Computer-based written emotional disclosure: the effects of advance or real-time guidance and moderation by Big 5 personality traits.

Standard written emotional disclosure (WED) about stress, which is private and unguided, yields small health benefits. The effect of providing individualized guidance to writers may enhance WED, but has not been tested. This trial of computer-based WED compared two novel therapist-guided forms of WED - advance guidance (before sessions) and real-time guidance (during sessions, through instant messaging) - to both standard WED and control writing; it also tested Big 5 personality traits as moderators of guided WED. Young adult participants (n = 163) with unresolved stressful experiences were randomized to conditions, had three, 30-min computer-based writing sessions, and were reassessed six weeks later. Contrary to hypotheses, real-time guidance WED had poorer outcomes than the other conditions on several measures, and advance guidance WED also showed some poorer outcomes. Moderator analyses revealed that participants with low baseline agreeableness, low extraversion, or high conscientiousness had relatively poor responses to guidance. We conclude that providing guidance for WED, especially in real-time, may interfere with emotional processing of unresolved stress, particularly for people whose personalities have poor fit with this interactive form of WED.

Pain and emotion: a biopsychosocial review of recent research.

OBJECTIVE AND METHOD: Research on emotion and pain has burgeoned. We review the last decade's literature, focusing on links between emotional processes and persistent pain. RESULTS: Neurobiological research documents the neural processes that distinguish affective from sensory pain dimensions, link emotion and pain, and generate central nervous system pain sensitization. Psychological research demonstrates that greater pain is related to emotional stress and limited emotional awareness, expression, and processing. Social research shows the potential importance of emotional communication, empathy, attachment, and rejection. CONCLUSIONS: Emotions are integral to the conceptualization, assessment, and treatment of persistent pain. Research should clarify when to eliminate or attenuate negative emotions, and when to access, experience, and express them. Theory and practice should integrate emotion into cognitive-behavioral models of persistent pain.

Does emotional disclosure about stress improve health in rheumatoid arthritis? Randomized, controlled trials of written and spoken disclosure.

Studies of the effects of disclosing stressful experiences among patients with rheumatoid arthritis (RA) have yielded inconsistent findings, perhaps due to different disclosure methods--writing or speaking--and various methodological limitations. We randomized adults with RA to a writing (n=88) or speaking (to a recorder) sample (n=93), and within each sample, to either disclosure or 1 of 2 control groups (positive or neutral events), which conducted four 20-minute, at-home sessions. Follow-up evaluations at 1, 3, and 6 months included self-reported, behavioral, physiological, and blinded physician-assessed outcomes. In both writing and speaking samples, the disclosure and control groups were comparably credible, and the linguistic content differed as expected. Covariance analyses at each follow-up point indicated that written disclosure had minimal effects compared with combined controls--only pain was reduced at 1 and 6 months, but no other outcomes improved. Spoken disclosure led to faster walking speed at 3 months, and reduced pain, swollen joints, and physician-rated disease activity at 6 months, but there were no effects on other outcomes. Latent growth curve modeling examined differences in the trajectory of change over follow-up. Written disclosure improved affective pain and walking speed; spoken disclosure showed only a marginal benefit on sensory pain. In both analyses, the few benefits of disclosure occurred relative to both positive and neutral control groups. We conclude that both written and spoken disclosure have modest benefits for patients with RA, particularly at 6 months, but these effects are limited in scope and consistency.

Written Emotional Disclosure: Testing Whether Social Disclosure Matters.

Studies suggest that written emotional disclosure can improve health. Unknown, however, is whether the presence or absence of an audience for one's disclosure matters, and whether time management control writing has any effects. Undergraduates (N = 165) with unresolved stress were randomized to 1 of 3 groups that wrote for 4 sessions: shared written disclosure (submitted to researchers), private written disclosure (not submitted), or time management control writing; or to a fourth group (no-writing control). At 3-month follow-up, the two control groups were equivalent on outcomes. Both shared and private disclosure resulted in less cognitive intrusion and avoidance than the combined control groups. Yet, shared disclosure reduced depression and interpersonal sensitivity more than either private disclosure or the control groups, and only shared disclosure reduced physical symptoms. Although truly private writing improves cognitive stress effects, shared writing has broader benefits, suggesting that social disclosure for one's writing matters.

Does Written Emotional Disclosure about Stress Improve College Students' Academic Performance? Results from Three Randomized, Controlled Studies.

Several early studies and subsequent reviews suggested that written emotional disclosure (WED)-writing repeatedly about personal stressful experiences-leads to improved academic performance of college students. Yet a critical review of available studies casts some doubt on this, so we conducted three randomized, controlled experiments of the effects of WED versus control writing on grade point average (GPA) of college students. In all three studies, WED writing was implemented effectively-it contained more negative emotion language and generated more negative mood than did control writing. In Study 1, WED did not influence GPA during either the writing semester or subsequent semester among 96 students with headaches. In Study 2, WED had no effect on GPA compared with either control writing or no writing conditions among 124 students with unresolved stress. In Study 3, WED did not influence GPA or retention among 68 academically at-risk ethnic minority students, although secondary analyses suggested some benefits of WED among students who wrote more than once, particularly men. These three studies challenge the belief that WED improves academic performance of college students, and research should examine subgroups of students who might benefit from WED.

Clinical psychology students' perceptions of diversity training: a study of exposure and satisfaction.

This study examined clinical psychology graduate students' definitions of diversity and their perceptions of their exposure to and satisfaction regarding their level of diversity training. Four hundred and ninety-one students from Counsel of University Directors of Clinical Psychology (CUDCP) member programs completed an online survey. Overall, students perceived that their programs considered diversity narrowly, concentrating primarily on ethnicity, race, and culture to the neglect of sexual orientation, religion, language, and physical disability. Likewise, students expressed greater satisfaction with training regarding ethnicity/race and gender than broader areas of diversity, but rated the importance of addressing all areas of diversity as high. Although this study underscores the limited experience that students perceive they have had with various underrepresented groups, programs appear to have incorporated a variety of diversity training modalities that could be expanded upon to meet the interests of psychology students.

Evidence-based practice in psychology: perceptions of graduate students in scientist-practitioner programs.

The evidence-based practice movement in psychology (EBPP) is a relatively recent initiative to improve client care by integrating the best available research evidence with clinicians' expertise in the context of patient values and preferences. As this movement gains momentum in the field of psychology, training programs will likely need to modify their curricula to include training in the process of EBPP. An online survey was conducted of clinical psychology graduate students in programs that identified themselves as having a scientist-practitioner or clinical science model (N = 1,195). Understanding of, experiences with, attitudes towards, and training in EBPP was assessed. Students had a generally favorable view of psychology's move toward EBPP. Although students reported a moderate amount of exposure to and experiences with EBPP, misunderstandings about the principles of EBPP were prevalent. Compared to students planning primarily clinical practice careers, students planning primarily clinical research careers were more favorable towards EBPP, expected EBPP to be more influential in their future careers, and were more likely to use research, but less likely to use client preferences to guide treatment planning. Recommendations for modifying training programs to promote EBPP are discussed.

Alexithymia and pain in three chronic pain samples: comparing Caucasians and African Americans.

OBJECTIVE: African Americans often report greater pain than do Caucasians, but the factors responsible for this discrepancy are not known. We examined whether alexithymia-the trait of difficulty identifying and describing one's feelings and lacking introspection-may contribute to this ethnic group difference. We tested whether the mean level of alexithymia is higher, and whether alexithymia and pain are more highly correlated, among African Americans than among Caucasians in patients with chronic pain disorders. DESIGN: Three cross-sectional, correlational studies were conducted on three separate samples of patients with chronic pain. Analyses examined the full sample and then Caucasians and African Americans separately. SETTING AND PATIENTS: Patients were recruited primarily from treatment settings. Samples were patients with rheumatoid arthritis (N = 155), migraine headaches (N = 160), or systemic lupus erythematosus (N = 123), and each sample included only Caucasians or African Americans. MEASURES: The Toronto Alexithymia Scale-20 assessed global alexithymia and three alexithymia facets. Pain severity, functional disability, or symptoms were also measured on each sample. RESULTS: Similar findings occurred across all three samples. African Americans had only slightly higher mean alexithymia levels than did Caucasians, and this was partly accounted for by socioeconomic differences between groups. More importantly, alexithymia correlated only weakly with pain or symptom severity for each full sample, but the two ethnic groups showed different patterns. Alexithymia correlated positively with pain severity among African Americans, but was uncorrelated with pain among Caucasians, even after covarying for various socioeconomic variables. CONCLUSIONS: Alexithymia is more correlated with pain severity among African Americans with chronic pain disorders than among Caucasians, potentially contributing to the higher pain reports among African Americans.