A large number of people with HIV have experienced numerous stressful or traumatic events in their lifetimes. These factors have been shown to lead to negative treatment outcomes for HIV, both psychologically and physically. In fact, many people with HIV have a history of sexual assault and physical abuse. All of these events elevate the rates of post-traumatic stress (PTSD) in people with HIV, especially women. Depression, avoidance, and denial are all forces that minimize treatment adherence and increase disease progression. Therefore, novel approaches have been designed to address the psychological issues that decrease treatment participation in individuals living with HIV. One such method is expressive writing.
In a recent study, Gail Ironson of the University of Miami’s Department of Psychology tested how an expressive writing (EW) exercise, designed to address traumatic events, would affect health outcomes in a sample of 244 men and women with HIV when compared to a daily writing control experiment. The participants were evaluated for PTSD and physical health symptoms at baseline, one month, 6 months, and 12 months after they completed 4 writing exercises. Ironson found that the women who completed the EW had greater PTSD, stress, and depression symptom reductions than the men or any participants in the control experiment. This finding was even more evident in the women who exhibited PTSD at baseline.
“For men, an unexpected result was that they had a greater decrease in depression in the daily-events writing control condition than in the trauma-writing condition,” said Ironson. There was no difference in PTSD symptom severity for men in either group. This finding suggests that women are more receptive to the positive effects of EW than men. Ironson believes future research should explore the mechanisms that cause this effect in order to better understand how and why this occurs. However, the men did benefit from the daily writing exercise despite the fact that it did not focus on traumatic events specifically. Ironson noted that even though writing exercises show promise for those with PTSD and HIV, individual therapy can perhaps provide further benefits. A therapist can help clients overcome mental blocks that may stall expressive writing. Also, therapists can guide men and women with PTSD and HIV through the process of looking at traumatic events and help them learn how to cope with the feelings that cause the stress, depression and trauma in adaptive ways that will contribute to positive health outcomes and better disease management.
Ironson, G., O’Cleirigh, C., Leserman, J., Stuetzle, R., Fordiani, J., Fletcher, M., and Schneiderman, N. (2012). Gender-specific effects of an augmented written emotional disclosure intervention on posttraumatic, depressive, and HIV-disease-related outcomes: A randomized, controlled trial. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0030814
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