title: Randomized controlled expressive writing pilot in individuals with Parkinson's disease and their caregivers.
abstract: BACKGROUND
  Individuals with Parkinson's disease (PD) and their caregivers are at risk for emotional distress and hypercortisolism. Expressive writing is an effective complementary intervention to ameliorate the psychological and physiological effects of chronic illness. This pilot study aimed to evaluate feasibility and preliminary effectiveness of an expressive writing intervention for individuals with PD and their caregivers.
  
  
  METHODS
  Individuals with PD (N = 27) and their caregivers (N = 14) were randomly assigned to expressive (N = 15 patients, eight caregivers) or neutral (N = 12 patients, six caregivers) writing conditions. Cortisol awakening response (CAR), non-motor functioning, quality of life, and performance on tests of cognitive functioning were assessed at baseline, immediate post, 4-month, and 10-month post intervention.
  
  
  RESULTS
  Attrition was a challenge as eight patients (29.62 %) and four caregivers (28.57 %) chose to discontinue before beginning the intervention or were lost to follow up prior to completing the intervention or the first follow up visit. Significant reduction in anxiety, marginally significant improvement in depression and caregiver burden, and significant improvements in performance on tests of learning and memory were observed, but these changes did not differ by writing condition. CAR significantly differed over time between patients and caregivers and writing conditions.
  
  
  CONCLUSIONS
  Some evidence for the feasibility and effectiveness of writing to alleviate hypercortisolism was demonstrated in a small sample of PD patients; however, relatively high attrition rates and the lack of difference between expressive and neutral writing conditions on emotional and neurocognitive outcomes suggests expressive writing procedure modifications may be needed to obtain optimal results for this population.
  
  
  BACKGROUND
  ClinicalTrials.gov, NCT02217735 , Study Start Date: August 30, 2011.
authors.affiliation: Parkinson's and Movement Disorders Center, Virginia Commonwealth University, P.O. Box 980539, Richmond, VA, 23298-0539, USA. theresevcash@gmail.com.|Department of Psychology, Virginia Commonwealth University, Richmond, USA. theresevcash@gmail.com.
authors.forename: Therese Verkerke
authors.initials: TV
authors.lastname: Cash
authors.affiliation: Parkinson's and Movement Disorders Center, Virginia Commonwealth University, P.O. Box 980539, Richmond, VA, 23298-0539, USA. sarah.lageman@vcuhealth.org.|Department of Neurology, Virginia Commonwealth University, Richmond, USA. sarah.lageman@vcuhealth.org.
authors.forename: Sarah K
authors.initials: SK
authors.lastname: Lageman
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D017028:Caregivers / Q000523:psychology*; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*; D010865:Pilot Projects; D011788:Quality of Life / Q000523:psychology; D013315:Stress, Psychological / Q000628:therapy; D014956:Writing; D055815:Young Adult