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

Published online by Cambridge University Press:  12 March 2021

Vincent Paquin Open the ORCID record for Vincent Paquin [Opens in a new window] ,
Johanna Bick ,
Rebecca Lipschutz ,
Guillaume Elgbeili ,
David P. Laplante ,
Brian Biekman ,
Alain Brunet ,
Suzanne King  and
David Olson
Vincent Paquin
Affiliation:
Department of Psychiatry, McGill University, Montreal, QC, Canada Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada
Johanna Bick
Affiliation:
Department of Psychology, University of Houston, Houston, TX, USA
Rebecca Lipschutz
Affiliation:
Department of Psychology, University of Houston, Houston, TX, USA
Guillaume Elgbeili
Affiliation:
Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada
David P. Laplante
Affiliation:
Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada Center for Child Development and Mental Health, Lady Davis Institute for Medical Research, Montreal, QC, Canada
Brian Biekman
Affiliation:
Department of Psychology, University of Houston, Houston, TX, USA
Alain Brunet
Affiliation:
Department of Psychiatry, McGill University, Montreal, QC, Canada Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada
Suzanne King*
Affiliation:
Department of Psychiatry, McGill University, Montreal, QC, Canada Mental Health and Society Division, Douglas Research Centre, Montreal, QC, Canada
David Olson
Affiliation:
Department of Obstetrics and Gynaecology, University of Alberta, Edmonton, AB, Canada
*
Author for correspondence: Suzanne King, E-mail: suzanne.king@mcgill.ca
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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

Among disaster-stricken perinatal women, expressive writing was ineffective in reducing levels of post-traumatic stress, and may have exacerbated these symptoms in some.

Keywords

Expressive writingnatural disasterpost-traumatic stresspregnancy
Type
Original Article
Information
Psychological Medicine , Volume 52 , Issue 16 , December 2022 , pp. 3895 - 3903
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Amadeo, K. (2019). Hurricane Harvey Shows How Climate Change Can Impact the Economy. Retrieved April 26, 2020, from The Balance website: https://www.thebalance.com/hurricane-harvey-facts-damage-costs-4150087.Google Scholar
Ayers, S., Crawley, R., Button, S., Thornton, A., Field, A. P., Flood, C., … Smith, H. (2018). Evaluation of expressive writing for postpartum health: A randomised controlled trial. Journal of Behavioral Medicine, 41(5), 614–626. doi: 10.1007/s10865-018-9970-3.CrossRefGoogle Scholar
Beaglehole, B., Mulder, R. T., Frampton, C. M., Boden, J. M., Newton-Howes, G., & Bell, C. J. (2018). Psychological distress and psychiatric disorder after natural disasters: Systematic review and meta-analysis. The British Journal of Psychiatry, 213(6), 716–722. doi: 10.1192/bjp.2018.210.CrossRefGoogle ScholarPubMed
Bonanno, G. A., Brewin, C. R., Kaniasty, K., & Greca, A. M. L. (2010). Weighing the costs of disaster: Consequences, risks, and resilience in individuals, families, and communities. Psychological Science in the Public Interest, 11(1), 1–49. doi: 10.1177/1529100610387086.CrossRefGoogle ScholarPubMed
Brock, R. L., O'Hara, M. W., Hart, K. J., McCabe, J. E., Williamson, J. A., Laplante, D. P., … King, S. (2014). Partner support and maternal depression in the context of the Iowa floods. Journal of Family Psychology, 28(6), 832–843. doi: 10.1037/fam0000027.CrossRefGoogle ScholarPubMed
Broglio, K. (2018). Randomization in clinical trials: Permuted blocks and stratification. JAMA, 319(21), 2223–2224. doi: 10.1001/jama.2018.6360.CrossRefGoogle ScholarPubMed
Brunet, A., Weiss, D. S., Metzler, T. J., Best, S. R., Neylan, T. C., Rogers, C., … Marmar, C. R. (2001). The peritraumatic distress inventory: A proposed measure of PTSD criterion A2. American Journal of Psychiatry, 158(9), 1480–1485. doi: 10.1176/appi.ajp.158.9.1480.CrossRefGoogle ScholarPubMed
Creamer, M., Bell, R., & Failla, S. (2003). Psychometric properties of the impact of event scale—revised. Behaviour Research and Therapy, 41(12), 1489–1496. doi: 10.1016/j.brat.2003.07.010.CrossRefGoogle ScholarPubMed
Dancause, K. N., Laplante, D. P., Hart, K. J., O'Hara, M. W., Elgbeili, G., Brunet, A., & King, S. (2015). Prenatal stress due to a natural disaster predicts adiposity in childhood: The iowa flood study. Journal of Obesity, 2015, 1–10. doi: 10.1155/2015/570541.CrossRefGoogle ScholarPubMed
Foa, E., Hembree, E. A., Rothbaum, B. O., & Rauch, S. (2019). Prolonged exposure therapy for PTSD: Emotional processing of traumatic experiences - therapist guide. In prolonged exposure therapy for PTSD. New York, NY: Oxford University Press. Retrieved from http://www.oxfordclinicalpsych.com/view/10.1093/med-psych/9780190926939.001.0001/med-9780190926939.CrossRefGoogle Scholar
Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132(6), 823–865. doi: 10.1037/0033-2909.132.6.823.CrossRefGoogle ScholarPubMed
Goldmann, E., & Galea, S. (2014). Mental health consequences of disasters. Annual Review of Public Health, 35(1), 169–183. doi: 10.1146/annurev-publhealth-032013-182435.CrossRefGoogle ScholarPubMed
Hoyt, M. A., Austenfeld, J., & Stanton, A. L. (2016). Processing coping methods in expressive essays about stressful experiences: Predictors of health benefit. Journal of Health Psychology, 21(6), 1183–1193. doi: 10.1177/1359105314550347.CrossRefGoogle ScholarPubMed
Laplante, D. P., Barr, R. G., Brunet, A., Du Fort, G. G., Meaney, M. L., Saucier, J.-F., … King, S. (2004). Stress during pregnancy affects general intellectual and language functioning in human toddlers. Pediatric Research, 56(3), 400–410. doi: 10.1203/01.PDR.0000136281.34035.44.CrossRefGoogle ScholarPubMed
Lenth, R. (2020). emmeans: Estimated Marginal Means, aka Least-Squares Means [R package version 1.4.6]. Retrieved from https://CRAN.R-project.org/package=emmeans.Google Scholar
Lepore, S. J., & Greenberg, M. A. (2002). Mending broken hearts: Effects of expressive writing on mood, cognitive processing, social adjustment and health following a relationship breakup. Psychology & Health, 17(5), 547–560. doi: 10.1080/08870440290025768.CrossRefGoogle Scholar
Mair, P., & Wilcox, R. (2020). Robust statistical methods in R using the WRS2 package. Behavior Research Methods, 52(2), 464–488. doi: 10.3758/s13428-019-01246-w.CrossRefGoogle Scholar
Mavranezouli, I., Megnin-Viggars, O., Daly, C., Dias, S., Welton, N. J., Stockton, S., … Pilling, S. (2020). Psychological treatments for post-traumatic stress disorder in adults: A network meta-analysis. Psychological Medicine, 50(4), 542–555. doi: 10.1017/S0033291720000070.CrossRefGoogle ScholarPubMed
Paquin, V., Elgbeili, G., Laplante, D. P., Kildea, S., & King, S. (2021). Positive cognitive appraisal “buffers” the long-term effect of peritraumatic distress on maternal anxiety: The Queensland Flood Study. Journal of Affective Disorders, 278, 5–12. doi: 10.1016/j.jad.2020.09.041.CrossRefGoogle ScholarPubMed
Pavlacic, J. M., Buchanan, E. M., Maxwell, N. P., Hopke, T. G., & Schulenberg, S. E. (2019). A meta-analysis of expressive writing on posttraumatic stress, posttraumatic growth, and quality of life. Review of General Psychology, 23(2), 230–250. doi: 10.1177/1089268019831645.CrossRefGoogle Scholar
Pennebaker, J. W., & Beall, S. K. (1986). Confronting a traumatic event: Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95(3), 274. doi: 10.1037/0021-843X.95.3.274.CrossRefGoogle ScholarPubMed
Qian, J., Zhou, X., Sun, X., Wu, M., Sun, S., & Yu, X. (2020). Effects of expressive writing intervention for women's PTSD, depression, anxiety and stress related to pregnancy: A meta-analysis of randomized controlled trials. Psychiatry Research, 288, 112933. doi: 10.1016/j.psychres.2020.112933.CrossRefGoogle ScholarPubMed
Reinhold, M., Bürkner, P.-C., & Holling, H. (2018). Effects of expressive writing on depressive symptoms—A meta-analysis. Clinical Psychology: Science and Practice, 25(1), e12224. doi: 10.1111/cpsp.12224.Google Scholar
Rose, S., Bisson, J., Churchill, R., & Wessely, S. (2002). Psychological debriefing for preventing post traumatic stress disorder (PTSD). Cochrane Database of Systematic Reviews, 2(CD000560), 1–39. 10.1002/14651858.CD000560.Google Scholar
Rose, S., Bisson, J., & Wessely, S. (2003). A systematic review of single-session psychological interventions (‘debriefing’) following trauma. Psychotherapy and Psychosomatics, 72(4), 176–184. doi: 10.1159/000070781.CrossRefGoogle ScholarPubMed
Sayer, N. A., Noorbaloochi, S., Frazier, P. A., Pennebaker, J. W., Orazem, R. J., Schnurr, P. P., … Litz, B. T. (2015). Randomized controlled trial of online expressive writing to address readjustment difficulties among U.S. Afghanistan and Iraq war veterans. Journal of Traumatic Stress, 28(5), 381–390. doi: 10.1002/jts.22047.CrossRefGoogle ScholarPubMed
Severson, E., Olson, J., Hyde, A., Brémault-Phillips, S., King, S., Bick, J., … Olson, D. (submitted for publication). Experiencing trauma during or before pregnancy: Qualitative secondary analysis after two natural disasters. [submitted for publication].Google Scholar
Simcock, G., Kildea, S., Elgbeili, G., Laplante, D. P., Stapleton, H., Cobham, V., & King, S. (2016). Age-related changes in the effects of stress in pregnancy on infant motor development by maternal report: The Queensland Flood Study. Developmental Psychobiology, 58(5), 640–659. doi: 10.1002/dev.21407.CrossRefGoogle ScholarPubMed
Sloan, D. M., Marx, B. P., Lee, D. J., & Resick, P. A. (2018). A brief exposure-based treatment vs cognitive processing therapy for posttraumatic stress disorder: A randomized noninferiority clinical trial. JAMA Psychiatry, 75(3), 233–239. doi: 10.1001/jamapsychiatry.2017.4249.CrossRefGoogle ScholarPubMed
Tingley, D., Yamamoto, T., Hirose, K., Keele, L., & Imai, K. (2014). Mediation: R package for causal mediation analysis. Journal of Statistical Software, 59(5), 1–38. 10.18637/jss.v059.i05..CrossRefGoogle Scholar
van Buuren, S., & Groothuis-Oudshoorn, K. (2011). Mice: Multivariate imputation by chained equations in R. Journal of Statistical Software, 45(1), 1–67. doi: 10.18637/jss.v045.i03.Google Scholar
van den Bergh, B. R. H., van den Heuvel, M. I., Lahti, M., Braeken, M., de Rooij, S. R., Entringer, S., … Schwab, M. (2017). Prenatal developmental origins of behavior and mental health: The influence of maternal stress in pregnancy. Neuroscience & Biobehavioral Reviews, 117, 26–64.CrossRefGoogle ScholarPubMed
Watson, D., O'Hara, M. W., Simms, L. J., Kotov, R., Chmielewski, M., McDade-Montez, E. A., … Stuart, S. (2007). Development and validation of the inventory of depression and anxiety symptoms (IDAS). Psychological Assessment, 19(3), 253–268.CrossRefGoogle ScholarPubMed
Weiss, D. S., & Marmar, C. R. (1997). The impact of event scale—revised. In Wilson, J. P. & Keane, T. M. (Eds.), Assessing psychological trauma and PTSD (pp. 399–411). New York, NY: The Guilford Press.Google Scholar
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