MINDBODY TOOLKIT

Journaling


Therapeutic journaling is a key skill in the reduction of chronic pain and stress related illness. The connection is sometimes hard to see initially but science and experience shows its effectiveness.(1)

Understanding the link between pain and current stressors and previous stressors, whether physical or emotional, is explained more fully in our Understanding Pain page and in the Understanding Your Story page.

What our approach does is help you make sense of your body’s journey and all the factors that may have influenced it. In the practice we use the SIRPA questionnaire to build a timeline of your health story. When we have identified key parts of this story, journaling is one of the tools that can be used as a very effective way of processing that information to see what effects the most significant events had.

Why does it help? When we have experienced a trauma, however big or small, whether physical or emotional or at any point since childhood it can leave the body feeling overwhelmed and under threat even if the danger is long gone. Our subconscious can spend a huge amount of time dealing with the effects of this and though we are not consciously aware of it, it will influence our actions and our ability to relax. Being in a perpetual state of alert increases the tone in the muscles and this produces pain.

Journaling helps to identify the true underlying feeling associated with the event. When the thoughts and feelings following a significant event go round and round in our heads, they can become a persistent underlying stressor. When we make the link between the event, the feeling associated with it and the onset of the pain we can rationalise it with journaling. It helps to change the nervous system response and aids the body to unlearn the pain.

There are many ways to journal and here are some ways you get started.
As with all our tools if you are unsure as to whether they are suitable for you please contact us for advice and support.

References:

  1. Smyth JM et al. (1999) Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: a randomized trial. JAMA Apr 14;281(14):1304-9. “Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences had clinically relevant changes in health status at 4 months compared with those in the control group.”

Our Recommendations for Effective Journaling

  • Find a quiet place where you won’t be disturbed and be aware that it may bring up emotions.
  • Set enough time aside to write.
  • Use cheap paper and an easy flow pen.
  • There is no right or wrong way of doing it.
  • Don’t worry about the spelling or the punctuation or even finishing the sentences just let the words tumble out onto the page.
  • Burn or shred your words as soon as you finish. Do not re-read them, this is about connecting with the emotion and the event not analysing it.

Journaling for Chronic Pain

A brief summary of some journaling techniques that can help address issues contributing to chronic pain.

Unsent Letters

Often in our health journey there can be people that have upset us and contributed to the overwhelm. A bully, a teacher who told you you would never achieve, a person who is close but doesn’t support you and even sometimes your nearest and dearest. Journaling doesn’t mean that you have to change your relationship with that person but it does mean you can release the feelings associated with them or the event which means you can change the way your system responds.

A really great way of doing this is with an unsent letter. It starts just like a letter. ‘Dear …’ and you can then air all your grievances however big or small. You may find that once you have started it becomes less like a letter and may morph into free writing. This is fine, just go where your mind and pen take you. You don’t need to be polite or make excuses for the other person’s actions, just write what you really feel. Knowing that no one will see it allows you to write exactly what you need to say.

When we process significant thoughts and events, we can become very good at telling our story without the emotion. Journaling allows us to tell the story and acknowledge the feelings associated with it. This often uncovers our ‘aha’ moment and allows us to address the connection between the event and current symptoms.

Expressive or Free Writing

This is just as it sounds. Unstructured, free-flowing, stream of consciousness journaling. Just start and the beginning and write whatever thoughts come into your mind. They can be positive or negative, past or present, ordered or random. Just let the words spill onto the page and see where they take you. Once you have finished, do not reread the writing. Burn or shred it.

A dramatic example of the change journaling can make is illustrated in Mark Owens’ story. He was a patient of Dr. David Hanscom, a spinal surgeon who works with the mindbody approach to pain. (At 7m 30s he describes his first introduction to expressive writing).

Rationalised Journaling

This can be very helpful if we are struggling with a problem or have a situation that feels out of your control or overwhelming.

  • Take a piece of paper and divide it into 2 columns top to bottom with a line.
  • In the left column write your concern or situation that feels out of control.
  • In the right column write what you can do about it.

This helps to break down a bigger problem into smaller parts. Some of which you will be able to do something about and possibly some that you will not. Identifying which parts you can action gives you control of the situation. With the elements that you can do nothing about, try to breathe and let them go. This is hard but if you have absolutely no way of influencing the situation try not to spend any energy on it.

We have created some simple note pads to help rationalise your worries. They are available at the practice.

Worry Box

If you are struggling to let go of a concern completely, we recommend a worry box. Just jot your concerns down on a piece of paper and place them in a box. This gets the worry out of your head and decreases the stress it is causing. You can keep it in the box and re-engage and journal about it when you are ready to release it.

Inner Voice/Inner Child Dialogue

Often, we stop listening to our inner voice or inner child. This voice often represents our true feelings. Re-engaging with our inner voice can be very enlightening and can promote kindness towards self and lessen the harmful negative self-talk that is often present if we feel overwhelmed.

  • Take a piece of paper and divide it into 2 columns top to bottom with a line.
  • Label the left column: Adult/External Voice.
  • Label the right column: Child/Inner Voice:

With your adult voice ask out loud and write a question in the left column. Then listen to the response from your inner voice. Write down the first thing that comes to mind in the right hand column. Continue this conversation, always asking the adult/external voice question out loud as you are writing it and ‘listening’ to the inner voice response.

When you first do this type of journaling you may want to imagine you are talking to a young child that perhaps you don’t know very well. Try to ask a simple question first, e.g. how are you today? Then listen to the response in your head before moving on to more searching questions. This type of journaling can be very revealing and our inner/child voice can be sad or quite stroppy like a ‘petulant teenager’. You sometimes need to build a rapport. Once you start to engage more with your inner voice and become able to listen to this voice throughout the day, without even having to journal. Making this connection helps to ensure you can make choices that truly sit well with.

If you have any questions or want any advice or support, please contact us.

A Patient Story

A patient who suffered with Fibromyalgia also suffered with panic attacks for 17 years (anxiety associated with Fibromyalgia is common). The attacks would come on at bedtime and the patient felt she was going to die. Through looking at her timeline and asking what was going on when she first had these attacks and then journaling about the event the patient was able to identify the trigger and why it was causing ongoing overwhelm that was influencing her nervous system and contributing to the unsafe feeling. It was like the penny dropped and by writing about it and rationalising the thoughts it contributed to significant improvement. Journaling lessened the overwhelm from the traumatic event which allowed a beneficial change in the nervous system response. The patient is now recovered and has virtually no pain and no panic attacks.


Other 'Key Skills' Toolkits

You may be interested in our other ‘Key Skills’ chapters within the Mindbody Toolkit: