Background and Purpose Behavioral medicine interventions that directly reduce arousal and negative emotions, such as relaxation training (RT), are conceptually different from interventions that temporarily increase negative emotions, such as written emotional disclosure (WED), but no studies have directly compared their efficacy. We compared the effects of RT and WED on people with tension or migraine headaches. Methods College students with either tension (n = 51) or migraine (n = 90) headaches were randomized to 1 of 3 groups: RT, WED, or a neutral writing control condition; 4 sessions were held over 2 weeks. Mood was measured before and after each session, and outcomes (headache frequency, severity, disability, and general physical symptoms) were assessed at baseline and at 1-month and 3-month follow-ups. Results As expected, RT led to an immediate increase in calmness, whereas WED led to an immediate increase in negative mood, for both headache samples. Intent-to-treat analyses showed that for the tension headache sample, RT led to improved headache frequency and disability compared to both WED and the control group, but WED had no effect. For migraine headaches, RT improved pain severity relative to the control group, but WED again had no effect. Conclusions A brief RT protocol was effective for tension headaches, but WED had no effect on health status for either tension or migraine headaches. Modifications to WED, such as targeting people with unresolved stress, providing guidance to enhance the potency of the writing, or including additional at-home writing and exposure exercises, may improve its efficacy for people with headaches and other health problems.
Alexithymia is more correlated with pain severity among African Americans with chronic pain disorders than among Caucasians, potentially contributing to the higher pain reports among African Americans.
Objectives-We tested whether emotional skills and headache management self-efficacy (HMSE) moderated effects of written emotional disclosure (WED) compared to control writing and a different intervention, relaxation training (RT).Design/Methods-Undergraduates with migraine headaches reported emotional approach coping (EAC) and HMSE; were randomized to WED, RT, or control; and assessed on health measures at baseline and 3-month follow-up.Results-Greater EAC predicted improvement following WED compared to RT and control, whereas low HMSE predicted improvement following both WED and RT, compared to control.Conclusions-Emotional skill may specifically-and low health management self-efficacy may generally-predict positive responses to WED.Written emotional disclosure (WED) has modest benefits for people with health problems, but personality differences likely moderate its effects. Also, comparing WED to another intervention can test whether moderators are specific to WED or general to various interventions. Relaxation training (RT) may be an ideal comparison intervention.We hypothesized that having emotional skills predicts benefits of WED, but may be irrelevant for RT. In contrast, being low in self-efficacy to manage health problems may predict benefits of both interventions. We tested these two moderators on the effects of WED, RT, and neutral control writing in young adults with migraine headaches. Methods Participants and ProceduresNinety undergraduates (80 women; age M=21.4; 59% European American, 19% African American, 22% other) reporting migraines at least once per month, came individually to the lab, had a diagnostic interview to confirm migraines, and completed baseline moderator and health measures. They were randomized into groups and conducted four, 20-minute lab sessions over two weeks. Follow-up assessments were scheduled at 1 and 3 months.The WED group was instructed to write about facts and feeling about a stressful experience, and to try to write about the same topic repeatedly, create a narrative, and relate the stressor to their lives. The RT group listened to 20-minute sections of an audiotape that trained participants , 2000). Outcome measures were headache frequency (number of days in the last month with a headache), pain severity rated on the McGill Pain Questionnaire-short form (Melzack, 1987), functional and emotional disability rated on the 25-item Headache Disability Inventory (Jacobson, Ramadan, Aggarwal, & Newman, 1994), and negative and positive affect for the past month rated on the Positive and Negative Affect Schedule (Watson, Clark, & Tellegen, 1988). Data Analytic ApproachEight-two participants (91%) provided outcome data (58: both follow-ups; 17: 1-month only; 7: 3-month only); 8 dropped without follow-up. Groups did not differ in who lacked complete follow-up data (11 WED, 10 RT, 11 TMC). We analyzed the final available outcomes using intent-to-treat analyses (replacing the eight missing outcomes with baseline values). To test moderation, we examined interaction terms (m...
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. Does Written Emotional Disclosure about Stress Improve College Students' Academic Performance? Results from Three Randomized, Controlled StudiesAcademic performance and retention of college students are influenced by many factors, but psychological stress in particular appears to cause poorer performance and attrition (Haines, Norris, & Kashy, 1996;Meilman, Manley, Gaylor, & Turco, 1992;Misra, McKean, West, & Russo, 2000). Stressful life experiences and resulting emotional struggles may impair academic performance and increase attrition by interfering with adaptive behaviors, such as studying or class attendance, or by hindering vital cognitive processes, such as concentration.The consequences of stressful events, however, hinge on how the experience and associated negative emotions are processed and resolved (Borkovec, Roemer, & Kinyon, 1995;Horowitz, 1986). In general, inhibiting or avoiding thoughts and feelings related to stressors serves to prolong or exacerbate the stress response and has maladaptive emotional, cognitive, and behavioral effects. In contrast, resolution of stressors is facilitated when people voluntarily recall a stressful event, experience and express the emotions related to it,
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