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

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Effects of mode of writing on emotional narratives.

J Trauma Stress. 1999 Apr;12(2):355-61.

Brewin CR, Lennard H.

The authors hypothesized that writing longhand about a stressful experience, compared to typing, arouses greater negative emotion. Eighty college students were randomly assigned to describe either a neutral or stressful topic by typing or writing longhand, in a 2 x 2 factorial design. Students describing the stressful topic, compared to the neutral topic, wrote for a longer period, used more words, and reported greater negative and less positive affect. Consistent with prediction, writing about a stressful experience longhand induced greater negative affect than typing, and led to more self-rated disclosure. These findings suggest a method whereby therapists can help patients control their levels of negative affect when producing a trauma narrative.

https://www.ncbi.nlm.nih.gov/pubmed/10378172