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Examine distress, emotional approach coping, and attachment as moderators of effects of written (WED) versus interpersonal (IED) emotional disclosure and written time management (WTM).
Fifty-seven undergraduates with stressful experiences randomized to a single session of WED, IED, or WTM. Assessment of immediate reaction (NA) and 6-week follow-up (intrusions/avoidance).
Those with higher baseline distress had increased NA, avoidance and intrusions when engaged in WED or IED (vs. WTM). For emotional processors, WED (vs. IED) produced less NA, avoidance, and intrusions. Attachment predicted increased NA in WTM.
Baseline distress and personality characteristics form boundary conditions for written disclosure.
Individual differences and method of disclosure may explain variability in the effects of emotional disclosure interventions. We evaluated boundary conditions for written emotional disclosure (WED) by examining baseline distress, emotional approach coping, and attachment quality as moderators of the effects of single-session WED, compared to either interpersonal emotional disclosure (difference in method), or written time management (difference in content). To distinguish process from outcome, we examined immediate engagement in the disclosure process (increased NA) as well as longer-term stress responses (reduced thought intrusions and avoidance).
We recruited 57 undergraduates (81% female; 44% Caucasian, 26 % African-American, 8.8% Asian, 1.8% Hispanic; Age M = 22.5, SD = 7.04) reporting stressful/traumatic experiences that continue to bother them “moderately” or “very much.” At visit 1, participants provided consent and completed baseline questionnaires. At visit 2, participants were randomized, and conducted a 30-minute session either writing alone in a journal or speaking to a facilitator. Participants rated their NA before and after the session. At visit 3 (six weeks later), participants completed follow-up questionnaires.
For written emotional disclosure (WED), participants wrote the facts and deepest feelings about a personally stressful experience, and for interpersonal emotional disclosure (IED), they spoke about the same topic to an empathic yet nondirective, listening facilitator. For written time management (WTM), participants wrote about their plans for the next 24 hours, next month, and next year.
Potential moderators were baseline global distress (Brief Symptom Inventory; Derogatis & Melisaratos, 1983; α = .97), secure attachment (Relationship Scales Questionnaire; Griffin & Bartholomew, 1994; α = .78), and emotional processing and expression (Emotional Approach Coping Scale; Stanton, Kirk, Cameron, & Danoff-Burg, 2000; α = .80 and .81 respectively).
Process (NA) was measured with the Positive and Negative Affect Scale-Expanded (Watson & Clark, 1994; α = .74 and .84 pre- and post-session). Outcomes (Avoidance; baseline α = .68; follow-up α =.78 and Intrusions; baseline α = .91; follow-up α =.92) were measured with the Impact of Events Scale-Revised (Weiss & Marmar, 1997).
As a manipulation check of session engagement, groups were compared on NA change (post- minus pre-session). As expected, WED (M = 0.55, SD = 1.53) led to greater increase in NA than WTM (M = − 0.22, SD = 0.39; p = .03). Change in NA for the IED group (M = .09, SD = .58) did not differ from either WED or WTM.
To test moderators, we calculated intrusion and avoidance change scores (follow-up minus baseline) and compared WED with IED and then with WTM, by entering group, moderator (after centering), and interaction term in regressions predicting outcome change scores. Table 1 presents standardized betas of the relationship between moderator and outcome for each group by itself, and the interaction terms for group comparisons. Results of analyses predicting the process measure (NA change) also are presented.
Regarding outcomes, baseline distress predicted a trend toward increased avoidance (but not intrusions) for WED, with significant decreases in both for WTM. Group differences in these patterns were confirmed by significant interactions predicting both avoidance and intrusions. Emotional processing predicted increased avoidance and intrusions for IED only, and significant interactions confirmed that emotional processing moderated the effects of WED versus IED on avoidance and intrusions. Emotional expression predicted a significant increase in intrusions and a trend for increased avoidance in IED. The difference between WED and IED was marginally significant for intrusions. Finally, attachment style predicted a trend toward increased avoidance for WTM, but no significant interactions.
Individual differences moderated the effects of different disclosure interventions for undergraduates with stressful/traumatic experiences. In a single 30-minute WED session, distressed individuals demonstrated increases in both post-session negative affect and 6-week follow-up avoidance relative to the relief experienced by similar persons in the WTM condition. Conversely, attachment style predicted substantially increased NA in the time management condition relative to WED. Finally, emotional processing and expression predicted poorer outcomes in the interpersonal disclosure (vs. WED).
This study has limitations. First, to mimic brief disclosure experiences that commonly occur, we studied a single disclosure session rather than multiple sessions. Second, to mirror the WED condition (where there is no feedback), IED facilitators engaged only in nondirective support; thus, IED findings may not generalize to more interactive interpersonal disclosures (e.g. supportive therapies). Third, the WTM condition may have an active component (providing structure and order to one’s life), and a no-writing control condition may clarify findings.
Disclosure may operate differently for different individuals and as a function of method of disclosure. In this study, those with high baseline distress appear activated by the 30-minute session and have poorer outcomes. Highly distressed individuals may need multiple sessions, or perhaps WED may be beneficial only to those with less distress. Despite research suggesting they would most likely benefit (Stanton et al., 2000), emotionally sophisticated individuals engaging in IED had poorer outcomes. Securely attached persons showed similar patterns in the WTM condition. Perhaps such individuals are prepared for, expecting to engage in, and would benefit from a more active intervention. Additional research with larger samples, other potential moderators, and experimental manipulation of interpersonal disclosure is needed to replicate these findings and further our understanding of the boundary conditions of disclosure.
Preparation of this manuscript was supported, in part, by NIH grant AR049059. We thank Dana Nevedal, Christina Sawula, and Megan Lasco for their assistance in data collection.