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 (N = 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.

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.

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.

Writing therapy after traumatic events: therapeutic approaches and mechanisms of change

Psychother Psychosom Med Psychol. 2013 Sep;63(9-10):391-7. doi: 10.1055/s-0033-1349078. Epub 2013 Oct 11.

Knaevelsrud C1, Böttche M.

The (written) disclosure of information, thoughts and emotions of individually significant tops is associated with positive effects on well-being and the psychological health. The applicability of expressive writing as a psychotherapeutic intervention for stress reactions after stressful/traumatic life events were also intensely discussed in the clinical context. However, structural and content-related variation of the initial writing paradigm resulted in significantly different effects on general psychological health and posttraumatic stress symptoms.This overview provides current findings to application and efficacy of expressive writing respectively writing therapy for posttraumatic stress disorder. Mechanisms of expressive writing (inhibition, habituation, construction of a coherent narrative, emotion regulation, social integration) are analyzed with regard to their relevance concerning PTSD. Finally, potentials for application in the clinical practice are discussed.