The Effectiveness of Expressive Writing Therapy in Improving Emotion Regulation Among Mothers with Childhood Maltreatment Experiences

Rifa Viscarini; Ilmi Hatta

doi:10.37278/jipsi.v8i1.1368

Authors

Rifa Viscarini Master’s Program in Professional Psychology, Universitas Islam Bandung
Ilmi Hatta Psychology, Universitas Islam Bandung

DOI:

https://doi.org/10.37278/jipsi.v8i1.1368

Keywords:

Expressive Writing Therapy, Emotion Regulation, Childhood Trauma, Mothers

Abstract

Childhood maltreatment is associated with long-term difficulties in emotion regulation that may persist into adulthood and influence parenting practices. Mothers with histories of childhood maltreatment are particularly vulnerable to emotional dysregulation, increasing the risk of maladaptive parenting responses and the intergenerational transmission of trauma. Therefore, this study aimed to examine the effectiveness of Expressive Writing Therapy (EWT) in improving emotion regulation among mothers with a history of childhood maltreatment. Using a Single-Case Experimental Design (SCED) with a Multiple Baseline Across Participants approach, the intervention was administered to three mothers who demonstrated difficulties in emotion regulation. Childhood maltreatment experiences were identified using the Childhood Trauma Questionnaire–Short Form (CTQ-SF), while emotion regulation was assessed using the Difficulties in Emotion Regulation Scale–Short Form (DERS-SF). CTQ-SF screening confirmed histories of severe emotional abuse among all participants, with one participant additionally reporting severe physical abuse, emotional neglect, and physical neglect. The intervention consisted of four structured expressive writing sessions conducted over a two-week period. Data were analyzed through visual inspection, trend analysis, level change analysis, variability analysis, and Non-overlap of All Pairs (NAP) statistics. The findings demonstrated consistent improvements in emotion regulation across all participants following the intervention. Aggregate NAP analysis indicated large treatment effects, with the strongest improvements observed in impulse control and emotion regulation strategies (NAP = 100%), followed by nonacceptance and goal-directed behavior. Participants also reported reductions in trauma-related emotional responses, particularly emotional suppression and rumination, which had developed in relation to their childhood maltreatment experiences. These improvements appeared to occur through emotional exposure, cognitive processing, and enhanced self-regulation facilitated by expressive writing. The findings suggest that Expressive Writing Therapy is an effective and accessible intervention for improving emotion regulation and reducing trauma-related emotional difficulties among mothers with childhood maltreatment histories. The intervention may contribute to preventing the intergenerational transmission of trauma by promoting healthier emotional functioning and more adaptive parenting responses.

References

K. McRae and J. J. Gross, “Emotion regulation,” Emotion, vol. 20, no. 1, pp. 1–9, 2020.

E. M. Ortiz‐Jiménez, A. Butjosa, J. Gómez‐Benito, and S. Ochoa, “Emotional awareness, child maltreatment and child exposed to intimate partner violence: A systematic review of their relationship with symptoms and protective factors,” Child Abuse Review, vol. 33, no. 6, p. e2907, 2024.

Q. He and Y. Xiang, “Childhood maltreatment and emotion regulation: A systematic review and meta-analysis,” Child Abuse & Neglect, vol. 119, p. 105030, 2021.

World Health Organization, “Child maltreatment,” 2022. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/child-maltreatment

P. K. Trickett, K. Kim, and J. Prindle, “Variations in emotional abuse experiences among multiply maltreated adolescents and relations with developmental outcomes,” Child Abuse & Neglect, vol. 35, no. 10, pp. 876–886, 2011, doi: 10.1016/j.chiabu.2011.08.001.

M. A. Gruhn and B. E. Compas, “Effects of maltreatment on coping and emotion regulation in childhood and adolescence: A meta-analytic review,” Child Abuse & Neglect, vol. 108, p. 104621, 2020, doi: 10.1016/j.chiabu.2020.104621.

J. L. Jenness, A. B. Miller, M. L. Rosen, and K. A. McLaughlin, “Emotion dysregulation mediates the relationship between child maltreatment and internalizing symptoms in children and adolescents,” Development and Psychopathology, vol. 32, no. 3, pp. 1017–1027, 2020, doi: 10.1017/S095457941900092X.

J. W. Pennebaker and S. K. Beall, “Confronting a traumatic event: Toward an understanding of inhibition and disease,” Journal of Abnormal Psychology, vol. 95, no. 3, pp. 274–281, 1986, doi: 10.1037/0021-843X.95.3.274.

J. W. Pennebaker and J. M. Smyth, Opening Up by Writing It Down: How Expressive Writing Improves Health and Eases Emotional Pain, 2nd ed. New York, NY, USA: Guilford Press, 2016.

J. Park, Ö. Ayduk, and E. Kross, “Stepping back to move forward: Expressive writing promotes self-distancing,” Emotion, vol. 16, no. 3, pp. 349–364, 2016, doi: 10.1037/emo0000121.

J. L. Austenfeld and A. L. Stanton, “Writing about emotions versus goals: Effects on hostility and medical care utilization moderated by emotional approach coping processes,” British Journal of Health Psychology, vol. 13, no. 1, pp. 35–38, 2008, doi: 10.1348/135910707X250857.

S. J. Lepore and J. M. Smyth, The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-Being. Washington, DC, USA: American Psychological Association, 2002.

J. J. Gross and R. A. Thompson, “Emotion regulation: Conceptual foundations,” in Handbook of Emotion Regulation, 3rd ed., J. J. Gross, Ed. New York, NY, USA: Guilford Press, 2023, pp. 3–20.

K. L. Gratz and L. Roemer, “Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale,” Journal of Psychopathology and Behavioral Assessment, vol. 26, no. 1, pp. 41–54, 2004.

A. Aldao and S. Nolen-Hoeksema, “Specificity of cognitive emotion regulation strategies: A transdiagnostic examination,” Behaviour Research and Therapy, vol. 48, no. 10, pp. 974–983, 2010.

J. Belsky and M. Pluess, “Beyond risk, resilience, and dysregulation: Phenotypic plasticity and human development,” Development and Psychopathology, vol. 25, no. 4pt2, pp. 1243–1261, 2013.

X. Guo, “The effects of expressive writing on mental health: A meta-analytic review,” Psychological Bulletin, vol. 148, no. 2, pp. 135–165, 2022.

N. D. Savera, R. Purwaningrum, and R. R. Hidayat, “A literature review: Does expressive writing effective to reduce stress?,” ProGCouns: Journal of Professionals in Guidance and Counseling, vol. 3, no. 2, pp. 87–99, 2022.

K. Lukenda, S. Sülzenbrück, and C. Sutter, “Expressive writing as a practice against work stress: A literature review,” Journal of Workplace Behavioral Health, vol. 39, no. 1, pp. 106–137, 2024.

N. Mianti, R. Hasanuddin, and D. R. Dewi, “The impact of expressive writing on emotional resilience among trauma survivors,” Jurnal Psikologi Klinis, vol. 19, no. 1, pp. 55–68, 2024.

L. M. E. Asari, R. W. Pratama, and I. A. Manurung, “Efektivitas expressive writing dalam meningkatkan subjective well-being,” Jurnal Psikologi Insight, vol. 25, no. 1, pp. 13–23, 2023.

J. M. Pavlacic, E. M. Buchanan, N. P. Maxwell, T. G. Hopke, and S. E. Schulenberg, “A meta-analysis of expressive writing on posttraumatic stress, posttraumatic growth, and quality of life,” Review of General Psychology, vol. 23, no. 2, pp. 230–250, 2019.

A. Tonarelli et al., “Expressive writing. A tool to help health workers. Research project on the benefits of expressive writing,” Acta Bio Medica: Atenei Parmensis, vol. 88, suppl. 5, p. 13, 2017.

M. Lotze, “Emotional writing and the brain: An fMRI study,” NeuroReport, vol. 20, no. 8, pp. 770–774, 2009.

J. W. Pennebaker and C. K. Chung, “Expressive writing, emotional upheavals, and health,” in Foundations of Health Psychology, H. S. Friedman and R. C. Silver, Eds. New York, NY, USA: Oxford University Press, 2007, pp. 263–284.

R. S. Bernard, L. L. Cohen, C. B. McClellan, and J. E. MacLaren, “Effect of a brief expressive writing intervention on psychiatric symptoms and quality of life among veterans with posttraumatic stress disorder,” Behavior Therapy, vol. 43, no. 2, pp. 423–431, 2012.

D. M. Sloan, B. P. Marx, M. J. Bovin, B. A. Feinstein, and M. W. Gallagher, “Written exposure therapy for veterans diagnosed with PTSD: A pilot study,” Journal of Traumatic Stress, vol. 25, no. 5, pp. 588–591, 2012.

B. A. van der Kolk, The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. New York, NY, USA: Viking, 2014.

B. Bradley, J. A. DeFife, C. Guarnaccia, J. Phifer, N. Fani, K. J. Ressler, and D. Westen, “Emotion dysregulation and negative affect: Association with psychiatric symptoms,” Journal of Clinical Psychiatry, vol. 72, no. 5, pp. 685–691, 2011.

P. D. Zindler, T. P. Hogan, and J. R. Graham, “Maladaptive emotion regulation as a mediator of the relation between childhood abuse and adult symptoms,” Journal of Aggression, Maltreatment & Trauma, vol. 19, no. 3, pp. 275–296, 2010

J. L. Austenfeld and A. L. Stanton, “Writing about emotions versus goals: Effects on hostility and medical care utilization moderated by emotional approach coping processes,” British Journal of Health Psychology, vol. 13, no. 1, pp. 35–38, 2008, doi: 10.1348/135910707X250857.

R. J. North, A. Pai, J. G. Hixon, and C. J. Holahan, “Finding positive meaning in stress: The role of cognitive reappraisal, problem-focused coping, and coping self-efficacy,” Journal of Personality and Social Psychology, vol. 101, no. 2, pp. 365–381, 2011, doi: 10.1037/a0021889.

J. Park, Ö. Ayduk, and E. Kross, “Regulating the self to regulate emotion: Controlling thoughts and behaviors to manage negative emotions,” Trends in Cognitive Sciences, vol. 20, no. 11, pp. 749–761, 2016.

R. I. Parker, K. J. Vannest, J. L. Davis, and S. B. Sauber, “Combining nonoverlap and trend for single-case research: Tau-U,” Behavior Therapy, vol. 42, no. 2, pp. 284–299, 2011.

R. I. Parker and K. Vannest, “An improved effect size for single-case research: Nonoverlap of all pairs,” Behavior Therapy, vol. 40, no. 4, pp. 357–367, 2009.

D. L. Gast and A. D. Spriggs, Single Case Research Methodology: Applications in Special Education and Behavioral Sciences, 2nd ed. New York, NY, USA: Routledge, 2014.

A. E. Kazdin, Single-Case Research Designs: Methods for Clinical and Applied Settings, 2nd ed. New York, NY, USA: Oxford University Press, 2011.

W. W. Fisher, C. C. Piazza, and H. S. Roane, Handbook of Applied Behavior Analysis. New York, NY, USA: Guilford Press, 2017.

R. Manolov and P. Onghena, “Analyzing data from single-case alternating treatments designs,” Psychological Methods, vol. 23, no. 3, p. 480, 2018.

T. R. Kratochwill and J. R. Levin, Eds., Single-Case Research Design and Analysis: New Directions for Psychology and Education. New York, NY, USA: Routledge, 2015.