title: The effects of expressive writing before or after punch biopsy on wound healing.
abstract: OBJECTIVE
  Recent studies have shown that written emotional disclosure (expressive writing) performed in the two weeks prior to wounding improves healing of punch biopsy wounds. In many clinical settings, it would be more practical for patients to perform this intervention after wounding. The aim of this study was to investigate whether expressive writing could speed the healing of punch biopsy wounds if writing was performed after wounds were made.
  
  
  METHODS
  One hundred and twenty-two healthy participants aged between 18 and 55years were randomly allocated to one of four groups in a 2 (intervention) by 2 (timing) design. Participants performed either expressive writing or neutral writing, either before or after receiving a 4mm punch biopsy wound. Wounds were photographed on day 10 (primary endpoint) and day 14 after the biopsy to measure epithelisation. Participants also completed questionnaires on stress and affect two weeks prior to the biopsy, on the day of biopsy and two weeks after biopsy.
  
  
  RESULTS
  There was a significant difference in healing at day 10 between groups, χ2(3, N=97)=8.84, p=0.032. A significantly greater proportion of participants who performed expressive writing before the biopsy had fully reepithelialised wounds on day 10 compared to participants who performed neutral writing either before or after wounding, with no other significant differences between groups. Amongst people who wrote expressively after wounding, those who finished writing over the first 6days were significantly more likely to be healed at 14days than those who finished writing later. There were significant differences in positive and negative affect over the healing period between the pre and post expressive writing groups.
  
  
  CONCLUSIONS
  Expressive writing can improve healing if it is performed prior to wounding. Performing expressive writing after wounding may be able to improve healing depending on the timing of writing and wound assessment. Expressive writing causes affect to worsen followed by subsequent improvement and it is important to consider this in the timing of intervention delivery. Further research with patient groups is required to determine the clinical relevance of these findings.
authors.affiliation: Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92109, Auckland 1142, New Zealand. Electronic address: hrob458@aucklanduni.ac.nz.
authors.forename: Hayley
authors.initials: H
authors.lastname: Robinson
authors.affiliation: Department of Dermatology, Counties Manukau District Health Board, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand; Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92109, Auckland 1142, New Zealand. Electronic address: Paul.Jarrett@middlemore.co.nz.
authors.forename: Paul
authors.initials: P
authors.lastname: Jarrett
authors.affiliation: Division of Primary Care, School of Medicine, Faculty of Medical and Health Sciences, The University of Nottingham, Nottingham NG7 2RD, United Kingdom. Electronic address: kavita.vedhara@nottingham.ac.uk.
authors.forename: Kavita
authors.initials: K
authors.lastname: Vedhara
authors.affiliation: Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92109, Auckland 1142, New Zealand. Electronic address: e.broadbent@auckland.ac.nz.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Broadbent
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin; D013315:Stress, Psychological / Q000523:psychology*; D014945:Wound Healing / Q000502:physiology*; D014956:Writing; D055815:Young Adult
keywords: Affect; Biopsy; Expressive writing; Post; Pre; Wound healing