HSR&D Citation Abstract
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RCT of an online expressive writing intervention for Veteran reintegration difficulty.
Sayer NA, Noorbaloochi S, Frazier PA, Pennebaker JW, Orazem RJ, Schnurr PP, Murdoch M, Carlson KF, Gravely AA, Litz B. RCT of an online expressive writing intervention for Veteran reintegration difficulty. Poster session presented at: American Psychological Association Annual Convention; 2015 Aug 6; Toronto, Canada.
Statement of the Problem: There is a need for accessible and nonstigmatizing interventions
to improve health and reintegration among veterans returning from war with difficulty
reintegrating into civilian life. This study examined the efficacy of a brief, portable online
intervention writing expressively about transitioning to civilian life.
Subjects Used: Participants were 1,292 US Iraq and Afghanistan war veterans with selfreported
reintegration difficulty who had internet access, email, and a telephone number.
Those with severe depression were excluded. Thirty-nine percent (n = 508) of the sample
was female; 64% (n = 829) self-identified as White. Over half (n = 686) met screening
criteria for PTSD.
Procedures: We used a repeated measures randomized block design with gender as the
blocking factor. Participants were randomized to four sessions of online expressive writing
(n = 508), four sessions of online factual writing (n = 507), or no writing (n = 277) at a ratio
of 2:2:1. We assessed self-reported outcomes at baseline, and then 3- and 6-months later.
Primary outcomes were PTSD symptom severity, distress, anger, physical complaints,
reintegration difficulty, social support and satisfaction with life. Clinically significant
distress, PTSD screening and employment status were secondary outcomes. We reviewed
each essay for suicidality/homicidality and monitored for adverse events. We analyzed all
outcomes with generalized linear mixed models using intention-to-treat.
Results: Six months post intervention, veterans who wrote expressively experienced greater
reductions in physical complaints, anger and distress compared with veterans who wrote
factually (ps < .05; ds = .13 to .20) and greater reductions in PTSD symptoms, distress,
anger, physical complaints, and reintegration difficulty compared with veterans who did not
write at all (ps = . 001; ds = .22 to .35). Relative to control conditions, expressive writing did
not lead to improved social support or life satisfaction. Secondary analyses found beneficial
effects of expressive writing on clinically significant distress, PTSD screening status and
employment. There were no serious adverse events.
Conclusions: Expressive writing could benefit veterans struggling with postdeployment
reintegration difficulties. Because expressive writing can be delivered safely over the
internet without clinician involvement, it carries potential to reach individuals who might
otherwise not get help (e.g., because of access barriers to traditional care or stigma).
However, between-group effect sizes were small. Expressive writing cannot substitute for
evidence-based treatments for diagnosable disorders.