Expressive disclosure to improve well-being in patients with amyotrophic lateral sclerosis: a randomised, controlled trial.

Psychol Health. 2013;28(6):701-13. doi: 10.1080/08870446.2012.754891. Epub 2013 Jan 7.

Averill AJ1, Kasarskis EJ, Segerstrom SC.

Amyotrophic lateral sclerosis (ALS) is a terminal neurological disease associated with progressive paralysis, loss of communicative ability and functional decline. Expressive disclosure may help people with ALS, particularly those who are emotionally or socially inhibited, meet psychological challenges associated with the disease. People with ALS (Nā€‰=ā€‰48) were randomised to expressive disclosure about their disease or no disclosure. Psychological well-being (affect, depression and quality of life) was assessed pre-intervention and also three and six months later. Results of multi-level models indicated that the group that disclosed thoughts and feelings about ALS had higher well-being than the control group at three months post-intervention, but not six months. Ambivalence over emotional expression (AEE) moderated three-month post-intervention well-being. Those low in AEE had higher well-being than those high in AEE regardless of condition. Those high in AEE, who disclosed, had increased well-being from pre-intervention, whereas controls had decreased well-being from pre-intervention. Expressive disclosure may be helpful for people with ALS, but only those who have difficulty expressing emotions. In addition, the intervention had only temporary effects; the dynamic challenges of ALS progression may mean that the effect of processing thoughts and feelings about the disease in one stage may not generalise to later stages.


Self-report and linguistic indicators of emotional expression in narratives as predictors of adjustment to cancer.

J Behav Med. 2006 Aug;29(4):335-45. Epub 2006 Jul 15.

Owen JE1, Giese-Davis J, Cordova M, Kronenwetter C, Golant M, Spiegel D.

Emotional expression and cognitive efforts to adapt to cancer have been linked to better psychological adjustment. However, little is known about the relationship between linguistic indicators of emotional and cognitive coping efforts and corresponding self-report measures of related constructs. In this study, we sought to evaluate the interrelationships between self-reports of emotional suppression and linguistic indicators of emotional and cognitive coping efforts in those living with cancer. Seventy-one individuals attending a community cancer support group completed measures of emotional suppression and mood disturbance and provided a written narrative describing their cancer experience. Self-reports of emotional suppression were associated with more rather than less distress. Although linguistic indicators of both emotional expression and cognitive processing were generally uncorrelated with self-report measures of emotional suppression and mood disturbance, a significant interaction was observed between emotional suppression and use of cognitive words on mood disturbance. Among those using higher levels of emotional suppression, increasing use of cognitive words was associated with greater levels of mood disturbance. These findings have implications for a) the therapeutic use of emotion in psychosocial interventions and b) the use of computer-assisted technologies to conduct content analysis.

The effects of guided written disclosure on psychological symptoms among parents of children with cancer.

J Fam Nurs. 2007 Aug;13(3):370-84.

Duncan E1, Gidron Y, Rabin E, Gouchberg L, Moser AM, Kapelushnik J.

This study examines whether structured writing about receiving a diagnosis and treatment for pediatric cancer reduces distress among highly distressed parents of children with cancer (PCWC). Eight PCWC completed measures of posttraumatic stress symptoms (PTSS) and depressive symptoms at two baselines, and again after writing, with 1-month gaps between assessments. Using a guided disclosure protocol (GDP), parents were asked to write about receiving the diagnosis first in a chronological manner, then to explicitly label their emotions at the time of diagnosis and explain the impact of the child’s illness on their life. Finally, they were asked to reflect on current feelings, future coping ability, and personal growth. Although symptoms of distress did not change between baselines, significant reductions were found in PTSS from the first baseline to postwriting, but not in depression. This preliminary study suggests that the GDP may reduce PTSS in distressed PCWC.

Effects of writing about emotions versus goals on psychological and physical health among third-year medical students.

J Pers. 2006 Feb;74(1):267-86.

Austenfeld JL1, Paolo AM, Stanton AL.

A randomized, controlled trial compared writing about emotional topics (EMO) to writing about goals as the “best possible self” (BPS; after King, 2001) and evaluated emotional approach coping, i.e., efforts to cope through processing and expressing emotion, as a moderator of writing effects on psychological and physical health in 64 third-year medical students. In participants with higher baseline hostility, the EMO condition was associated with less hostility at 3 months compared to the BPS and control conditions. Emotional processing (EP) and emotional expression (EE) moderated the effect of experimental condition on depressive symptoms at 3 months; high EP/EE participants reported fewer depressive symptoms in the EMO condition, whereas low EP/EE individuals reported fewer depressive symptoms in the BPS condition compared to the EMO and control conditions. A moderating effect of EP on physical health was also identified, such that low EP individuals who wrote about goals (BPS) had fewer health care visits at 3 months compared to low EP participants in the EMO and control conditions.

Does altering the writing instructions influence outcome associated with written disclosure?

Behav Ther. 2007 Jun;38(2):155-68. Epub 2007 Jan 18.

Sloan DM1, Marx BP, Epstein EM, Lexington JM.

This study examined the effect of changing the instructional set for written disclosure on psychological and physical health reports among traumatized college students with current posttraumatic stress symptoms. Eighty-two participants were randomly assigned to one of three writing conditions that focused on emotional expression (EE), insight and cognitive assimilation, or to a control condition. Participants assigned to the EE condition reported significant improvements in psychological and physical health 1 month following the writing sessions relative to the other two conditions. The EE participants also reported and displayed significantly greater initial psychophysiological reactivity and subsequent habituation compared with the other two conditions. These findings suggest the importance of emphasizing emotional expression during written disclosure and underscore the importance of examining how modifying the written disclosure protocol can affect outcome.