Letters

RAPID RESPONSE FROM BMJ.COM

As of August 19, four rapid responses had been posted on bmj.com in response to the paper by Schilte et al, as well as replies to each from the first author. Below we reproduce an edited version of one of the rapid responses. The original rapid responses and the author's replies may be found at http://bmj.com/cgi/eletters/323/7304/86EDITOR

Talking to a physician vs writing alone

This article originally appeared in BMJ USA

EDITOROn its surface, the study by Schilte et al suggests that disclosure of emotional events has no effect on markers of physical health or health-related behaviorsa finding at odds with dozens of published studies during the past few years. ^{1 2} A critical difference between the study by Schilte et al and most other disclosure studies is that Schilte et al required participants to talk about a traumatic experience to another person. Most successful disclosure studies, on the other hand, have had participants write anonymously about a trauma for several days either in a laboratory, a neutral setting, or at home.

The Schilte study may help us learn when disclosure can be helpful or harmful. It may also speak to recent controversies surrounding critical incident stress debriefing (CISD), in which recently traumatized individuals are pressed to talk about their emotions to people in a group context. An increasing number of controlled tests of techniques wherein people have been asked to talk about emotional upheavals to others have found this form of debriefing to be either unhealthy or to have no effect.³

Having to deal with deeply emotional topics in a social setting forces the listener to help regulate what is and isn't said. The social pressure of talking to an "expert" may invite embarrassment or humiliation on the part of the patient. When people are writing (or talking into a tape recorder) by themselves, they are able to determine how much they are willing to disclose. In short, solitary disclosure allows people to determine their own dose.

James W Pennebaker. 
Department of Psychology, University of Texas at Austin, USA pennebaker{at}psy.utexas.edu