The Effects Of Web-Based Interactive Emotional Disclosure On Stress And Health: A Randomized, Controlled Study

The purpose of this study was to develop and assess the relative effectiveness of two novel alternatives to standard written emotional disclosure for coping with stressful traumatic experiences. In addition to standard emotional disclosure and time management writing control conditions, two guided feedback conditions were created with a goal of enhancing the disclosure paradigm by eliciting the most effective components of disclosure writing. All of the writing conditions in the study utilized the internet for both completion of the writing and receipt of feedback in the indicated conditions. The guided conditions included a feedback writing condition in which guidance was provided between writing sessions and an instant message condition in which guidance was provided in real-time during the writing session. It was hypothesized that all disclosure groups would exhibit improvements in symptoms as measured by the BSI Global Severity Index, the IES-R total score, the PHS total score, and a concurrent increase in PTGI overall scale ratings relative to the control writing condition. Furthermore, it was anticipated that participants in the instant message condition would exhibit the greatest amount of symptom reduction and posttraumatic growth on the selected outcome measures, followed by the feedback writing condition, the standard emotional disclosure condition, and that the control condition would exhibit minimal symptom change or growth. Participants (N = 163) were undergraduate students enrolled in psychology courses. The participants were pre-screened to include only those who reported having experienced a trauma or stressor that continued to bother them and cause intrusive, avoidant, and hyperarousal symptoms. Invited participants who consented to involvement with the study completed baseline questionnaires and were randomized to experimental condition of either time management control, standard emotional disclosure, feedback, or instant message writing at their second laboratory visit. Participants completed three 30-minute writing sessions over the course of one week, and 151 participants returned to complete follow-up questionnaires six weeks after their initial writing session. The study hypotheses were not supported and the groups were found to be generally equivalent with regard to psychiatric and physical symptom reduction as well as posttraumatic growth. Each group exhibited reduction in symptoms on the BSI, IES-R, and PHS, and unexpected reductions in PTGI scores. Further analyses revealed that the experimental conditions were initially perceived as equally credible interventions, although at follow-up the feedback enhanced conditions were deemed most credible. The instant message condition performed differently than the other disclosure conditions in that it produced a less intense emotional reaction to the writing sessions, which may in part be a product of the relatively brief content produced relative to the to the other disclosure conditions. It was determined that future studies may benefit from selection of a more neutral control writing condition and possibly also sampling from a clinical population. Despite the lack of support for the study hypotheses, it is too early to dismiss the potential benefits of internet-based feedback-enhanced emotional disclosure interventions for patients who are unable or unwilling to access traditional PTSD treatment