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From the Department of Veteran Affairs Health Care System, Palo Alto, California (A.H.S.H., K.H.); and Stanford University, Stanford, CA (A.H.S.H., C.E.T., K.H., J.F.).
Address correspondence and reprint requests to Alex H. S. Harris, PhD, Center for Health Care Evaluation (MC:152), VA Palo Alto Health Care System, 795 Willow Road, Menlo Park, CA 94025. E-mail: alexsox{at}sbcglobal.net
Objective: Nonpharmacologic treatments for asthma may act as useful adjuncts to pharmacotherapy but should be recommended to patients only after several well-controlled studies provide evidence of efficacy. Research demonstrating that written emotional expression can improve pulmonary function in patients with asthma consists of one impressive yet unreplicated study (1). Our main objective was to test and extend previous research finding that written emotional expression improves pulmonary function in patients with asthma compared with writing on neutral topics.
Methods: We conducted a randomized, controlled trial of outpatient asthmatics recruited from hospitals and the community. Of the 137 adult patients with asthma who were randomized, 117 began and 114 completed the study. Patients were randomly assigned to write for 20 minutes, once per week, for 3 weeks about stressful experiences (n = 41), positive experiences (n = 37), or neutral experiences (n = 36; control group). At baseline, postintervention, and 2-month follow up, patients were assessed by spirometry.
Results: The mean change from baseline to 2-month follow up in percentage of predicted forced expiratory volume in 1 second (FEV1) was 4.2% in the stress-writing group, 1.3% in the positive-writing group, and 3.0% in the control group. In forced vital capacity (FVC), there was 3.1% improvement in the stress-writing group, 3.6% in the positive-writing group, and 2.4% in the control group. These changes were not statistically or clinically significant.
Conclusions: The present study reduces confidence in the ability of written emotional expression to benefit the disease status of asthma patients.
Key Words: asthma • experiences (events) • stress • written communication • coping behavior • treatment
Abbreviations: FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; VAPAHCS = Veteran Affairs Palo Alto Health Care System; PTSD = posttraumatic stress disorder; COPD = chronic obstructive pulmonary disease.
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