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Frankfurt S, Frazier P, Litz BT, Schnurr PP, Orazem RJ, Gravely A, Sayer N. Online expressive writing intervention for reintegration difficulties among veterans: Who is most likely to benefit? Psychological trauma : theory, research, practice and policy. 2019 Apr 18.
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Abstract: OBJECTIVE: Some veterans may benefit from psychosocial interventions to facilitate reintegration and prevent chronic impairments following discharge from the service. In a randomized controlled trial, an online expressive writing intervention for Iraq and Afghanistan War veterans with reintegration difficulties reduced distress relative to control conditions, albeit with small between-group effect sizes (Sayer, Noorbaloochi et al., 2015). The aims of this study were to further explore changes in distress severity in the parent study's experimental group by identifying subgroups with similar trajectories and examining predictors of those trajectories. METHOD: We used latent class growth modeling to identify trajectories of change in distress among veterans randomized into expressive writing (N = 508). We also tested six predictors of trajectory membership: baseline probable PTSD, social support, combat exposure, sex, VA user status, and active-duty versus National Guard/Reserve status. The sample was mostly White, middle-aged, Army veterans deployed from active duty, all of whom reported reintegration difficulties. RESULTS: A four-class model, with the following classes, best fit the data: Low Baseline Distress-Moderate Decrease (60%; Cohen's d = -0.69), Moderate Baseline Distress-No Change (25%; Cohen's d = -0.16), Severe Baseline Distress-Small Increase (10%; Cohen's d = 0.23), and Severe Baseline Distress-Very Large Decrease (5%; Cohen's d = -4.80). Veterans without probable PTSD, with less combat exposure, and with higher social support were more likely to be in classes with decreasing distress. CONCLUSION: Analyses revealed several subgroups with unique patterns of change. Non-therapist-assisted expressive writing may be most suitable for veterans with less complex psychosocial problems. (PsycINFO Database Record (c) 2019 APA, all rights reserved).