The effects of written emotional disclosure and coping skills training in rheumatoid arthritis: a randomized clinical trial.

J Consult Clin Psychol. 2014 Aug;82(4):644-58. doi: 10.1037/a0036958. Epub 2014 May 26.

Lumley MA1, Keefe FJ2, Mosley-Williams A3, Rice JR2, McKee D2, Waters SJ2, Partridge RT1, Carty JN1, Coltri AM1, Kalaj A1, Cohen JL1, Neely LC1, Pahssen JK4, Connelly MA2, Bouaziz YB2, Riordan PA2.

Two psychological interventions for rheumatoid arthritis (RA) are cognitive-behavioral coping skills training (CST) and written emotional disclosure (WED). These approaches have developed independently, and their combination may be more effective than either one alone. Furthermore, most studies of each intervention have methodological limitations, and each needs further testing.

METHOD:

We randomized 264 adults with RA in a 2 × 2 factorial design to 1 of 2 writing conditions (WED vs. control writing) followed by 1 of 2 training conditions (CST vs. arthritis education control training). Patient-reported pain and functioning, blinded evaluations of disease activity and walking speed, and an inflammatory marker (C-reactive protein) were assessed at baseline and 1-, 4-, and 12-month follow-ups.

RESULTS:

Completion of each intervention was high (>90% of patients), and attrition was low (10.2% at 12-month follow-up). Hierarchical linear modeling of treatment effects over the follow-up period, and analyses of covariance at each assessment point, revealed no interactions between writing and training; however, both interventions had main effects on outcomes, with small effect sizes. Compared with control training, CST decreased pain and psychological symptoms through 12 months. The effects of WED were mixed: Compared with control writing, WED reduced disease activity and physical disability at 1 month only, but WED had more pain than control writing on 1 of 2 measures at 4 and 12 months.

CONCLUSIONS:

The combination of WED and CST does not improve outcomes, perhaps because each intervention has unique effects at different time points. CST improves health status in RA and is recommended for patients, whereas WED has limited benefits and needs strengthening or better targeting to appropriate patients.

https://www.ncbi.nlm.nih.gov/pubmed/24865870

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Relaxation training and written emotional disclosure for tension or migraine headaches: a randomized, controlled trial.

Ann Behav Med. 2008 Aug;36(1):21-32. doi: 10.1007/s12160-008-9046-7. Epub 2008 Aug 12.

D’Souza PJ1, Lumley MA, Kraft CA, Dooley JA.

Behavioral medicine interventions that directly reduce arousal and negative emotions, such as relaxation training (RT), are conceptually different from interventions that temporarily increase negative emotions, such as written emotional disclosure (WED), but no studies have directly compared their efficacy. We compared the effects of RT and WED on people with tension or migraine headaches.

METHODS:

College students with either tension (n = 51) or migraine (n = 90) headaches were randomized to one of three groups: RT, WED, or a neutral writing control condition; four sessions were held over 2 weeks. Mood was measured before and after each session, and outcomes (headache frequency, severity, disability, and general physical symptoms) were assessed at baseline and at 1-month and 3-month follow-ups.

RESULTS:

As expected, RT led to an immediate increase in calmness, whereas WED led to an immediate increase in negative mood, for both headache samples. Intent-to-treat analyses showed that, for the tension headache sample, RT led to improved headache frequency and disability compared to both WED and the control group, but WED had no effect. For migraine headaches, RT improved pain severity relative to the control group, but WED again had no effect.

CONCLUSIONS:

A brief RT protocol was effective for tension headaches, but WED had no effect on health status for either tension or migraine headaches. Modifications to WED, such as targeting people with unresolved stress, providing guidance to enhance the potency of the writing, or including additional at-home writing and exposure exercises, may improve its efficacy for people with headaches and other health problems.

https://www.ncbi.nlm.nih.gov/pubmed/18696172

Health effects of written emotional disclosure in adolescents with asthma: a randomized, controlled trial.

J Pediatr Psychol. 2006 Jul;31(6):557-68. Epub 2005 Jul 13.

Warner LJ1, Lumley MA, Casey RJ, Pierantoni W, Salazar R, Zoratti EM, Enberg R, Simon MR.

To test the effects of written emotional disclosure on the health of adolescents with asthma and to examine how language in disclosures predicts outcomes.

METHODS:

We randomized 50 adolescents with asthma to write for 3 days at home about stressful events (disclosure) or control topics. At baseline and 2 months after writing, we assessed symptoms, affect, disability, internalizing behavior problems, and lung function; parents independently rated internalizing behavior and disability.

RESULTS:

Compared with control writing, disclosure writing led to improved positive affect and internalizing problems. Disclosure also decreased asthma symptoms and functional disability among adolescents with baseline elevations of these difficulties. Lung function was not changed. Disclosures with more negative emotion, insight, and causal words–and increased causal or insight words over days–predicted improved health.

CONCLUSIONS:

Written emotional disclosure improves emotional and behavioral functioning among adolescents with asthma, particularly those whose writings suggest emotional processing and cognitive restructuring.

https://www.ncbi.nlm.nih.gov/pubmed/16014820