Visual Journaling for Health

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Visual Journaling for Health

  1. 1. Visual Journaling
  2. 2. Theoretical and clinical foundations of visual journaling <ul><li>Disclosure research </li></ul><ul><li>Positive psychology </li></ul><ul><ul><li>Flow </li></ul></ul><ul><li>Art therapy </li></ul><ul><li>Stress & coping theory </li></ul><ul><ul><li>Emotional regulation </li></ul></ul>
  3. 3. <ul><li>“ All sorrows can be borne if you put them into a story or tell a story about them.” - Isak Dinesen </li></ul>Artistic expression is an act of disclosure
  4. 4. Disclosure <ul><li>Psychosomatic Theory </li></ul><ul><ul><li>Suppression of emotion has adverse health consequences </li></ul></ul>
  5. 5. What is emotion? <ul><li>“...evaluation and response mechanisms that have evolved to indicate historically recurrent adaptive challenges and opportunities and to promote and organize appropriate behavior.” </li></ul><ul><li>“...emotions tend to be comparatively short-lived and object specific and involve a pattern of physiological, experiential, expressive, cognitive, and behavioral changes. The totality of these changes prepares the organism to engage or not engage in adaptive action.” </li></ul><ul><ul><ul><li>Consedine, Magai & Bonanno, 2002 p. 205 </li></ul></ul></ul>
  6. 6. Emotional inhibition <ul><li>The situation in which a person inhibits emotional expression while aroused by that emotion, whether consciously and voluntarily or unconsciously and/or involuntarily </li></ul><ul><ul><li>This has been associated with many immune-related health outcomes such as heart disease, cancer, and viral infections (for an extensive review of this literature, see Consedine, Magai & Bonanno, 2002) </li></ul></ul><ul><li>Pennebaker: emotional inhibition causes an increase in stress physiology and intrusive, ruminative thoughts </li></ul><ul><ul><li>His body of work has shown repeatedly that emotional expression by way of writing results in improvements in physiological states, emotional states, and clinical status </li></ul></ul>
  7. 7. The theory of catharsis <ul><li>Anger and aggressive impulses tend to persist in the psyche until they’re expressed </li></ul><ul><li>Healthy expression of negative affective states protects one from their potentially harmful effects </li></ul><ul><li>Most modern catharsis research discredits the notion that aggressive catharsis reduces the likelihood of later aggressive behavior </li></ul><ul><ul><li>However aggressive catharsis does result in an elevation of mood (Bushman, Baumeister & Phillips, 2001) </li></ul></ul>
  8. 8. How does emotional disclosure work? We’re not really sure... <ul><li>Constructing narratives about our lives can have several benefits: </li></ul><ul><ul><li>effective integration of thoughts and feelings into a coherent whole </li></ul></ul><ul><ul><li>memories of events become more organized </li></ul></ul><ul><ul><li>narration affords a sense of predicability and control over events </li></ul></ul><ul><li>Counters the negative effects of suppressing thoughts and feelings about negative life events (well documented in the literature) </li></ul>
  9. 9. Writing about stressful events often results in a change of attributions <ul><li>Word use tends to change in people who participate in expressive writing research </li></ul><ul><li>Greater use of positive emotion words, less use of negative emotion words </li></ul><ul><li>An increase in the use of causal and insight words </li></ul><ul><li>This may reflect a change in the meaning and understanding of stressful and traumatic events - insight gained by writing about them </li></ul>
  10. 10. The research on written disclosure: a meta-analysis of 146 randomized studies (Frattaroli, 2006) <ul><li>Experimental disclosure offers a significant benefit to psychological and physical health as well as overall daily functioning </li></ul><ul><li>The best effects are seen under these conditions: </li></ul><ul><ul><li>Participants with a health problem or history of trauma </li></ul></ul><ul><ul><li>Allowing participants to disclose (write) at home </li></ul></ul><ul><ul><li>At least three disclosure sessions for optimal dosing </li></ul></ul><ul><ul><li>Have participants disclose about more recent, salient events that had not been fully integrated and processed cognitively </li></ul></ul>
  11. 11. Types of Disclosure <ul><li>Talk Therapy </li></ul><ul><li>Therapeutic Writing </li></ul><ul><li>Art Therapy </li></ul><ul><li>Talking with friends </li></ul>
  12. 12. Documented benefits of disclosure <ul><li>Lowered levels of stress hormones </li></ul><ul><li>Reduced cardiovascular reactivity </li></ul><ul><li>Development of benign appraisals </li></ul><ul><li>Changes in immune function </li></ul><ul><li>Strengthening of social support </li></ul>
  13. 13. Therapeutic Writing An organized approach to writing about stressful or traumatic events
  14. 14. Therapeutic writing research: Smyth et al. (1999) <ul><li>112 patients with rheumatoid arthritis (n=51) or asthma (n=61) randomized into stressful event vs. neutral writing topics </li></ul><ul><li>Writing took place for 20 minutes a day, four days in a row </li></ul><ul><li>Immune and clinical parameters were measured before, immediately after, and 4 months after the intervention </li></ul><ul><li>Experimental groups in both disease categories had significant improvements in both types of measures </li></ul>
  15. 15. Effects of written emotional expression on immune function in patients with HIV (Petrie et al., 2004) <ul><li>37 patients randomized to either emotional expression exercise vs. neutral topic exercise </li></ul><ul><li>Writing was done for 30 minutes per day for 4 consecutive days </li></ul><ul><li>Emotional writing participants had significant improvements in HIV viral load and CD4+ lymphocyte counts compared to control and pre-intervention measures </li></ul>
  16. 16. Emotional disclosure through writing or speaking affects activation of Epstein-Barr virus <ul><li>Esterling et al., 1994 </li></ul><ul><li>57 EBV+ college students wrote or spoke about stressful or trivial events for 20 minutes a day once a week for 3 weeks </li></ul><ul><li>Both stress-disclosure groups exhibited significant declines in EBV viral capsid antigen levels compared to controls and to baseline measures </li></ul>
  17. 17. Written emotional disclosure supports academic performance among college students <ul><li>Lumley & Provenzano, 2003 </li></ul><ul><li>74 college students randomized into stressful experience writing and time management writing groups </li></ul><ul><li>Students wrote for 4 consecutive days - GPAs compared for each group at the end of the semester </li></ul><ul><li>Control group displayed drop in GPA while expressive group had a slight increase in GPA for the subsequent semester </li></ul>
  18. 18. What about emotional arousal while writing? <ul><li>Most studies show that experimental participants experience an INCREASE in negative affectivity (activation) after the first session </li></ul><ul><ul><li>This is to be expected and participants should be informed of this </li></ul></ul><ul><li>However for the vast majority of participants, this activation (which is probably part of the integration process) is followed by a decrease in negative affect below baseline </li></ul>Sloan & Marx, 2004
  19. 19. Art Therapy
  20. 20. Product-oriented art therapy <ul><li>Emphasis on eliciting unconscious or non-verbal psychic material in visual form </li></ul><ul><li>The imagery is then discussed, processed, and integrated as a verbal narrative </li></ul><ul><li>This is useful for children and highly traumatized people who are resistant or otherwise unable to “tell the story” with words </li></ul><ul><li>Media: Usually drawing, painting and sculpture </li></ul>
  21. 21. Process-oriented art therapy <ul><li>Emphasis on encouraging creative expression as an experience, not as the means to a product </li></ul><ul><li>Interpretation of imagery is optional </li></ul><ul><li>Primary goal is to induce positive affective states, relaxation, and a sense of mastery over self and objects in the world </li></ul><ul><li>Media can include anything from painting to dance to music </li></ul>
  22. 22. Art Therapy Today, most art therapists use a combination of process- and product-focused techniques
  23. 23. Positive psychology: the study of human strengths, resilience and flourishing <ul><li>A relatively new field in psychology </li></ul><ul><li>Focuses on practices, theories, and experiences that enhance human existence </li></ul><ul><ul><li>Counters traditional focus on psychopathology </li></ul></ul>
  24. 24. Visual journaling is a form of transcendence - a basic human strength <ul><li>A means to rise above the mundane existence to see a higher order of things, often used to describe human spirituality - A human quality that is associated with better physical and mental health, and a longer lifespan </li></ul>
  25. 25. Elements of Transcendence from Positive Psychology <ul><li>Appreciation of Beauty and Excellence </li></ul><ul><li>Gratitude </li></ul><ul><li>Hope (Optimism, Future-mindedness) </li></ul><ul><li>Humor </li></ul><ul><li>Spirituality </li></ul>
  26. 26. Appreciation of Beauty and Excellence <ul><li>This is experienced as the ability to feel awe </li></ul><ul><li>The defining feature is the emotional experience of awe or wonder when in the presence of beauty or excellence </li></ul>
  27. 27. Gratitude <ul><li>The sense of thankfulness in response to a gift, along with the emotion of grace </li></ul><ul><ul><li>Grace: the sense that we have benefited from the actions of another </li></ul></ul>
  28. 28. Hope/Optimism <ul><li>A stance toward the future and the goodness it might hold </li></ul><ul><ul><li>Thinking about the future and expecting that good things will happen </li></ul></ul><ul><ul><li>Acting in ways to make the good outcomes more likely </li></ul></ul><ul><li>These thoughts and actions sustain good cheer in the here and now and galvanize goal-directed action </li></ul>
  29. 29. Playfulness & Humor <ul><li>“The humorous individual is one who is skilled at laughing and gentle teasing, bringing smiles to the faces of others, at seeing the light side, and at making (not necessarily telling) jokes” Peterson & Seligman, 2004, p. 530. </li></ul><ul><li>“good” humor: draws attention to life’s contradictions, sustaining good cheer in the face of despair, building social bonds, lubricates social interaction </li></ul>
  30. 30. Spirituality <ul><li>The ability to discover and express your purpose in life </li></ul><ul><li>To learn how to experience love, joy, peace and fulfillment </li></ul><ul><li>To help yourself and others achieve full potential </li></ul>
  31. 31. Cultivating attention to enhance transcendence and happiness <ul><li>Mindfulness - being present to experience </li></ul><ul><li>Focusing on one thing at a time makes the thing work better... </li></ul><ul><li>“Just remember that the things that get attention flourish.” - Victoria Moran </li></ul><ul><li>Visual journaling is an effective, easy way to explore the various aspects of transcendence </li></ul>
  32. 32. What’s so great about happiness? <ul><li>Women who flashed a Duchenne (genuine) smile in their yearbook photos as freshmen have more marital satisfaction 25 years later (Harker & Keltner, 2001) </li></ul><ul><li>Brief raising of positive mood enhances positive thinking and makes physicians more accurate and faster to come up with complicated diagnoses (Fredrickson, 2001) </li></ul><ul><li>In business meetings, a ratio of greater than 2.9:1 for positive to negative statements predicts economic flourishing (Fredrickson & Losada, 2005) </li></ul>
  33. 33. Measuring and Inducing Happiness Seligman et al., 2005 Seligman et al., 2005 <ul><li>Research in the effects of specific behaviors on happiness in college students </li></ul><ul><li>Three good things: write down 3 good things that happened each day </li></ul><ul><li>Gratitude Visit: write and deliver a letter of gratitude to someone who’s been especially kind to you </li></ul><ul><li>Happiness and Depressive symptoms measured before and after, and in controls </li></ul>
  34. 34. Effects of happiness interventions on happiness one week to six months afterward (Seligman et al., 2005)
  35. 35. Finding FLOW: Mihaly Csikszentmihalyi “chick-sent-me-high-ee” “chick-sent-me-high-ee” <ul><li>A state of immersion in what one is doing to the extent that time seems to “stop” </li></ul><ul><li>Characterized by feelings of great absorption, engagement, fulfillment, and skill </li></ul><ul><li>Flow is being so involved in what you’re doing that every action, thought and movement follows inevitably from the one before - like playing jazz... </li></ul>
  36. 36. The construct of “flow” was originally developed based on observations of artists at work <ul><li>Acts of creativity are the quintessential flow experiences </li></ul><ul><li>Time becomes distorted, motivation is intrinsic, the feedback is immediate, and emotions are processed </li></ul>
  37. 37. Byproducts of creative activity: Engagement and flow <ul><li>Flow is the “experience associated with engaging one’s highest strengths and talents to meet just-doable challenges.” (Duckworth, Steen & Seligman, 2005, p. 638) </li></ul><ul><li>Time stops, we concentrate, we feel completely at home - all thoughts and feelings fade to the background as we become immersed in an activity </li></ul><ul><li>Flow can be measured with several different questionnaires and interview protocols </li></ul>
  38. 38. Flow <ul><li>Clear goals and immediate feedback </li></ul><ul><li>Balance between challenge and skills </li></ul><ul><li>Action and awareness are merged </li></ul><ul><li>Sense of time gets distorted </li></ul><ul><li>The activity becomes autotelic: there is no reason to do this except to feel the experience it provides </li></ul>
  39. 39. Stress and coping theory <ul><li>Stressors in life make demands on us that require the ability to solve problems and regulate our emotions </li></ul><ul><li>Chronic stress is harmful to health and a key preventive step is to learn to express and discharge negative emotions like anger and sadness and cultivate positive emotions like joy, acceptance, serenity, contentment and intimacy with others </li></ul><ul><li>There are several strategies known to benefit one’s emotional state and protect from stress </li></ul>
  40. 40. Emotional Regulation Strategies <ul><li>Emotional Social Support </li></ul><ul><li>Venting </li></ul><ul><li>Disclosure </li></ul><ul><li>Avoidance & Denial </li></ul><ul><li>Artistic & Social Expression </li></ul><ul><li>Meditation </li></ul><ul><li>Exercise </li></ul>
  41. 41. Generating positive affect (PA) as a way to manage stress <ul><li>Good emotional regulation is ssociated with positive reappraisals, problem-focused coping, and the ability to find positive meaning of events </li></ul><ul><li>PA predicts increases in psychological well-being and health </li></ul><ul><li>PA enhances one’s ability to recover from acute stress physiology more quickly and completely </li></ul>
  42. 42. Positive affective states are good for health - stress-buffering effects <ul><li>Positive emotions tend to encourage exploration and creativity </li></ul><ul><li>PA encourages the development of social, intellectual and physical resources </li></ul><ul><li>PA also appears to generate psychological resources like resilience, endurance and optimism (Fredrickson, 1998; Salovey, Rothman, Detweiler & Steward, 2000) </li></ul>
  43. 43. Positive affective states are good for health <ul><li>Emotions are the principle link between psychological stress and physical disease </li></ul><ul><li>Chronic negative affective states like anxiety and depression are strongly linked with poor health outcomes and shortened longevity </li></ul><ul><li>In studies of writing in several populations (but not all), greater use of positive affect words correspond with living longer (Cohen & Pressman, 2006) </li></ul>
  44. 44. Positive affective states are good for health - documented direct effects (Cohen & Pressman, 2006) <ul><li>Higher trait PA has been associated with better health behaviors (better sleep quality, more exercise, and lower levels of stress hormones) </li></ul><ul><li>PA is also associated with elevated levels of oxytocin and growth hormone and endogenous opioids </li></ul><ul><li>Laboratory-induced PA has also been shown to change immune function </li></ul><ul><li>PA has an impact on social support - relationships are more intimate and stable when one has a high degree of PA </li></ul>
  45. 45. Associations between positive affect (happiness) and behavior & health outcomes Lyubomirsky, King & Diener, 2005
  46. 46. Associations between positive affect (happiness) and behavior & health outcomes Lyubomirsky, King & Diener, 2005
  47. 47. Associations between positive affect (happiness) and behavior & health outcomes Lyubomirsky, King & Diener, 2005
  48. 48. Using writing and creative activity to foster positive affect <ul><li>Writing about positive events daily for 3 days resulted in fewer visits to student health center in a study of undergraduates (Burton & King, 2004) </li></ul><ul><li>Writing about things participants were thankful for, every week for 10 weeks, significantly increased overall affective tone, optimism, and social connectivity (Emmons & McCullough, 2003) </li></ul><ul><li>The “Three Good Things” exercise (Duckworth, Steen & Seligman, 2005 ) results in increased positive affect and social integration and fewer symptoms of depression </li></ul><ul><ul><li>Write every day for a week about three good things that happened that day and why they happened </li></ul></ul>
  49. 49. Visual Journaling
  50. 50. Visual Journaling <ul><li>Learning and memory are greatly enhanced by multisensory stimuli </li></ul><ul><li>Color, especially, is known to evoke emotional responses </li></ul><ul><li>Journaling can become more meaningful when it incorporates color, images and other multimedia elements </li></ul>
  51. 51. Visual Journaling <ul><li>A good way to induce the flow state </li></ul><ul><li>Private artwork, so there is no external critic </li></ul><ul><li>Adds a deeper meaning to personal disclosure that, upon reflection, can yield new insight </li></ul>
  52. 52. The ultimate visual journal: Carl Jung’s “Red Book” <ul><li>Illustrated journal of his deepest musings about human spirituality and psychology </li></ul><ul><li>Kept private by his family until 2009 </li></ul><ul><li>Considered a masterpiece of depth psychology and spiritual art </li></ul>
  53. 53. Why visual journaling and not just writing? <ul><li>Life is a multisensory experience and most memories, especially emotional ones, are stored as imagery and not as stories </li></ul><ul><li>Multisensory stimuli are better at evoking memories and retrieving learned material </li></ul><ul><li>Emotions are more readily accessed and expressed with the use of color and images </li></ul>
  54. 54. The joy of artistic expression
  55. 55. Art and self-actualization <ul><li>Art happens when we operate from our deepest, most authentic selves – the selves that are extensions of the divine </li></ul><ul><li>The activity does not matter… </li></ul>
  56. 56. Creativity is a fundamental part of being human Art is our ancient practice of working with what is to create what has never been….
  57. 57. Why is art so healing? As human beings, we ARE art – a pure expression of the divine impulse to create…
  58. 58. Art is a form of communication Creativity is a conversation between our spirits and the world around us…
  59. 59. Visual journaling is a non-threatening way to be creative <ul><li>“Private” art that one can share or not </li></ul><ul><li>There’s no right or wrong way to do it </li></ul><ul><li>It’s not done according to “plan,” it’s simply allowed to unfold </li></ul>
  60. 60. What’s the difference between scrapbooking and visual journaling? <ul><li>A scrapbook is a collection of memorabilia from life events meant to be shared </li></ul><ul><li>A visual journal is a multimedia exploration of one’s experiences, thoughts, dreams, emotions, ideas and more </li></ul><ul><ul><li>It’s most beneficial when it’s kept private, or only shared voluntarily </li></ul></ul><ul><ul><li>Each entry can have a theme or simply begin with some writing about the day’s events - or an image from memory or a dream </li></ul></ul>
  61. 61. The visual journal of Dan Eldon, killed at age 23 while traveling in Africa
  62. 62. Frida Kahlo’s visual journal - one she kept all her life
  63. 63. What tools do you need for visual journaling? <ul><li>Some time to yourself and the desire to express yourself </li></ul><ul><li>Something to write in and something to write with </li></ul><ul><li>Your imagination </li></ul>
  64. 64. Tools for visual journaling: The paper <ul><li>A bound journal is best, with good quality paper that won’t bleed </li></ul><ul><ul><li>Spiral bound is okay </li></ul></ul><ul><ul><li>Many prefer book binding for longevity </li></ul></ul><ul><li>Size is a personal decision - but a minimum of 8x10 inches is recommended </li></ul>
  65. 65. Tools for journaling: Writing implements <ul><li>Any good pen will do, but make sure it has waterproof ink </li></ul><ul><li>Fine-point sharpies are great, and inexpensive </li></ul><ul><li>Rotring Art Pens are another great choice - they come with all kinds of nibs, including calligraphy - for maximal versatility and a more “arty” look and feel </li></ul>
  66. 66. Tools for journaling: Adding color <ul><li>Colored pencils are the easiest, least messy way to start adding color to your journal </li></ul><ul><ul><li>Try watercolor pastel pencils for varied textures and effects </li></ul></ul><ul><li>Pastels, either chalk or oil, come in brilliant colors and are wonderfully blendable - they are a marvelous tool for washes and sketching </li></ul><ul><ul><li>You can blend pastels with a blending stick or your fingers </li></ul></ul><ul><ul><li>Baby wipes are a great way to keep your hands clean while you work </li></ul></ul>
  67. 67. Tools for journaling: Adding color <ul><li>Paints: watercolors are the best because they dry quickly and come in beautiful colors </li></ul><ul><ul><li>If your journal doesn’t have paper thick enough to paint on, you can always paste a piece of watercolor paper onto a page and paint on that </li></ul></ul><ul><ul><li>Winsor & Newton make a very nice paintbox that’s easy to travel with </li></ul></ul><ul><li>Crayons are my least favorite way to add color to a journal - they’re not precise, they don’t blend at all, and the waxy texture doesn’t allow much writing or pasting over them </li></ul>
  68. 68. Tools for journaling: Adding images <ul><li>Digital photography and inexpensive printers are the greatest gift to visual journaling ever </li></ul><ul><ul><li>Take a photo of something you see that inspires or interests you - a closeup of your cat’s face, a flower in your garden, a cool bug, the dregs in your coffee cup - whatever you see that sparks your imagination or makes you think </li></ul></ul><ul><ul><li>Print it on decent paper - matte photo paper is best </li></ul></ul><ul><ul><li>Paste it in your journal and write about it </li></ul></ul>
  69. 69. Tools for journaling: Adding images <ul><li>Glue sticks are another wonder of modern art supplies. They aren’t messy, they’re quick and easy to use, and you can get archival, permanent adhesive </li></ul><ul><li>Stickers, receipts, ticket stubs, a note from a friend, even a leaf - all these things are fodder for sparking creativity and can be glued into your journal </li></ul><ul><li>Of course, drawing images that spring to mind while you’re journaling are always a great addition to the work </li></ul><ul><ul><li>If you draw something and it looks stupid or “bad” to you - write about that! </li></ul></ul>
  70. 70. Beginning a session <ul><li>Journaling is most helpful when it’s done on a regular basis </li></ul><ul><li>Start by taking a moment or two to relax and ease the day’s distractions from your mind </li></ul><ul><li>Focus your awareness on your physical state - tense, relaxed, aroused - and take note of it </li></ul><ul><li>Begin with words or an image and see what develops </li></ul>
  71. 71. One way to start: embellish your writing <ul><li>Doodle in the margins of your writing </li></ul><ul><li>Write in different colors - express emotions with the colors - blue for sadness, red for excitement, etc. </li></ul><ul><li>Use watercolors, pastels, or crayons to make washes on and around the writing </li></ul><ul><ul><li>Be sure to use waterproof ink! </li></ul></ul>
  72. 72. Anyone can make an image... <ul><li>We don’t call it drawing </li></ul><ul><li>We allow whatever’s inside of us to flow </li></ul><ul><li>Then we take a look at the paper and let it tell us a story </li></ul><ul><li>We can use our spontaneous images as writing prompts - or vice versa - allow our spontaneous writing to generate images </li></ul>
  73. 73. Things to remember about visual journaling <ul><li>Visual journaling is a way to reconnect with the part of you that yearns to be manifesting your spirit in the here and now, the world of the five senses, where it can be held and seen and touched and smelled and learned from - if only by you </li></ul><ul><li>If nobody else ever sees your journal, your art is in no way diminished, because you experienced the process of making it - and that process is an act of connection with the flow of life and the eternal well of unique creation </li></ul><ul><li>You are unique in the universe, and everything you make is unique and precious as well! </li></ul>
  74. 74. Things to remember about visual journaling <ul><li>The only tools you really need are your courage and your spirit </li></ul><ul><li>You can freely express yourself and dare yourself to make mistakes - record a weird dream, write a clumsy poem - sketch a deer that ends up looking like a brown Volkswagon - it’s OKAY! </li></ul><ul><ul><li>Maybe one of the biggest lessons is to learn to laugh at yourself and embrace the playful part of you that can so easily be lost in the everyday of adult life </li></ul></ul><ul><li>Or maybe you’ll discover ideas, hopes, values, dreams, and intelligence that you didn’t know you had... </li></ul>
  75. 75. From Traci Bunkers’ blog: http://tracibunkers.blogspot.com/2008/02/022008.html
  76. 76. <ul><li>Burton, C., & King, L. (2004). The health benefits of writing about intensely positive experiences. Journal of Research in Personality, 38, 150-163. </li></ul><ul><li>Bushman, B., Baumeister, R., & Phillips, C. (2001). Do people aggress to improve their mood? Catharsis beliefs, affect regulation opportunity, and aggressive responding. Journal of Personality and Social Psychology, 81, 17-32. </li></ul><ul><li>Cohen, S., & Pressman, S. (2006). Positive affect and health. Current Directions in Psychological Science, 15, 122-125. </li></ul><ul><li>Consedine, N., Magai, C., & Bonanno, G. (2002). Moderators of the emotion inhibition-health relationship: A review and research agenda. Review of General Psychology, 2, 204-228 </li></ul>References
  77. 77. <ul><li>Duckworth, A., Steen, T., & Seligman, M. (2005). Positive psychology in clinical practice. Annual Review of Clinical Psychology, 1, 629-651. </li></ul><ul><li>Emmons, R., & McCullough, M. (2003). Counting blessings versus burdens: An experimental investigation of gratitude and subject well-being in daily life. Journal of Personality and Social Psychology, 84, 377-389. </li></ul><ul><li>Esterling, B., Antoni, M., Fletcher, M., Margulies, S., & Schneiderman, N. (1994). Emotional disclosure through writing or speaking modulates latent Epstein-Barr virus antibody titers. Journal of Consulting and Clinical Psychology, 62, 130-140. </li></ul><ul><li>Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132, 823-865. </li></ul><ul><li>Fredrickson, B. (1998). What good are positive emotions? Review of General Psychology, 2, 300-319. </li></ul>References
  78. 78. <ul><li>Fredrickson, B. (2001). The role of positive emotions in positive psychology: The broaden-and-build theory of positive emotions. American Psychologist, 56, 218-226. </li></ul><ul><li>Fredrickson, B., & Losada, M. (2005). Positive affect and the complex dynamics of human flourishing. American Psychologist, 60, 678-686. </li></ul><ul><li>Harker, L., & Keltner, D. (2001). Expressions of positive emotions in women's college yearbook pictures and their relationhip to personality and life outcomes across adulthood. Journal of Personality and Social Psychology, 80, 112-124. </li></ul><ul><li>Lumley, M., & Provenzano, K. (2003). Stress management through written emotional disclosure improves academic performance among college students with physical symptoms. Journal of Educational Psychology, 95, 641-649. </li></ul>References
  79. 79. <ul><li>Petrie, K., Fontanilla, I., Thomas, M., Booth, R., & Pennebaker, J. (2004). Effect of written emotional expression on immune function in patients with Human Immunodeficiency Virus infection: A randomized trial. Psychosomatic Medicine, 66, 272-275. </li></ul><ul><li>Salovey, P., Rothman, A., Detweiler, J., & Steward, W. (2000). Emotional states and physical health. American Psychologist, 55, 110-121. </li></ul><ul><li>Seligman, M., Steen, T., Park, N., & Peterson, C. (2005). Positive psychology progress: Empirical validation of interventions. American Psychologist, 60, 410-421. </li></ul><ul><li>Sloan, D., & Marx, B. (2004). A closer examination of the structured written disclosure procedure. Journal of Consulting and Clinical Psychology, 72, 165-175. </li></ul>References
  80. 80. <ul><li>Smyth, J., Stone, A., Hurewitz, A., & Kaell, A. (1999). Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: A randomized trial. JAMA, 281, 1304-1309. </li></ul><ul><li>Tugade, M., & Fredrickson, B. (2004). Resilient individuals use positive emotions to bounce back from negative emotional experiences. Journal of Personality and Social Psychology, 86, 320-333. </li></ul>References

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