AIDS and Behavior

, Volume 10, Issue 1, pp 13–26 | Cite as

The Effects of Expressive Writing on Adjustment to HIV

  • Inna D. Rivkin
  • Julie Gustafson
  • Ilene Weingarten
  • Dorothy Chin
Intervention Research

Previous research suggests that writing about stressful experiences results in better health and psychological well-being. In the present study, a multi-ethnic sample of 79 HIV-positive women and men participated in a structured interview, and wrote about either their deepest thoughts and feelings about living with HIV (expressive writing) or their activities in the last 24 hr (control). Sixty-two participants returned for the 2-month follow-up and 50 returned for the 6-month follow-up interview. Oral fluid samples of beta2-microglobulin were taken at the baseline and follow-up assessments to examine the immunological effects of writing. No effects of writing condition were found, but expressive writing participants who included increasing insight/causation and social words in their writing had better immune function and reported more positive changes at follow-up. Results suggest that cognitive processing and changes in social interactions may be critical to the benefits of writing.

KEYWORDS:

expressive writing cognitive processing human immunodeficiency virus health 

Notes

ACKNOWLEDGEMENTS

This research was supported by a seed grant from the UCLA AIDS Institute University AIDS Research Program (UARP) awarded to the first author (444040-MY-18012). who was also supported by NIMH training grant MH19127 to Oscar Grusky during some phases of the project. The authors wish to acknowledge James Pennebaker for his text analysis program, Honghu Liu for statistical consultation, Najib Aziz for B2-M specimen analysis, and SoYeon Karen Chung, Julia Bande, Jenny Tan, Elizabeth Robles, and Naomi Bitow for assistance with data collection, entry, and coding. Finally, the authors wish to acknowledge all the research participants who shared their experiences and stories. Without them this research would not be possible

REFERENCES

  1. Bower, J. E., Kemeny, M. E., Taylor, S. E., and Fahey, J. L. (1998). Cognitive processing, discovery of meaning, CD4 decline, and AIDS-related mortality among bereaved HIV-seropositive men. Journal of Consulting and Clinical Psychology, 66, 979–986.PubMedCrossRefGoogle Scholar
  2. Center for Disease Control (2002). HIV Among U.S. Women: Minority and Young Women at Continuing Risk. National Center for HIV, STD, and TB Prevention, Division of HIV/AIDS website. (http://www.cdc.gov /hiv /pubs/facts/women.html)Google Scholar
  3. Chin, D., and Kroesen, K. W. (1999). Disclosure of HIV infection among Asian/Pacific Islander American women: Cultural stigma and support. Cultural Diversity and Ethnic Minority Psychology, Special Issue: HIV/AIDS and Ethnic Minority Women, Families, and Communities, 5, 222–235.Google Scholar
  4. de Moor, C., Sterner, J., Hall, M., Warneke, C., Gilani, Z., Amato, R., and Cohen, L. (2002). A pilot study of the effects of expressive writing on psychological and behavioral adjustment in patients enrolled in a phase II trial of vaccine therapy for metastatic renal cell carcinoma. Health Psychology, 21, 615–619.PubMedCrossRefGoogle Scholar
  5. Donnelly, D. A., and Murray, E. J. (1991). Cognitive and emotional changes in written essays and therapy interviews. Journal of Social and Clinical Psychology, 10, 334–350.Google Scholar
  6. Esterling, B. A., Antoni, M. H., Fletcher, M. A., Margulies, S., and Schneiderman, N. (1994). Emotional disclosure through writing or speaking modulates latent Epstein-Barr virus antibody titers. Journal of Consulting and Clinical Psychology, 62, 130–140.PubMedCrossRefGoogle Scholar
  7. Fahey, J. L., Taylor, J. M., Detels, R., Hofman, B., Melmed, R., Nishanian, P., and Giorgi, J. (1990). The prognostic value of cellular and serologic markers in infection with human immunodeficiency virus Type 1. New England Journal of Medicine, 322, 166–172.PubMedCrossRefGoogle Scholar
  8. Folkman, S., Moskowitz, J. T., Ozer, E. M., and Park, C. L. (1997). Positive meaningful events and coping in the context of HIV/AIDS. In B. H. Gottlieb (Ed.), Coping with Chronic Stress. The Plenum Series on Stress and Coping (pp. 293–314). New York: Plenum Press.Google Scholar
  9. Francis, M. E., and Pennebaker, J. W. (1993). LIWC: Linguistic Inquiry and Word Count. (Tech. Rep.). Dallas: Southern Methodist University.Google Scholar
  10. Gidron, Y., Duncan, E., Lazar, A., Biderman, A., Tandeter, H., and Shvartzman, P. (2002). Effects of guided written disclosure of stressful experiences on clinic visits and symptoms in frequent clinic attenders. Family Practice, 19, 161–166.PubMedCrossRefGoogle Scholar
  11. Griffin, K. W., Rabkin, J. G., Remien, R. H., and Williams, J. B. W. (1998). Disease severity, physical limitations and depression in HIV-infected men. Journal of Psychosomatic Research, 44, 219–227.PubMedCrossRefGoogle Scholar
  12. Heckman, T. G., Anderson, E. S., Sikkema, K. J., Kochman, A., Kalichman, S. C., and Anderson, T. (2004). Emotional distress in nonmetropolitan persons living with hiv disease enrolled in a telephone-delivered, coping improvement group intervention. Health Psychology, 23, 94–100.PubMedCrossRefGoogle Scholar
  13. Herek, G. M., and Capitanio, J. P. (1999). AIDS stigma and sexual prejudice. American Behavioral Scientist, 42, 1130–1147.Google Scholar
  14. Hockemeyer, J., and Smyth, J. M. (2002). Evaluating the feasibility and efficacy of a self-administered manual-based stress management intervention for individuals with asthma: Results from a controlled study. Behavioral Medicine, 27, 161–172.PubMedCrossRefGoogle Scholar
  15. Ickovics, J. R., Hamburger, M. E., Vlahov, D., Schoenbaum, E. E., Schuman, P., Boland, R. J., and Moore, J. (2001). Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: Longitudinal analysis from the HIV epidemiology research study. JAMA: Journal of the American Medical Association, 285, 1466–1474.PubMedCrossRefGoogle Scholar
  16. Ingram, D., and Hutchinson, S. A. (1999). HIV-positive mothers and stigma. Health Care for Women International, 20, 93–103.PubMedCrossRefGoogle Scholar
  17. Ironson, G., Schneiderman, H., Kumar, M., and Antoni, M. H. (1994). Psychosocial stress, endocrine and immune response in HIV-1 disease. Homeostasis in Health and Disease, 35, 137–148.Google Scholar
  18. Jordan, K. B., and L'Abate, L. (1995). Programmed writing and therapy with symbiotically enmeshed patients. American Journal of Psychotherapy, 49, 225–236.PubMedGoogle Scholar
  19. Kalichman, S. C., DiMarco, M., Austin, J., Luke, W., and DiFonzo, K. (2003). Stress, social support, and HIV-status disclosure to family and friends among HIV-positive men and women. Journal of Behavioral Medicine, 26, 315–332.PubMedCrossRefGoogle Scholar
  20. Kelly, B., Raphael, B., Judd, F., Kernutt, G., Burnett, P., and Burrows, G. (1998). Posttraumatic stress disorder in response to HIV infection. General Hospital Psychiatry, 20, 345–352.PubMedCrossRefGoogle Scholar
  21. Kemeny, M. E., and Dean, L. (1995). Effects of AIDS-related bereavement on HIV progression among New York city gay men. AIDS Education and Prevention, 7(Suppl), 36–47.PubMedGoogle Scholar
  22. Klein, K., and Boals, A. (2001). Expressive writing can increase working memory capacity. Journal of Experimental Psychology: General, 130, 520–533.CrossRefGoogle Scholar
  23. Latkin, C. A., Vlahov, D. (1998). Socially desirable response tendency as a correlate of accuracy of self-reported HIV serostatus for HIV seropositive injection drug users. Addiction, 93, 1191–1197.PubMedCrossRefGoogle Scholar
  24. Lee, R. S., Kochman, A., and Sikkema, K. J. (2002). Internalized stigma among people living with HIV-AIDS. AIDS and Behavior, 6, 309–319.CrossRefGoogle Scholar
  25. Lepore, S. J. (1997). Expressive writing moderates the relation between intrusive thoughts and depressive symptoms. Journal of Personality and Social Psychology, 73, 1030–1037.PubMedCrossRefGoogle Scholar
  26. Leserman, J., Petitto, J. M., Gu, H., Gaynes, B. N., Barroso, J., Golden, R. N., Perkins, D. O., Folds, J. D., and Evans, D. L. (2002). Progression to AIDS, a clinical AIDS condition and mortality: Psychosocial and physiological predictors. Psychological Medicine, 32, 1059–1073.PubMedCrossRefGoogle Scholar
  27. Lindan, C. P., Avins, A. L., Woods, W. J., Hudes, E. S., Clark, W., and Hulley, S. B. (1994). Levels of HIV testing and low validity of self-reported test results among alcoholics and drug users. AIDS, 8, 1149–1155.PubMedCrossRefGoogle Scholar
  28. Mason, H. R. C., Marks, G., Simoni, J., Ruiz, M. S., and Richardson, J. L. (1995). Culturally sanctioned secrets? Latino men's nondisclosure of HIV infection to family, friends, and lovers. Health Psychology, 14, 6–12.PubMedCrossRefGoogle Scholar
  29. Moneyham, L., Seals, B., Demi, A., and Sowell, R. (1996). Experiences of disclosure in women infected with HIV. Health Care for Women International, 17, 209–221.PubMedCrossRefGoogle Scholar
  30. Nishanian, P., Aziz, N., Chung, J., Detels, R., and Fahey, J. L. (1998). Oral fluids as an alternative to serum for measurement of markers of immune activation. Clinical and Diagnostic Laboratory Immunology, 5, 507–512.PubMedGoogle Scholar
  31. Norman, S. A., Lumley, M. A., Dooley, J. A., and Diamond, M. P. (2004). For whom does it work? Moderators of the effects of written emotional disclosure in a randomized trial among women with chronic pelvic pain. Psychosomatic Medicine, 66, 174–183.PubMedCrossRefGoogle Scholar
  32. O'Cleirigh, C., Ironson, G., Antoni, M., Fletcher, M. A., McGuffey, L., Balbin, E., Schneiderman, N., and Solomon, G. (2003). Emotional expression and depth processing of trauma and their relation to long-term survival in patients with HIV/AIDS. Journal of Psychosomatic Research, Special Issue: HIV and Immunology, 54, 225–235.Google Scholar
  33. Paez, D., Velasco, C., and Gonzalez, J. L. (1999). Expressive writing and the role of alexythimia as a dispositional deficit in self-disclosure and psychological health. Journal of Personality and Social Psychology, 77, 630–641.PubMedCrossRefGoogle Scholar
  34. Park, C. L., and Blumberg, C. J. (2002). Disclosing trauma through writing: Testing the meaning-making hypothesis. Cognitive Therapy and Research, 26, 597–616.CrossRefGoogle Scholar
  35. Pennebaker, J. W. (1993). Putting stress into words: Health, linguistic, and therapeutic implications. Behaviour Research and Therapy, 31, 539–548.PubMedCrossRefGoogle Scholar
  36. Pennebaker, J. W. (2004). Theories, therapies, and taxpayers: On the complexities of the expressive writing paradigm. Clinical Psychology: Science and Practice, 11, 138–142.CrossRefGoogle Scholar
  37. Pennebaker, J. W., and Francis, M. E. (1996). Cognitive, emotional, and language processes in disclosure: Physical health and adjustment. Cognition and Emotion, 10, 601–626.CrossRefGoogle Scholar
  38. Pennebaker, J. W., and Graybeal, A. (2001). Patterns of natural language use: Disclosure, personality, and social integration. Current Directions in Psychological Science, 10, 90–93.CrossRefGoogle Scholar
  39. Pennebaker, J. W., Kiecolt-Glaser, J. K., and Glaser, R. (1988). Disclosure of traumas and immune function: Health implications for psychotherapy. Journal of Consulting and Clinical Psychology, 56, 239–245.PubMedCrossRefGoogle Scholar
  40. Pennebaker, J. W., Mayne, T. J., and Francis, M. E. (1997). Linguistic predictors of adaptive bereavement. Journal of Personality and Social Psychology, 72, 863–871.PubMedCrossRefGoogle Scholar
  41. Petrie, K. J., Fontanilla, I., Thomas, M. G., Booth, R. J., Pennebaker, J. W. (2004). Effects of written emotional expression on immune function in patients with human immunodeficiency virus infection: A randomized trial. Psychosomatic Medicine, 66, 272–275.PubMedCrossRefGoogle Scholar
  42. Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  43. Rivkin, I. D. (2000). The effects of emotional expression on adjustment to stressful events (Doctoral dissertation, University of California, Los Angeles, 2000). Dissertation Abstracts International, 64, 589.Google Scholar
  44. Rosenberg, H. J., Rosenberg, S. D., Ernstoff, M. S., Wolford, G. L., Amdur, R. J., Elshamy, M. R., Bauer-Wu, S. M., Ahles, T. A., and Pennebaker, J. W. (2002). Expressive disclosure and health outcomes in a prostate cancer population. International Journal of Psychiatry in Medicine, 32, 37–53.PubMedCrossRefGoogle Scholar
  45. Siegel, K., and Schrimshaw, E. W. (2000). Perceiving benefits in adversity: Stress-related growth in women living with HIV/AIDS. Social Science and Medicine, 51, 1543–1554.PubMedCrossRefGoogle Scholar
  46. Sikkema, K. J., Kochman, A., DiFranceisco, W., Kelly, J. A., and Hoffman, R. G. (2003). AIDS-related grief and coping with loss among HIV-positive men and women. Journal of Behavioral Medicine, 26, 165–181.PubMedCrossRefGoogle Scholar
  47. Simoni, J. M., Mason, H. R. C., Marks, G., and Ruiz, M. S. (1995). Women's self-disclosure of HIV infection: Rates, reasons, and reactions. Journal of Consulting and Clinical Psychology, 63, 474–478.PubMedCrossRefGoogle Scholar
  48. Simoni, J. M., and Ng, M. T. (2000). Trauma, coping and depression among women with HIV/AIDS in New York City. AIDS Care, 12, 567–580.PubMedCrossRefGoogle Scholar
  49. Smyth, J. M. (1998). Written emotional expression: Effect sizes, outcome types, and moderating variables. Journal of Consulting and Clinical Psychology, 66, 174–184.PubMedCrossRefGoogle Scholar
  50. Smyth, J. M., Stone, A. A., Hurewitz, A., and Kaell, A. (1999). Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: A randomized trial. JAMA: Journal of the American Medical Association, 281, 1304–1309.PubMedCrossRefGoogle Scholar
  51. Stanton, A. L., Danoff-Burg, S., Sworowski, L. A., Collins, C. A., Branstetter, A. D., Rodriguez-Hanley, A. et al., (2002). Randomized, controlled trial of written emotional expression and benefit-finding in breast cancer patients. Journal of Clinical Oncology, 10, 4160–4168.CrossRefGoogle Scholar
  52. Stein, N., Folkman, S., Trabasso, T., and Richards, T. A. (1997). Appraisal and goal processes as predictors of psychological well-being in bereaved caregivers. Journal of Personality and Social Psychology, 72, 872–884.PubMedCrossRefGoogle Scholar
  53. Ullrich, P. M., and Lutgendorf, S. K. (2002). Journaling about stressful events: Effects of cognitive processing and emotional expression. Annals of Behavioral Medicine, 24, 244–250.PubMedCrossRefGoogle Scholar
  54. Updegraff, J. A., Taylor, S. E., Kemeny, M. E., and Wyatt, G. E. (2002). Positive and negative effects of HIV infection in women with low socioeconomic resources. Personality and Social Psychology Bulletin, 28, 382–394.CrossRefGoogle Scholar
  55. Vinokur, A. D., and Van Ryn, M. (1993). Social support and undermining in close relationships: Their independent effects on the mental health of unemployed persons. Journal of Personality and Social Psychology, 65, 350–359.PubMedCrossRefGoogle Scholar
  56. Wyatt, G. E., and Chin, D. (1999). HIV and ethnic minority women, families, and communities: An overview. Cultural Diversity and Ethnic Minority Psychology, Special Issue: HIV/AIDS and Ethnic Minority Women, Families, and Communities, 5, 179–182.Google Scholar
  57. Zich, J. M., Attkisson, C. C., and Greenfield, T. K. (1990). Screening for depression in primary care clinics: The CES-D and the BDI. International Journal of Psychiatry in Medicine, 20, 259–277.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2005

Authors and Affiliations

  • Inna D. Rivkin
    • 1
    • 3
  • Julie Gustafson
    • 1
  • Ilene Weingarten
    • 2
  • Dorothy Chin
    • 1
  1. 1.Department of Psychiatry and Biobehavioral SciencesUniversity of CaliforniaLos AngelesUSA
  2. 2.Graduate School of Education and PsychologyPepperdine UniversityLos AngelesUSA
  3. 3.Neuropsychiatric InstituteUniversity of CaliforniaLos AngelesUSA

Personalised recommendations