Shannon Curry Westgaard, MA Pepperdine University Graduate School of Education & Psychology

1. The Journal Project: Written Expression of Trauma as Intervention for High School Students in Ayacucho Peru Shannon Curry Westgaard, MA Pepperdine University Graduate School of Education & Psychology

2. Presentation Outline • Project Overview and Goals • Cultural Considerations in Therapy • History, Benefits, and Mechanisms of Written Expression • Processing Traumatic Events • Trauma in Ayacucho, Peru- The Sendero Luminoso Guerilla Movement & Effects of War and Terrorism on Child Development

3. Project Goals 1. To determine whether or not expressive writing is an effective therapeutic intervention for adolescents in Ayacucho, Peru; a community that demonstrates residual trauma from the Sendero Luminoso (Shining Path) guerrilla war which terrorized the Andes region of Peru for nearly two decades. 2. To encourage the development of evidence-based culturally relevant therapeutic interventions 3. To involve the community of Ayacucho Peru in the present research project.

4. Purpose of the Proposed Study • Non-expression of emotional experiences and trauma can lead to depression and fragmented personal narrative (Pennebaker, Mayne & Francis, 1997; Gallardo & Curry, in press). • Written expression as a therapeutic intervention: • Shown to decrease depression, distress, negative mood, & negative affect associated with traumatic experiences (Sloan & Marx, 2004) • Accelerates the coping process (Pennebaker, Colder, & Sharp, 1990) • Facilitates cognitive assimilation of traumatic experience into personal narrative (Smyth, 1998) • Does not require interpersonal disclosure • Free of cost • Portable • Without time-constraints

5. Cultural Interventions and Considerations • Latino Cultural Themes as a General Guide (not all-inclusive) • More than 1/2 of Latino clients in U.S. terminate mental health care after just one therapy session (Cheung, 1991)

6. Traditional Western Therapeutic Model • Unfamiliar Setting (Counseling Office) • Unfamiliar Person (Counselor) • Time-Structured (50 min. session) • Can be costly

7. Latino Cultural Themes that Conflict with Western Therapy • Orgullo: Pride/dignity. Expression of personal issues to non-family members may be seen as “losing face.” • Machismo: Emphasis on strength, dignity, respect, bravery, and family responsibility. May translate as discomfort with open expression of emotional vulnerability. • Familismo: Overall importance of family. Both Orgullo and Machismo are related to this. • Personalismo: People first. May conflict with Western emphasis on time structures (e.g., strict start and end times). • (Neff, 2001; Gallardo & Curry, in press)

8. Pennebaker & Beall (1983) • Examination of the physical and mental effects of disclosing traumatic events independent of social feedback • The Inhibition Model • 4 Groups: • Trauma-Fact, • Trauma-Emotion • Trauma-Combination • Control • Short-term Effects • Inhibition Model Implications

9. Pennebaker & Beall (1983) Continued • 3 Month Follow-Up • Trauma-Emotion: “It helped me think about what I felt during those times. I never realized how it affected me before.” • Trauma-Combination: “Although I have not talked with anyone about what I wrote, I was finally able to deal with it, work through the pain instead of trying to block it out. Now it doesn’t hurt to think about it.” • A process beyond catharsis

10. Design Characteristics of Past Studies Using Written Expression • Pennebaker, Colder, & Sharp, 1990; Lewis & Butcher, 1992; Krantz & Pennebaker, 1996; Pennebaker, 1997; Pennebaker, Mayne, & Francis 1997; Smyth & Greenberg, 2000; Smyth & Helm, 2003; Alford, et al., 2005 • 1-5 days long, 15-30 minute writing sessions • Superficial vs. Emotional Topics • No feedback given

11. Written Expression Across Populations • Comparable benefits across education, SES, sex, ethnicity, and culture (Pennebaker & Seagal, 1999; Ramírez-Esparza & Pennebaker, 2006) • Graduate degree professionals • College undergraduates • Medical students • Maximum security prisoners, 6th grade education • Crime victims • Chronic pain sufferers • Children • Elderly • Major U.S. ethnic groups • English-speakers • Non-English speakers • Limited international samples

12. Traumatic Memories • Traumatic Memories as sensory experiences (Terr, 1993), difficult to integrate into narrative account of personal experience (Wall & Levey, 2005) • Ordinary Memories as components of personal narrative (Christianson, 1992; van der Kold, 1994)

13. Writing as Integration of Traumatic Memories • Confrontation/recognition of traumatic memory • Process of insight (causes, emotions, implications, personal meaning) • Merging of Unconscious & Conscious (Smyth & Greenberg, 2000) • Reclaiming life experience • Integration into personal narrative • Fragmented Self Cohesive Self • Linguistic Inquiry Word Count- Increase in insight related words • (Alford, 2005; Pennebaker & Beall, 1983; Pennebaker, Mayne, & Francis, 1997)

14. Evidence of a Cognitive Process • Meta-analytic comparison of stress-management interventions across 3,736 participants (Blonk et al., 2001) • Translation of experience into language: • Dance, music, and art therapies compared to therapies involving translation of experience into writing (Krantz & Pennebaker, 1996) • Written expression and interpersonal therapy among psychologically healthy samples (Donnelly & Murray, 1991; Pennebaker, 1997)

15. Trauma in Peru:The Manchay Tiempo (Time of Fear) • Sendero Luminoso (Shining Path) • A.K.A. Communist Party of Peru • May 17th, 1980- Burning of presidential ballot boxes • “The Moral Compaign” • April 1983- Massacre in Huancasancos • 69 villagers killed • 11 women (some pregnant) • 18 children (as young as 6-months-old) • Mid-1980’s- Country-wide terrorism

16. Not Just Sendero Luminoso… • 1981: Andes become “Emergency Zone,” military deployed to detain “suspicious persons” • Truth and Reconciliation Commission (2003) report: • 1980 - 2000: 69,280 dead or disappeared • Half attributed to Sendero Luminoso • One-third attributed to government security forces • Remaining attributed to local militias, smaller guerrilla groups, some still unattributable • (Human Rights Watch, 2003)

17. Participants • Approx. 120 high school students, 16-18 yrs. • Common Issues for Children Exposed to Traumatic Events • Post-Traumatic Stress Disorder • Depression • Anxiety • Persistent Fearfulness (esp. when exposed to mass casualties, e.g., 1983 massacre in Ayacucho) • Sleep disturbances • Rigidity in routine • Irritable/argumentative • Difficulty concentration • Frequent illness • Anxious Attachment • American Academy of Child and Adolescent Psychiatry, 1998; Comer and Kendall, 2007; Yule et al., 2002

18. Peruvian American Medical Society • (PAMS): Group of physicians and professionals dedicated to assisting Peru through multi-national collaborative health campaigns

19. Participants • Approximately 120 high school students • Grades 11-12 • Ages 16-18 • (40-50 students per classroom, 4 classrooms for study, 75% assumed acceptance rate) • Majority expected to have been born & raised in Ayacucho • Environmental stressors, traumatic events

20. Timeline of Events • March 2009: • Measures given for baseline • First 4 day writing session w/control and experimental groups • Measures given immediately following last session • April 2009: • Follow-up measures given • Start of long-term (1 year) study with LIWC

21. Question & Answer