Journal Article

Unexpected effects of expressive writing on post-disaster distress in the Hurricane Harvey Study: a randomized controlled trial in perinatal women

Paquin, Vincent, Lipschutz, Rebecca, Biekman, Brian, Laplante, David P., Olson, David, King, Suzanne, Brunet, Alain, Elgbeili, Guillaume, Bick, Johanna

2022

Overview

Expressive writing requires journaling stressor-related thoughts and feelings over four daily sessions of 15 min. Thirty years of research have popularized expressive writing as a brief intervention for fostering trauma-related resilience; however, its ability to surpass placebo remains unclear. This study aimed to determine the efficacy of expressive writing for improving post-traumatic stress symptoms in perinatal women who were living in the Houston area during major flooding caused by Hurricane Harvey. A total of 1090 women were randomly allocated (1:1:1) to expressive writing, neutral writing or no writing. Interventions were internet-based. Online questionnaires were completed before randomization and at 2 months post-intervention. The primary outcome was post-traumatic stress symptoms, measured with the Impact of Event Scale-Revised; secondary outcomes were affective symptoms, measured with the 40-item Inventory of Depression and Anxiety Scales. Feelings throughout the intervention were reported daily using tailored questionnaires. In intention-to-treat analyses, no post-treatment between-group differences were found on the primary and secondary outcomes. Per-protocol analyses yielded similar results. A number of putative moderators were tested, but none interacted with expressive writing. Expressive writing produced greater feelings of anxiety and sadness during the intervention compared to neutral writing; further, overall experiences from the intervention mediated associations between expressive writing and greater post-traumatic stress at 2 months post-intervention. Among disaster-stricken perinatal women, expressive writing was ineffective in reducing levels of post-traumatic stress, and may have exacerbated these symptoms in some.

• Publisher: Cambridge University Press
• Subject: Affective symptoms / Anxiety / Brief interventions / Clinical trials / Disaster recovery / Disaster relief / Disasters / Efficacy / Emotions / Floods / Hurricanes / Internet / Intervention / Measures / Mental depression / Mental disorders / Mental health / Moderators / Natural disasters / Original Article / Perinatal / Post traumatic stress disorder / Pregnancy / Psychological distress / Questionnaires / Resilience / Sadness / Scholarship / Stress / Trauma / Women / Womens health / Writing