Written expressive disclosure in adults with irritable bowel syndrome: A randomized controlled trial

Abstract

Background: The benefits of written expressive disclosure (WED) to health are documented in a variety of healthy and clinical populations. This study investigates the effect of WED on health-related outcomes in irritable bowel syndrome (IBS).

Methods: Adults (N = 189) meeting Rome III criteria for IBS were randomly assigned to write about their: (1) deepest thoughts and feelings about the most stressful life event of the past five years (n = 67), (2) deepest thoughts and feelings about their IBS (n = 61) or (3) daily activities in an objective manner (control condition; n = 61). Participants completed four 20-min writing sessions over 2-6 weeks. Gastrointestinal (GI) symptoms, healthcare utilization, health-related quality of life (HR-QOL), pain catastrophizing, and pain self-efficacy were assessed at baseline, one month post-writing completion, and three months post-writing completion.

Results: A significant group (combined WED vs. control) X time interaction was detected for healthcare utilization, F(1,147) = 6.16, p = 0.014, η² = 0.04. Specifically, number of GI-related medical appointments significantly increased from baseline to 3-month follow-up in the control group, while no significant change was observed in the combined WED group. Among the WED group, individuals assigned to write about their IBS experienced greater improvements in pain self-efficacy than those assigned to write about a life stressor, F(1,92) = 3.89, p = 0.024, η² = 0.08. GI symptom severity, HR-QOL, and pain catastrophizing improved significantly across groups over time, with no significant between-group differences.

Conclusion: Writing about one's deepest thoughts and feelings about IBS may increase pain self-efficacy and reduce healthcare utilization compared to control writing in adults with IBS.

Keywords: Chronic pain; Disorders of gut-brain interaction; Expressive writing; Irritable bowel syndrome; Journaling; Minimal-contact.

Figure 1:

Consort flow diagram.

Figure 2:

Mean number of appointments for GI symptoms at baseline and 3-month follow-up within the combined WED and control writing groups. Error bars denote 95% confidence intervals of the mean.