THE THERAPEUTIC BENEFIT OF EXPRESSIVE WRITING FOR POSTTRAUMATIC SYMPTOMS: A RANDOMIZED CONTROLLED TRIAL OF EMOTIONAL MODERATORS AND WRITING MODALITY

Expressive writing is a therapeutic intervention requiring individuals to write about distressing events and their emotional responses to these experiences (Pennebaker & Beall, 1986). The use of expressive writing has improved behavioural, physiological, and psychological outcomes in many populations, including individuals with posttraumatic stress disorder (PTSD; Baikie & Wilhelm, 2005). Greater self-disclosure on such writing tasks has been associated with higher perceived benefits and helpfulness (Brewin & Lennard, 1999). Researchers have investigated how expressive writing protocols can be utilized online to increase levels of self-disclosure when writing about traumatic experiences and, consequently, improve PTSD symptom outcomes. Researchers have not yet assessed for modality-based differences (e.g., typed vs. hand-written expressive writing) for therapeutic efficacy or emotional engagement. The present investigation examined whether 1) typed and hand-written expressive writing equally reduced PTSD symptoms; and 2) emotional engagement affected the efficacy of expressive writing in reducing PTSD symptoms. A community and student sample (n = 29) with clinically significant PTSD symptoms completed the trial. Participants were randomized to one of four conditions with different writing modalities (i.e., typed or hand-written) and paradigms (i.e., control or expressive writing). In one session, participants were administered three 15-minute writing tasks and self-report questionnaires evaluating aspects of emotion (i.e., recognition, expression, trait negative emotionality) and PTSD symptom severity. An optional 7-day follow-up questionnaire re-evaluating PTSD symptom severity was also administered to participants. Each experimental group had non-significant decreases in PTSD symptoms from pre- to post-intervention, these

changes being dependant on pre-intervention symptom severity; however, alexithymia, i

dissociation (i.e., attentional dissociation and dissociative amnesia), negative affect, emotional approach coping, and the presence of a learning disability did affect symptom changes, and when these factors were considered the experimental conditions significantly differed in their effect on symptom outcomes. In conclusion, findings of the current trial suggest that a day-intensive session of expressive writing neither reduces PTSD symptoms nor differs in efficacy based on its method of completion unless emotional engagement with the task is considered. Further investigation into how learning disabilities and emotional predispositions affect engagement with expressive writing is warranted to clarify its efficacy in clinical PTSD populations.

http://ourspace.uregina.ca/bitstream/handle/10294/7086/D%27Ambrosio_Christina_Ma_Psyc_200338097_Fall2016.pdf

Advertisements

Betrayal trauma: relationship to physical health, psychological distress, and a written disclosure intervention.

J Trauma Dissociation. 2005;6(3):83-104.

Freyd JJ1, Klest B, Allard CB.

In the current study we sought, first, to distinguish associations with health arising from types of trauma as indicated by betrayal trauma theory (Freyd, 1996, 2001), and, second, to investigate the impact of disclosing a trauma history in survey form and/or writing essays about betrayal traumas. We recruited 99 community adults reporting at least 12 months of chronic medical illness or pain, 80 of whom completed all four sessions of this six-month longitudinal intervention study. Participants were randomly assigned to write about betrayal traumas or neutral events, and they were randomly assigned to complete an extensive trauma survey or a long personality inventory, producing four groups of participants. All 99 participants were assessed at their initial visit for trauma history using the Brief Betrayal Trauma Survey (BBTS) and physical and mental symptoms. The BBTS assesses exposure to both traumas high in betrayal (such as abuse by a close other) and traumas low in betrayal but high in life-threat (such as an automobile accident). Exposure to traumas with high betrayal was significantly correlated with number of physical illness, anxiety, dissociation, and depression symptoms. Amount of exposure to other types of traumas (low betrayal traumas) did not predict symptoms over and above exposure to betrayal trauma. While neither the survey manipulation nor the writing intervention led to main effects on change in symptoms over time, there were interactions between betrayal trauma history and condition such that participants with many betrayal traumas fared better in the control conditions while participants with fewer betrayal traumas had better outcomes if they were placed in the trauma writing and/or survey conditions. We discuss ongoing and future research aimed at evaluating the role of increased structure in writing assignments as beneficial for those with severe histories of betrayal trauma.

Does writing reduce posttraumatic stress disorder symptoms?

Violence Vict. 2003 Oct;18(5):569-80.

Deters PB1, Range LM.

To see if writing about their trauma lessened PTSD and related symptoms, 57 undergraduates, previously screened for traumatic experiences, wrote for 15 minutes on 4 days across 2 weeks about either their trauma or a trivial topic. They reported PTSD, impact, suicide ideas, dissociation, and depression pre-, post-, and at 6-week follow-up testing. Trauma and trivial writers were not different. Surprisingly, at follow-up everyone reported less severe PTSD symptoms, impact, and dissociation, and fewer health visits, but about the same suicidal ideation and depression. On PTSD symptoms and impact, the pattern of improvement was different: Those writing about trauma got worse at posttesting, but improved to better than their initial state by follow-up. Those writing about a trivial topic got better by posttesting, and held that position at follow-up. In this project, writing seemed to reduce PTSD symptoms regardless of whether it concerned the trauma or what they ate for lunch.

https://www.ncbi.nlm.nih.gov/pubmed/14695022