Authors' objectives:

Emotional disclosure is a technique whereby people are encouraged to write or talk in private about a traumatic, stressful or upsetting event, usually from their past. Typically they write for 15-20 minutes in 3-4 days and are encouraged to go into as much detail as possible about their feelings surrounding the event. This systematic review examines the effectiveness of emotional disclosure compared to neutral writing or non-intervention.

Authors' results and conclusions: One hundred and forty seven studies were found. Sixty-one trials were included, 72 studies were excluded and sufficient details were not available for a further 15 studies. Studies were excluded mainly because they were either not RCTs or because the emotional disclosure was indistinguishable from counselling. Of the excluded studies, five RCTs only published subgroup results and 2 had no follow-ups available. Of the included trials, 59 were RCTs and 2 were randomised crossover trials. Thirteen were on people with pre-existing morbidity such as fibromyalgia, rheumatoid arthritis and cancer, 17 had psychological inclusion criteria such as PTSD and the remaining RCTs and 2 crossover trials had physically healthy volunteers. Of the 61 included trials, many were small (n<50) and the reporting quality was generally poor. All trials reported physical health, psychological, performance, immunological or physiological outcomes.

Authors' recommendations: A wide variety of physical health outcomes were measured but many not reported. Objectively measured physical health in people with pre-existing morbidity either found no difference or an improvement for the intervention groups. Objectively measured health centre visits showed no significant differences between intervention and control (WMD 0.06, 95%CI 0.26 to +0.13, random effects). Self-report health centre visits showed a similar result. Self-assessed health behaviours, where reported, were found not to be different between the two groups. Other questionnaire measures showed conflicting results. In people with pre-existing morbidity, there were improvements in the intervention groups compared to controls for pain, sleep quality, physical dysfunction, physical symptoms, fibromyalgia impact, health interference with daily functioning and perceived somatic symptoms. None of the RCTs demonstrated worse physical health. For psychological outcomes there was more positive and negative mood for intervention compared to control but no differences in anxiety, depression or impact of events. Other psychological outcomes, where reported, either showed no difference or a mixture of results with no clear trend or conflicting results. There is no clear evidence to demonstrate the efficacy of the intervention reviewed. This finding is contrary to a previous meta-analysis and numerous recent editorials on the subject. It may be that the rather biased reporting of outcomes has resulted in a more positive impression of the intervention than is actually the case, but neither is there any evidence that it does any harm. Without solid evidence of effectiveness there is a danger of its proliferation in inappropriate circumstances in clinical practice. There is a need for a large, good quality RCT, adequately powered to detect a small effect size, to establish whether this type of emotional disclosure has any effect at all.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.birmingham.ac.uk/Documents/college-mds/haps/projects/WMHTAC/REPreports/2003/emotional_disclosure.pdf

Year Published: 2003

URL for published report: http://www.birmingham.ac.uk/research/activity/mds/projects/HaPS/PHEB/WMHTAC/REP/reports-list.aspx

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: West Midlands Health Technology Assessment Collaboration

Contact Address: Elaena Donald-Lopez, West Midlands Health Technology Assessment Collaboration, Department of Public Health and Epidemiology, University of Birmingham, Edgbaston, Birmingham B15 2TT Tel: +44 121 414 7450; Fax: +44 121 414 7878

Contact Name: louise.a.taylor@bham.ac.uk

Contact Email: louise.a.taylor@bham.ac.uk

Copyright: University of Birmingham