Change mechanisms and clinical utility of written self -disclosure in a behavioral medicine setting

Although written self-disclosure has been found to have physical and mental health benefits in psychologically healthy populations, its degree of effectiveness in clinical populations and the mechanisms of change remain unclear. The present study examined the clinical utility of written self-disclosure in a behavioral medicine population and examined a proposed model of change. The proposed model of change states that written self disclosure is helpful because it decreases experiential avoidance allowing for subsequent increases in perceived meaning and acceptance. Decreased experiential avoidance and increased acceptance lead, in turn, to decreased negative affect (habituation). Participants were 50 patients referred for one of several behavioral medicine programs at a local HMO who were randomly assigned to four sessions of writing or relaxation training. Participants in the writing condition spent 20 minutes writing about a traumatic life event. They also completed several process and outcome measures of emotional engagement, cognitive avoidance, construction of meaning, and acceptance. Relaxation training participants spent 20 minutes listening to recorded instructions for eliciting the relaxation response. All participants completed physical and psychological health outcome measures. Although results did not show any between-group differences in outcome, differential patterns of decreases in negative affect and distress support the proposed model of change. High attrition from the writing group, however, calls into question the acceptability and usefulness of written self-disclosure as a stand-alone intervention in clinical populations.