title: Does emotional disclosure about stress improve health in rheumatoid arthritis? Randomized, controlled trials of written and spoken disclosure.
abstract: Studies of the effects of disclosing stressful experiences among patients with rheumatoid arthritis (RA) have yielded inconsistent findings, perhaps due to different disclosure methods--writing or speaking--and various methodological limitations. We randomized adults with RA to a writing (n=88) or speaking (to a recorder) sample (n=93), and within each sample, to either disclosure or 1 of 2 control groups (positive or neutral events), which conducted four 20-minute, at-home sessions. Follow-up evaluations at 1, 3, and 6 months included self-reported, behavioral, physiological, and blinded physician-assessed outcomes. In both writing and speaking samples, the disclosure and control groups were comparably credible, and the linguistic content differed as expected. Covariance analyses at each follow-up point indicated that written disclosure had minimal effects compared with combined controls--only pain was reduced at 1 and 6 months, but no other outcomes improved. Spoken disclosure led to faster walking speed at 3 months, and reduced pain, swollen joints, and physician-rated disease activity at 6 months, but there were no effects on other outcomes. Latent growth curve modeling examined differences in the trajectory of change over follow-up. Written disclosure improved affective pain and walking speed; spoken disclosure showed only a marginal benefit on sensory pain. In both analyses, the few benefits of disclosure occurred relative to both positive and neutral control groups. We conclude that both written and spoken disclosure have modest benefits for patients with RA, particularly at 6 months, but these effects are limited in scope and consistency.
authors.affiliation: Wayne State University, Detroit, MI, USA Henry Ford Health System, Detroit, MI, USA Oakland University, Rochester, MI, USA Boise State University, Boise, Idaho, USA Chelsea Community Hospital, Chelsea, MI, USA John D. Dingell Veterans Affairs Medical Center, MI, USA Kamil Orthopedic Group, West Bloomfield, MI, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Lumley
authors.forename: James C C
authors.initials: JCC
authors.lastname: Leisen
authors.forename: Ty R
authors.initials: TR
authors.lastname: Partridge
authors.forename: Tina M
authors.initials: TM
authors.lastname: Meyer
authors.forename: Alison M
authors.initials: AM
authors.lastname: Radcliffe
authors.forename: Debra J
authors.initials: DJ
authors.lastname: Macklem
authors.forename: Linda A
authors.initials: LA
authors.lastname: Naoum
authors.forename: Jay L
authors.initials: JL
authors.lastname: Cohen
authors.forename: Lydia M
authors.initials: LM
authors.lastname: Lasichak
authors.forename: Michael R
authors.initials: MR
authors.lastname: Lubetsky
authors.forename: Angelia D
authors.initials: AD
authors.lastname: Mosley-Williams
authors.forename: Jose L
authors.initials: JL
authors.lastname: Granda
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001172:Arthritis, Rheumatoid / Q000473:pathology / Q000503:physiopathology / Q000523:psychology*; D030881:Disclosure; D004644:Emotions / Q000502:physiology*; D004912:Erythrocytes / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008037:Linguistics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009043:Motor Activity / Q000502:physiology; D010147:Pain Measurement; D012189:Retrospective Studies; D057566:Self Report; D013315:Stress, Psychological / Q000523:psychology*; D013997:Time Factors; D016138:Walking / Q000502:physiology