Randomised controlled trial of expressive writing and quality of life in men and women treated for colon or rectal cancer.

Psychol Health. 2015;30(3):284-300. doi: 10.1080/08870446.2014.971798. Epub 2014 Oct 27.

Lepore SJ1, Revenson TA, Roberts KJ, Pranikoff JR, Davey A.

This randomised trial tested (i) whether a home-based expressive writing (EW) intervention improves quality of life in patients with colorectal cancer (CRC) and (ii) whether the intervention is more beneficial for men or for people who feel constrained in disclosing cancer-related concerns and feelings.

DESIGN:

Patients treated for CRC were randomised to an EW (n = 101) or control writing (CW; n = 92) group. Assessments were completed at 1 month pre- and post-intervention. Sex and perceived social constraints on disclosure were evaluated as moderators.

MAIN OUTCOME MEASURES:

Primary outcomes were depressive symptoms, sleep problems and quality of life indicators.

RESULTS:

Eighty-one per cent of participants completed all writing assignments. Consistent with hypotheses, relative to the CW group, participants in the EW group expressed more negative emotion in writing and rated their writings as more meaningful, personal and emotionally revealing. There were no significant main effects of EW or moderating effects of sex or social constraints on outcomes.

CONCLUSIONS:

Although EW is feasible to use with persons who have CRC, it was not effective as a stand-alone psychotherapeutic intervention. Neither was it more effective for men nor for people who felt they could not freely disclose cancer-related concerns and feelings.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289438/

Does Written Emotional Disclosure about Stress Improve College Students’ Academic Performance? Results from Three Randomized, Controlled Studies.

J Coll Stud Ret. 2010;12(4):407-428.

Radcliffe AM1, Stevenson JK, Lumley MA, D’Souza P, Kraft C.

Several early studies and subsequent reviews suggested that written emotional disclosure (WED)-writing repeatedly about personal stressful experiences-leads to improved academic performance of college students. Yet a critical review of available studies casts some doubt on this, so we conducted three randomized, controlled experiments of the effects of WED versus control writing on grade point average (GPA) of college students. In all three studies, WED writing was implemented effectively-it contained more negative emotion language and generated more negative mood than did control writing. In Study 1, WED did not influence GPA during either the writing semester or subsequent semester among 96 students with headaches. In Study 2, WED had no effect on GPA compared with either control writing or no writing conditions among 124 students with unresolved stress. In Study 3, WED did not influence GPA or retention among 68 academically at-risk ethnic minority students, although secondary analyses suggested some benefits of WED among students who wrote more than once, particularly men. These three studies challenge the belief that WED improves academic performance of college students, and research should examine subgroups of students who might benefit from WED.

full text

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3082942/

Targeting Interventions: Moderators of the Effects of Expressive Writing and Assertiveness Training on the Adjustment of International University Students.

Int J Adv Couns. 2011 Jun 1;33(2):101-112.

Hijazi AM1, Tavakoli S, Slavin-Spenny OM, Lumley MA.

Acculturative stress is a common experience for international students and is associated with psychological and physical problems. In a previous study, the authors reported that two stress reduction interventions-expressive writing (EW) and assertiveness training (AT)-had limited overall benefits among international students at an American University. The current analyses of data from that study investigated whether individual differences moderated the effects of EW and AT. Results indicate that greater acculturative stress at baseline predicted greater improvement from both interventions, compared with control. Women benefited more from AT than EW, except that EW improved women’s physical symptoms. Men benefited more from EW than AT. Students with limited emotional awareness and expression tended to benefit from both interventions, relative to control. Finally, nation of origin cultural differences generally did not predict outcomes. It is concluded that the benefits of EW and AT and can be enhanced by targeting these interventions to specific subgroups of international students.

https://www.ncbi.nlm.nih.gov/pubmed/21660220

Gender-specific effects of an augmented written emotional disclosure intervention on posttraumatic, depressive, and HIV-disease-related outcomes: a randomized, controlled trial.

J Consult Clin Psychol. 2013 Apr;81(2):284-98. doi: 10.1037/a0030814. Epub 2012 Dec 17.

Ironson G1, O’Cleirigh C, Leserman J, Stuetzle R, Fordiani J, Fletcher M, Schneiderman N.

Trauma histories and symptoms of PTSD occur at very high rates in people with HIV and are associated with poor disease management and accelerated disease progression. The authors of this study examined the efficacy of a brief written trauma disclosure intervention on posttraumatic stress, depression, HIV-related physical symptoms, and biological markers of HIV disease progression.

METHOD:

HIV-infected men and women were randomized to four 30-min expressive writing sessions in either a treatment (trauma writing) or an attention control (daily events writing) condition. The disclosure intervention augmented the traditional emotional disclosure paradigm with probes to increase processing by focusing on trauma appraisals, self-worth, and problem solving. Outcomes were assessed at baseline, 1-, 6-, and 12-month follow-up.

RESULTS:

Hierarchical linear modeling (N = 244, intent-to-treat analyses) revealed no significant treatment effects for the group as a whole. Gender by treatment group interactions were significant such that women in the trauma-writing group had significantly reduced posttraumatic stress disorder (PTSD) symptoms (p = .017), depression (p = .009), and HIV-related symptoms (p = .022) compared with their controls. In contrast, men in the trauma-treatment condition did not improve more than controls on any outcome variables. Unexpectedly, men in the daily-event-writing control group had significantly greater reductions in depression then men in the trauma-writing group. Treatment effects were magnified in women when the analysis was restricted to those with elevated PTSD symptoms at baseline.

CONCLUSIONS:

A brief (4-session) guided written emotional disclosure intervention resulted in significant and meaningful reductions in PTSD, depression, and physical symptoms for women with HIV, but not for men.

https://www.ncbi.nlm.nih.gov/pubmed/23244367