title: Effects of guided written disclosure of stressful experiences on clinic visits and symptoms in frequent clinic attenders.
abstract: BACKGROUND
  Psychosocial variables such as major stressful life events/daily stressful events have been associated with health care utilization.
  
  
  OBJECTIVE
  Our aim was to examine the effects of a guided disclosure protocol (GDP) of past traumas on symptoms and clinic visits among frequent clinic attenders.
  
  
  METHODS
  Forty-one frequent clinic attenders (> or =2 visits/3 months) took part. Patients were randomly assigned individually to either a casual content writing control group (n = 19) or a trauma content writing experimental GDP group (n = 22). GDP patients wrote about an upsetting event chronologically (day 1), verbally described their thoughts and feelings and described the event's impact on life (day 2), and finally wrote about their current perspective on and future coping with the event (day 3). Three months later, patients were reassessed blindly for symptoms and clinic visits, and an average of 15 months later they were assessed blindly for clinic visits again.
  
  
  RESULTS
  Compared with controls, GDP patients reported lower symptom levels at 3 months (2.3 versus 5.2), and made fewer clinic visits during the 3 (1.3 versus 3.0) and 15 month (5.1 versus 9.7) follow-ups. The percentage of GDP patients making > or =10 visits during the 15 month follow-up was smaller (10%) than among controls (33%).
  
  
  CONCLUSIONS
  The findings extend previous findings to frequent clinic users, using a new form of written disclosure aimed at shifting trauma from implicit to explicit memory. The GDP may be an inexpensive additional intervention in primary care for reducing symptoms and clinic visits among frequent clinic users.
authors.affiliation: Department of Sociology of Health, Ben-Gurion University, Be'er-Sheeba, Israel.
authors.forename: Yori
authors.initials: Y
authors.lastname: Gidron
authors.forename: Elaine
authors.initials: E
authors.lastname: Duncan
authors.forename: Alon
authors.initials: A
authors.lastname: Lazar
authors.forename: Aya
authors.initials: A
authors.lastname: Biderman
authors.forename: Howard
authors.initials: H
authors.lastname: Tandeter
authors.forename: Pesach
authors.initials: P
authors.lastname: Shvartzman
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D011320:Primary Health Care / Q000379:methods* / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012650:Self Disclosure; D013001:Somatoform Disorders / Q000523:psychology*; D013315:Stress, Psychological / Q000523:psychology*; D014956:Writing