Disclosure of traumas and immune function: Health implications for psychotherapy

Gender Differences in Adolescents' Reactions to the Murder of Their Teacher

One month following the murder of their teacher, 63 adolescents responded to a questionnaire concerning different aspects of the event. Those adolescents who learned about the murderfrom siblings andfriends reported sufferingfrom more intrusive images and depressive thoughts than those adolescents who learned about the event from parents. Girls reported reacting more strongly and talking more with both theirfriends and their parents about the event than did boys. Differing explanations regarding the observed gender differences are suggested Correlations in the data indicate that those students who reported being the most depressed and anxious were those who talked with their friends about the event. Talking with one's parents was associated with less depressive thinking and less avoidance.

Web-based intervention improves social acknowledgement and disclosure of trauma, leading to a reduction in posttraumatic stress disorder symptoms

This study aims to investigate the effectiveness of web-based intervention on social acknowledgement and disclosure of trauma and to examine the mediating effect of the improvement in social acknowledgement and disclosure of trauma on the reduction of posttraumatic stress disorder symptoms. A randomized controlled trial was used, with 21 participants in a web-based intervention group and 29 participants in a wait-list control group completing a pre-test and post-test. Results showed that social acknowledgement and disclosure of trauma improved significantly after 1-month intervention, and this improvement mediated the reduction in the posttraumatic stress disorder symptoms. Implications and limitations of this study are discussed.

Writing about the Perceived Benefits of Traumatic Events: Implications for Physical Health

Research by Pennebaker and his colleagues supports the healing power of writing about traumatic events. This study explored the importance of writing about the perceived benefits of traumatic events as a factor in this process. The study included 118 participants who were randomly assigned to write about one of four topics in a 2 (writing about perceived benefits vs. not writing about perceived benefits)× 2 (writing about trauma vs. not writing about trauma) factorial design. Participants also completed questionnaire measures of subjective well-being and released health center information for the year. Participants who wrote only about trauma or perceived benefits showed significantly fewer health center visits for illness 3 months after writing. In addition, 5 months after writing, the trauma-only and perceived-benefits-only groups maintained a difference from the control group. These results suggest that writing about perceived benefits from traumatic events may provide a less upsetting but effective way to benefit from writing.

The Health Benefits of Writing about Life Goals

In a variation on Pennebaker’s writing paradigm, a sample of 81 undergraduates wrote about one of four topics for 20 minutes each day for 4 consecutive days. Participants were randomly assigned to write about their most traumatic life event, their best possible future self, both of these topics, or a nonemotional control topic. Mood was measured before and after writing and health center data for illness were obtained with participant consent. Three weeks later, measures of subjective well-being were obtained. Writing about life goals was significantly less upsetting than writing about trauma and was associated with a significant increase in subjective well-being. Five months after writing, a significant interaction emerged such that writing about trauma, one’s best possible self, or both were associated with decreased illness compared with controls. Results indicate that writing about self-regulatory topics can be associated with the same health benefits as writing about trauma.

What is it about Revealing Secrets that is Beneficial?

Two studies explored what it is about revealing secrets that makes people feel better about them. In Study 1, undergraduates (N = 137) indicated whether they had gained new insights or catharsis from revealing secrets to confidants in the past. Gaining insights predicted feeling positive about the secrets, whereas gaining catharsis predicted feeling negative about them. In Study 2, undergraduates (N = 85) were randomly assigned to write about their (a) secrets while trying to gain new insights, (b) secrets while trying to gain catharsis, or (c) previous day. The new insights group felt more positive about their secrets than did the other groups and came to terms with their secrets more than did those in the catharsis group. Not coming to terms with the secrets was associated with feeling negative about them. It is suggested that focusing solely on venting emotions may be an unhelpful or even harmful way of dealing with secrets.

The Good, the Bad, and the Healthy: Impacts of Emotional Disclosure of Trauma on Resilient Self-Concept and Psychological Distress

This study examined the impact of disclosing traumas on resilient self-perceptions and psychological distress. Participants (N = 50) wrote about a traumatic life event or their plans for the next day and completed measures of resilience and distress before disclosing (pretest) and 3 months later (posttest). Results revealed that trauma participants increased in positive self-perceptions (mastery, personal growth, self-acceptance) and decreased in distress (depression, interpersonal sensitivity, anxiety, somatization) from pretest to posttest. Control participants showed no changes except for autonomy, on which they decreased. Results suggest that in addition to reducing psychological distress, disclosing traumas change self-perception, resulting in a more resilient self-concept.

Associations Between Attachment Representations and Health Behaviors in Late Adolescence

In this study, we tested the associations among attachment ratings and health behaviors by relationship status. For individuals in relationships, attachment security was associated positively with health promotion and quality sleep and negatively with risk behaviors; fearfulness was associated positively with risk behaviors. With the exception of sleep behaviors, associations with security and fearfulness were reversed for single participants. Associations between dismissingness and quality of sleep support the proposal that individuals who deny or dismiss their attachment needs may experience physical symptoms of distress that affect their health. Future work exploring the benefits of security when coping with illness or lifestyle change is discussed.

Social Sharing of Emotion in Anticipation of Cardiac Surgery

This study examined associations between social sharing of emotions, social support and preoperative psychological distress. Social sharing was operationalized in terms of quantity and quality. Quantity of social sharing was measured daily using a diary method. Quality of social sharing was measured with the Quality of Sharing Inventory. Participants were 157 hospitalized Greek patients. Hierarchical regression analysis showed that controlling for distress on admission, quality of social sharing was negatively related to distress one day before surgery ( p < .01). No effects were found for quantity of social sharing. Results emphasize the importance of studying qualitative aspects of emotional disclosure.

Predicting Pain and Adjustment in Rheumatoid Arthritis

The role of disclosure and emotional processing of stressful life events has not been studied in chronically ill populations. We attempted to predict the pain, physical dysfunction, and affective disturbance of 82 patients with rheumatoid arthritis (RA) from their life stress and from various measures of emotional processing: disclosure to others and thought frequency about stressful events, positive and negative emotional expression, ambivalence about emotional expression and secrecy. After controlling for demographics (gender, race, education, disability status), disease measures (duration of diagnosis, objective disease activity), and life stress, we found that pain was related to an increased expression of negative emotion; physical dysfunction was related to an increased frequency of thinking about stressful events; and affective disturbance was related to both increased ambivalence about emotional expression and increased thought frequency. We conclude that RA pain and adjustment are better predicted by emotional processing of stressful life events—including disclosure to others and emotional expression—than by the experience of stressful events, per se.

Cognitive and Emotional Processing in Narratives of Women Abused by Intimate Partners

This study examined relationships between cognitive and emotional processing with changes in pain and depression among intimate partner violence survivors. Twenty-five women who wrote about their most traumatic experiences completed measures of pain and depressive symptoms before the first writing session and again 4 months following the last writing session. Reduced pain was significantly associated with less use of positive and negative emotion words. Relationships between cognitive and emotional aspects of writing with changes in depressive symptoms fell short of statistical significance. The results suggest that emotional processing in narrative writing predicts changes in pain in intimate partner violence survivors.

“It'll Come Right Back at Me”

This study is based on qualitative analysis of interviews with 30 rape survivors. Participants who had been raped by men they knew often delayed telling anyone about the rape and experienced more negative reactions than those attacked by strangers. Reactions ranged from support and inconsistent support to silence/avoidance and hostility. The unpredictable pattern of reactions made all the survivors more hesitant about discussing their experiences with others. The results suggest the critical importance of the social context in which survivors discuss sexual victimization and why, at times, silence may be the most logical response.

Personal Web Home Pages of Adolescents With Cancer: Self-Presentation, Information Dissemination, and Interpersonal Connection

The content of personal Web home pages created by adolescents with cancer is a new source of information about this population of potential benefit to oncology nurses and psychologists. Individual Internet elements found on 21 home pages created by youths with cancer (14-22 years old) were rated for cancer-related selfpresentation, information dissemination, and interpersonal connection. Examples of adolescents' online narratives were also recorded. Adolescents with cancer used various Internet elements on their home pages for cancer-related self-presentation (eg, welcome messages, essays, personal history and diary pages, news articles, and poetry), information dissemination (e.g., through personal interest pages, multimedia presentations, lists, charts, and hyperlinks), and interpersonal connection (eg, guestbook entries). Results suggest that various elements found on personal home pages are being used by a limited number of young patients with cancer for self-expression, information access, and contact with peers.

The Effects of Mental Simulation on Coping with Controllable Stressful Events

Previous research has revealed that writing or talking about traumatic stressors can improve health and psychological well-being. The present study investigated whether similar benefits may be conferred by mental simulation and whether such simulations can improve coping and affective responses to ongoing stressful events. All participants designated an ongoing stressful event in their lives. One third of the participants visualized the event and the emotions they had experienced (event simulation), one third visualized having resolved the problem (outcome simulation), and one third were simply followed over time (control). Event simulation participants reported more positive affect, both immediately and 1 week later, and indicated higher levels of planned and reported active coping strategies, compared with the other two conditions. Discussion focuses on the potential of structured mental simulation to facilitate coping with stressful events.

Keeping Emotional Memories Secret

The present study investigated two predictions derived from inhibition theory. It was hypothesized that emotional secrecy has a negative impact on (1) physical and (2) subjective well-being. Also, the study examined whether the relation holds when controlling for negative affectivity (NA), a variable that can be assumed to mediate the relation between emotional secrecy and physical and subjective well-being. Consistent with the hypothesis, emotional secrecy negatively affected physical health. This finding was not explained by NA, which contributed independently to physical health. Contrary to the prediction, emotional secrecy affected life satisfaction but indirectly through the mediating influence of physical health. The implications of these results for future research on emotional secrecy and physical and subjective well-being are discussed.

Structural Models of the Relations of Assault Severity, Social Support, Avoidance Coping, Self-Blame, and PTSD Among Sexual Assault Survivors

A number of studies have identified which survivors of sexual assault are more likely to develop symptoms of posttraumatic stress disorder (PTSD). Most correlates that have been identified have been at the individual level. Insufficient attention has been given to whether survivors' social interactions impact their individual responses to assault and subsequent levels of psychological symptomatology. In this study, a large, diverse sample of community-residing women ( N = 636) was surveyed. Structural equation modeling was used to examine the relationships between assault severity, global support, negative social reactions, avoidance coping, self-blame, traumatic life experiences, and PTSD symptoms. The results suggest that negative social reactions and avoidance coping are the strongest correlates of PTSD symptoms and that the association typically observed between victim self-blame and PTSD symptoms may be partially due to the effect of negative social reactions from others. These reactions may contribute to both self-blame and PTSD. Implications for future research and clinical practice are discussed.

Social Reactions, Coping Strategies, and Self-Blame Attributions in Adjustment to Sexual Assault

The present study investigated the impact of social reactions of others to sexual-assault victims on disclosure of their victimization. A convenience sample of adult sexual-assault victims ( N = 155) completed a mail survey in which they reported information about their sexual assaults and postassault experiences. As expected, all negative social reactions were strongly associated with increased psychological symptoms, whereas most positive social reactions were unrelated to adjustment. The only social reactions related to better adjustment were being believed and being listened to by others. Victims experiencing negative social reactions also reported poorer adjustment even when other variables known to affect psychological recovery were controlled. Avoidance coping mediated the association of negative social reactions with adjustment. Implications of these findings for research and treatment of sexual-assault survivors are discussed.

Writing About Emotional Experiences as a Therapeutic Process

For the past decade, an increasing number of studies have demonstrated that when individuals write about emotional experiences, significant physical and mental health improvements follow The basic paradigm and findings are summarized along with some boundary conditions Although a reduction in inhibition may contribute to the disclosure phenomenon changes in basic cognitive and linguistic processes during writing predict better health Implications for theory and treatment are discussed

Disease disclosure in individuals with cystic fibrosis: Association with psychosocial and health outcomes

BACKGROUND

This study aimed to quantify cystic fibrosis (CF) disclosure and examine associations between disclosure and psychosocial and health outcomes.

METHODS

Participants completed measures assessing disease disclosure and psychosocial outcomes. Data from chart reviews and pharmacy records were obtained.

RESULTS

Participants (N=128; ages 16-63) were more likely to disclose to romantic partners (97%) and close friends (94%) than to casual friends (79%), bosses (71%), or co-workers (53%). Participants reported more comfort discussing CF with and doing treatments in front of romantic partners and close friends than other groups. Disclosure was associated with higher social support, social functioning, and medication adherence self-efficacy. Lower lung-function was associated with disclosure to bosses and co-workers.

CONCLUSIONS

Clinicians should consider discussing disclosure with patients, as limited disclosure may have a negative impact on psychosocial outcomes.

Effects of an expressive writing intervention on a group of public employees subjected to work relocation

BACKGROUND

Pennebaker's writing technique has yielded good results on health, psychological and performance dimensions. In spite of the positive outcomes, the technique has rarely been applied directly within the workplace and its effects on burnout have never been tested.

METHOD

18 public employees subjected to work relocation were asked to write about their present work situation or another difficult event of their life (Writing Group), while another 17 were not assigned any writing task (Control Group).

OBJECTIVE

To assess whether there was an improvement in burnout, alexithymia and psychological well-being in the Writing Group compared with the baseline measurement and the Control Group.

RESULTS

While the baseline levels in the Writing and Control Groups in the 3 dimensions considered were similar, scores in the Writing Group at both a second (1 month after the end of the procedure) and third measurement (7 months after the end) improved when compared with the baseline, whereas those in the Control Group worsened.

CONCLUSIONS

Pennebaker's writing technique appears to promote adaptive coping strategies in stressful situations, and to increase occupational and psychological well-being as well as the ability to process emotions. It also appears to buffer the negative effects of work-related stress.

Exploring domestic violence and social distress in Australian-Indian migrants through community theater

In many parts of the world, young adult women have higher levels of common mental disorders than men. The exacerbation of domestic violence (DV) by migration is a salient social determinant of poor mental health. Ecological models describe factors contributing to DV as operating at individual, family, cultural, and societal levels. We explored the interplay among these factors in an Indian community living in Melbourne, Australia, in a qualitative participatory action research study using a modified Forum Theater approach. We here present findings on connections between migration, societal factors, and social/family/cultural factors in DV. The study captured the voices of women living in the community as they describe how DV contributes to their emotional difficulties. Improved understanding of the sociocultural dynamics of DV and the associated social distress in this migrant Indian community can be used to guide the development of culturally sensitive prevention and response programs to assist migrant women from the Indian subcontinent who present with psychopathology and suicidal behaviors associated with DV.

Another Way to Talk: Exploring Photovoice as a Strategy to Support Safe Disclosure Among Men and Women With HIV

HIV status disclosure can reduce stigma and facilitate medication adherence and safer sex among people living with HIV (PLH). Effective disclosure interventions are limited, however, and new strategies are necessary. We conducted a pilot Photovoice-based project with 38 PLH in four cities in the Midwest and Northeast U.S. and explored how the project affected disclosure perspectives and experiences. Participants attended three group Photovoice sessions, one individual session, and an optional photo exhibit. Qualitative strategies of theme and narrative analysis of photos and session transcripts revealed that participants discussed three categories of disclosures to others: fearful, reluctant, and open. The project supported all disclosure types, helping fearful participants manage their emotions, reluctant participants plan for more effective disclosures, and open participants share their HIV status. Pilot findings suggest that Photovoice should be further developed and studied as a safe and powerful strategy to improve disclosure and subsequent health and prevention outcomes among PLH.

"I Didn't Know Whether I Was Right or Wrong or Just Bewildered": Ambiguity, Responsibility, and Silencing Women's Talk of Men's Domestic Violence

Little has been written about the impact on women of the man's obscuring and deflecting of responsibility when domestic violence is used by him against her. Women's advocates report that women who seek shelter from domestic violence assume blame for the violence and struggle to shift from this position of responsibility. Women are likely to be silenced if they assume responsibility and are less likely to come forward. In this study, we use discourse analysis to describe the ambiguities around responsibility that worked to silence 20 women and the sociocultural influences that supported this ambiguity. We discuss the implications for prevention.

Social media users have different experiences, motivations, and quality of life

While the number of individuals participating in internet-based social networks has continued to rise, it is unclear how participating in social networks might influence quality of life (QOL). Individuals differ in their experiences, motivations for, and amount of time using internet-based social networks, therefore, we examined if individuals differing in social network user experiences, motivations and frequency of social network also differed in self-reported QOL. Two-hundred and thirty-seven individuals (aged 18-65) were recruited online using the online platform Mechanical Turk (MTurk). All participants completed a web-based survey examining social network use and the World Health Organization Quality of Life Scale Abbreviated Version (WHOQOL-Bref) to assess QOL. Individuals who reported positive associations with the use of social networks demonstrated higher QOL while those reporting negative associates demonstrated lower QOL. Moreover, individuals using social networks to stay connected to friends demonstrated higher QOL while those using social networking for dating purposes reported lower QOL. Frequency of social network use did not relate to QOL. These results suggest that QOL differs among social network users. Thus, participating in social networking may be a way to either promote or detract from QOL.

Evaluating guilt and shame in an expressive writing alcohol intervention

Expressive writing interventions have shown positive physical and psychological health benefits over time, with the presumed mechanism being emotional disclosure. However, work utilizing expressive writing in behavior change has been minimal. The current research applied the expressive writing paradigm to reduce drinking intentions among college students, and evaluated the role of event-related guilt and shame in intervention effects. College students (N=429) completed a baseline survey and were randomly assigned to one of three conditions: Negative (write about a heavy drinking event that was negative); Positive (write about a heavy drinking event that was positive); or Neutral (write about their first day of college). After writing, readiness to change and future drinking intentions were assessed. Results revealed intervention effects on intended drinks per week and intended number of drinks during peak and typical drinking occasions. Participants in the negative condition also displayed higher levels of event-related guilt and shame. Results showed that guilt mediated intervention effects on readiness to change, which also mediated the association between guilt-reparative behavior and drinking intentions. Results provide initial support for an expressive writing intervention on alcohol use and underscore the importance of eliciting emotions associated with reparative behavior when considering negative past experiences and future behavior change.

Living Legends: Effectiveness of a Program to Enhance Sense of Purpose and Meaning in Life Among Community-Dwelling Older Adults

OBJECTIVE. We investigated the therapeutic benefits (i.e., sense of purpose and meaning in life) of the Living Legends program, which includes life review writing and an intergenerational exchange, compared with life review writing alone, for community-dwelling older adults.

METHOD. This study was a randomized controlled trial with a connected qualitative component. We analyzed quantitative data using independent-samples t tests and written descriptions of program experiences using Collaizi’s qualitative methodology; we then used a triangulation protocol to integrate the qualitative and quantitative data.

RESULTS. For participants in the writing workshop plus intergenerational exchange, sense of purpose and meaning in life increased significantly (p &lt; .0001) compared with those in the writing workshop alone. Qualitative themes revealed additional program benefits.

CONCLUSION. Living Legends enhanced participants’ sense of purpose and meaning in life, a factor known to prevent cognitive loss and disability, compared with life review writing alone.

Identifying attentional deployment tactics in older adults' written narratives about emotionally upsetting events

Essays about distressing events written by 58 older adults on three occasions (n = 174) were coded to identify how older adults responded when confronting an emotionally upsetting event. Participants limited the experience of negative emotion by transitioning from negative to positive aspects of the event within a writing session, and across sessions, switched writing topics and moved from writing about past events to current problems. The use of attentional deployment tactics was associated with lower negative affect. This study confirms results found in quantitative studies and uncovers new processes that promote emotion regulation.

How does immediate recall of a stressful event affect psychological response to it?

BACKGROUND AND OBJECTIVES

In forensic settings, individuals who experience a traumatic event are often encouraged to recall it soon afterwards to preserve their memory for it. Some theories of the development of post-traumatic stress disorder (PTSD) suggest that this may increase psychopathology. The primary aim of the study was to examine the effect of immediate recall of a trauma analogue video on psychopathology.

METHOD

Eighty-five undergraduate students were randomised to view a video of a car accident, described as either a real event (high stress) or training event (low stress). They then completed either the Self-Administered Interview (SAI©, Gabbert, Hope, & Fisher, 2009) or a filler task. All participants returned one week later to provide an account of the event.

RESULTS

As predicted, participants in the SAI early recall task condition remembered the video content better one week after seeing the video, shown both by their greater recall of correct details and greater rejection of misinformation. However, completing the SAI resulted in higher anxiety immediately afterwards, and more severe PTSD-like symptoms one week later, compared to control condition. PTSD intrusion-like symptoms also predicted more accurate recall, while avoidance predicted poorer memory.

LIMITATIONS

While the trauma analogue video used in this study has been previously used, and did effectively trigger post-traumatic-like symptoms, it is unclear how well these results generalise to actual trauma situations.

CONCLUSIONS

These results suggest the relationship between PTSD symptoms and memory might be more complex than previously recognised, with intrusive phenomena possibly promoting memory and avoidance symptoms compromising memory.

Language Analysis as a Window to Bereaved Parents' Emotions During a Parent-Physician Bereavement Meeting

Parent-physician bereavement meetings may benefit parents by facilitating sense making, which is associated with healthy adjustment after a traumatic event. Prior research suggests a reciprocal relationship between sense making and positive emotions. We analyzed parents' use of emotion words during bereavement meetings to better understand parents' emotional reactions during the meeting and how their emotional reactions related to their appraisals of the meeting. Parents' use of positive emotion words increased, suggesting the meetings help parents make sense of the death. Parents' use of positive emotion words was negatively related to their own and/or their spouse's appraisals of the meeting, suggesting that parents who have a positive emotional experience during the meeting may also have a short-term negative reaction. Language analysis can be an effective tool to understand individuals' ongoing emotions and meaning making processes during interventions to reduce adverse consequences of a traumatic event, such as a child's death.

Confronting as autonomy promotion: Speaking up against discrimination and psychological well-being in racial minorities

Few studies have considered confrontation in the context of coping with discriminatory experiences. These studies test for the first time whether confronting racial discrimination is associated with greater psychological well-being and physical health through the promotion of autonomy. In two separate samples of racial minorities who had experienced racial discrimination, confrontation was associated with greater psychological well-being, and this relationship was mediated by autonomy promotion. These findings did not extend to physical health symptoms. These studies provide preliminary evidence that confrontation may aid in the process of regaining autonomy after experiencing discrimination and therefore promote well-being.

The collective benefits of feeling good and letting go: positive emotion and (dis)inhibition interact to predict cooperative behavior

Cooperation is central to human existence, forming the bedrock of everyday social relationships and larger societal structures. Thus, understanding the psychological underpinnings of cooperation is of both scientific and practical importance. Recent work using a dual-process framework suggests that intuitive processing can promote cooperation while deliberative processing can undermine it. Here we add to this line of research by more specifically identifying deliberative and intuitive processes that affect cooperation. To do so, we applied automated text analysis using the Linguistic Inquiry and Word Count (LIWC) software to investigate the association between behavior in one-shot anonymous economic cooperation games and the presence inhibition (a deliberative process) and positive emotion (an intuitive process) in free-response narratives written after (Study 1, N = 4,218) or during (Study 2, N = 236) the decision-making process. Consistent with previous results, across both studies inhibition predicted reduced cooperation while positive emotion predicted increased cooperation (even when controlling for negative emotion). Importantly, there was a significant interaction between positive emotion and inhibition, such that the most cooperative individuals had high positive emotion and low inhibition. This suggests that inhibition (i.e., reflective or deliberative processing) may undermine cooperative behavior by suppressing the prosocial effects of positive emotion.

An experimental study on the effectiveness of disclosing stressful life events and support messages: when cognitive reappraisal support decreases emotional distress, and emotional support is like saying nothing at all

How can we best support others in difficult times? Studies testing the effects of supportive communication revealed mixed findings. The current study focuses on the effects of supportive communication following different disclosure styles, and includes outcome measures to assess emotional well-being. Hypotheses were tested in a 2 (disclosure style: cognitive reappraisal disclosure vs. emotional disclosure) ×3 (support message: cognitive reappraisal response vs. socio-affective response vs. no response) between subjects factorial design. Receiving a cognitive reappraisal response, rather than a socio-affective response or no response, decreased emotional distress in the emotional disclosure group. Support messages showed no effects in the cognitive reappraisal disclosure group. Although socio-affective responses were positively evaluated, cognitive reappraisal responses may be more effective during emotional upheaval because they provide a positive way out of negative emotions.

Randomised controlled trial of a cognitive narrative intervention for complicated grief in widowhood

OBJECTIVE

The implementation of bereavement interventions is frequently requested, and its effectiveness has been controversial. The aim of this study is to evaluate the effectiveness of a cognitive narrative intervention for complicated grief (CG) for controlling post-traumatic and depressive issues.

METHOD

The study is a randomised controlled trial and uses the Socio Demographic Questionnaire (SDQ), the Inventory of Complicated Grief (ICG), the Beck Depression Inventory (BDI) and the Impact of Events Scale-Revised (IES-R). There were three phases in the study: (1) The SDQ and CG evaluations were applied to bereaved elders (n = 82). The bereaved elders with the 40 highest ICG values (≥25) were randomly allocated into two groups: the intervention group (n = 20) and control group (n = 20); (2) participants were evaluated using the BDI and IES-R and the IG gave informed consent to participate in an intervention with four weekly 60-min sessions addressing recall, emotional and cognitive subjectivation, metaphorisation and projecting. (3) Two months later, the ICG, BDI and IES-R assessments were repeated.

RESULTS

Outcome measures showed a statistically significant reduction of CG, depressive and traumatic symptoms compared to the controls. Very high effect sizes for the ICG, BDI and IES-R reflect the effectiveness of the intervention along the longitudinal profile.

CONCLUSIONS

These results reinforce the importance of brief interventions that combine a reduced number of sessions with lower costs, which is reflected in an increased adherence to the programme along with high effectiveness.

Patterns and predictors of disclosure of a diagnosis of cancer

BACKGROUND

The value of talking (i.e. disclosing ones innermost thoughts and feelings) has been recognised as playing an important role in helping people work through their difficulties. Although disclosing a diagnosis of cancer has been identified to be one of the hardest aspects of having the disease, relatively little is known about the extent to which people talk about their diagnosis of cancer. This study aimed to identify disclosure patterns among patients with cancer and to determine the factors associated with disclosure.

METHODS

Patients (n = 120) who had received a diagnosis of either lung, colorectal or skin cancer completed a questionnaire assessing potential psychosocial predictors of disclosure.

RESULTS

Results indicated that the majority of patients (95%) found it helpful to disclose information and did so to a variety of social targets, with the highest levels of disclosure being reported to medical personnel (38% talked 'very much'), followed by family members (24%) and then friends (12%). There were no differences in disclosure across cancer types, with the exception of patients with colorectal cancer who disclosed information more to nurses and other cancer patients. Men disclosed information more than women to some social targets. Dispositional openness (B = .233, p < 0.05) and treatment type (B = -.240, p < 0.01) were found to predict 13% of the variance in degree of disclosure.

CONCLUSIONS

The results suggest that individual differences and social and clinical factors impact on disclosure and that medical professionals play an important role in the disclosure process.

Cancer-Related Disclosure Among Adolescent and Young Adult Cancer Survivors: A Qualitative Study

Purpose: Adolescents and young adults (AYAs) employ self-disclosure in normative social interactions and in promoting identity development. Disclosure is associated with numerous psychological and physical benefits. Little research has examined how AYA cancer survivors diagnosed during adolescence disclose their cancer history. Methods: Using a qualitative design, this study explored cancer-related disclosures among survivors (N=26) 16-24 years old at study (M=19.6 years), 14-18 years old at diagnosis (M=15.6 years), and currently at least 6 months post-treatment (M=3.2 years). Semi-structured interview guides were developed and used. Disclosure-related topics included survivorship communications and others' responses to AYAs' disclosure of their cancer experiences. Results: Grounded theory and thematic content analysis guided analyses, with an inductive data-driven approach. Three themes and eight subthemes emerged: "it depends" decision-making processes (don't ask/don't tell, shared experience, relationship potential), perceptions of others' responses (perceived apprehension, positive responses), and methods of disclosure (verbal, written, behavioral). No thematic differences were found by gender or age, although females reported greater frequency of disclosures. Conclusion: Disclosure emerged as a nuanced and complex process. "It depends" decision-making processes were most frequently endorsed, consistent with developmental complexities of this age group. This reflects social and psychological changes and highlights unique challenges for AYA survivors. This also reflects the importance of peers and social interactions as variables that influence disclosure. In the context of AYA cancer survivorship, understanding ways in which disclosure may bolster or hinder social support can assist survivors, clinicians, and families navigate survivorship. Implications for future research are discussed.

Community-based implementation and effectiveness in a randomized trial of a risk reduction intervention for HIV-serodiscordant couples: study protocol

Background

The HIV/AIDS epidemic continues to disproportionately affect African American communities in the US, particularly those located in urban areas. Despite the fact that HIV is often transmitted from one sexual partner to another, most HIV prevention interventions have focused only on individuals, rather than couples. This five-year study investigates community-based implementation, effectiveness, and sustainability of ‘Eban II,’ an evidence-based risk reduction intervention for African-American heterosexual, serodiscordant couples.

Methods/design

This hybrid implementation/effectiveness implementation study is guided by organizational change theory as conceptualized in the Texas Christian University Program Change Model (PCM), a model of phased organizational change from exposure to adoption, implementation, and sustainability. The primary implementation aims are to assist 10 community-based organizations (CBOs) to implement and sustain Eban II; specifically, to partner with CBOs to expose providers to the intervention; facilitate its adoption, implementation and sustainment; and to evaluate processes and determinants of implementation, effectiveness, fidelity, and sustainment. The primary effectiveness aim is to evaluate the effect of Eban II on participant (n = 200 couples) outcomes, specifically incidents of protected sex and proportion of condom use. We will also determine the cost-effectiveness of implementation, as measured by implementation costs and potential cost savings. A mixed methods evaluation will examine implementation at the agency level; staff members from the CBOs will complete baseline measures of organizational context and climate, while key stakeholders will be interviewed periodically throughout implementation. Effectiveness of Eban II will be assessed using a randomized delayed enrollment (waitlist) control design to evaluate the impact of treatment on outcomes at posttest and three-month follow-up. Multi-level hierarchical modeling with a multi-level nested structure will be used to evaluate the effects of agency- and couples-level characteristics on couples-level outcomes (e.g., condom use).

Discussion

This study will produce important information regarding the value of the Eban II program and a theory-guided implementation process and tools designed for use in implementing Eban II and other evidence-based programs in demographically diverse, resource-constrained treatment settings.

Trial registration

NCT00644163

A voxel-based morphometry study of regional gray and white matter correlate of self-disclosure

Self-disclosure is an important performance in human social communication. Generally, an individual is likely to have a good physical and mental health if he is prone to self-disclosure under stressful life events. However, as for now, little is known about the neural structure associated with self-disclosure. Therefore, in this study, we used voxel-based morphometry to explore regional gray matter volume (rGMV) and white matter volume (rWMV) associated with self-disclosure measured by the Jourard Self-disclosure Questionnaire in a large sample of college students. Results showed that individual self-disclosure was significantly and positively associated with rGMV of the left postcentral gyrus, which might be related to strengthen individual's ability of body feeling; while self-disclosure was significantly and negatively associated with rGMV of the right orbitofrontal cortex (OFC), which might be involved in increased positive emotion experience seeking (intrinsically rewarding). In addition, individual self-disclosure was also associated with smaller rWMV in the right inferior parietal lobule (IPL). These findings suggested a biological basis for individual self-disclosure, distributed across different gray and white matter areas of the brain.

Effect of written emotional disclosure on secondary hyperalgesia in women with trauma history

OBJECTIVE

This study investigated the effects of written emotional disclosure on a model of chronic pain in healthy women with and without trauma history.

METHOD

Participants were prescreened for their trauma history (N = 78) and randomized to a disclosure or a control writing condition. Pain testing occurred either 1 day or 1 month after disclosure. Capsaicin was applied to the forearm to evoke spontaneous burning pain at the application site and mechanical secondary hyperalgesia in the surrounding untreated skin.

RESULTS

As hypothesized, the effect of disclosure on the area and intensity of secondary hyperalgesia depended on trauma history and time of testing (F(1,69) ≥ 7.37, p = .008). Disclosure increased secondary hyperalgesia in participants with trauma history compared with those without trauma when testing occurred 1 day after writing (F(1,69) ≥ 5.27, p ≤ .025), whereas the opposite pattern was observed 1 month later (F(1,69) ≥ 4.88, p ≤ .031). Of the participants with trauma history in the disclosure condition, secondary hyperalgesia was reduced at 1 month compared with 1 day after writing (p = .001). Moreover, greater use of positive emotional words predicted reduced secondary hyperalgesia at 1 month (β = -0.71, p = .022). In contrast, disclosure had no effect on spontaneous pain.

CONCLUSIONS

Disclosure modulates secondary hyperalgesia observed in women with trauma history, producing a short-term enhancement and a long-term reduction. This suggests that disclosure has a long-term protective effect that reduces sensitization of pain, which may explain the therapeutic effects of disclosure in patients with chronic pain.

The benefits and risks of telling and listening to stories of difficulty over time: experimentally testing the expressive writing paradigm in the context of interpersonal communication between friends

The overarching goal of the current study was to determine the impact of talking interpersonally over time on emerging adults' individual and relational health. Using an expressive writing study design (see Frattaroli, 2006), we assessed the degree to which psychological health improved over time for college students who told and listened to stories about friends' current difficulties in comparison with tellers in control conditions. We also investigated the effects on tellers' and listeners' perceptions of each other's communication competence, communicated perspective-taking, and the degree to which each threatened the other's face during the interaction over time to better understand the interpersonal communication complexities associated with talking about difficulty over time. After completing prestudy questionnaires, 49 friend pairs engaged in three interpersonal interactions over the course of 1 week wherein one talked about and one listened to a story of difficulty (treatment) or daily events (control). All participants completed a poststudy questionnaire 3 weeks later. Tellers' negative affect decreased over time for participants exposed to the treatment group, although life satisfaction increased and positive affect decreased across time for participants regardless of condition. Perceptions of friends' communication abilities decreased significantly over time for tellers. The current study contributes to the literature on expressive writing and social support by shedding light on the interpersonal implications of talking about difficulty, the often-overlooked effects of disclosure on listeners, and the health effects of talking about problems on college students' health.