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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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