Quality & Quantity

, Volume 48, Issue 6, pp 2939–2962 | Cite as

Targeting writing interventions to emotional processing level: a factorial experimental design

  • Cheryl J. Maddalena
  • Ruth Saxey-Reese
  • Elizabeth Lester Barnes


Emotional processing (EP) from the emotional approach coping measure has been shown to moderate the effect of writing interventions. This study targeted writing interventions to EP level, with low EP participants receiving a best possible self (BPS) script and high EP participants receiving an emotional expression (EMO) script, versus a control (CTL) writing script. A factorial experimental design was used to balance the potential factors gender, spacing of interventions, and whether participants were instructed to keep or give their writing samples to the administrator. Post-test measures were taken 1 month after completion of writing. Sixty-four undergraduates (66 % female) participated. Those with high EP (\(\hbox {EP}\,\ge \,3\)) were assigned EMO or CTL; those with low EP (\(\hbox {EP}\,\le \,3\)) were assigned BPS or CTL. These targeted interventions had significantly better results than CTL for change in last month’s need based healthcare visits (\(p = .0058\)) and health symptoms (\(p = .0107\)). Analysis of health symptoms showed that only cold/flu (\(p = .0369\)), headaches (\(p = .0393\)), sinus (\(p = .0411\)), and diarrhea (\(p = .0089\)) showed a significant change. Data modeling suggests that gender, EP, intervention, and spacing were active factors contributing to change in health, and that interactions between them should also be taken into account. Analysis of the CTL intervention showed a marked worsening of health for low EP participants but a mild or negligible effect on health for high EP.


Writing interventions Best possible self Emotional approach coping Emotional processing Factorial design Expressive writing Design of experiments 


  1. Austenfeld, J.L., Paolo, A.M., Stanton, A.L.: Effects of writing about emotions versus goals on psychological and physical health among third-year medical students. J. Pers. 74(1), 267–285 (2006)CrossRefGoogle Scholar
  2. Austenfeld, J.L., Stanton, A.L.: Writing about emotions versus goals: effects on hostility and medical care utilization moderated by emotional approach coping processes. Br. J. Health Psychol. 13(1), 35–38 (2008)CrossRefGoogle Scholar
  3. Baikie, K.A.: Who does expressive writing work for? examination of alexithymia, splitting, and repressive coping style as moderators of the expressive writing paradigm. Br. J. Health Psychol. 13(1), 61–66 (2008). doi:10.1348/135910707X250893 CrossRefGoogle Scholar
  4. Brockelman, K.: The interrelationship of self-determination, mental illness, and grades among university students. J. Coll. Stud. Dev. 50(3), 271–286 (2009)CrossRefGoogle Scholar
  5. Burton, C., King, L.: Effects of (very) brief writing on health: the two-minute miracle. Br. J. Health Psychol. 13(1), 9–14 (2008)CrossRefGoogle Scholar
  6. Collins, L.M., Dziak, J.J., Li, R.: Design of experiments with multiple independent variables: a resource management perspective on complete and reduced factorial designs. Psychol. Methods 14(3), 202–224 (2009). PMCID: PMC2796056CrossRefGoogle Scholar
  7. Crandall, R.: The measurement of self-esteem and related constructs. In: Robinson, J.P., Shaver, P. (eds.) Measurements of Social Psychological Attitudes, pp. 45–167. Institute for Social Research, Ann Arbor (1973)Google Scholar
  8. Deci, E.L., Ryan, R.M.: The “what” and “why” of goal pursuits: human needs and the self-determination of behavior. Psychol. Inq. 11(4), 227–268 (2000). doi:10.1207/S15327965PLI1104_01 CrossRefGoogle Scholar
  9. Diener, E., Emmons, R.A., Larsen, R.J., Griffin, S.: The satisfaction with life scale. J. Pers. Assess. 49, 71–75 (1985). doi:10.1207/s15327752jpa4901_13 CrossRefGoogle Scholar
  10. Dziak, J., Nahum-Shani, I.R., Collins, L.M.: Multilevel factorial experiments for developing behavioral interventions: Power, sample size, and resource considerations. Psychol. Methods 17(2), 153–175 (2012). doi:10.1037/a0026972 CrossRefGoogle Scholar
  11. Esterling, B.A., Antoni, M.H., Fletcher, M.A., Margulies, S., Schneiderman, N.: Emotional disclosure through writing or speaking modulates latent Epstein-Barr virus antibody titers. J. Consult. Clin. Psychol. 62, 130–140 (1990)CrossRefGoogle Scholar
  12. Frattaroli, J.: Experimental disclosure and its moderators: a meta-analysis. Psychol. Bull. 132, 823–865 (2006)CrossRefGoogle Scholar
  13. Freund, R.J., Littell, R.C., Creighton, L.: Regression Using JMP. SAS Institute Inc, Cary (2003)Google Scholar
  14. Greenberg, M.A., Stone, A.A.: Emotional disclosure about traumas and its relation to health: effects of previous disclosure and trauma severity. J. Pers. Soc. Psychol. 63, 75–84 (1992)CrossRefGoogle Scholar
  15. Harris, A.H.S.: Does expressive writing reduce health care utilization? A meta-analysis of randomized trials. J. Consult. Clin. Psychol. 74(2), 243–252 (2006)CrossRefGoogle Scholar
  16. Horneffer, K.J., Chan, K.: Alexithymia and relaxation: considerations in optimising the emotional effectiveness of journaling about stressful experiences. Cogn. Emot. 23(3), 611–622 (2009). doi:10.1080/02699930802009381 CrossRefGoogle Scholar
  17. King, L.A.: The health benefits of writing about life goals. Pers. Soc. Psychol. Bull. 27, 798–807 (2001)CrossRefGoogle Scholar
  18. King, A.C., Ahn, D.F., Atenzia, A.A., Kraemer, H.C.: Exploring refinements in targeted behavioral medicine intervention to advance public health. Ann. Behav. Med. 35, 251–260 (2008)CrossRefGoogle Scholar
  19. Koopman, C., Ismailji, T., Holmes, D., Classen, C.C., Palesh, O., Wales, T.: The effects of expressive writing on pain, depression and posttraumatic stress disorder symptoms in survivors of intimate partner violence. J. Health Psychol. 10(2), 211–221 (2005). doi:10.1177/1359105305049769 CrossRefGoogle Scholar
  20. Kraft, C.A., Lumley, M.A., D’Souza, P.J., Dooley, J.A.: Emotional approach coping and self-efficacy moderate the effects of written emotional disclosure and relaxation training for people with migraine headaches. Br. J. Health Psychol. 13, 67–71 (2008)CrossRefGoogle Scholar
  21. Low, C.A., Stanton, A.L., Danoff-Burg, S.: Expressive disclosure and benefit finding among breast cancer patients: mechanisms for positive health effects. Health Psychol. 25(2), 181–189 (2006)CrossRefGoogle Scholar
  22. Lumley, M.A., Naoum, L., Kelley, J.: Alexithymia as a moderator of the effects of written and verbal emotional disclosure. Poster presented at the Annual Meeting of the American Psychosomatic Society, Monterey, CA (2001)Google Scholar
  23. Lumley, M.A., Tojek, T.M., & Macklem, D.J.: Effects of written emotional disclosure among repressive and alexithymic people. In: Lepore, S.J., Smyth, J.M. (eds.) The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-Being, pp. 75–95. American Psychological Association, Washington, DC (2002). http://dx.doi.org/10.1037/10451-004. Accessed 28 Sep 2013
  24. McClelland, G.H.: Optimal design in psychological research. Psychol. Methods 2(1), 3–19 (1997). doi:10.1037/1082-989X.2.1.3 Google Scholar
  25. McNair, D.M., Lorr, M., Droppleman, L.F.: Manual for the Profile of Mood States. Educational and Industrial Testing Service, San Diego (1971)Google Scholar
  26. Master, S.L., Amodio, D.M., Stanto, A.L., Yee, C.M., Hilmert, C.J., Taylor, S.E.: Neurobiological correlates of coping through emotional approach. Brain Behav. Immun. 23(1), 27–35 (2009)CrossRefGoogle Scholar
  27. National Endowment for the Arts.: National Initiatives: Operation Homecoming. Retrieved Feb 10, 2012, from http://www.nea.gov/national/homecoming/about.html (2012)
  28. Nazarian, D., Smyth, J.M.: Context moderates the effects of an expressive writing intervention: a randomized two-study replication and extension. J. Soc. Clin. Psychol. 29(8), 903–929 (2010). doi:10.1521/jscp.2010.29.8.903 Google Scholar
  29. Pennebaker, J.W., Beall, S.: Confronting a traumatic event: toward an understanding of inhibition and disease. J. Abnorm. Psychol. 95, 274–281 (1986)CrossRefGoogle Scholar
  30. Pennebaker, J.W., Kiecolt-Glaser, J.K., Glaser, R.: Disclosure of traumas and immune function: health implications for psychotherapy. J. Consult. Clin. Psychol. 56, 239–245 (1988)CrossRefGoogle Scholar
  31. Pennebaker, J.W., Seagal, J.D.: Forming a story: the health benefits of narrative. J. Clin. Psychol. 55(10), 1243–1254 (1999)CrossRefGoogle Scholar
  32. Petrie, K.J., Booth, R.J., Pennebaker, J.W., Davidson, K.P.: Disclosure of trauma and immune response to a hepatitis B vaccination program. J. Consult. Clin. Psychol. 63, 787–792 (1995)CrossRefGoogle Scholar
  33. Pritchard, M.E., Wilson, G., Yamnitz, B.: What predicts adjustment among college students? A longitudinal panel study. J. Am. Coll. Health 56, 15–21 (2007)CrossRefGoogle Scholar
  34. Reifman, A., Biernat, M., Lang, E.L.: Stress, social support, and health in married professional women with small children. Psychol. Women Q. 15, 431–445 (1991)CrossRefGoogle Scholar
  35. Rosenberg, M.: Society and the Adolescent Self-Image. Princeton University Press, Princeton (1965)Google Scholar
  36. Scheier, M.F., Carver, C.S.: Optimism, coping, and health: assessment and implications of generalized outcome expectancies. Health Psychol. 4(3), 219–247 (1985). doi:10.1037/0278-6133.4.3.219 CrossRefGoogle Scholar
  37. Schnell, K., Herpertz, S.C.: Effects of dialectic-behavioral-therapy on the neural correlates of affective hyperarousal in borderline personality disorder. J. Psychiatr. Res. 41(10), 837–847 (2007)CrossRefGoogle Scholar
  38. Smyth, J.M.: Written emotional expression: effect sizes, outcome types, and moderating variables. J. Consult. Clin. Psychol. 60, 174–184 (1998)CrossRefGoogle Scholar
  39. Smyth, J.M., Anderson, C.F., Hockemeyer, J.R., Stone, A.A.: Does emotional non-expressiveness or avoidance interfere with writing about stressful life events? an analysis in patients with chronic illness. Psychol. Health 17(5), 561–569 (2002). doi:10.1080/08870440290025777 CrossRefGoogle Scholar
  40. Smyth, J.M., Hockemeyer, J.R., Tulloch, H.: Expressive writing and post-traumatic stress disorder: effects on trauma symptoms, mood states, and cortisol reactivity. Br. J. Health Psychol. 13(1), 85–93 (2008). doi:10.1348/135910707X250866 CrossRefGoogle Scholar
  41. Smyth, J.M., Pennebaker, J.W.: Exploring the boundary conditions of expressive writing: in search of the right recipe. Br. J. Health Psychol. 13, 1–7 (2008)CrossRefGoogle Scholar
  42. Stanton, A.L., Danoff-Burg, S., Cameron, C.L., Ellis, A.P.: Coping through emotional approach: problems of conceptualization and confounding. J. Pers. Soc. Psychol. 66(2), 350–362 (1994). doi:10.1037/0022-3514.66.2.350 CrossRefGoogle Scholar
  43. Stanton, A.L., Kirk, S.B., Cameron, C.L., Danoff-Burg, S.: Coping through emotional approach: scale construction and validation. J. Pers. Soc. Psychol. 78(6), 1150–1169 (2000)CrossRefGoogle Scholar
  44. Watson, D. & Clark, A.L.: The PANAS-X: manual for the positive and negative affect schedule—expanded form. Retrieved Feb 14, 2012, from http://ir.uiowa.edu/psychology_pubs/11 (1991)
  45. Weinman, J., Ebrecht, M., Scott, S., Walburn, J., Dyson, M.: Enhanced wound healing after emotional disclosure intervention. Br. J. Health Psychol. 13(1), 95–102 (2008). doi:10.1348/135910707X251207 CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2013

Authors and Affiliations

  • Cheryl J. Maddalena
    • 1
  • Ruth Saxey-Reese
    • 2
  • Elizabeth Lester Barnes
    • 2
  1. 1.Big Tree ArtsBoiseUSA
  2. 2.Boise State UniversityBoiseUSA

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