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

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.

Prenatal stress from the COVID-19 pandemic predicts maternal postpartum anxiety as moderated by psychological factors: The Australian BITTOC Study

“…At two-months postpartum, the scale asked women to report their hardship throughout their entire pregnancy. We patterned this new scale after questionnaires our group ( www.mcgill.ca/spiral ) has developed in the past to capture objective events occurring during environmental crises such as the 1998 Quebec ice storm ( Laplante et al, 2007 ), the 2008 Iowa floods ( Ping et al, 2015 ), the 2011 flooding in Queensland ( King et al, 2015 ), the 2016 Fort McMurray, Alberta wildfires ( Olson et al, 2019 ), and the 2017 floods in Houston, Texas following Hurricane Harvey ( Paquin et al, 2021a ). Each scale must be tailor made to reflect the typical experiences of those exposed to the particular event.…”

“…A team of researchers then works together to weight the responses to individual items to reflect the relative hardship imposed by each, and to make each category worth the same potential maximum number of points. The objective hardship scales from these previous disaster studies have predictive validity for maternal outcomes such as post-partum depression ( Brock et al, 2014 ; Kildea et al, 2018 ; Paquin et al, 2021a ) and anxiety ( Kildea et al, 2018 ; Paquin et al, 2021a ). For the pandemic in Australia, the measure has three subscales: Threat50 (e.g., the extent to which a participant or their friends and family members suffered from COVID-19 symptoms), Loss50 (e.g., financial loss), and Change50 (e.g., change in daily routines, employment, and pregnancy plans).…”

Exploring the use of AI text-to-image generation to downregulate negative emotions in an expressive writing application

“…Thus, internet-based technologies have been applied in the field of healthcare to promote better self-monitoring [ 29 , 30 ]. However, researchers have also warned about the potential negative effects of technology-mediated writing tools, highlighting how unsupervised writing exercises that require users to write about distressing past events could stimulate negative emotions and reduce the exercise’s overall effectiveness [ 11 , 14 ].…”

“…Open Sci. 10: 220238 also warned about the potential negative effects of technology-mediated writing tools, highlighting how unsupervised writing exercises that require users to write about distressing past events could stimulate negative emotions and reduce the exercise's overall effectiveness [11,14].…”

“…In a meta-analysis of 39 randomized controlled trials, Reinhold et al [ 10 ] found that expressive writing exerted only limited effects in reducing depressive symptoms, and sometimes exacerbated results in unpredictable ways. In unsupervised settings, expressive writing can occasionally increase psychological distress [ 11 , 12 ], even to the point of causing patients to discontinue their treatment [ 13 , 14 ]. These conflicting findings indicate that, despite the efficacy and convenience of expressive writing for emotion regulation, care should be taken when deploying this approach in self-directed practices.…”