The one stop shop for emotional wellbeing

Say Anything app offers you expressive writing therapy tool, access to targeted blogs and podcast, access to your local therapists, links to the research behind our product, in-house built self-awareness and self-development exercises. Everything is available within two clicks on your mobile device.

"This app was created to save you time, money and effort, yet allow you to feel happier, more connected and listened to. Our goal is to be a leading online platform for supporting emotional and mental wellbeing by offering the largest array of resources. I would love to hear your view on how we can ensure that we reach that goal."

         Patrycja Miskolczi (Patti), The Founder

Life Coach explains how Say Anything App can support the emotional wellbeing of mums

"There are several areas that I had a time in my life when it has been difficult to find people to talk to, I had a very difficult boss for a number of years and I also had a period of depression, anxiety and I also lost my daughter at 19 days old.

I think that this app will be very useful for those difficult times particularly when I was experiencing depression I felt that I couldn’t express myself in my normal way, I didn’t have the energy to write things, and I didn’t want to burden (I am not sure about this verb) my friends, so having an app like this would be very great to be able to just express what’s going on inside of my head which probably doesn’t have sense for me but certainly would make a sense to anyone else."

Jackie Meek, Life Coach 


Men need to talk more about their emotional wellbeing

Nick experienced PTSD after serving in the Army. He talks about how important it is, especially for men to express their feelings and find a support network to avoid suicidal thoughts. He also explains how using Say Anything app could inspire and empower those in need.


Why Say Anything?

This app was created in response to personal experience of mental health problems and clinical research on expressive writing therapy. We have carefully selected a range of coping tools that are proven to help you to self-soothe and take control of your emotional wellbeing.

Expressive writing (the practice of pouring your heart and mind into words without worrying about usual writing conventions) is good medicine. James Pennebaker, a professor of psychology at The University of Texas–Austin who conducted research into expressive writing says, "This can help people sleep better, feel and think better, and have richer social lives, all of which can bolster immune function and improve health."

Say Anything’s secure social network is available 24/7, 365 days a year. If you need to talk about your day and how you feel, others will too. Peer support is a well evidenced way of helping you to feel better when you’re down. Talking to others who are going through something similar can really help. Say Anything will connect you with people who are available when you need them, at any time of day or night. You can search active users on our world map and take advantage of geographical distance and time difference.

Are you struggling with loneliness, anger or sadness? Does life sometimes feel overwhelming? Are difficult thoughts or secrets weighing you down? Do you stop yourself from speaking up for fear of embarrassment, judgement or feeling like a burden?

 Whatever the situation, whatever the emotion, you needn’t feel alone. 

If only 
we were free
to show how we feel

We still are. The fact that we grow up, does not make us numb to our feelings and emotions. Express how you feel, because you can. And you should. Say Anything App allows you to do it in a gentle and secure way.

"Nobody wants to feel like a burden. Parents often struggle to open up about their experience of low mood because they worry that they will be judged for not coping or not being good enough. They are sometimes so tired and stressed that they lose their sense of identity and can't make sense of their feelings. Say Anything gives them everything they might need to maintain or improve their wellbeing within one mobile app"

 Caroline Harrison, Councellor

It is proven that it works

Our app is probably the first digital tool that gives you immediate access to expressive writing therapy which research shows is an effective self-cure in a wide range of mental and physical health conditions.

Research

Emotional and physical health benefits of expressive writing
By Karen A.Baikie and Kay Wilhelm in www.cambridge.org


Abstract

Writing about traumatic, stressful or emotional events has been found to result in improvements in both physical and psychological health, in non-clinical and clinical populations. In the expressive writing paradigm, participants are asked to write about such events for 15–20 minutes on 3–5 occasions. Those who do so generally have significantly better physical and psychological outcomes compared with those who write about neutral topics. Here we present an overview of the expressive writing paradigm, outline populations for which it has been found to be beneficial and discuss possible mechanisms underlying the observed health benefits. In addition, we suggest how expressive writing can be used as a therapeutic tool for survivors of trauma and in psychiatric settings.

 

Over the past 20 years, a growing body of literature has demonstrated the beneficial effects that writing about traumatic or stressful events has on physical and emotional health. In the first study on expressive writing (Pennebaker & Beall, 1986), college students wrote for 15 minutes on 4 consecutive days about ‘the most traumatic or upsetting experiences’ of their entire lives, while controls wrote about superficial topics (such as their room or their shoes). Participants who wrote about their deepest thoughts and feelings reported significant benefits in both objectively assessed and self-reported physical health 4 months later, with less frequent visits to the health centre and a trend towards fewer days out of role owing to illness. The authors concluded that:

 

‘writing about earlier traumatic experience was associated with both short-term increases in physiological arousal and long-term decreases in health problems’ (Pennebaker & Beall, 1986: p. 280).

Expressive writing studies

The basic writing paradigm (Pennebaker, 19941997a 1997b Smyth & Pennebaker, 1999) used in most of the subsequent expressive writing studies involves participants writing about traumatic or emotional experiences (Box 1) for 3–5 sessions, often over consecutive days, for 15–20 minutes per session. Most studies have been conducted in the laboratory, although more recently writing has been done at home or in a clinical setting. Participants often reveal a considerable range and depth of emotional trauma in their writing. Although many report being upset by the writing experience, they also find it valuable and meaningful (Pennebaker, 1997b ). Control participants are asked to write as objectively and factually as possible about neutral topics such as a particular room or their plans for the day, without revealing their emotions or opinions. No feedback is given on the writing.

Abstract

Writing about traumatic, stressful or emotional events has been found to result in improvements in both physical and psychological health, in non-clinical and clinical populations. In the expressive writing paradigm, participants are asked to write about such events for 15–20 minutes on 3–5 occasions. Those who do so generally have significantly better physical and psychological outcomes compared with those who write about neutral topics. Here we present an overview of the expressive writing paradigm, outline populations for which it has been found to be beneficial and discuss possible mechanisms underlying the observed health benefits. In addition, we suggest how expressive writing can be used as a therapeutic tool for survivors of trauma and in psychiatric settings.

 

Over the past 20 years, a growing body of literature has demonstrated the beneficial effects that writing about traumatic or stressful events has on physical and emotional health. In the first study on expressive writing (Pennebaker & Beall, 1986), college students wrote for 15 minutes on 4 consecutive days about ‘the most traumatic or upsetting experiences’ of their entire lives, while controls wrote about superficial topics (such as their room or their shoes). Participants who wrote about their deepest thoughts and feelings reported significant benefits in both objectively assessed and self-reported physical health 4 months later, with less frequent visits to the health centre and a trend towards fewer days out of role owing to illness. The authors concluded that:

 

‘writing about earlier traumatic experience was associated with both short-term increases in physiological arousal and long-term decreases in health problems’ (Pennebaker & Beall, 1986: p. 280).

Expressive writing studies

The basic writing paradigm (Pennebaker, 19941997a 1997b Smyth & Pennebaker, 1999) used in most of the subsequent expressive writing studies involves participants writing about traumatic or emotional experiences (Box 1) for 3–5 sessions, often over consecutive days, for 15–20 minutes per session. Most studies have been conducted in the laboratory, although more recently writing has been done at home or in a clinical setting. Participants often reveal a considerable range and depth of emotional trauma in their writing. Although many report being upset by the writing experience, they also find it valuable and meaningful (Pennebaker, 1997b ). Control participants are asked to write as objectively and factually as possible about neutral topics such as a particular room or their plans for the day, without revealing their emotions or opinions. No feedback is given on the writing.

Longer-term benefits of expressive writing

Health outcomes

  1.  Fewer stress-related visits to the doctor

  2.  Improved immune system functioning

  3.  Reduced blood pressure

  4.  Improved lung function

  5.  Improved liver function

  6.  Fewer days in hospital

  7.  Improved mood/affect

  8.  Feeling of greater psychological well-being

  9.  Reduced depressive symptoms before examinations

  10.  Fewer post-traumatic intrusion and avoidance symptoms

Social and behavioural outcomes

  1.  Reduced absenteeism from work

  2.  Quicker re-employment after job loss

  3.  Improved working memory

  4.  Improved sporting performance

  5.  Higher students’ grade point average

  6.  Altered social and linguistic behaviour

Objectively assessed outcomes

Expressive writing results in significant improvements in longer-term physical health outcomes such as illness-related visits to the doctor (Pennebaker & Beall, 1986Pennebaker et al, 1988Pennebaker & Francis, 1996King & Miner, 2000), blood pressure (Davidson et al, 2002, citing Crow et al), lung function (Smyth et al, 1999), liver function (Francis & Pennebaker, 1992) and number of days in hospital (Norman et al, 2004). Expressive writing has also produced significant benefits in a number of measures of immune system functioning (Pennebaker et al, 1988Esterling et al, 1994Booth et al, 1997Petrie et al, 19952004).

Significant benefits have also been found for such objective outcomes as students’ grade point average (Pennebaker & Francis, 1996Cameron & Nicholls, 1998), absenteeism from work (Francis & Pennebaker, 1992), re-employment after job loss (Spera et al, 1994), working memory (Klein & Boals, 2001) and sporting performance (Scott et al, 2003). In addition, writing about emotional topics changed the way that participants interacted with others, suggesting that writing may also have an impact on objectively assessed social and linguistic behaviour (Pennebaker & Graybeal, 2001).

Self-reported physical health outcomes

Expressive writing also produces longer-term benefits in self-reported health outcomes such as visits to the doctor (Cameron & Nicholls, 1998), physical symptoms (Park & Blumberg, 2002) and number of days out of role because of illness (Pennebaker & Beall, 1986Smyth et al, 2001).

In general, expressive writing does not affect health-related behaviours such as exercise, diet or drug/alcohol use (Pennebaker et al, 1988).

Self-reported emotional health outcomes

Some studies have also found longer-term benefits of expressive writing for emotional health outcomes, including mood/affect (Pennebaker et al, 1988Páez et al, 1999), psychological well-being (Park & Blumberg, 2002), depressive symptoms before examinations (Lepore, 1997) and post-traumatic intrusion and avoidance symptoms (Klein & Boals, 2001). However, the findings for emotional health are not as robust or as consistent as those for physical health.

Meta-analyses

A meta-analysis of 13 studies using expressive writing with healthy participants (Smyth, 1998) found a significant overall benefit (d = 0.47, P<0.0001) and specific benefits in objective or self-reported physical health, psychological well-being, physiological functioning and general functioning outcomes. Smyth's review suggests that, for physically and psychologically healthy individuals, the effects produced by expressive writing are substantial and similar in magnitude to the effects of other psychological interventions, many of which are more involved, time-consuming and expensive.

In clinical populations, a meta-analysis (Frisina et al, 2004) of nine expressive writing studies also found a significant benefit for health (d = 0.19, P<0.05), although when analysed separately the effects for physical health outcomes in medically ill populations were significant (d = 0.21, P = 0.01) but those for psychological health outcomes in psychiatric populations were not (d = 0.07, P = 0.17). Although the benefits are more modest than in studies with healthy participants, this meta-analysis suggests that expressive writing nevertheless has positive effects in clinical populations.

Who can benefit?

Medical conditions

In comparisons with controls, expressive writing produced significant benefits for individuals with a variety of medical problems (Box 3). Study participants with asthma or rheumatoid arthritis showed improvements in lung function and physician-rated disease severity respectively, following a laboratory-based writing progamme (Smyth et al, 1999), although people with rheumatoid arthritis using a home-based videotaped programme showed no benefit (Broderick et al, 2004). Some studies found that patients with cancer reported benefits such as better physical health, reduced pain and reduced need to use healthcare services (Rosenberg et al, 2002Stanton & Danoff-Burg, 2002), although others failed to find any benefits (Walker et al, 1999de Moor et al, 2002). Patients with HIV infection showed improved immune response similar to that seen in mono-therapy with anti-HIV drugs (Petrie et al, 2004) and individuals with cystic fibrosis showed a significant reduction in hospital-days over a 3-month period (Taylor et al, 2003). Women with chronic pelvic pain reported reductions in pain intensity ratings (Norman et al, 2004) and poor sleepers reported shorter sleep-onset latency (Harvey & Farrell, 2003). Benefits have also been found for post-operative course after papilloma resection (Solano et al, 2003) and for primary care patients (Klapow et al, 2001Gidron et al, 2002).

 

Medical conditions that might benefit from expressive writing programmes

 

  1.  Lung functioning in asthma

  2.  Disease severity in rheumatoid arthritis

  3.  Pain and physical health in cancer

  4.  Immune response in HIV infection

  5.  Hospitalisations for cystic fibrosis

  6.  Pain intensity in women with chronic pelvic pain

  7.  Sleep-onset latency in poor sleepers

  8.  Post-operative course

Psychological conditions

Other studies have investigated expressive writing in preselected groups of trauma survivors and individuals with specific psychological difficulties, with mixed results. Students with a trauma history have shown improvements in physical health (Greenberg et al, 1996Sloan & Marx, 2004a ), post-traumatic stress disorder (PTSD) symptomatology and other aspects of psychological health (Schoutrop et al, 19972002Sloan & Marx, 2004a ), although not all studies find benefits (Deters & Range, 2003).

Limited benefits were obtained for male psychiatric prison inmates (Richards et al, 2000), victims of natural disaster (Smyth et al, 2002) and individuals who had experienced a recent relationship breakup (Lepore & Greenberg, 2002).

Expressive writing was beneficial, but not significantly more so than control writing, for females writing about body image (Earnhardt et al, 2002), children of alcoholics (Gallant & Lafreniere, 2003), caregivers of children with chronic illness (Schwartz & Drotar, 2004), students screened for suicidality (Kovac & Range, 2002) and individuals who had experienced a bereavement (Range et al, 2000O'Connor et al, 2003).

Compared with controls, expressive writing was detrimental for adult survivors of childhood abuse (Batten et al, 2002) and for a small sample of eight Vietnam veterans with PTSD (Gidron et al, 1996).

Our review of the literature shows that psychological health benefits tend to be more often found when participants’ traumas and/or symptoms are clinically more severe, although results are inconsistent. One explanation for this inconsistency may be that many of the studies with null findings instructed participants to write about the specific traumatic event they were selected for, rather than using the standard instructions (Box 1), which allow them to write about events of their choosing. In studies where expressive writing was beneficial, many participants wrote about topics other than their particular physical illness or psychological problem, but still showed improvements in that area (Smyth & Pennebaker, 1999).

Individual differences

In addition to studying specific health populations, researchers have explored various individual difference indices to identify those subgroups for whom expressive writing is most beneficial. Results have been inconsistent. Variables generally found to be unrelated to outcome include age, trauma severity, baseline physical and psychological health levels, negative affectivity and measures of inhibition and prior disclosure.

Smyth's (1998) meta-analysis found that the effects were greater for males than for females. Expressive writing is more beneficial for those high in alexithymia (Páez et al, 1999Baikie, 2003Solano et al, 2003) and high in splitting (Baikie, 2003), characteristics often seen in patients with psychosomatic disorders and borderline personality disorder respectively, suggesting potential for the use of expressive writing in these populations.

Conclusion

As can be seen, each of the proposed theories has supporting and contradictory evidence (Sloan & Marx, 2004b ). The mechanism of action appears to be complex, with the demonstrated benefits potentially resulting from some combination of immediate cognitive and/or emotional changes, longer-term cognitive and/or emotional changes, social processes and biological effects, rather than being accounted for by any single factor (Pennebaker, 2004).

How to use expressive writing as a therapeutic tool

Expressive writing has primarily been investigated in carefully controlled research settings, with results generalising well across laboratories. However, given its simplicity, expressive writing appears to have great potential as a therapeutic tool in diverse clinical settings or as a means of self-help, either alone or as an adjunct to traditional therapies (see also Smyth & Helm, 2003Pennebaker, 2004). For example, promising results have been found using e-mail-based writing assignments (Sheese et al, 2004), an internet-based writing intervention for post-traumatic stress (Lange et al, 2000) and writing tasks for couples recovering from an extramarital affair (Snyder et al, 2004).

In extending the paradigm to clinical settings, following as much of the traditional protocol as possible will make it more likely that health benefits will be achieved (see also Batten, 2002). Although there is no direct evidence, it has been suggested that the more structured approach of the expressive writing paradigm is more beneficial than simple diary-keeping (Smyth & Pennebaker, 1999). In addition, it seems that incorporating both the cognitive and the emotional components of the experience (i.e. thoughts and feelings) is helpful (Pennebaker & Beall, 1986Smyth & Pennebaker, 1999). Suggestions for using expressive writing in clinical or self-help settings are given.

Suggestions for the clinical use of expressive writing 

  1.  Expressive writing tasks can be set as homework, or can be carried out before, during or after a session

  2.  Writing should be carried out in a private, personalised place, free from distractions

  3.  Write on three or four occasions, usually on consecutive days or weeks

  4.  Set aside 30 minutes, with 20 minutes for writing and 10 minutes for patients to compose themselves afterwards

  5.  Use the writing instructions 

  6.  Let the patient select a traumatic/stressful experience: do not specify a particular trauma or event

  7.  Allow the patient to structure the writing rather than imposing structure

  8.  If possible, give the patient the option to write by hand or on a computer

  9.  Explain to the patients that their writing is private, for themselves not for you and that confidentiality and anonymity are assured; explain that you will not read their writing unless they want you to

  10.  Do not give feedback

  11.  Writing should be kept by the patient or separate from the clinical file

As the application of expressive writing outside of research settings is relatively recent, it is recommended that clinicians collect some data to assess its effectiveness in their particular setting, including appropriate pre- and post-writing measures of physical health, psychological health or general functioning. 

Notes on expressive writing

As a clinical psychiatrist working in a public teaching hospital, I (K.W.) have found expressive writing to be a useful addition to my repertoire of short-term psychological interventions for people who harm themselves, in the medical wards and for out-patients with stress-related symptoms, anxiety and depression. I use it together with daily mood charts, problem-solving, goal-setting, relaxation, mindfulness, exercise prescription and other interventions that form part of the Black Dog Institute's general practitioner education programme (for related screening measures and information sheets follow the prompt for Clinician aids on the Institute's website at http://www.blackdoginstitute.org.au).

I keep a series of empty journals of different colours (to offer a choice) and ask patients to write on four occasions, following the instructions in Box 1. They are told to write for themselves and it is up to them whether they want to share the writing with anyone else. Later, I give some feedback on the changes in writing (after linguistic analysis), if requested.

Writing has helped people to resolve longstanding issues about relationships at home and work, and to put into words feelings that have been too sensitive to describe face to face. Some patients have shown their writing to significant others and found this helpful.

Research suggests that writing may be more beneficial for men and, in my experience, men have certainly found it an acceptable intervention.

The writing is intended for patients to use as a short-term intervention to start a process of dialogue with themselves or to ‘unblock’ a difficult issue. It is not intended to replace face-to-face interaction and is best done with a follow-up appointment for debriefing.

As the whole point is to bring up issues that are emotionally charged, it is important to work out the best timing for the writing and to have a contingency plan if the patient becomes distressed.

For some people the experience has been extremely helpful and has quickly resolved issues that have been mulled over – sometimes for years – with no resolution.

I encourage people to continue to use their journals in whatever way they think best, and most do so.

Cautions and limitations

Expressive writing is generally associated with an immediate increase in negative affect, but this short-term distress does not appear to be detrimental or to pose a longer-term risk to participants (Hockemeyer et al, 1999). Given the large number of studies conducted to date, with only a few finding any worsening of symptoms for those writing about traumatic experiences, the expressive writing paradigm appears to be reasonably safe for participants, even if no specific benefits are obtained. However, it is recommended that patients be told that they can stop writing at any time, should they wish, and appropriate contact numbers should be made available in case of distress. Patients should be encouraged to write for a maximum of 20 min at each session, so that the task does not seem too overwhelming, although they may choose to continue writing once the time is up if they wish and if this is feasible.

Regardless of the demonstrated benefits of expressive writing, it should not replace appropriate medical or psychological treatment in clinical populations; it should be used as an adjunct to standard treatment while further research is being conducted.

MCQs

  1. 1 Successful outcome in expressive writing requires:

    1. a correct statement of the facts

    2. b revealing subconscious thought processes

    3. c being able to discuss the writing with a significant other

    4. d being able to write freely for one's self

    5. e verbal expression of emotion while writing.

    2 Expressive writing has been shown to lead to:

    1. a significant improvement in lung function in asthma sufferers

    2. b improved immune response in HIV patients

    3. c decreased admission rates in cystic fibrosis

    4. d improvements in joint stiffness in rheumatoid arthritis

    5. e improved immune response in glandular fever.

    3 People engaging in expressive writing are instructed to:

    1. a write by hand or on a computer

    2. b always play soft music while writing

    3. c answer a set of questions provided

    4. d write freely without worrying about grammar

    5. e think about a topic prior to the session.

     4 Expressive writing results in:

    1. a higher college grades for students

    2. b more exercise taken per week

    3. c higher rates of re-employment after redundancy

    4. d fewer visits to the general practitioner or health centre

    5. e better diet.

    5 The instruction for an expressive writing task should include:

    1. a nominating a particular time of day

    2. b writing about ‘deepest thoughts and feelings’

    3. c writing about the same topic on each occasion

    4. d writing about a very traumatic experience

    5. e specific instruction not to write at bedtime.

     MCQ answers

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