—13 years, 105 workshops, and 861 youth later—
We work everyday to transform the lives of youth at the edge — and our work is more than powerful performances.
The hippocampus, derived from the Greek word for seahorse, is a key anatomical structure in the brain. Amazingly complex, neuroscientists continue to discover more about how it functions: there is general agreement that the hippocampus plays a central role in the human capacity to turn personally experienced events and their associated emotions into memories. The PlayWrite workshop — combining written expression with movement — provides an opportunity for young people to unscramble complex emotional experiences into narrative form.
PlayWrite workshops are presently offered at 8-10 alternative schools and organizations in the Portland metropolitan area. The schools serve youth who have not thrived in the mainstream educational system. Approximately 75-80% of these youngsters have been exposed to childhood trauma, abuse, and neglect (there is now increasing evidence that verbal aggression and/or neglect may be more traumatic over time than physical abuse). Four of the schools are housed within secure facilities. PlayWrite workshops take place during school time, and involve 25+ hours of one-on-one contact time over a three-week period.
Following the workshop, teachers and staff are asked to complete questionnaires for each student in their charge. The questions ask about observed changes in behavior that persist 3-6 months after the workshop. Results from four of the schools where we held workshops in the 2005-06 school year show the following changes:
- 65% of the workshop students improved their participation in class, were more willing to engage in conversation with an adult, and expressed their ideas more clearly.
- 59% had greater confidence in presenting their work to an audience, showed greater appreciation of others’ creativity, and were significantly more willing to take on new assignments.
- 55% were persistent in sticking with challenging work.
- More than 50% were better able to collaborate with their peers in creative work, could more easily ask for and receive help, and used creative outlets for expressing their feelings.
Anecdotal reports from participants, their teachers and counselors support these data, and reveal dramatic shifts in positive directions. That support helped secure foundation funding for a research study designed and implemented by scientists at the University of Oregon and the Oregon Health & Science University.1 This was a small-scale, randomized efficacy trial, with a waitlist control design. Their study indicated that workshop participants experienced improvements across multiple domains. School respondent reports suggested that relative to adolescents on the waitlist (control group), workshop participants had decreased levels of:
- Hyperactivity: being restless and easily distracted (75%).
- Mood symptoms: including withdrawal, shame, and lethargy (63%).
- Anhedonia: an inability to experience pleasure or happiness (58%).
- Anger Dysregulation: culturally inappropriate (i.e. disruptive or destructive) emotional expression of anger and irritability (e.g., tantrums) (50%).
- Emotion symptoms: including anxiety, somatic complains, depression (50%).
In addition, the self-report data indicated that PlayWrite participants reported improved impulse control (63%) as well as greater expressivity (63%). What might be the mechanisms underlying these positive changes?
Over the past two decades, numerous research studies have shown that writing with feeling about significant emotional events produces positive changes. These changes occur in both physical health and behavior, and persist through every follow-up period.2,3 A recent study by Keith J. Petrie and his colleagues elegantly demonstrates these effects.4 The benefits are enhanced when expression is manifested through writing combined with movement – which the PlayWrite program does. As the noted Stanford physician David Spiegel points out, if there were “…similar outcome evidence about a new drug, it likely would be in widespread use within a short time.”5 So the question arises, what is going on in the brain? Much of the neurological research has focused on the traumatic end of this spectrum.
Neurophysiological research is revealing the dynamics of how the emotional memories of traumatic events may be processed in the brain. Recent studies on Post-Traumatic Stress Disorder suggest that PTSD might be a useful model for thinking about this problem. Here’s what we know (or think we know):
- Highly charged emotional experiences, particularly traumatic ones, interfere with the formation of declarative memory (the conscious recall of experience), but do not inhibit implicit memory, the memory system that controls conditioned emotional responses and sensorimotor sensations related to experience.6
- When the individual is subsequently stressed, the high state of arousal seems to promote the retrieval of traumatic memories along with the sensory memories and behaviors associated with those events. It is as though the individual relives the event.
- Animal studies have shown that individuals exposed to high stressors react to novel stimuli (that produce high arousal) with fright and by perseverating in familiar behavior, regardless of the outcome. There is no choice involved: hippocampal function has been disrupted by stress-induced corticosterone production and a reduction in serotonin (which is correlated with an increase in impulsivity and aggression in humans). Thus there is no opportunity for analytic thought and executive function, because the neocortex is not involved.
- There is extensive neurogenesis in the hippocampus throughout life. Animal studies have demonstrated that “new neurons continue to be added in specific regions of the adult brain, including the dentate gyrus, a subregion of the hippocampus that is crucial in cognitive functions such as learning and memory.”7
Emotional writing exercises, combined with exploration of emotion through movement and sound, may be a mechanism for unblocking communication between the hippocampus and the neocortex, as well as modulating the activation of the amygdala, when traumatic memories are retrieved. Putting emotion into written language is a crucial element. The relationship between coach and writer in a PlayWrite workshop embodies profound trust and acceptance, which co-operates with attuned challenge. The coach has an unshakeable belief in the strength and creative power of the writer.
The process proceeds over several days. The words and feelings are entirely generated by, and thus belong entirely to, the writer. In the PlayWrite program, each writer is constantly pushed to draw on the emotional truth of his or her own experience in the creation of a play, a drama that emerges from deep conflict between two non-human characters.
The critical element in the PlayWrite process is the one-to-one interaction between coach and writer. This series of interactions, and the way they are structured, may promote remodeling through increased neurogenesis, particularly in the hippocampus. Over the ten days of the workshop, supported by an empathic yet challenging coach, a student writer is often able to transform traumatic implicit memories into narratives, leading to persisting improvements in health and behavior.
Beyond the positive changes cited above, there may be intergenerational effects on future behavior. The cycle of abuse and neglect can be broken. Mary Main8 and her colleagues9 have shown that people who are able to construct a coherent narrative of their childhood are likely (>80%) to form secure (i.e., healthy) attachments with their children, even if they have suffered childhood trauma such as abuse and/or neglect.10 These individuals are also less prone to develop psychopathology such as anti-social personality disorders and other disorders that may lead to violent behavior.
Writing a play demands writing about feelings. The author must be able to see events unfolding from different points of view, and to honestly inhabit those opposing points of view. PlayWrite
workshops require the writer to use his or her own emotional experiences to build characters, understand the history of those characters’ relationship, and explore emotional conflict. The
playwright creates a dramatic narrative – utilizing his or her own life experiences – that works through emotional conflict and crisis toward resolution. These efforts work in harmony with PlayWrite’s primary purpose: supporting and challenging young people in the process of creating art.
A quantitative analysis by Dr. Jacqueline Waggoner in 2007* found that “the PlayWrite program engendered compassion and understanding while improving students’ skills in writing, speaking, and listening.” Dr. Waggoner’s study provided the impetus for a wait-list control study of PlayWrite workshops. The research protocol was designed and implemented by a team from the University of Oregon and the Oregon Health & Science University; this two-year research study by Bernstein, Ablow & Nigg was completed in 2012. The results are far-reaching: the study found that – compared to controls – PlayWrite participants improved their ability to appropriately manage their anger, showed increased emotional regulation, and lower hyperactivity as well as better impulse control.
To learn more about our impact, please read the PlayWrite Efficacy Report; Mindsight at Work: Interpersonal Neurobiology in Action, by Debra Pearce-McCall, PhD; or Writing to Heal the Hurt, an Oregonian article by Inara Verzemnieks.
Our graduates speak — years later — of the impact our workshop had on their lives. If you would like to support PlayWrite's efforts, please consider making a donation today.
1 Bernstein, Rosemary, M.A., Jennifer Ablow, PhD., and Joel Nigg, PhD., "PlayWrite Inc. Efficacy Study 2012: Results in Brief." 2 Pennebaker, James W. Opening Up, New York, Guilford Press, 1997. 3 Pennebaker, James W. "Writing about Emotional Experiences as a Therapeutic Process," Psychological Science, Vol. 8 Nr. 3 pp. 162-166 (May 1997). 4 Petrie, Keith J., PhD, et al. "Effect of Written Emotional Expression on Immune Function in Patients with Human Immunodeficiency Virus Infection: A Randomized Trial," Psychosomatic Medicine, 66:272-275 (2004). 5 Speigel, David "Healing Words: Emotional Expression and Disease Outcome," Journal of the American Medical Association, Vol. 281, No. 14 pg. 1329 (April 1999). 6 van de Kolk, Bessel A., (1994) "The Body Keeps the Score: Memory and the Evolving Psychobiology of Post-Traumatic Stress" Harvard Review of Psychiatry, 1, 253-265. 7 Ge, S.,, et al. "A Critical Period for Enhanced Synaptic Plasticity in Newly Generated Neurons of the Adult Brain," Neuron, Vol. 54, Nr. 4, pp. 559-566 (May 2007). 8 Main, M. (1991) "Metacognitive knowledge, metacognitive monitoring, and singular (coherent) versus multiple (incoherent) models of attachment: Findings and directions for future research."in C.M. Parkes, J. Stenson-Hinde & P. Marris (Eds.), Attachment across the life cycle (pp. 127-159) London, Routldge. 9 Hesse, E. & Main, M. (1999) Unresolved/disorganized responses to trauma in non-maltreating parents: Previously unexamined risk factor of offspring. Psychoanalytic Inquiry, 19, 4 ff. 10 75-80% of the youth who participate in PlayWrite workshops have been exposed to childhood trauma, abuse and/or neglect.
*The PlayWrite Project: Empowering marginalized youth with tools for creative expression. Paper presentation at Hawaii International Conference on Education, Honolulu, HI. Dr. Waggoner is an Associate Professor in the School of Education at the University of Portland. She has taught graduate quantitative and qualitative research and statistics, tests and measurement, assessment, and Data Driven Decision Making for over 25 years and is the author of numerous papers and publications.