title: Randomized clinical trial of expressive writing on wound healing following bariatric surgery.
abstract: Writing emotionally about upsetting life events (expressive writing) has been shown to speed healing of punch-biopsy wounds compared to writing objectively about daily activities. We aimed to investigate whether a presurgical expressive writing intervention could improve surgical wound healing.
  
  
  
  Seventy-six patients undergoing elective laparoscopic bariatric surgery were randomized either to write emotionally about traumatic life events (expressive writing) or to write objectively about how they spent their time (daily activities writing) for 20 min a day for 3 consecutive days beginning 2 weeks prior to surgery. A wound drain was inserted into a laparoscopic port site and wound fluid analyzed for proinflammatory cytokines collected over 24 hr postoperatively. Expanded polytetrafluoroethylene tubes were inserted into separate laparoscopic port sites during surgery and removed after 14 days. Tubes were analyzed for hydroxyproline deposition (the primary outcome), a major component of collagen and marker of healing. Fifty-four patients completed the study.
  
  
  
  Patients who wrote about daily activities had significantly more hydroxyproline than did expressive writing patients, t(34) = -2.43, p = .020, 95% confidence interval [-4.61, -0.41], and higher tumor necrosis factor-alpha, t(29) = -2.42, p = .022, 95% confidence interval [-0.42, -0.04]. Perceived stress significantly reduced in both groups after surgery.
  
  
  
  Expressive writing prior to bariatric surgery was not effective at increasing hydroxyproline at the wound site 14 days after surgery. However, writing about daily activities did predict such an increase. Future research needs to replicate these findings and investigate generalizability to other surgical groups. (PsycINFO Database Record
authors.affiliation: Department of Psychological Medicine, The University of Auckland.
authors.forename: Heidi
authors.initials: H
authors.lastname: Koschwanez
authors.affiliation: Department of Psychological Medicine, The University of Auckland.
authors.forename: Hayley
authors.initials: H
authors.lastname: Robinson
authors.affiliation: Department of General Surgery, Auckland City Hospital.
authors.forename: Grant
authors.initials: G
authors.lastname: Beban
authors.affiliation: Department of Surgery, The University of Auckland.
authors.forename: Andrew
authors.initials: A
authors.lastname: MacCormick
authors.affiliation: Department of Surgery, The University of Auckland.
authors.forename: Andrew
authors.initials: A
authors.lastname: Hill
authors.affiliation: Department of Surgery, The University of Auckland.
authors.forename: John
authors.initials: J
authors.lastname: Windsor
authors.affiliation: Department of Molecular Medicine and Pathology, The University of Auckland.
authors.forename: Roger
authors.initials: R
authors.lastname: Booth
authors.affiliation: Auckland Science Analytical Services, The University of Auckland.
authors.forename: Mia
authors.initials: M
authors.lastname: Jüllig
authors.affiliation: Department of Psychological Medicine, The University of Auckland.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Broadbent
mesh_terms: D050110:Bariatric Surgery / Q000379:methods*; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014945:Wound Healing / Q000502:physiology*; D014956:Writing / Q000592:standards*