The feasibility and effectiveness of an expressive writing intervention for rheumatoid arthritis via home-based videotaped instructions

Abstract

Background: Expressive emotional writing has demonstrated efficacy for improving health status in a wide variety of healthy persons and recently in patients with chronic disease.

Purpose: This study was a randomized, controlled effectiveness trial with 4 arms: 2 active treatment writing groups, 1 inactive writing group, and 1 attention control group. It represents the first attempt to translate the expressive writing intervention into a low-cost, community-based intervention in the form of a videotaped program.

Methods: Feasibility of the approach and patient adherence were examined in a community rheumatology practice with rheumatoid arthritis patients (N = 373).

Results: The videotape format was able to convey the intervention instructions accurately and produced the expected and differential ratings of stressfulness and emotional provocation across the 3 writing programs. Seventy-nine percent of eligible patients agreed to take the program home; 49% of these patients reported that they followed the protocol. Physician Disease Activity Rating and the Physical Component Summary of the SF36v2 Health Survey were assessed pre and post program.

Conclusions: Intent-to-treat analyses found no effect of the treatment. Pretreatment differences among the protocol-adherent patients complicated treatment outcome interpretation. The standard writing instructions did not yield an effect; a modified set of instructions to extract meaning from the traumatic event yielded equivocal results. Contrasts between efficacy and effectiveness trials and the challenge of achieving significant outcomes in effectiveness trials are discussed.