Effects of writing about stressful experiences on symptom reduction in patients with asthma or rheumatoid arthritis - A randomized trial

Context Nonpharmacological treatments with little patient cost or risk are useful supplements to pharmacotherapy in the treatment of patients with chr onic illness. Research has demonstrated that writing about emotionally trau matic experiences has a surprisingly beneficial effect on symptom reports, well-being, and health care use in healthy individuals. Objective To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using standa rdized quantitative outcome measures. Design Randomized controlled trial conducted between October 1996 and Decem ber 1997. Setting Outpatient community residents drawn from private and institutional practice. Patients Volunteer sample of 112 patients with asthma (n = 61) or rheumatoi d arthritis (n = 51) received the intervention; 107 completed the study, 58 in the asthma group and 49 in the rheumatoid arthritis group. Intervention Patients were assigned to write either about the most stressfu l event of their lives (n = 71; 39 asthma, 32 rheumatoid arthritis) or abou t emotionally neutral topics (n = 41; 22 asthma, 19 rheumatoid arthritis) ( the control intervention); Main Outcome Measures Asthma patients were evaluated with spirometry and rh eumatoid arthritis patients were clinically examined by a rheumatologist. A ssessments were conducted at baseline and at 2 weeks and 2 months and 4 mon ths after writing and were done blind to experimental condition. Results Of evaluable patients 4 months after treatment, asthma patients in the experimental group showed improvements in lung function (the mean perce ntage of predicted forced expiratory volume in 1 second [FEV1] improved fro m 63.9% at baseline to 76.3% at the 4-month follow-up; P<.001), whereas con trol group patients showed no change. Rheumatoid arthritis patients in the experimental group showed improvements in overall disease activity (a mean reduction in disease severity from 1.65 to 1,19 [28%] on a scale of 0 [asym ptomatic] to 4 [very severe]at the 4-month follow-up; P = .001), whereas co ntrol group patients did not change. Combining all completing patients, 33 (47.1%) of 70 experimental patients had clinically relevant improvement, wh ereas 9 (24.3 %) of 37 control patients had improvement (P =,001). Conclusion Patients with mild to moderately severe asthma or rheumatoid art hritis who wrote about stressful life experiences had clinically relevant c hanges in health status at 4 months compared with those in the control grou p. These gains were beyond those attributable to the standard medical care that all participants were receiving. It remains unknown whether these heal th improvements will persist beyond 4 months or whether this exercise will prove effective with other diseases.