Effects of disclosure of traumatic events on illness behavior among psychiatric prison inmates.

J Abnorm Psychol. 2000 Feb;109(1):156-60.

Richards JM1, Beal WE, Seagal JD, Pennebaker JW.

To assess the health effects of writing about traumatic events in a clinical population, 98 psychiatric prison inmates were randomly assigned to 1 of 3 conditions in which they were asked to write about their deepest thoughts and feelings surrounding upsetting experiences (trauma writing condition), write about trivial topics (trivial writing control), or go about their daily routine without writing (no-writing control). Both writing groups wrote for 20 min per day for 3 consecutive days. Participants in the trauma condition reported experiencing more physical symptoms subsequent to the intervention relative to those in the other conditions. Despite this, controlling for prewriting infirmary visits, sex offenders in the trauma writing condition decreased their postwriting infirmary visits. These results are congruent with predictions based on stigmatization and inhibition.

https://www.ncbi.nlm.nih.gov/pubmed/10740948

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Symptom management in older primary care patients: feasibility of an experimental, written self-disclosure protocol.

Ann Intern Med. 2001 May 1;134(9 Pt 2):905-11.

Klapow JC1, Schmidt SM, Taylor LA, Roller P, Li Q, Calhoun JW, Wallander J, Pennebaker J.

Distress-driven symptoms are prevalent among older primary care patients and account for a large percentage of office visits and increased medical costs. An experimental written self-disclosure protocol has been shown to reduce symptoms and use of health care services in healthy adults. Written self-disclosure as a method for reducing symptoms has not been evaluated in the primary care setting.

OBJECTIVE:

To evaluate the feasibility of adapting an experimental written self-disclosure protocol for the primary care setting.

DESIGN:

Randomized, single-blind feasibility study.

SETTING:

University-based geriatric and internal medicine primary care clinics.

PATIENTS:

45 patients 66 years of age or older without a psychiatric diagnosis.

INTERVENTION:

Three 20-minute writing sessions focusing on distressing experiences (in the intervention group) or health behaviors (in the control group).

MEASUREMENTS:

The feasibility outcomes were patient recruitment, protocol logistics, and patient and provider satisfaction. The clinical outcomes were somatic and distress symptoms, health care utilization, and associated costs.

RESULTS:

One third of patients screened were recruited; 96% of patients recruited completed the protocol. Clinic contact time was an average of 55 minutes per patient. Patients and providers reported high levels of satisfaction with the protocol. Reductions in symptoms were minimal for both groups. Use of outpatient services and associated costs decreased in both groups, but the reduction was twice as great in the treatment group as in the control group.

CONCLUSIONS:

Findings support the feasibility of implementing the protocol as a primary care intervention.

https://www.ncbi.nlm.nih.gov/pubmed/11346327

Effects of guided written disclosure of stressful experiences on clinic visits and symptoms in frequent clinic attenders.

Fam Pract. 2002 Apr;19(2):161-6.

Gidron Y1, Duncan E, Lazar A, Biderman A, Tandeter H, Shvartzman P.

Psychosocial variables such as major stressful life events/daily stressful events have been associated with health care utilization.

OBJECTIVE:

Our aim was to examine the effects of a guided disclosure protocol (GDP) of past traumas on symptoms and clinic visits among frequent clinic attenders.

METHODS:

Forty-one frequent clinic attenders (> or =2 visits/3 months) took part. Patients were randomly assigned individually to either a casual content writing control group (n = 19) or a trauma content writing experimental GDP group (n = 22). GDP patients wrote about an upsetting event chronologically (day 1), verbally described their thoughts and feelings and described the event’s impact on life (day 2), and finally wrote about their current perspective on and future coping with the event (day 3). Three months later, patients were reassessed blindly for symptoms and clinic visits, and an average of 15 months later they were assessed blindly for clinic visits again.

RESULTS:

Compared with controls, GDP patients reported lower symptom levels at 3 months (2.3 versus 5.2), and made fewer clinic visits during the 3 (1.3 versus 3.0) and 15 month (5.1 versus 9.7) follow-ups. The percentage of GDP patients making > or =10 visits during the 15 month follow-up was smaller (10%) than among controls (33%).

CONCLUSIONS:

The findings extend previous findings to frequent clinic users, using a new form of written disclosure aimed at shifting trauma from implicit to explicit memory. The GDP may be an inexpensive additional intervention in primary care for reducing symptoms and clinic visits among frequent clinic users.

https://www.ncbi.nlm.nih.gov/pubmed/11906981

Emotional disclosure about traumas and its relation to health: effects of previous disclosure and trauma severity.

J Pers Soc Psychol. 1992 Jul;63(1):75-84.

Greenberg MA1, Stone AA.

This study sought to replicate previous findings that disclosing traumas improves physical health and to compare the effects of revealing previously disclosed versus undisclosed traumas. According to inhibition theory, reporting about undisclosed traumas should produce greater health benefits. Sixty healthy undergraduates wrote about undisclosed traumas, previously disclosed traumas, or trivial events. Contrary to expectations, there were no significant between-groups differences on longer term health utilization and physical symptom measures. However, Ss who disclosed more severe traumas reported fewer physical symptoms in the months following the study, compared with low-severity trauma Ss, and tended to report fewer symptoms than control Ss. Results suggest that health benefits occur when severe traumas are disclosed, regardless of whether previous disclosure has occurred.

https://www.ncbi.nlm.nih.gov/pubmed/1494986

Emotional expression and physical health: revising traumatic memories or fostering self-regulation?

J Pers Soc Psychol. 1996 Sep;71(3):588-602.

Greenberg MA1, Wortman CB, Stone AA.

Health benefits derived from personal trauma disclosure are well established. This study examined whether disclosing emotions generated by imaginative immersion in a novel traumatic event would similarly enhance health and adjustment. College women, preselected for trauma presence, were randomly assigned to write about real traumas, imaginary traumas, or trivial events. Yoked real-trauma and imaginary-trauma participants wrote about real-trauma participants’ experiences. Imaginary-trauma participants were significantly less depressed than real-trauma participants at immediate posttest, but they were similarly angry, fearful, and happy. Compared with control group participants, both trauma groups made significantly fewer illness visits at 1-month follow-up; however, real-trauma participants reported more fatigue and avoidance than did the other groups. Imaginary-trauma group effects could reflect catharsis, emotional regulation, or construction of resilient possible selves.

https://www.ncbi.nlm.nih.gov/pubmed/8831163

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

Does writing about the bereavement lessen grief following sudden, unintentional death?

Death Stud. 2000 Mar;24(2):115-34.

Range LM1, Kovac SH, Marion MS.

Writing about traumatic events produces improvement in an array of areas including physical and psychological functioning. To see if these improvements extended to improved bereavement recovery after the accidental or homicidal death of a loved one, 64 undergraduates (51 women, 13 men) began, and 44 completed, a writing project. At pretest, they completed measures of depression, anxiety, grief, impact, and non-routine health visits. Then, they were randomly assigned to write about either the bereavement experience (profound condition), or innocuous topics (trivial condition). They wrote for 15 minutes a day for four days, then completed the same measures a second time (posttest). Six weeks later, they were mailed the same measures again (follow-up). A 2 (CONDITION: Profound versus Trivial) x 3 (Time: Pre-, Post-, or Follow-up) MANOVA yielded a significant main effect for time, but no main effect for condition and no interaction. Follow-up ANOVAs indicated that, across conditions, from pretest to follow-up testing participants reported less anxiety and depression, less impact, greater grief recovery, but about the same health center visits. A 2 (CONDITION) x 4 (Writing Day) MANOVA and follow-up tests indicated that those in the profound condition reported less subjective distress from Day 1 to Day 3, compared to those in the trivial condition. Combined with Kovac and Range (1999), present results suggest that writing projects may be more beneficial to those experiencing the unique bereavement of suicidal death, rather than those experiencing the nonintentional death of a loved one by accident or homicide.

https://www.ncbi.nlm.nih.gov/pubmed/11010659