Skip to main content
Log in

The health effects of at-home written emotional disclosure in fibromyalgia: A randomized trial

  • Published:
Annals of Behavioral Medicine

Abstract

Background: The presence and severity of the chronic pain syndrome fibromyalgia (FM) is associated with unresolved stress and emotional regulation difficulties. Written emotional disclosure is intended to reduce stress and may improve health of people with FM.Purpose: This study tests the effects of at-home, written emotional disclosure about stressful experiences on the health of people with FM and uses multiple follow-ups to track the time course of effects of disclosure.Methods: Adults with FM (intention-to-treat, n = 83; completers, n = 72) were randomized to write for 4 days at home about either stressful experiences (disclosure group) or neutral time management (control group). Group differences in immediate mood effects and changes in health from baseline to 1-month and 3-month follow-ups were examined.Results: Written disclosure led to an immediate increase in negative mood, which did not attenuate across the 4 writing days. Repeated-measures analyses from baseline to each follow-up point were conducted on both intention-to-treat and completer samples, which showed similar outcomes. At 1 month, disclosure led to few health benefits, but control writing led to less negative affect and more perceived support than did disclosure. At 3-month follow-up, these negative affect and social support effects disappeared, and written disclosure led to a greater reduction in global impact, poor sleep, health care utilization, and (marginally) physical disability than did control writing. Interpretation of these apparent benefits needs to be made cautiously, however, because the disclosure group had somewhat poorer health than controls at baseline and the control group showed some minor worsening over time.Conclusions: Written emotional disclosure can be conducted at home, and there is tentative evidence that disclosure benefits the health of people with FM. The benefits, however, may be delayed for several months after writing and may be of limited clinical significance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Hayes SC, Wilson KG, Gifford EV, Follette VM, Strosahl K: Experimental avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment.Journal of Consulting & Clinical Psychology. 1996,64:1152–1168.

    Article  CAS  Google Scholar 

  2. Barlow DH, Allen LB, Choate ML: Toward a unified treatment for emotional disorders.Behavior Therapy. 2004,35:205–230.

    Article  Google Scholar 

  3. Taylor GJ, Bagby RM, Parker JDA:Disorders of Affect Regulation: Alexithymia in Medical and Psychiatric Illness. Cambridge, UK: Cambridge University Press, 1997.

    Google Scholar 

  4. Austenfeld JL, Stanton AL: Coping through emotional approach: A new look at emotion, coping, and health-related outcomes.Journal of Personality. 2004,72:1335–1363.

    Article  PubMed  Google Scholar 

  5. Wenzlaff RM, Wegner DM: Thought suppression.Annual Review of Psychology. 2000,51:59–91.

    Article  PubMed  CAS  Google Scholar 

  6. John OP, Gross JJ: Healthy and unhealthy emotion regulation: Personality processes, individual differences, and life span development.Journal of Personality. 2004,72:1301–1333.

    Article  PubMed  Google Scholar 

  7. Lepore SJ, Greenberg MA: Mending broken hearts: Effects of expressive writing on mood, cognitive processing, social adjustment and health following a relationship breakup.Psychology & Health. 2002,17:547–560.

    Article  Google Scholar 

  8. Ullrich PM, Lutgendorf SK: Journaling about stressful events: Effects of cognitive processing and emotional expression.Annals of Behavioral Medicine. 2002,24:244–250.

    Article  PubMed  Google Scholar 

  9. Greenberg MA, Stone AA: Emotional disclosure about traumas and its relation to health: Effects of previous disclosure and trauma severity.Journal of Personality & Social Psychology. 1992,63:75–84.

    Article  CAS  Google Scholar 

  10. Greenberg MA, Wortman CB, Stone AA: Emotional expression and physical heath: Revising traumatic memories or fostering self-regulation?Journal of Personality & Social Psychology. 1996,71:588–602.

    Article  CAS  Google Scholar 

  11. King LA, Miner KN: Writing about the perceived benefits of traumatic events: Implications for physical health.Personality & Social Psychology Bulletin. 2000,26:220–230.

    Article  Google Scholar 

  12. Esterling BA, Antoni MH, Fletcher MA, Margulies S, Schneiderman N: Emotional disclosure through writing or speaking modulates latent Epstein-Barr virus antibody titers.Journal of Consulting & Clinical Psychology. 1994,62:130–140.

    Article  CAS  Google Scholar 

  13. Petrie KJ, Booth RJ, Pennebaker JW, Davison KP, Thomas MG: Disclosure of trauma and immune response to a hepatitis B vaccination program.Journal of Consulting & Clinical Psychology. 1995,63:787–792.

    Article  CAS  Google Scholar 

  14. Cameron LD, Nicholls G: Expression of stressful experiences through writing: Effects of a self-regulation manipulation for pessimists and optimists.Health Psychology. 1998,17:84–92.

    Article  PubMed  CAS  Google Scholar 

  15. Pennebaker JW, Colder M, Sharp LK: Accelerating the coping process.Journal of Personality & Social Psychology. 1990,58:528–537.

    Article  CAS  Google Scholar 

  16. Klein K, Boals A: Expressive writing can increase working memory capacity.Journal of Experimental Psychology: General. 2001,130:520–533.

    Article  CAS  Google Scholar 

  17. Smyth JM: Written emotional expression: Effect sizes, outcome types, and moderating variables.Journal of Consulting & Clinical Psychology. 1998,66:174–184.

    Article  CAS  Google Scholar 

  18. Smyth JM, Stone AA, Hurewitz A, Kaell A: Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis: A randomized trial.Journal of the American Medical Association. 1999,281:1304–1309.

    Article  PubMed  CAS  Google Scholar 

  19. Warner LJ, Lumley MA, Casey RJ, et al.: Health effects of written emotional disclosure in adolescents with asthma: A randomized, controlled trial.Journal of Pediatric Psychology. 2006,31:557–568.

    Article  PubMed  Google Scholar 

  20. Stanton AL, Danoff-Burg S, Sworowski LA, et al.: Randomized, controlled trial of written emotional expression and benefit finding in breast cancer patients.Journal of Clinical Oncology. 2002,20:4160–4168.

    Article  PubMed  Google Scholar 

  21. Petrie KJ, Fontanilla I, Thomas MG, Booth RJ, Pennebaker JW: Effect of written emotional expression on immune function in patients with human immunodeficiency virus infection: A randomized trial.Psychosomatic Medicine. 2004,66:272–275.

    Article  PubMed  Google Scholar 

  22. Solano L, Donati V, Pecci F, Persichetti S, Colaci A: Postoperative course after papilloma resection: Effects of written disclosure of the experience in subjects with different alexithymia levels.Psychosomatic Medicine. 2003,65:477–484.

    Article  PubMed  Google Scholar 

  23. Gidron Y, Duncan E, Lazar A, et al.: Effects of guided written disclosure of stressful experiences on clinic visits and symptoms in frequent clinic attenders.Family Practice. 2002,19:161–166.

    Article  PubMed  Google Scholar 

  24. de Moor C, Sterner J, Hall M, et al.: 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. 2002,21:615–619.

    Article  PubMed  Google Scholar 

  25. Rosenberg HJ, Rosenberg SD, Ernstoff MS, et al.: Expressive disclosure and health outcomes in a prostate cancer population.International Journal of Psychiatry in Medicine. 2002,32:37–53.

    Article  PubMed  Google Scholar 

  26. Norman SA, Lumley MA, Dooley JA, Diamond MP: 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. 2004,66:174–183.

    Article  PubMed  Google Scholar 

  27. Kelley JE, Lumley MA, Leisen JCC: Health effects of emotional disclosure in rheumatoid arthritis patients.Health Psychology. 1997,16:331–340.

    Article  PubMed  CAS  Google Scholar 

  28. Broderick JE, Stone AA, Smyth JM, Kaell AT: The feasibility and effectiveness of an expressive writing intervention for rheumatoid arthritis via home-based videotaped instructions.Annals of Behavioral Medicine. 2004,27:50–59.

    Article  PubMed  Google Scholar 

  29. Walker BL, Nail LM, Croyle RT: Does emotional expression make a difference in reactions to breast cancer?Oncology Nursing Forum. 1999,26:1025–1032.

    PubMed  CAS  Google Scholar 

  30. Harris AHS, Thoresen CE, Humphreys K, Faul J: Does writing affect asthma? A randomized trial.Psychosomatic Medicine. 2005,67:130–136.

    Article  PubMed  Google Scholar 

  31. Rivkin ID, Gustafson J, Weingarten I, Chin D: The effects of expressive writing on adjustment to HIV.AIDS and Behavior. 2006,10:13–26.

    Article  PubMed  Google Scholar 

  32. Bower JE, Kemeny ME, Taylor SE, Fahey JL: Finding positive meaning and its association with natural killer cell cytotoxicity among participants in a bereavement-related disclosure intervention.Annals of Behavioral Medicine. 2003,25:146–155.

    Article  PubMed  Google Scholar 

  33. Stroebe M, Stroebe W, Schut H, Zech E, van den Bout J: Does disclosure of emotions facilitate recovery from bereavement? Evidence from two prospective studies.Journal of Consulting & Clinical Psychology. 2002,70:169–178.

    Article  Google Scholar 

  34. Klapow JC, Schmidt SM, Taylor LA, et al.: Symptom management in older primary care patients: feasibility of an experimental, written self-disclosure protocol.Annals of Internal Medicine. 2001,134:905–911.

    PubMed  CAS  Google Scholar 

  35. Schilte AF, Portegijs PJ, Blankenstein AH, et al.: Randomised controlled trial of disclosure of emotionally important events in somatisation in primary care.British Medical Journal. 2001,323:1–6.

    Article  Google Scholar 

  36. Ames SC, Patten CA, Offord KP, et al.: Expressive writing intervention for young adult cigarette smokers.Journal of Clinical Psychology. 2005,61:1555–1570.

    Article  PubMed  Google Scholar 

  37. Frisina PG, Borod JC, Lepore SJ: A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations.Journal of Nervous & Mental Disease. 2004,192:629–634.

    Article  Google Scholar 

  38. Gidron Y, Peri T, Connolly JF, Shalev AY: Written disclosure in posttraumatic stress disorder: Is it beneficial for the patient?Journal of Nervous and Mental Disease. 1996,184:505–507.

    Article  PubMed  CAS  Google Scholar 

  39. Richards JM, Beal WE, Seagal JD, Pennebaker JW: Effects of disclosure of traumatic events on illness behavior among psychiatric prison inmates.Journal of Abnormal Psychology. 2000,109:156–160.

    Article  PubMed  CAS  Google Scholar 

  40. Sloan DM, Marx BP: A closer examination of the structured written disclosure procedure.Journal of Consulting & Clinical Psychology. 2004,72:165–175.

    Article  Google Scholar 

  41. Lepore SJ, Greenberg MA, Bruno M, Smyth JM: Expressive writing and health: Self-regulation of emotion-related experience, physiology, and behavior. In Lepore SJ, Smyth JM (eds)The writing cure: How expressive writing promotes health and emotional well-being. Washington, DC: American Psychological Association, 2002, 99–117.

    Chapter  Google Scholar 

  42. Pennebaker JW, Keough KA: Revealing, organizing, and reorganizing the self in response to stress and emotion. In Contrada RJ, Ashmore RD (eds),Self, social identity, and physical health: Interdisciplinary explorations. New York: Oxford University Press, 1999, 101–121.

    Google Scholar 

  43. Sloan DM, Marx BP: Taking pen to hand: Evaluating theories underlying the written disclosure paradigm.Clinical Psychology: Science & Practice. 2004,11:121–137.

    Article  Google Scholar 

  44. Foa EB, Zoellner LA, Feeny NC, Hembree EA, Alvarez-Conrad J: Does imaginal exposure exacerbate PTSD symptoms?Journal of Consulting and Clinical Psychology. 2002,70:1022–1028.

    Article  PubMed  Google Scholar 

  45. Tarrier N, Pilgrim H, Sommerfield C, et al.: A randomized trial of cognitive therapy and imaginal exposure in the treatment of chronic posttraumatic stress disorder.Journal of Consulting and Clinical Psychology. 1999,67:13–18.

    Article  PubMed  CAS  Google Scholar 

  46. Wolfe F, Ross K, Anderson J, Russell IJ, Hebert L: The prevalence and characteristics of fibromyalgia in the general population.Arthritis & Rheumatism. 1995,38:19–28.

    Article  CAS  Google Scholar 

  47. Wolfe F, Ross K, Anderson J, Russell IJ: Aspects of fibromyalgia in the general population: sex, pain threshold, and fibromyalgia symptoms.Journal of Rheumatology. 1995,22:151–156.

    PubMed  CAS  Google Scholar 

  48. Goldenberg DL, Simms RW, Geiger A, Komaroff AL: High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice.Arthritis & Rheumatism. 1990,33:381–387.

    Article  CAS  Google Scholar 

  49. Walker EA, Keegan D, Gardner G, et al.: Psychosocial factors in fibromyalgia compared with rheumatoid arthritis: II. Sexual, physical, and emotional abuse and neglect.Psychosomatic Medicine. 1997,59:572–577.

    PubMed  CAS  Google Scholar 

  50. Van Houdenhove B, Neerinckx E, Lysens R, et al.: Victimization in chronic fatigue syndrome and fibromyalgia in tertiary care: a controlled study on prevalence and characteristics.Psychosomatics. 2001,42:21–28.

    Article  PubMed  Google Scholar 

  51. Anderberg UM, Marteinsdottir I, Theorell T, von Knorring L: The impact of life events in female patients with fibromyalgia and in female healthy controls.European Psychiatry. 2000,15:295–301.

    Article  PubMed  CAS  Google Scholar 

  52. McBeth J, Macfarlane GJ, Benjamin S, Morris S, Silman AJ: The association between tender points, psychological distress, and adverse childhood experiences: A community-based study.Arthritis & Rheumatism. 1999,42:1397–1404.

    Article  CAS  Google Scholar 

  53. Yunus MB: Psychological aspects of fibromyalgia syndrome:A component of the dysfunctional spectrum syndrome.Baillieres Clinical Rheumatology. 1994,8:811–837.

    Article  CAS  Google Scholar 

  54. Sherman JJ, Turk DC, Okifuji A: Prevalence and impact of posttraumatic stress disorder-like symptoms on patients with fibromyalgia syndrome.Clinical Journal of Pain. 2000,16:127–134.

    Article  PubMed  CAS  Google Scholar 

  55. Cohen H, Neumann L, Haiman Y, et al.: Prevalence of posttraumatic stress disorder in fibromyalgia patients: overlapping syndromes or post-traumatic fibromyalgia syndrome?Seminars in Arthritis & Rheumatism. 2002,32:38–50.

    Article  Google Scholar 

  56. Bansevicius D, Westgaard RH, Stiles T: EMG activity and pain development in fibromyalgia patients exposed to mental stress of long duration.Scandinavian Journal of Rheumatology. 2001,30:92–98.

    Article  PubMed  CAS  Google Scholar 

  57. Davis MC, Zautra AJ, Reich JW: Vulnerability to stress among women in chronic pain from fibromyalgia and osteoarthritis.Annals of Behavioral Medicine. 2001,23:215–226.

    Article  PubMed  CAS  Google Scholar 

  58. Brosschot JF, Aarsse HR: Restricted emotional processing and somatic attribution in fibromyalgia.International Journal of Psychiatry in Medicine. 2001,31:127–146.

    Article  PubMed  CAS  Google Scholar 

  59. Dailey PA, Bishop GD, Russell IJ, Fletcher EM: Psychological stress and the fibrositis/fibromyalgia syndrome.Journal of Rheumatology. 1990,17:1380–1385.

    PubMed  CAS  Google Scholar 

  60. Sayar K, Gulec H, Topbas M: Alexithymia and anger in patients with fibromyalgia.Clinical Rheumatology. 2004,23:441–448.

    Article  PubMed  Google Scholar 

  61. Lumley MA, Smith JA, Longo DJ: The relationship of alexithymia to pain severity and impairment among patients with chronic myofascial pain: Comparisons with self-efficacy, catastrophizing, and depression.Journal of Psychosomatic Research. 2002,53:823–830.

    Article  PubMed  Google Scholar 

  62. Smith JA, Lumley MA, Longo DJ: Contrasting emotional approach coping with passive coping for chronic myofascial pain.Annals of Behavioral Medicine. 2002,24:326–335.

    Article  PubMed  Google Scholar 

  63. Broderick JE, Junghaenel DU, Schwartz JE: Written emotional expression produces health benefits in fibromyalgia patients.Psychosomatic Medicine. 2005,67:326–334.

    Article  PubMed  Google Scholar 

  64. Park CL, Blumberg CJ: Disclosing trauma through writing: Testing the meaning-making hypothesis.Cognitive Therapy & Research. 2002, 26:597–616.

    Article  Google Scholar 

  65. Wolfe F, Smythe HA, Yunus MB, et al.: The American College of Rheumatology 1990 criteria for the classification of fibromyalgia. Report of the Multicenter Criteria Committee.Arthritis & Rheumatism. 1990,33:160–172.

    Article  CAS  Google Scholar 

  66. Pennebaker JW, Francis ME, Booth RJ:Linguistic Inquiry and Word Count (LIWC): LIWC2001. Mahwah, NJ: Lawrence Erlbaum Associates, Inc., 2001.

    Google Scholar 

  67. Labouvie-Vief G, Lumley MA, Jain E, Heinze H: Age and gender differences in cardiac reactivity and subjective emotion responses to emotional autobiographical memories.Emotion. 2003,3:115–126.

    Article  PubMed  Google Scholar 

  68. Watson D, Clark LA:The PANAS-X. Manual for the Positive and Negative Affect Schedule-Expanded Form. Iowa City: University of Iowa Press, 1994.

    Google Scholar 

  69. Burckhardt CS, Clark SR, Bennett RM: The fibromyalgia impact questionnaire: Development and validation.Journal of Rheumatology. 1991,18:728–733.

    PubMed  CAS  Google Scholar 

  70. White KP, Harth M: An analytical review of 24 controlled clinical trials for fibromyalgia syndrome (FMS).Pain. 1996,64:211–219.

    Article  PubMed  CAS  Google Scholar 

  71. Dunkl PR, Taylor AG, McConnell GG, Alfano AP, Conaway MR: Responsiveness of fibromyalgia clinical trial outcome measures.Journal of Rheumatology. 2000,27:2683–2691.

    PubMed  CAS  Google Scholar 

  72. Meenan RF, Mason JH, Anderson JJ, Guccione AA, Kazis LE: AIMS2. The content and properties of a revised and expanded Arthritis Impact Measurement Scales Health Status Questionnaire.Arthritis & Rheumatism. 1992,35:1–10.

    Article  CAS  Google Scholar 

  73. Krupp LB, LaRocca NG, Muir-Nash J, Steinberg AD: The fatigue severity scale. Application to patients with multiple sclerosis and systemic lupus erythematosus.Archives of Neurology. 1989,46:1121–1123.

    PubMed  CAS  Google Scholar 

  74. Roehrs T, Bonahoom A, Pedrosi B, Rosenthal L, Roth T: Treatment regimen and hypnotic self-administration.Psychopharmacology. 2001,155:11–17.

    Article  PubMed  CAS  Google Scholar 

  75. Sloan DM, Marx BP, Epstein EM: Further examination of the exposure model underlying the efficacy of written emotional disclosure.Journal of Consulting and Clinical Psychology. 2005,73:549–554.

    Article  PubMed  Google Scholar 

  76. Neale JM, Cox DS, Valdimarsdottir H, Stone AA: The relation between immunity and health: Comment on Pennebaker, Kiecolt-Glaser, and Glaser.Journal of Consulting & Clinical Psychology. 1988,56:636–637.

    Article  CAS  Google Scholar 

  77. Leserman J: Sexual abuse history: Prevalence, health effects, mediators, and psychological treatment.Psychosomatic Medicine. 2005,67:906–915.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mark A. Lumley Ph.D..

Additional information

This article is based on the dissertation of Mazy E. Gillis, conducted under the direction of Mark A. Lumley. The research was supported by a dissertation grant from the Blue Cross Blue Shield of Michigan Foundation and in part by a Postdoctoral Fellowship Award and Clinical Science Award from the Arthritis Foundation and by National Institute of Health grant R01 AR049059.

We thank the Arthritis Foundation for their assistance in recruitment and Heather Koch and Ayna Johansen for their assistance in data collection and coding. Data from this study were presented at the annual meeting of the American Psychosomatic Society, Phoenix, Arizona, in 2003.

About this article

Cite this article

Gillis, M.E., Lumley, M.A., Mosley-Williams, A. et al. The health effects of at-home written emotional disclosure in fibromyalgia: A randomized trial. ann. behav. med. 32, 135–146 (2006). https://doi.org/10.1207/s15324796abm3202_11

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1207/s15324796abm3202_11

Keywords

Navigation