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The feasibility and effectiveness of an expressive writing intervention for rheumatoid arthritis via home-based videotaped instructions

  • Published:
Annals of Behavioral Medicine

Abstract

Background: Expressive emotional writing has demonstrated efficacy for improving health status in a wide variety of healthy persons and recently in patients with chronic disease.Purpose: This study was a randomized, controlled effectiveness trial with 4 arms: 2 active treatment writing groups, 1 inactive writing group, and 1 attention control group. It represents the first attempt to translate the expressive writing intervention into a low-cost, community-based intervention in the form of a videotaped program.Methods: Feasibility of the approach and patient adherence were examined in a community rheumatology practice with rheumatoid arthritis patients (N = 373).Results: The videotape format was able to convey the intervention instructions accurately and produced the expected and differential ratings of stressfulness and emotional provocation across the 3 writing programs. Seventy-nine percent of eligible patients agreed to take the program home; 49% of these patients reported that they followed the protocol. Physician Disease Activity Rating and the Physical Component Summary of the SF36v2 Health Survey were assessed pre and post program.Conclusions: Intent-to-treat analyses found no effect of the treatment. Pretreatment differences among the protocol-adherent patients complicated treatment outcome interpretation. The standard writing instructions did not yield an effect; a modified set of instructions to extract meaning from the traumatic event yielded equivocal results. Contrasts between efficacy and effectiveness trials and the challenge of achieving significant outcomes in effectiveness trials are discussed.

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Author information

Authors and Affiliations

  1. Department of Psychiatry & Behavioral Science, Putnam Hall, Stony Brook University, 11794-8790, Stony Brook, NY

    Joan E. Broderick Ph.D., Arthur A. Stone Ph.D. & Joshua M. Smyth Ph.D.

  2. Syracuse University, USA

    Alan T. Kaell M.D.

Authors
  1. Joan E. Broderick Ph.D.
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  2. Arthur A. Stone Ph.D.
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  3. Joshua M. Smyth Ph.D.
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  4. Alan T. Kaell M.D.
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Corresponding author

Correspondence to Joan E. Broderick Ph.D..

Additional information

This research was supported in part by a grant from the Fetzer Institute, Kalamazoo, Michigan.

We thank E. Roy Berger, M.D. and William J. LiPera, M.D. for their assistance in the production of the videotapes, Lisa Christie (research assistant), and Patricia Brasley and Nancy Simington of the Long Island Arthritis Foundation for their support and assistance. We would also like to thank Drs. Bennett, Hamburger, Johnson, Rumore, Shulman, and Tan from Rheumatology Associates of Long Island for providing access to their patients and pre and post Disease Activity Ratings for each patient.

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Broderick, J.E., Stone, A.A., Smyth, J.M. et al. The feasibility and effectiveness of an expressive writing intervention for rheumatoid arthritis via home-based videotaped instructions. ann. behav. med. 27, 50–59 (2004). https://doi.org/10.1207/s15324796abm2701_7

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  • DOI: https://doi.org/10.1207/s15324796abm2701_7

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