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The effects of expressive writing before or after punch biopsy on wound healing

Robinson, Hayley; Jarrett, Paul; Vedhara, Kavita; Broadbent, Elizabeth


Hayley Robinson

Paul Jarrett

Professor in Applied Psychology

Elizabeth Broadbent


Objective: Recent studies have shown that written emotional disclosure (expressive writing) performed in the two weeks prior to wounding improves healing of punch biopsy wounds. In many clinical settings, it would be more practical for patients to perform this intervention after wounding. The aim of this study was to investigate whether expressive writing could speed the healing of punch biopsy wounds if writing was performed after wounds were made.

Methods: One hundred and twenty-two healthy participants aged between 18 and 55 years were randomly allocated to one of four groups in a 2 (intervention) by 2 (timing) design. Participants performed either expressive writing or neutral writing, either before or after receiving a 4 mm punch biopsy wound. Wounds were photographed on day 10 (primary endpoint) and day 14 after the biopsy to measure epithelisation. Participants also completed questionnaires on stress and affect two weeks prior to the biopsy, on the day of biopsy and two weeks after biopsy.
Results: There was a significant difference in healing at day 10 between groups, χ2(3, N = 97) = 8.84, p = 0.032. A significantly greater proportion of participants who performed expressive writing before the biopsy had fully reepithelialised wounds on day 10 compared to participants who performed neutral writing either before or after wounding, with no other significant differences between groups. Amongst people who wrote expressively after wounding, those who finished writing over the first 6 days were significantly more likely to be healed at 14 days than those who finished writing later. There were significant differences in positive and negative affect over the healing period between the pre and post expressive writing groups.
Conclusions: Expressive writing can improve healing if it is performed prior to wounding. Performing expressive writing after wounding may be able to improve healing depending on the timing of writing and wound assessment. Expressive writing causes affect to worsen followed by subsequent improvement and it is important to consider this in the timing of intervention delivery. Further research with patient groups is required to determine the clinical relevance of these findings.


Robinson, H., Jarrett, P., Vedhara, K., & Broadbent, E. (2017). The effects of expressive writing before or after punch biopsy on wound healing. Brain, Behavior, and Immunity, 61,

Journal Article Type Article
Acceptance Date Nov 23, 2016
Online Publication Date Nov 24, 2016
Publication Date Mar 31, 2017
Deposit Date Feb 10, 2017
Publicly Available Date Feb 10, 2017
Journal Brain, Behavior, and Immunity
Print ISSN 0889-1591
Electronic ISSN 0889-1591
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 61
Keywords Biopsy; Wound healing; Expressive writing; Pre; Post; Affect
Public URL
Publisher URL


Robinson Brain Behav Immun 2016.pdf (540 Kb)

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