Health benefits derived from personal trauma disclosure are well established. This study examined whether disclosing emotions generated by imaginative immersion in a novel traumatic event would similarly enhance health and adjustment. College women, preselected for trauma presence, were randomly assigned to write about real traumas, imaginary traumas, or trivial events. Yoked real-trauma and imaginary-trauma participants wrote about real-trauma participants' experiences. Imaginary-trauma participants were significantly less depressed than real-trauma participants at immediate posttest, but they were similarly angry, fearful, and happy. Compared with control group participants, both trauma groups made significantly fewer illness visits at 1-month follow-up; however, real-trauma participants reported more fatigue and avoidance than did the other groups. Imaginary-trauma group effects could reflect catharsis, emotional regulation, or construction of resilient possible selves.

Recent studies have found a significant association between PTSD and low heart rate variability (HRV), a biomarker of autonomic dysregulation. Research indicates that respiratory sinus arrhythmia (RSA) biofeedback increases HRV while reducing related pathological symptoms. This controlled pilot study compared RSA biofeedback to progressive muscle relaxation (PMR) as adjunctive interventions for 38 persons with PTSD symptoms in a residential treatment facility for a substance use disorder. Both groups were assessed at pre-intervention and 4-week post-intervention. Group x time interactions revealed significantly greater reductions in depressive symptoms and increases in HRV indices for the RSA group. Both groups significantly reduced PTSD and insomnia symptoms and a statistical trend was observed for reduced substance craving for the RSA group. Increases in HRV were significantly associated with PTSD symptom reduction. Overall, these results provide preliminary support for the efficacy of RSA biofeedback in improving physiological and psychological health for individuals with PTSD.

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.

the brightest spot of all is that at least I can write down all my thoughts and feelings; otherwise, I'd absolutely suffocate." -Anne Frank (March 16, 1944)There is mounting evidence that people who have experienced stressful life events reap physical and psychological health benefits when they engage in expressive writing (Smyth, 1998). In this chapter, we discuss how self-regulation processes might mediate the beneficial effects of expressive writing. Specifically, we suggest that expressive writing can improve regulation of emotion-related experience, physiological responses, and behaviors, which, in turn, can enhance physical and mental health outcomes (also see M. A. Greenberg 6r Lepore, in press). EMOTIONMore than a century ago, Darwin (1872) and James (1884) suggested that emotions are adaptive behavioral and physiological response tenden-

Cognitive processing theories of post‐traumatic adaptation (Horowitz, 1986a; Janoff‐Bulman, 1992) propose that repeated comparisons of trauma content with preexisting cognitive schemas result in trauma reappraisal or schematic revision. Thus, intrusive ruminations should facilitate cognitive integration and resolution of past traumas. However, research has shown that some survivors become stuck in endless, repetitive rumination cycles. This raises the issue of how to differentiate ruminations that promote cognitive integration from those that merely prolong or exacerbate psychological distress. Identifying substantive dimensions for categorizing cognitions about past traumas could enhance prediction of their effects on adjustment and inform clinical treatment interventions. This paper seeks to: (a) Assess the current state of theoretical knowledge concerning cognitive adaptation to trauma, (b) integrate theoretical postulates with empirical research findings, (c) define gaps or inconsistencies in our understanding of the cognitive adaptation process, and (d) identify foci for future theory and research.

Self-report, situation-specific assessments of coping, such as the Ways of Coping Scale (WOC), have been used frequently in recent years. Several potential issues in the development and use of these questionnaires have been identified, including the applicability of coping items to different kinds of stressful events, the definition of the period for which Ss report coping efforts, and the meaning of the "extent" response key that is used for reporting coping items. In this study, 91 college students completed the WOC and were then interviewed about their responses; interview questions were focused on the 3 issues stated above. The hypothesized concerns about the WOC were supported. Many of the coping items were not applicable to certain kinds of stressful events. Also, how the coping report period was defined varied across Ss and the way in which the extent response key was interpreted differed across both Ss and WOC items.

This study evaluated a theoretically and empirically based model of the progression of acute neck and back pain to chronic pain and disability, developed from the literature in chronic pain, cognition, and stress and trauma. Clinical information and standardized psychosocial measures of cumulative traumatic events exposure (TLEQ), depressed mood (CES-D), pain (DDS), physical disability (PDI), and pain beliefs (PBPI) were collected at baseline from 84 acute back pain patients followed at an Acute Back Clinic over 3 months. Path analysis was used for the longitudinal prediction of perceived pain and disability. The predictive model accounted for 26% of the variance in persistent pain intensity and 58% of the variance in perceived physical disability at 3 months. Greater exposure to past traumatic life events and depressed mood were most predictive of chronic pain; depressed mood and negative pain beliefs were most predictive of chronic disability. More cumulative traumatic life events, higher levels of depression in the early stages of a new pain episode, and early beliefs that pain may be permanent significantly contribute to increased severity of subsequent pain and disability. Replication in a larger sample is desirable to confirm these paths. Early detection of elevated depressive symptoms and high trauma exposure may identify individuals at greater risk for developing chronic pain syndromes who may benefit from early multidisciplinary intervention.

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