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For Whom Does It Work? Moderators of the Effects of Written Emotional Disclosure in a Randomized Trial Among Women With Chronic Pelvic Pain

From the Departments of Psychology (S.A.N., M.A.L.), Anesthesiology (J.A.D.), and Obstetrics and Gynecology (M.P.D.), Wayne State University, Detroit, MI.

Address correspondence and reprint requests to Mark A. Lumley, PhD, Department of Psychology, Wayne State University, 71 West Warren Avenue, Detroit, MI. E-mail: mlumley{at}sun.science.wayne.edu

OBJECTIVE: Although written emotional disclosure has potential as a stress management intervention for people with health problems, the main (group) effects of disclosure in medical populations are limited. This study sought to identify individual difference moderators of the effects of written disclosure among women with chronic pelvic pain.

METHODS: In a prospective, randomized trial, 48 women with chronic pelvic pain completed 3 individual difference measures and then wrote for 3 days about stressful consequences of their pain (disclosure) or positive events (control). Health status was assessed at baseline and 2 months after writing.

RESULTS: Main effect group comparisons indicated that disclosure writing resulted in significantly lower evaluative pain intensity ratings than control writing at follow-up, but there were no main effects on other outcome variables (sensory or affective pain, disability, affect). Three baseline individual difference measures, however, significantly moderated group effects. Compared with control writing, disclosure led to less disability among women with higher baseline ambivalence over emotional expression or higher catastrophizing, and to increased positive affect among women with higher baseline negative affect. Ambivalence, but not catastrophizing, was independent of negative affect in its moderation effect.

CONCLUSION: Although the main effects of writing about the stress of pelvic pain are limited, women with higher baseline ambivalence about emotional expression or negative affect appear to respond more positively to this intervention.

Key Words: pelvic pain, • expressive writing, • disclosure, • negative affect, • ambivalence, • moderator.

Abbreviations: CPP = chronic pelvic pain;; PANAS-X = Positive and Negative Affect Schedule, Expanded Version;; MPQ = McGill Pain Questionnaire;; SIP = Sickness Impact Profile;; AEQ = Ambivalence Over Emotional Expression Questionnaire;; CSQ = Coping Strategies Questionnaire.

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