Anxiety

Can Expressive Writing Fight Off the Coronavirus?

Lowering anxiety and stress via expressive writing may help fight infections.

Posted Mar 06, 2020

The unfolding Coronavirus epidemic is generating tremendous individual and societal anxiety, as reported in almost every newspaper in the world. Why wouldn't it? Paradoxically, this survival reaction intended to protect you from danger may harm you.

Kira_Yan/AdobeStock
Source: Kira_Yan/AdobeStock

Anxiety is a normal and essential physiological response to a threat–whether it is mental or physical. It is the sensation generated by your elevated stress hormones such as adrenaline, cortisol, cytokines, and histamines. It is powerful, intended to be deeply unpleasant so as to compel you to take action, and it is not responsive to isolated psychological interventions. Dr. Stephen Porges, who developed the Polyvagal Theory, has studied the effects of this autonomic nervous system to threats for decades. It is an all-encompassing reaction that has profound effects on human behavior. (1)

Short-term anxiety is useful and necessary to escape danger. It is when the elevations of these hormones are sustained that your immune system is compromised. Your resistance to HIV, various strains of influenza, herpes zoster, hepatitis C, and other viral illnesses has been shown in many papers to be compromised. (2)

Unfortunately, since humans can’t escape their thoughts, all of us are subject to sustained elevations of these chemicals. Remember, anxiety is not the cause of the elevation but a reflection of a fired-up nervous system on alert. So, paradoxically, the legitimate and sustained anxiety about the Coronavirus epidemic compromises your body's ability to fight it. 

The primary defense for fighting off infections is a robust immune system. Expressive writing has been deeply researched regarding its effect on the body’s response to adversity. (3) One documented benefit is strengthening the immune system’s response to infection. (4)

Optimizing your body's chemistry

The way to decrease anxiety is to lower your stress hormones. There are several steps to achieving this and many specific techniques. What doesn’t work is positive thinking or distracting yourself. Here are the steps:

  • Separate yourself from the stress response. This amoral survival reaction is what you have and not who you are.
  •  Directly lower stress hormones. Some of the ways that this can be accomplished are mindfulness, exercise, meditation, visualization, massage, biofeedback, etc. 
  •  Dampen the stress response by stimulating neuroplastic changes in your brain. Instead of your response being stress/automatic survival reaction, your response to stress leads you to create some space and substitute a more rational response. Ongoing repetition will change the structure of your brain.

It is similar to learning a new language that I call, “an enjoyable life.” You can’t learn French by not speaking English. You have to engage with concentration and repetition. You are not going to lower pain (automatic default survival language) by trying to avoid or fix it. You must visualize what you want your life to look like and pursue it daily with or without your pain (anxiety).

The steps are awareness, separation, and reprogramming. 

Separation

This article will focus on the first and necessary step of separating from anxiety-producing thoughts.

Trying to control anxiety is similar to stopping an 11,000 hp dragster with bicycle hand brakes. It isn’t possible nor desirable. You would not live more than a few minutes without anxiety. The first step in separating from it is to eliminate the word “anxiety” from your vocabulary and substitute the phrase, “elevated stress chemicals.” 

Then visualize a large thermometer on the opposite wall and use it to estimate the levels of your stress hormones anytime you feel nervous or agitated. Use whatever methods you are comfortable with to lower the “temperature.”

Expressive writing

Research has demonstrated that expressive writing has a beneficial effect on the immune system and has been shown to decrease the viral load in HIV and the flu. (4)

Expressive writing is a separation exercise where you write down your thoughts, positive or negative, and immediately destroy them. Almost any frequency is effective, as long as you do it. I generally feel that 5 to 15 minutes once or twice per day is a good starting point. 

You can’t control your thoughts, but this technique will separate you from them. You are ripping up the paper for two reasons. You want to write with complete freedom, but more importantly, you don’t want to analyze your thoughts. What seem like “issues” are just thoughts. Since your brain will develop wherever you place your attention (neuroplasticity), any attention paid to them just reinforces them. 

You also are not getting rid of these thoughts by ripping them up. You are only disconnecting from them. They are permanently embedded in your brain and there are trillions of them. The thoughts are on the table and the distance from them is connected to your unconscious brain by vision and feel. That is it. It is simple but extraordinarily effective and powerful.

There are many forms of expressive writing and most of the research has focused on writing down intense emotions. However, some additional research suggests that is doesn’t matter. Just write with freedom and the key, regardless of what format you choose, is to get rid of it immediately. One of my pain colleagues succinctly observed that people that hold on to the paper are holding on to their pain.

Cognitive behavioral therapy (CBT)–book based

CBT is a more specific way of addressing reactions to unpleasant thoughts. Here is one suggestion. It is more focused on the input instead of the reaction.

The three-column writing technique:

Feeling Good (5) is the book that initiated my own journey out of “the abyss” of chronic pain, which included extreme anxiety. It is a great book and I will be forever grateful that I ran across it during such a critical period. David Burns said to write, so I began to write—a lot. It’s a great book and full of wisdom. I did not realize the importance of writing until much later. 

The first third of Feeling Good describes cognitive behavioral therapy and one of the main tools presented is the “three-column” technique, which represents the three phases of neuroplasticity: 1) awareness 2) separation and 3) creation of new circuits. 

The three columns are:

Negative thought                     Error in thinking                     Rational thought

By writing your negative thoughts in the first column, you are increasing your awareness of the problem.  

Some errors in thinking include “should thinking,” “labeling,” “mind-reading,” “catastrophizing,” emotional reasoning, etc. Categorizing your error represents the separation process. You are creating some space from your initial reaction. You then have a choice to either continue that line of thinking or to “re-structure” your thoughts. In the third column, the more rational follow-up thought is written down, creating a new neurologic circuit.

Here’s an example of the three-column technique in action. Consider it’s common for spouses to have different views on punctuality. You might always be on time while your spouse is habitually late. In this scenario, you’d likely have a similar set of thoughts every time he was late, such as, “My time isn’t being respected” or “He’s always late. He’s an inconsiderate person.”  

If your spouse was late to meet you for an event one night and you were still stewing about it afterward, here’s one way to process the situation. When you get home, take out a piece of paper, create three columns, and then fill them in:

Negative thought: Inconsiderate

Error in thinking: Labeling       

Rational thought: I don’t know why he was late. Need to discuss it.

You may have the same or similar thoughts the next time the lateness occurs, but by doing the writing repeatedly, their frequency and intensity will diminish.

The front page of the New York Times discussed the understandable marked increase in anxiety around the Coronavirus. Here is a suggestion of how the three-column technique could be utilized.

Negative thought: I am going to contract the Coronavirus and die.

Error in thinking: Catastrophizing

Rational thought: There is a chance I may contract it and there is very small chance of dying. I will take appropriate precautions and live my life. Remaining anxious adversely affects my immune system and compromises my ability to fight it.

You can't control the problem–only your response

Notice that this approach, or any form of expressive writing, doesn't involve analyzing or fixing the problem. It is only an exercise that addresses unpleasant thoughts. You are also not working on generating positive feelings to counteract the unpleasant ones. That would be futile and counterproductive in light of the mismatch between the conscious and unconscious brain. This exercise is only about addressing disruptive thoughts, which affect your body's physiology.     

Writing about the situation separates you from your thoughts via touch and feel. You are forming new circuits and calming down your nervous system. Any form of expressive writing is remarkably effective, especially considering its simplicity.

In short, sustained elevations of stress hormones (anxiety) compromise your immune system and paradoxically compromise your resistance to fight off infection. Expressive writing is a simple and effective way to dampen this response and enhance your capacity to deal with the virus. However, if it doesn't calm you down, then continue to pursue other avenues that will. Successfully learning methods to lower your levels of stress hormones will allow you to heal and flourish. Each person's journey is different.

References

1. Porges, Stephen. The Polyvagal Theory. Norton Co., New York, NY, 2011.

2. Coughlin, SS. Anxiety and depression: linkages with viral diseases. Public Health Reviews (2012); 34:1-17.

3.  Pennebaker, James and Joshua Smyth. Opening Up by Writing It Down, Third Edition: How Expressive Writing Improves Health and Eases Emotional Pain. The Guilford Press. New York, NY, 2016.

4. Petrie, K, et al.  Effect of Written Emotional Expression on Immune Function in Patients With Human Immunodeficiency Virus Infection: A Randomized Trial. Psychosomatic Medicine (2004); 66: 272-275. doi: 10.1097/01.psy.0000116782.49850.d3

5.  Burns, David. Feeling Good. Harper Collins, New York, NY, 1980.