and other things may be direct and

obvious maybe these are real aha moments

where you go oh my goodness I realize

now that you know what's been happening

for the last 6 months is a direct mirror

of what happened in that earlier

traumatic or very stressful episode or

perhaps the links are more opaque maybe

the link is you know I don't know why

but I keep thinking about this one

experience that I had and I keep

thinking about this one person and I

don't know how they're linked that's

fine put those down on paper you could

even draw a diagram but I should mention

it is important that you try to the best

of your ability to write things out in

complete sentences again they don't have

to be perfect grammar or even pseudo

perfect grammar the spelling can be off

your handwriting can be a mess although

if your handwriting is truly a mess it

might be hard to read later by the way

folks my older sister always teases me

that my handwriting is frozen in the

third grade actually uh would like to

show her my journal entries my

handwriting was actually quite a bit

better than it is now uh which basically

speaks to uh some degree of cognitive

decline for me but in any case the point

is that this third category of

establishing links between the prior

negative experience and whatever else is

an important component of the writing

protocol so whatever it takes to include

those links they are worth including now

I want to reemphasize that even though I

pointed to the positive health benefits

of using more positive words in one's

writing or speech as opposed to negative

words which tend to be associated with

worse Health outcomes both in terms of

physical and mental health it is

important and it's Central to this

writing protocol if you're going to get

the positive consequences of it that

you're not monitoring the words that

you're using too closely you're not

trying to write this so someone else can

see it you're not trying to write the

Great American novel you're not writing

your eulogy you're not writing your

autobiography you're really writing this

for you I can't emphasize that enough

you're doing this writing protocol so

that you can work through something that

is stressful or traumatic that resides

in your nervous system and that is not

serving you well indeed next we're going

to talk about what happens when these

narratives of our prior negative

experiences are not worked through that

they have not been put either to speech

or to pen to paper or typed out and

perhaps more importantly we're going to

talk about the incredibly positive

benefits both at the level of neural

changes SOC called neuroplasticity which

is the literal rewiring of neural

connections as well as psychological

benefits reduced anxiety improved mood

improved sleep and improved immune

function that are the consequence of

doing this four bouts of 15 to 30 minute

writing protocol as we all know quality

nutrition influences of course our

physical health but also our mental

health and our cognitive functioning our

memory our ability to learn new things

and to focus and we know that one of the

most important features of highquality

nutrition is making sure that we get

enough vitamins and minerals from

highquality unprocessed or minimally

processed sources as well as enough

probiotics and prebiotics and fiber to

support basically all the cellular

functions in our body including the gut

microbiome now I like most everybody try

to get optimal nutrition from Whole

Foods ideally mostly from minimally

processed or nonprocessed Foods however

one of the challenges that I and so many

other people face is getting enough

servings of high quality fruits and

vegetables per day as well as fiber and

probiotics that often accompany those

fruits and vegetables that's why way

back in 2012 long before I ever had a

podcast I started drinking ag1 and so

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okay so let's talk a little bit about

the positive mental and in particular

physical changes that occur in people

that do this writing exercise I should

mention that most of the studies and

again more than 200 quality

peer-reviewed studies of this protocol

have been carried out and are still

ongoing not just in pennebaker

laboratory but in many many other

Laboratories as well reveal that the

positive physical shifts that occur in

people that complete this for bouts of

writing in the way I described is both

significant and longlasting now of

course it is not the case that these

four episodes of writing can completely

cure major forms of depression or post-

trumatic stress disorder although they

have been shown to benefit that is to

reduce depressive symptoms and to reduce

the symptoms of post-traumatic stress

disorder considerably but they shouldn't

be considered complete Therapeutics for

those conditions however however they

have been shown to significantly improve

many other health metrics and I alluded

to some of these at the beginning of

today's episode there have for instance

been studies of this type of journaling

protocol for people that have been

suffering from chronic anxiety and

insomnia and indeed they experienced

significant

relief as well people who have suffered

from arthritis people who are going

through cancer treatment people who have

Lupus which is an autoimmune disorder

report significantly improved symptoms

not necessarily cured from those

conditions but significantly improved

symptoms as a consequence of doing this

writing protocol in addition and earlier

I mentioned this I realized but I'll

mention again people suffering from

fibromyalgia which is a chronic pain

condition that is or can be very

debilitating has shown significant

Improvement in symptomology that is

reduced chronic pain after they do this

four bouts of writing in the way that I

described and again the relief from pain

seems to be ongoing again not a total

cure of their symptoms I don't want to

uh provide false hope here or overblow

the um the positive impact of this

particular writing protocol but

nonetheless statistically significant

shifts that were pervasive over time in

addition people suffering from IBS or

irritable bowel syndrome have achieved

some significant degree of relief of

their symptoms relative to people who

also have irritable bowel syndrome but

who do not do the exact same protocol

that we're talking about today now of

course in all of these studies we're not

talking about people that simply do this

writing protocol as compared to people

that don't do the writing protocol

pennebaker and others of course are

excellent scientists and so they provide

adequate control conditions the control

conditions in most cases were to have

people also do 15 to 30 minutes of

writing but to do journaling in the more

conventional manner of autobiographical

report of what they've been up to lately

or what they plan to do in fact very

much like my journal entries from

college and uh in the subsequent to that

so it's important to understand that

what we're talking about today is a

journaling protocol which seems somewhat

conventional but the exact protocol is

highly unusual as we've been talking

about throughout today's episode and in

addition all of the data that we're

discussing in terms of positive mental

and physical effects are data that were

established relative that is are

statistically significant as compared to

a control group that also wrote for an

equivalent amount of time time tended to

write out an equivalent number of words

on average and yet we're writing about

something quite different than the

people that were in the so-called

experimental group so it's important to

keep in mind that we're not simply

talking about phenomenology here we're

talking about scientific studies where

very specific measurements of the

experimental group that is the group

that did this particular form of writing

about something very distressing or even

traumatic four times 15 to 30 minutes

per time relative to a control group

that did nearly the equ equivalent form

of mechanical processes of writing but

that the specific emotional content

related to that writing was the major

variable that differed in fact that is

one particular strength of the protocol

we're describing today that if you think

about it would be very hard to do in a

study say of physical exercise where you

have people perhaps you know run on a

treadmill getting their heart rate up to

85% of their maximum heart rate for 30

minutes 5 days a week you would expect

that that group compared to a group that

did nothing would experience

significantly greater shifts in positive

Health metrics like lowered blood

pressure certainly not during the

exercise bout during the exercise bout

you can bet that their blood pressure

and heart rate went way way up but that

of course afterwards they would adapt to

that exercise by having a resting heart

rate that was lower than any group that

did nothing or that walked on a

treadmill but it's actually very hard to

think about a control group that would

provide real equivalents of time spent

and effort spent but that would differ

only on one variable which would be

heart rate you could probably come up

with something but it'd be very

difficult to do whereas in the studies

that we're talking about during today's

episode essentially everything was the

same right people are still writing

they're still sitting they're still

doing it for the same amount of time

it's simply that the content of the

writing is different at the level of the

emotional tone of the subject that

they're writing about which I find both

exciting and personally quite motivating

to do the sort of protocol that I've

described today because it leads to such

dramatic shift in health across a huge

range of Dimensions both in people

suffering from certain conditions and

people who are not suffering from

certain conditions and then the question

becomes why what is actually happening

at a physiological level that can

explain all of these incredible

psychological and physical positive

shifts that occur okay so as with any

protocol that's shown in many many

studies again here are more than 200 100

peer-reviewed studies to have positive

effects on mental health or physical

health you can imagine that there's

going to be a constellation of positive

effects that occur that can explain say

the Improvement in autoimmune conditions

or the Improvement in anxiety that is a

reduction in anxiety or the Improvement

in sleep patterns it's not going to be

just one thing however there are some

general categories of physiological

changes that have been observed in

people that do the particular protocol

we're talking about today that I think

can explain a great number of the mental

and physical shifts that occur now one

of the more important studies in this

area that's been published and here

again this is a paper by jimes pen Baker

but I don't want to give the impression

that he's the only person or the only

laboratory that's looked at this

particular writing protocol many others

have as well and I'll provide links to

some of those in the show note captions

but this particular study I'm about to

describe explored how the disclosure of

traumas or the writing out of very

stressful

experiences can impact immune function

at the level of specific cell types of

our immune system that are challenged

in a way that mimics the sort of

challenge we would experience if we were

to be exposed to a bacteria or virus now

without getting into a detailed lecture

about immunology and by the way I did an

entire episode of The hubman Lab podcast

about immune function in the brain uh

some years ago and you can find that by

going to HUB lab.com just put immune

system into the search function it will

take you to that episode and to any

timestamps of other episodes where I

touch on the immune system or protocols

related to immune brain function in the

meantime this particular study is very

interesting and worth highlighting

because what they did was to essentially

have people do the exact same protocol

that we've been describing throughout

today's episode but they also included

blood draws from the subjects in those

experiments and they collected that

blood from subjects both before and

after the writing episodes in fact they

took the blood 15 weeks prior to the

study and again six weeks into the study

okay now keep in mind that people were

completing the writing exercise over the

course of at a maximum four weeks

but they were still monitoring these

subjects in terms of their psychological

and physical health after the final

writing exercise that was a key

component of essentially all of the

studies of this particular protocol

they'd assess people before they did the

writing assignment they assessed people

during the writing assignment and they

assess people often long after the

writing assignment was completed even

years after the writing assignment was

completed so in this particular

experiment they're drawing blood 15

weeks before and 6 weeks into the study

six weeks into the study is after all of

the writing that is the four bouts of

writing have been completed they also

divided subjects in this study into

people that were so-called high

disclosers so these are people that

revealed a lot about their particular

traumatic or stressful episode in their

writing and people that were low

disclosers they also included a control

group and the control group was

essentially as I described before it

consisted of people that also were doing

journaling for the equivalent amount of

time as people that were in the

experimental group but that we're not

writing about a traumatic or stressful

experience now the basic takeaway of the

study is as follows they take the blood

they are able to isolate from the blood

something called t-lymphocytes

t-lymphocytes are an essential component

of your immune system these are cells

that many people describe as white blood

cells they are manufactured in the bone

marrow which I still find amazing right

we think of bone is just these like you

know hard components of our body and our

skeleton that allow us to be upright and

to be rigid and to move about and you

know not be um you know jelly like but

indeed in the center of the bone is

marrow and the marrow itself is

performing an important physiological

role many roles in fact one of which is

to create these t-lymphocytes or white

blood cells they actually are born of

the bone marrow but then they mature in

a structure called the thymus the thymus

is an organ that sits essentially behind

your sternum and it's there that the

cells that originate from the bone

marrow

are matured into what are effectively

white blood cells which are essentially

cells that go out and combat infections

bacterial infections viral infections

even fungal infections now they combat

infection not alone but in collaboration

with other immune cell types that you

can learn about again in that episode

that I did about the immune system and

the nervous system if you choose to go

listen to it and even if you don't

here's what you need to know about this

study in this study what they found

is that when they took the blood from

these subjects isolated those T

lymphocytes and then challenged those

t-lymphocytes with something that mimics

an infection and they did that with

something called con canavalin a

concavalin a is what's considered aogen

it's something that activates

t-lymphocytes and it activates what are

called natural killer cells now that's a

lot of detail for sake of this episode

basically what the con canavalin a is

doing is it's mimicking an in section

but in this particular study this is all

being done on t-lymphocytes that have

been collected they're put into a dish

and then they're exposed to different

concentrations going from low to medium

to high of that con canavalin a

mimicking a lowgrade moderate or severe

infection and what they observed in this

study is remarkable I mean to me it this

just still blows my mind people that did

this four bouts of writing protocol

experienced greater degree of tlmy

activation from The concanavalin mitogen

Challenge which mimics infection then

did people who wrote about something

that wasn't stressful or traumatic now

that itself is pretty striking if you

think about it I mean we're talking

about a writing exercise that generates

an emotional state versus a writing

exercise that does not produce as

negative or intense an emotional state

and we're talking about a significant

effect on the immune system or the

mobilization of immune cells in response

to an immune

challenge in addition to that however

they observed that high disclosers that

is people that really poured themselves

into this writing protocol experienced a

greater degree of immune activation that

is a fighting off response to this

mitogen concanavalin a then did people

that were low disclosers so this really

speaks to the fact that the intensity

the emotional state during the writing

exercise is having a significant impact

on the immune system at the level of

something as basic and yet as powerful

as how much deployment of immune

response there is to an infection now

the field of so-called psychon

neuroimmunology has been around for more

than 30 years in fact if you don't apply

standard definitions to that field it's

been around for thousands of years but

really it's only in the last 10 years or

so that scientists and physicians at

least standard scientists and Physicians

have started to really adopt the

understanding and really apply to their

studies and their clinical practice this

firm idea that the body and mind are

linked in this way that emotions can

really shape our physical responses and

that physical responses also can shape

of course our mental responses now I'm

not trying to be disparaging at all of

traditional science or medicine it's

just that until recently these fields

have existed more or less as silos

people that studied bodily organs versus

people that studied the brain people

that studied emotions and psychology

versus people that studied the immune

system and there's been some crossover

but by and large it's been very siloed

now I mention this because if you look

into the history of why James pennebaker

and colleagues started exploring this

particular pattern of journaling it

actually relates to his own personal

experience and I don't want to spend too

much time on this but it's worth

mentioning that pener has actually

spoken about and written about in by the

way an excellent book that I've linked

to in the show note captions where he

talks about his experience in suffering

pretty severely from asthma as a child

and that that asthma was seasonal and

yet at some point later in his life

because he had certain relatives

visiting him in his new home

location that his asthma would come and

go as a consequence of interacting with

certain members of his family

independent of season and basically what

he deduced from his own personal

experience is that there must be some

link between our emotions either

negative or positive and our immune

system or other physical ailments or

thriving in the physical sense now he

certainly wasn't the first one to come

up with that hypothesis but indeed he

was one of the first to really start

exploring a protocol within the

laboratory an experimental protocol that

could really tap into high degrees of

emotionality in this case negative

emotions and the consequence of that on

physical health outcomes and this study

that I mentioned is but one one of those

examples and in that way he's truly a

Pioneer in thinking about quote unquote

psychon neuroimmunology but couching it

not in the direction that most people do

which is for instance there have been

lots of studies where people have said

okay in people that are chronically

stressed which includes of course

psychological stress what are the

effects on the nervous system the immune

system Etc and as you could imagine in

general people who were more stressed

over long long periods of time had worse

physical outcomes and people who were

less stressed had better physical

outcomes but the protocol that we're

talking about today is quite a bit

different so if you step back and think

about it's a little counterintuitive

what pennebaker essentially did was to

have

people deliberately induce a negative

experience and yet they're seeing

positive physical health outcomes or in

this case positive effects on immune

system function so that leads to the

question of what's really happening

during an after these four episodes of

writing and that's where things get

especially interesting as it relates to

the nervous system system and to

neuroplasticity or the nervous system's

ability to rewire itself in response to

experience so that's what we're going to

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docomo okay so what's happening at a

mechanistic level that allows people who

do these four bouts of writing about

something traumatic or stressful to

achieve these longlasting positive

shifts in mental and physical health now

there could be any number of different

changes occurring at the level of the

mind or body but what we're talking

about here is trying to find the pivotal

one or sometimes referred to as the

Lynch pin mechanism that when one Taps

into that mechanism it Wicks out into

all these different systems of the brain

and body and provides all of these

different positive benefits now in

researching this episode I thought long

and hard about this and came up with a

short list of ideas and as is always the

case people have worked in this area on

this particular protocol and protocols

similar to it in the the field of

Psychology and Neuroscience have also

generated their own short list and those

short lists converge at the level of one

particular mechanism that is worth

describing and that one particular

mechanism is anchored around the concept

of neuroplasticity that is our nervous

systems ability to change in response to

experience and if you've heard me talk

about neuroplasticity before

neuroplasticity in childhood occurs

through rather passive experience of any

sorts of events in fact one of the

Hallmarks of childhood is that just the

mere exposure to an experience reshapes

the brain not necessarily permanently

but often in a way that is very

longlasting now that's a feature of

childhood because if you think about

what the nervous system is really

designed to do for us it's of course

what allows us to move our limbs it's

what allows us to have a heart rate that

goes in the background without us having

to think about it so-called autonomic

functions it's what keeps us breathing

without us having to think about it and

on and on but one of the main functions

of the nervous system is to be a

predictive machine to make good guesses

about what's to come next and one of the

ways to make really good guesses about

what's to come next is to take a certain

period of life that we call childhood

superimpose on that period of life that

childhood what we call a critical period

or sensitive period during which our

experiences create a sort of map within

us that allow us to predict okay well if

this person's in the room later well

then that's likely to happen or if those

people are in the room any number of

different things could happen but of one

particular category of experience as

opposed to another that's really what

your nervous system does it becomes a

prediction machine and it becomes a

prediction Machine by drawing strong

correlations between emotional states

your physical surroundings your

perception of who's there what's there

what happened just prior to something

and how it made you feel later so when

we talk about recounting a stressful or

traumatic event if you recall there were

three components to it it involved facts

about that experience so literally who

was there what happened as to the best

of our recollection if you recall the

second thing it's also about recounting

how that experience made you feel at the

time and how it makes you feel now and

then if you recall the third thing

that's critical to include it's about

any links or associations between what

happened and really anything at all so

if you think about it all three of those

things in that list are really about

tapping into your neural map or your

schema as it's sometimes called or your

internal representation both conscious

and unconscious of what happened during

that stressful or traumatic event now a

Hallmark feature of traumas as well as a

Hallmark feature of addictions as well

as a Hallmark feature of compulsive

behaviors or negative habitual behaviors

and negative habitual States like

chronic stress anxiety the sorts of

things that trigger insomnia the sorts

of states of body that trigger immune

compromise and give us autoimmune or

other types of immune system challenges

are that a certain component of our

nervous system and our brain in

particular are less engaged than they

normally would be in the healthy

condition now I want to be clear that in

any one of these conditions whether or

not it's irritable bowel syndrome or

it's fibromyalgia or it's chronic

anxiety or depression there are many

many different brain centers and

networks that is stations within the

nervous system of the brain and body

that are involved I really want to

emphasize this there's no one location

in the brain for instance for fear or

anxiety it's always a network phenomenon

the relative activation of different

brain centers at different times and so

on but with respect to thinking about

traumas and stressful experiences we

have to ask ourselves what is it about

the emotional states and all the mapping

the representation around those

emotional experiences that would somehow

impact our immune system like our thymus

of all things or our bone marrow or

conversely what would it be about a

stressful experience that would impact

our heart rate that would somehow then

also change our brain so the mechanism

that seems to be a sort of Smoking Gun

of sorts that is the mechanism that

really does seem to be at least one of

those Lynch pin mechanisms is that when

we experience very stressful or

traumatic experiences our prefrontal

cortex the neural real estate that's

just behind our forehead which has

several different subdivisions in fact

is reduced in its overall levels of

activity and other areas of the brain

that sometimes are referred to as the

limit LIC areas of the brain although if

we were to be more accurate than that

the modern Neuroscience really refers to

these as subcortical structures they

aren't necessarily lyic structures per

se although they can include components

of the lyic system so they can include

things like the hypothalamus so this

dense collection of neurons that resides

over the roof of your mouth that's

involved in things like aggression or

temperature regulation sleep wake cycles

and so on as well as structures that

perhaps you've heard more about such as

the amygdala which is involved in threat

detection but other structures as well

all of which are subcord cortical now

those subcortical structures can be

compared in a fairly General but still

accurate way to the prefrontal cortex

which is involved in contextual planning

involved in assessing outcomes if I do a

what will happen if I do B what will

happen the prefrontal cortex is also

associated with our

self-concept of our identity who we are

what we are about what we value what

motivates our decisions to do or to not

do things so I don't want to create any

false impressions that the prefrontal

cortex is somehow a more evolved

structure than the subcortical and lyic

structures but in some sense it is it's

involved in more quote unquote

sophisticated functions or at least

functions that involve us really

thinking and being able to place a

coherent Narrative of what happened in

the past what's happening now and what's

likely to happen in the future if

conditions a b or c happen to arise okay

so that's a very brief top level Contour

less in prefrontal cortical function and

comparing it a bit to some subcortical

and lyic structure functions now there

have been neuroimaging studies in

particular Studies by the liberman

laboratory at University of California

Los Angeles but neuroimaging studies in

other Laboratories as well that have

established that when people recount

very stressful or traumatic events the

prefrontal cortex level of activity is

reduced as compared to when people

recall less stressful or less traumatic

events

in addition to that those subcortical

structures ramp up their activity when

people recall traumatic events at least

at first okay this is very important

what I'm about to tell you is that the

repeated visiting of stressful and

traumatic events in a structured way or

even in a pseudo structured way as is

the case when people first start

journaling about that stressful or

traumatic event on day one when it tends

to be a pretty unstructured narrative

that's actually been shown in the

literature and then over the course of

that second and third and fourth writing

bout people not only shift the sort of

language that they use to describe their

feelings and that event as we talked

about earlier but the degree to which

there's a more coherent narrative placed

on the structure of that writing

increases with each subsequent bout of

writing and this is very important

because what we're really talking about

here is people going deeper into their

recollection of the experience not

remaining at such a superficial level

and two things are happening even though

they're going deeper into this very

distressing event they're perhaps even

experiencing heightened levels of

distress right if you recall back to

earlier in the episode when I talked

about people who tend to be on the low

disclosure end of things they're not

very rbos they don't tend to use a lot

of emotional words and early on they're

not sharing too much about this

experience and over time it increases

whereas the other group decreased the

level of emotionality with each

subsequent writing bout but in each case

the coherence of the narrative that is

the degree to which the narrative takes

on a story-like structure increases from

the first to the fourth writing bout and

this is very important because what

we're really talking about here is

increasing the amount of

[Music]

truthtellah

in your mind what were the facts what

happened what didn't happen perhaps is

relevant too but what happened second

how did it make you feel that's

something that you are uniquely

qualified to answer factually because

only you can really know how you feel

sometimes it takes some effort to think

into how you feel to really get a clear

sense of how you felt and how you feel

but only you can report that factually

no one can dispute that those are your

feelings and that's part of what you're

writing about and then of course there's

the third component of what are the

connections between different

experiences that are coming to mind and

there again that is your unique factual

report of what's going on inside your

head around that event okay so what

we're talking about here is an exercise

in writing that yes is distressing but

that we know Based on neuroimaging data

overtime is increasing the Baseline

levels of activity in certain key areas

of the prefrontal cortex and that we

know is associated with improvements in

the symptomology around trauma and other

stressful events now it's extremely

important to highlight this

truth-telling component and the fact

that your truth about these experiences

is indeed your truth and it's such a key

component of the writing exercise so

what we're looking at here is a

situation where the event or events that

happened actually happen there's no

changing that but your narrative about

those events is vitally important in

terms of how you experience either Ono

going distress from or relief from those

events and in sort of a counterintuitive

way reporting those events in a way that

initially is very stressful or that can

be stressful in any number of those

different four writing bouts over time

provides relief from that stress so why

do I say counterintuitive well you could

say okay well then does distress itself

cause changes in the prefrontal cortex

that are positive No in fact the

opposite is true we know that being

under I conditions of duress or stress

or trauma reduces activity in the

prefrontal cortex and here we're saying

recalling that trauma and stress in ways

that are highly emotional and negative

is actually increasing ongoing activity

in the prefrontal cortex and indeed yes

that is the case so how could that be

during development neuroplasticity is a

passive process whatever we are exposed

to changes our brain in a way that

allows us to more reliably predict the

future right that's one of the key

functions of the brain but as an adult

meaning from age 25 onward and really

that's not a strict cut off could be

late teens maybe 19 all the way up to

say age 120 which we think is perhaps

the maximum lifespan that humans could

possibly reach we don't know most people

don't reach 120 but let's say from 19

all the way up to 120 we know that

neuroplasticity is created when the

nervous system goes into states that are

atypical as compared to our normal

waking States and one of the key

triggers for neuroplasticity is when we

have high levels of the so-called

catacol amines dopamine epinephrine

Endor norepinephrine in our brain and

body that creates a state change that we

call autonomic nervous system shift

where we have elevated heart rate more

distress High degrees of emotionality it

is highly uncomfortable often and yet

that signals to the neural tissue hey

something's happening here and we need

to rewire we need to change and the

actual rewiring occurs during deep sleep

sleep and states such as non-sleep deep

rest or anytime we're in a deep

relaxation State some of you have heard

me talk about neuroplasticity before but

the key elements to remember for today's

discussion is that these states of

heightened levels of emotionality are

the trigger for neuroplasticity and that

the actual rewiring of neural

connections happens in sleep and states

such as non-sleep deep breast so if we

were to be completely logical we would

sit back at this point and say okay

here's a protocol in which we

deliberately make ourselves stressed out

again about a very stressful or

traumatic event and yet even though that

stressful or traumatic event at first

created problems for our mental and

physical health by revisiting it and

triggering that stressful experience

again four times in a lot of detail

somehow it's giving me relief from that

experience it's creating positive mental

and physical shifts I mean how could

that be how could it be that the

negative experience on the one hand

creates problems and then on the other

hand recreating that negative experience

relieves those very same problems

there's something completely illogical

about that framework right well here's

where things get really interesting

there have been two separate collections

of work in the Psychology and

Neuroscience literature in the last 10

years which have focused mainly on two

concepts the first concept is that

extremely stressful and traumatic

experiences because they induce a

relative reduction in the activity in

the prefrontal cortex

divorce our mind from creating a

coherent structural narrative about what

happened during those particular

episodes and in doing so create a sort

of confusion about responsibility now

there's a whole discussion to be had

about this and we will have that

discussion in a future episode of the

podcast about how trauma is actually

mapped within the brain and body there

are a lot of theories about this right

sometimes we hear that it's all mapped

within the body sometimes we hear it's

all mapped within the brain turns out as

is almost always the case it's both but

there does seem to be both

neuroscience-based and psychology both

clinical and research psychology based

evidence for the idea that when people

experience very stressful and traumatic

events that the representation of those

events is somewhat fractured in the

sense that people by not talking about

them by not creating a coherent

narrative around them start to form

false correlations between the kind of

stress that they create in our body and

mind when we think about them and a

confusion about what happened a

confusion about why we feel terrible

when maybe we weren't the perpetrator or

create a sort of lack of coherence

between our bodily State and what we're

thinking especially because we're not

the perpetrator right here we're talking

about traumas and stressful things that

happened to us maybe we were

participants in that by virtue of our

circumstances but when we talk about

traumas what we're really talking about

are things that we would have never

elected to do otherwise okay so I don't

want to be too abstract about this but

again within the neuroscience and

psychology understanding of trauma and

stress it seems that there's a lack of

coherence about the narrative there's

also a mismatch between the bodily State

and thoughts about that experience and

there seems to be a confusion about who

or what was responsible for inducing

that negative state in a way that in

some sense causes people to set aside

that narrative and try and push it away

and not think about it because it is

confusing it can often even be

discombobulating for those that have

suffered from very stressful events and

Trauma I think some of this will

resonate with you now a separate

literature that's largely nested just

within the Neuroscience Community

although it's starting to Wick out into

the psychology Community as well is the

idea that when people tell the truth and

in particular when people tell the truth

with a very coherent structured

narrative the levels of activity in the

prefrontal cortex increase but not just

temporarily that is that there's

neuroplasticity of these prefrontal

cortical structures which are both

involved in generating coherent

narratives but are also involved in this

is super important that are also

involved in regulating the activity of

those subcortical structures like the

hypothalamus and lyic structures in

other words that when we can increase

our understanding of an event when we

can understand why certain emotions

arose what our role in it really was

what others roles in that particular

event were well then by incre ining the

activity of the prefrontal cortex it's

better both in that moment and going

forward to regulate the activity of

these other subcortical structures and I

think one of the more impressive

experiments within that whole field of

linking prefrontal activity to

truth-telling is an experiment that was

published a few years ago in the

proceedings of the National Academy of

Sciences entitled increasing honesty in

humans with non-invasive brain

stimulation now this is a very

artificial scenario where people come

into the laboratory and they have people

do what is essenti a die rolling game

they roll dice okay so they're rolling

Dice and then after they roll the dice

only they can see the score that they

get with those Dice and then a number is

presented on a screen and they have to

report whether or not the die roll that

they did matches or does not match the

number that's presented on the screen

and if it does match then they get a

monetary award and the monetary award is

not huge but it's not insignificant

either for each die roll where they

match the number that's presented on the

screen they get the equivalent of and

because this experiment was done in

Switzerland nine Swiss Franks which at

the time of the study corresponded

roughly to $9 and today corresponds to

roughly

$10 so they do this repeatedly and so in

some sense the subjects in these

experiments are in a place to make not

an enormous amount of money but again

not an insignificant amount either now

here's the key component of the study

the statistics of the dice that they

roll and the statistics of die rolling

and the numbers that they are

presented make sure that there can only

be a correct match on average 50% of the

time okay and in this experiment the

subjects are asked to report entirely on

the honor System what they got when they

rolled the dice and what one finds in

this study and other studies that have

been done subsequent to it is that when

you take everyday people so you take men

and women you take a broad age range

you're not selecting for sociopaths

you're not selecting for people in one

given profession or another pick your

favorite profession if you were to

assume any one given profession has less

honest people than others they collect

people from all sorts of walks of life

and people report getting the same

number that is presented to them that is

a match about 68% of the time which

means they are not Faithfully reporting

what happened now Nur Imaging studies

show that when people lie certain areas

of the frontal cortex increase in their

activity although the major effect when

one looks neurally is a reduction in the

prefrontal cortex and in particular

subcompartments of the prefrontal cortex

that we'll talk about in a moment and

this particular study entitled

increasing honesty in humans with

non-invasive brain

stimulation as the name suggests used

non-invasive brain stimulation so this

is transcranial magnetic stimulation

which is a really nice and convenient

tool because you don't have to drill

down through the skull you can simply

put this tool it's a little coil you put

it over a particular part of the brain

but on the outside of the skull indeed

on the outside of the hair and you can

either inhibit or stimulate particular

brain areas using this transcranial

stimulation I've actually had this done

not in this particular experiment but I

had it done when I was a graduate

student some years ago and it was placed

over my motor cortex and I was

instructed to tap my fingers in a

particular sequence and then they

inhibit neur activity in a particular

brain area and I was unable to tap in

that same sequence and they could even

shut down my ability to tap it was

terrifying frankly although I don't want

to discourage anyone from participating

in any of these experiments should you

choose and yes of course your motor

abilities come back immediately

afterwards that's why they can run these

experiments now in this experiment what

they did is they stimulated or inhibited

neural activity in particular areas of

the prefrontal cortex and what they

discovered was I think and many others

by the way also agree a remarkable

result

which is that when they stimulated over

a particular region of the prefrontal

cortex people's honest report of what

happened when they rolled the die

relative to the number they were

presented increased okay so they went

from reporting that they had matched the

number on the screen and therefore won

money 68% of the time that number was

reduced down to what down to 50% of the

time in other words this stimulation of

the prefrontal cortex

took dishonest people even though they

were should we say mildly dishonest or

dishonest only in certain conditions

there were getting into judgment calls

and I don't want to do that and made

them truly honest they Faithfully

represented reality when a particular

area of the prefrontal cortex and that

area by the way is the dorsal lateral

prefrontal cortex was activated they

became truly honest they Faithfully

represented what happened in the diary

rolling game now the conditions in this

experiment are Far and Away different

from the journaling protocol that we've

talked about up until now however there

have been subsequent studies that have

shown that indeed when people tell the

truth to the best of their abilities

they are absolutely trying to Faithfully

report what happened in a given

experience of theirs activity in the

prefrontal cortex goes up and it

persists afterwards there is indeed

neuroplasticity of the prefrontal cortex

so the hypothesis that seems to be the

most likely and indeed has the greatest

weight of evidence for it is that when

people accurately and truthfully report

an experience even if that experience is

a stressful and traumatic one the

repeated activation of the prefrontal

cortex that occurs during that

truthtellah a sort of runaway positive

effect in the sense that it creates a

more coherent framework and

understanding of the stressful thing

that happened right so all that

discombobulation and that lack of

coherent story that then leads to lack

of coherence in terms of one's autonomic

function so underlying stress and

confusion about who's responsible that

does seem to be resolved or at least

partially resolved and the prefrontal

cortex of course doesn't Harbor one area

just for faithful accurate reporting of

traumas and stressful events that very

same area that dorsal lateral prefrontal

cortex is responsible for faithful

reporting of all sorts of other things

and there are now more and more studies

showing that

truthtellah are in agreement that when

one sees all these positive shifts in

say immune system function like how

could it be that these cells produced by

the bone marrow and the thymus are

somehow better able to deal with an

infection when one has recounted a

traumatic or stressful event right first

of all it's counterintuitive second of

all why would that be I mean how are the

body and brain linked in that way well

they're linked through this thing that

we call the nervous system and the key

component of the nervous system in this

context is that when the prefrontal

cortex can organize its understanding of

why our autonomic nervous system was so

active well then the autonomic nervous

system it seems becomes less likely to

be active when it's not supposed to okay

that could at least partially explain

the reductions in anxiety the

improvements in sleep the reductions in

insomnia and because the nervous system

and the immune system are in direct

communication this often isn't discussed

but not only does the immune system

impact the brain but the brain has

Networks literally neural circuits that

inate structures like the spleen like

the phalus that can communicate with the

bone marrow right this isn't science

fiction this is really the case in fact

there was an article that just came out

in the journal Nature this month and

I'll provide a link to in the show note

captions which is finally starting to

acknowledge that yes while these fields

of immunology and brain science and

psychology have existed as disperate

silos up until now it's oh so clear that

the nervous system is the connection

between all these different components

of brain and body and so while it might

seem counterintuitive that a writing

protocol of the sort that we've been

talking about today could positively

impact the immune system or that a

writing protocol of the sort that we

were talking about today could

positively impact things like

Fibromyalgia symptoms well it makes

perfect sense really when we start to

think about the prefrontal cortex as

this highly flexible seat of our

cognition about our self-representation

our ideas about who we are and about

when certain elements within our brain

and body ought to be activated and when

they ought not to be activated because

so much of the negative symptomology of

stressful events and traumas is about

the kind of disarray and discombobulated

activation of wakefulness in the middle

of sleep right getting woken up in the

middle of the night and not being able

to go back to sleep or elevated heart

rate panic attacks anxiety and on and on

I talked about some of this in the hubin

lab podcast episode that I did about

stress and how to master stress with

particular protocol olss it also came up

in the discussion with Dr Paul kti in

the episode about trauma and the series

on mental health so what we're pulling

together here is a mechanistic

understanding of why something like

writing for 15 to 30 minutes about a

stressful or traumatic episode would or

even could induce all these positive

shifts in mental and physical health and

while we don't have a complete

understanding about the underlying

mechanisms the activation and the

neuroplasticity of the prefrontal cortex

seems to be one of the most logical and

the most likely that sits at the center

of at least the top list of the most

important mechanisms I want to be clear

that yes indeed I'm saying that when you

write about your truth about the facts

the events of an experience and your

emotions as they relate to that

experience and the connections that you

draw between any number of different

things around that experience that the

truth telling is the stimulus and that

the emotion that accompanies that

truth-telling is what allows for

neuroplasticity to occur and that indeed

truthtreatments

course and in fact the data on the sort

of journaling that we talked about today

indicate that people's progression

through talk therapy drug therapies etc

for depression and PTSD is accelerated

and significantly so when they do this

type of journaling so the sort of

journaling we're talking about today and

other therapies are not mutually

exclusive and yet the journaling

protocol that pen Baker and colleagues

came up with I think is spectacular

because it has a number of important

features and some of those are perhaps

obvious to you already first of all it's

completely Z zero cost I mean it costs a

bit of time but not even that much time

it has an emotional cost we should

acknowledge that it's intense right and

the more intense it seems the more

effective and third it's something that

really can be done either in the course

of four days or across an entire month

so it has some degree of flexibility to

it I would even say a great degree of

flexibility to it and last but certainly

not least it's been shown over and over

again I mean more than 200 peer-reviewed

studies not just from pener but from

others as well to have Myriad positive

effects on the body and the mind in ways

that are not just short-term but that

are pervasive not just over months but

indeed over years so I don't know about

you but when I first learned about this

literature I was well initially a little

bit skeptical because that's just my

nature I'm like wait how could

journaling have such a huge impact I

mean I've been journaling for years I

know other people that journal on a

regular basis and I've never heard of

this particular impact and I certainly

haven't heard heard or seen the data but

when I started looking at the data I

thought oh my goodness like how come I

haven't heard about this and I I don't

really have an answer for that although

I will say that penne Baker and others I

think were very early in their merging

of Mind and Body States although the

initial studies weren't really focused

on mind and body all the emphasis on

immune system and brain and Neuroscience

that actually came later so I think one

of the reasons we haven't heard about

this particular form of journaling is

that frankly it's nested within the

academic literature I haven't heard much

about it being incorporated into

clinical practices although I am sure it

is incorporated into clinical practices

and frankly whatever the reason I'm just

grateful to my colleague Dr David

Spiegel who again is our associate chair

of Psychiatry at Stanford he's a medical

doctor of incredibly highly esteemed

worldwide for his work on

neuroplasticity and helping people with

Stress and Anxiety and all sorts of

other challenges for informing me about

it so much so that I decided that next

month I'm going to do one bout of

writing for each week within that month

I've opted to not do the four

consecutive days of writing to me just

personally that seems a bit too intense

it's not the time commitment it's the

emotional commitment of placing myself

into close proximity of some really

challenging stressful maybe even

traumatic memories day after day after

day for 4 days personally I don't want

to do that other people might opt to do

that in um you know tighter succession

and do the the four days in a row what

the literature tells us again is that it

doesn't really matter um as long as you

do the four bouts of writing sometime

within a month period doesn't matter if

they all are back-to-back days or you

spread them out by a week or so just to

recap the other components of the

protocol you're going to write about the

same event for all four writing episodes

those writing episodes can be anywhere

from 15 to 30 minutes but not less

throughout each writing episode you're

going to continuously write right unless

you need to stop to catch your breath or

wipe your eyes dry of Tears you're going

to keep writing it is not necessary to

pay attention to grammar or spelling but

some degree of coherence maybe not

perfect complete sentences but some

degree of coherence is probably useful

especially if you decide to go back and

analyze what you wrote later which again

is an option you don't have to do that

but if you do want to do that you're

going to go back and circle the negative

words that is the words that you

perceive to be negative and you're going

to square the words that are positive

and if you like you can also reread them

and see whether or not as was observed

in the studies that we described there

was an increase in the amount of

coherence about the topic or the event

that you wrote about keep in mind that

for each of the four boutots of writing

you want to include both facts about the

events facts about how you felt and or

feel about those events now and third

any associations

whatsoever that happen to come to mind

about those events emotional states

people in your life anything past

present or future that third category of

things to include is really open to you

for anything you want to include the

only requirement for it to be included

is that it's true for you keep in mind

also that this writing protocol is for

you it is not necessarily to be shared

now there isn't a rule that says that

you cannot share it with anybody

although I do want to introduce the

important caveat that if you are going

to share it with someone that person

should be a dedicated Health Care

ideally mental health care professional

because there are data that suggest that

when we write about traumatic and

stressful events while it can be very

beneficial for us it can actually be

traumatic or challenging for people that

we read it to now there's huge variation

around that statement certainly many of

you probably know friends or family

members or other trusted ones that you

can talk to that would be able to hear

about your stressful or traumatic

experience and not be traumatized by it

however it does seem that the listener

can experience trauma and negative

symptoms such as challenges sleeping

distress Etc by hearing about very

stressful events that have occurred to

others okay this is thirdhand trauma or

observational trauma sometimes called so

if we were to adhere to the protocol as

it was used in the various studies that

form the basis for what we're talking

about today we would say that you are

writing about something that is for your

eyes only in fact you are welcome to

tear up or delete the document

afterwards and certainly you would want

to store it in a safe place so that it's

not going to fall into hands of somebody

that you wouldn't want seeing the

contents of that writing the other thing

to keep in mind is that while it's been

demonstrated over and over again that

over time these bouts of writing lead to

improvements in mental and physical

health as we talked about earlier it is

very normal and in fact quite likely

that one will feel pretty activated in

the negative sense that one will feel

somewhat low depressed angry sad

immediately after finishing one of these

bouts of writing especially if you fall

into the high expressor category so it's

important that as we mentioned earlier

that you have a buffer of time after

which you complete the writing before

moving into your other day's events I

also just personally wouldn't recommend

that you do this writing exercise just

prior to trying to go to sleep at night

if the experience is especially

stressful or traumatic and by definition

the writing exercise focuses on

stressful and traumatic events so keep

that in mind as well and then as a final

point but certainly a significant one is

to keep in mind that if this writing

protocol is creating in you significant

enough amounts of stress either

psychological or physical that you

simply don't want to do it or that it's

impeding other areas of life by all

means just stop okay there was very

little if any data within the papers

that I read that indicated that people

had to be removed from the study for

this reason but keep keep in mind that

we're talking about purposefully delving

into stressful or traumatic experiences

and writing about them in some detail so

it stands to reason that some people

might not be able to tolerate that and I

want to strongly request that before

anyone embark on this writing protocol

that you ask yourself whether or not you

are indeed prepared to deal with the

emotional state that might accompany

faithful accurate recollection of what

happened what you felt and any links or

experiences a full four four times

across the protocol I also see no reason

why you couldn't do this protocol for

something that wasn't the most stressful

or traumatic event in your life but

rather take your first pass at this

protocol with something that was very

stressful maybe even traumatic but

perhaps not the most traumatic event as

a way of sampling whether or not it's

for you in fact I plan to do that in

reviewing the literature and preparing

for today's episode I wrote down two

things possibly three that I would want

to write about and then I ra ated them

one through three one being the most

stressful perhaps even traumatic the

other being less stressful and the third

the least stressful of the three and

decided to go with writing about the

second in that list that is the

moderately stressful AK traumatic event

um as a way to First weade into this

protocol but I will adhere to the

protocol I'm going to write about that

same thing four times as opposed to

switching from one event to the next

Midway through the protocol so I am

going to adhere to the protocol I'll

certainly be happy to get back to you

and let you know how it goes I invite

you if you like to embrace this protocol

to try it we've provided links to the

literature that supports this protocol

again it's very rare perhaps the first

time that I've ever done an entire

podcast episode about a single protocol

or to formulate an entire podcast around

a protocol but frankly I don't look at

this protocol from pennebaker and

colleagues as just a protocol I look at

it as an entire body of literature that

includes a center of massive data that

all seem to point in the same direction

which is that writing about something

very stressful or traumatic for 15 to 30

minutes four times either on consecutive

days or separated out by a week between

each of those four writing sessions can

produce long lasting positive effects on

mental and physical health and to me

that's a protocol that is simply too

valuable to overlook and simply too

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discussed supplements while supplements

aren't necessary for every everybody

many people derived tendous benefit from

them for things like improving sleep for

hormone support and for improving Focus

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