Feature

Expressive writing helped one group of soldiers improve their marital relationships following a deployment, but didn't help a group of soldiers with high combat exposure deal any better with anger, according to the results of two new Army-sponsored studies.

Researchers became interested in expressive writing—narrative reflections on the emotional impact of an event—as a possible way to help soldiers deal with their symptoms of post-traumatic stress disorder, depression and anger following deployments to Iraq and Afghanistan. In fact, according to Army surveys, between 15 percent to 20 percent of service members who return from deployments report high levels of depression, anxiety and PTSD symptoms, said Amy Adler, PhD, a research psychologist with U.S. Army Medical Research Unit-Europe and study co-investigator.

Noting that soldiers who experience higher levels of combat experience report more symptoms of PTSD, depression and anxiety, Adler said researchers are concerned that some of these soldiers aren't "resetting" to better psychological functioning once they return home.

To explore expressive writing as a possible tool to help these service members, the researchers consulted with University of Texas psychologist James Pennebaker, PhD, who helped pioneer expressive writing as a treatment for trauma. Research with groups as varied as students, Holocaust survivors, the chronically physically ill, people with HIV, unemployed workers and maximum security prisoners had indicated that people who took a few hours to put their thoughts and feelings into words showed improved mental health, better immune system functioning and fewer doctor visits, Adler said.

To see if those results held up with service members returning from deployments, researchers recruited participants from an Army brigade combat team that returned from Iraq in the fall of 2007. In early spring 2008, soldiers were randomly assigned to write about their thoughts and feelings as they transitioned home, while control groups wrote about their exercise routines or did not write at all.

To their disappointment, researchers found that four months after participating in writing exercises, soldiers in the emotional writing group who had high levels of combat experiences scored higher on an anger scale, compared with soldiers not asked to write, said co-investigator Lt. Col. Paul Bliese, PhD, of the Walter Reed Army Institute of Research. The emotional writing exercise seemed to make soldiers angrier than they were before sitting down to write.

"Overall, it appears that, for soldiers in the high risk condition, those soldiers reporting lots of combat experiences, expressive writing is actually contraindicated," Adler said.

The study results demonstrate the importance of not using interventions developed from civilian populations without testing the intervention first with soldiers in a randomized controlled trial, she said.

"For us, it really underscores that you can't just take stuff off the shelf from the civilian literature and assume it's going to work in your population. You have to do the research," Adler said.

Trying to understand the finding, Adler said that having a soldier sit down and write about traumatic experiences, as opposed to an approach where soldiers talk about their experiences with their fellow soldiers in platoon-size units, may reinforce rumination.

The writing intervention tested in a second study did, however, appear to help service members' marriages. Drawn from more than 100 married couples in the Fort Hood, Texas, area, soldiers and spouses either wrote about what the transition home has been like for themselves and their families or their physical health habits. Overall, expressive writing improved marital satisfaction and decreased yelling, reported University of Texas doctoral student Jenna Baddeley, who co-authored the study with Pennebaker.

Those results came from the study group where soldiers did the expressive writing, but their spouses did not, she said. For that group of soldiers, the positive effects of the intervention peaked at one month, and fell off after about six months, Baddeley said.

Looking to the results, Baddeley said previous research with men who were asked to write found improvement in relationships, and that as a group, soldiers need to dampen down their emotions during deployments.

"We think booster sessions may be a good idea," she said.