By Susan Brink
Los Angeles Times | Posted: Wednesday, September 3, 2008 12:00 am
"The more (Virginia Tech students) can talk about what they've lived through, the more that they can be encouraged to emote … that gives them some security and insulation against burying those feelings and then having them surprise them later in life."
- Keith Ablow, psychiatrist, on NBC's "Today," April 17, 2007
In the aftermath of the April 16, 2007, fatal shootings of 32 students and faculty at Virginia Tech, Ablow was simply voicing post-Freudian conventional wisdom: When something horrible happens, vent.
"The common assumption is that in order to successfully cope with a traumatic or disturbing event, people need to talk about it, to express their feelings," says Mark Seery, psychologist at the University of Buffalo. "And if they don't, they're suppressing true feelings and that will cause problems down the road."
But, Seery says, that has not been proved true for all people in all circumstances. His most recent research, in the August issue of Journal of Consulting and Clinical Psychology, shows that after a large-scale traumatic event, such as the Sept. 11, 2001, terrorist attacks, quickly talking about one's emotions isn't necessarily for the best.
"In the immediate aftermath of a collective trauma, it's perfectly healthy to not want to express your thoughts and feelings," he says.
In fact, it can do more harm than good. Some people have periods of what psychologists call "healthy denial." Like Scarlet O'Hara, they cope by promising themselves to think about it tomorrow. Being pushed to give voice to their worst reactions too soon could embed the worst of it in memory and cause them to dwell on the tragedy. And if they can't or won't talk, urging them to act against their instincts could make them think that something is wrong with them.
The new study is in line with other mental health research that suggests that some things are better left temporarily unsaid - at least for some people. Those who immediately talk about the trauma of an attack or a hurricane can find, as often as not, that airing it doesn't change the memory and fails to bring relief. Seery found that those who responded quickly to prompts to write online about the attacks had higher levels of stress two weeks later. Months later, they were more likely to have symptoms of post-traumatic stress disorder.
In his bereavement research, James Pennebaker, chair of psychology at the University of Texas at Austin, found that choosing not to express feelings in the face of a death reflected resilience, rather than vulnerability. Pennebaker's research examines expressive emoting, and research results on bereavement and trauma often overlap.
None of this negates the value of talk therapy or of expressing thoughts and emotions when it feels right. But the new research suggests that widespread use of clinical techniques that are proved to help some situations - like a couple in marital trouble or a depressed person exploring emotions with a therapist - has gotten ahead of the evidence on the best course of mental health care after a disaster.
"Rubbing people's noses in their miserable experiences immediately after is probably bad for a significant number of people," Pennebaker says.
Seery's study confirmed the foolishness of requiring instant emoting from witnesses to a disaster. Focusing on responses to the Sept. 11, 2001, terrorist attacks, he surveyed 2,138 people online at intervals over two years. Part of an existing marketing panel, the volunteers were asked on Sept. 12, 2001, if they wanted to talk about the attacks. About 25 percent, or 579 people, chose not to respond to the e-mail prompt. Follow-up surveys by Seery and his team at two weeks, then every six months for two years, found that those who had nothing to say online after the attacks had better psychological functioning over the next two years. "In particular, they had lower risk of symptoms of PTSD," Seery says. "Not wanting to talk didn't predict any negative effects or delayed reaction."
If there are two kinds of people, those who want to talk and those who don't, then pushing the latter into talking might lock the trauma in memory, causing them to dwell on it. Those who don't feel a need to vent might be more resilient and have better coping skills, Seery says, and those who feel compelled to talk might be naturally more distressed by it and will continue to be deeply affected.
In any case, neither type should be asked to do what doesn't come naturally. "I come from a pretty stoic Kansas farm family," says Shawn Smith, who teaches crisis intervention at the University of Denver's Graduate School of Professional Psychology. "I was taught to suck it up and shown ways to do it, like humor. If somebody sat me down and made me relive it over and over again, or describe things in detail - things that I'd heard and smelled - I'd be going against what I was taught and not equipped to do it."
Seery found that those who didn't want to talk about the trauma remained healthy, no doubt using a variety of coping skills - spit-shining the house, working around the clock or heading to the mall or golf course to get their minds off it. They might be doing more than distracting themselves. They might be putting pain on hold until they muster up more strength or gain perspective.
It's after the dust of the initial shock has settled that talking about it can help. Taking pen to paper, to explore feelings, can be an equally good outlet, especially when people find themselves thinking obsessively about a trauma.
But it helps only if thoughts go forward, not round and round. "Thinking can become rumination, going from A to B and back to A to B," says Sonja Lyubomirsky, psychologist at the University of California, Riverside and author of "The How of Happiness." "People ruminate about negative things, and they get more pessimistic."
Says Pennebaker: "All things being equal, talking can be as good or better than writing if the person you're talking to is all accepting, is not hurt by what you say and is not judgmental."
And there's the rub - finding a tolerant listener.
"All of us have had an experience where we watch a look of horror wash across someone's face," Pennebaker says. "If people talk about something really personal, and the other person does not validate them, they're likely to be worse off than if they hadn't said anything."
Whatever the form, it's most helpful to mental healing when the words create a meaningful story. Such a story can move someone from the event, through insight and toward acceptance or a solution. "There has to be growth. There has to be change," Pennebaker says. "Otherwise, it's not therapy. It's theater."
Most of the hundreds of people he has studied who have been through a traumatic experience are able to speak or write themselves toward an understanding of what happened. "What I've loved about this work is that I think people are naturally their own best therapists," he says.When talking things over can backfire
Terrorist attacks, floods, fires and other disasters aside, sometimes it can be better to just zip your lip when it comes to personal problems too.
Among girls ages 8 to 14, for example, those who dwell on personal concerns with friends - such as whether Jason likes them or why they weren't invited to Taylor's party - are likely to be anxious and depressed, according to a study in the July 15, 2007, issue of the journal Developmental Psychology.
In a study of more than 800 students in third, fifth, seventh and ninth grades, girls and boys who rehashed problems and focused on negative feelings developed close friendships with co-complainers. But the girls (not the boys) ended up depressed and anxious, which led to more nervous chatter - an endless cycle.
"They're spending such a high percentage of time dwelling on problems that it probably makes them feel sad and hopeless," Amanda Rose, professor of psychological sciences at the University of Missouri-Columbia and author of the study, said in a news release.
"And it likely makes them feel more worried about the problems, and consequences."
Boys can talk about concerns with friends, but they spend less time ruminating, then glide away without feeling worse. Girls are more likely to focus on the same problem repeatedly. The girls in the study encouraged each other to talk about negative events and feelings and to speculate on consequences. "Some kids, especially girls, are taking talking about problems to an extreme," Rose said. "In general, talking … is healthy. Co-rumination likely represents too much of a good thing."