Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-22T05:25:01.412Z Has data issue: false hasContentIssue false

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
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: [email protected]

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.

Type
Original Article
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

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), 614626. 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), 716722. 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), 149. 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), 832843. doi: 10.1037/fam0000027.CrossRefGoogle ScholarPubMed
Broglio, K. (2018). Randomization in clinical trials: Permuted blocks and stratification. JAMA, 319(21), 22232224. 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), 14801485. 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), 14891496. 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, 110. 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), 823865. 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), 169183. 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), 11831193. 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), 400410. 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), 547560. 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), 464488. 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), 542555. 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, 512. 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), 230250. 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), 139. 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), 176184. 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), 381390. 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), 640659. 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), 233239. 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), 138. 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), 167. 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, 2664.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), 253268.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. 399411). New York, NY: The Guilford Press.Google Scholar
Supplementary material: File

Paquin et al. supplementary material

Paquin et al. supplementary material

Download Paquin et al. supplementary material(File)
File 197.7 KB