title: Randomized Controlled Trial of Online Expressive Writing to Address Readjustment Difficulties Among U.S. Afghanistan and Iraq War Veterans.
abstract: We examined the efficacy of a brief, accessible, nonstigmatizing online intervention-writing expressively about transitioning to civilian life. U.S. Afghanistan and Iraq war veterans with self-reported reintegration difficulty (N = 1,292, 39.3% female, M = 36.87, SD = 9.78 years) were randomly assigned to expressive writing (n = 508), factual control writing (n = 507), or no writing (n = 277). Using intention to treat, generalized linear mixed models demonstrated that 6-months postintervention, veterans who wrote expressively experienced greater reductions in physical complaints, anger, and distress compared with veterans who wrote factually (ds = 0.13 to 0.20; ps < .05) and greater reductions in PTSD symptoms, distress, anger, physical complaints, and reintegration difficulty compared with veterans who did not write at all (ds = 0.22 to 0.35; ps ≤ .001). Veterans who wrote expressively also experienced greater improvement in social support compared to those who did not write (d = 0.17). Relative to both control conditions, expressive writing did not lead to improved life satisfaction. Secondary analyses also found beneficial effects of expressive writing on clinically significant distress, PTSD screening, and employment status. Online expressive writing holds promise for improving health and functioning among veterans experiencing reintegration difficulty, albeit with small effect sizes.
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA.|Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.|Departments of Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Nina A
authors.initials: NA
authors.lastname: Sayer
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA.|Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Siamak
authors.initials: S
authors.lastname: Noorbaloochi
authors.affiliation: Department of Psychology, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Frazier
authors.affiliation: Department of Psychology, University of Texas, Austin, Texas, USA.
authors.forename: James W
authors.initials: JW
authors.lastname: Pennebaker
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Orazem
authors.affiliation: National Center for PTSD, White River Junction, Vermont, USA.|Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
authors.forename: Paula P
authors.initials: PP
authors.lastname: Schnurr
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA.|Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.|Section of General Internal Medicine, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA.
authors.forename: Maureen
authors.initials: M
authors.lastname: Murdoch
authors.affiliation: Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, Oregon, USA.|Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon, USA.
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Carlson
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VA Healthcare System, Minneapolis, Minnesota, USA.
authors.forename: Amy
authors.initials: A
authors.lastname: Gravely
authors.affiliation: VA Boston Healthcare System, Boston, Massachusetts, USA.|Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Brett T
authors.initials: BT
authors.lastname: Litz
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D055826:Afghan Campaign 2001-; D005260:Female; D006801:Humans; D020407:Internet; D054542:Iraq War, 2003-2011; D016014:Linear Models; D008297:Male; D010549:Personal Satisfaction; D012737:Sex Factors; D012917:Social Adjustment; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D014481:United States; D014728:Veterans / Q000523:psychology*; D014956:Writing