An internet-based expressive writing intervention for kidney transplant recipients

Background: Previous research has found that psychiatric problems and stress in kidney transplant recipients negatively impact upon their quality of life (QOL) and how they heal from surgery. In a pilot study, Possemato and Geller (in submission) reported that increased daily stress mediates the relationship between post-traumatic stress symptoms and poor QOL in kidney transplant recipients. Writing interventions based on Pennebaker's expressive writing model have been shown to modify both daily and post-traumatic stress symptoms and lead to many positive health benefits for healthy and medically ill participants. In this study, the effects of an expressive writing intervention on stress, PTSD symptoms, QOL and affect in kidney transplant recipients were explored. Methods: An innovative internet-based methodology was used to administer baseline self-report measures, three expressive writing assignments and follow-up questionnaires three month after baseline. A combination of general and transplant specific measures were used. Participants were recruited from transplant websites, local transplant awareness groups and a hospital transplant center and then randomly assigned to the experimental expressive writing condition or the medical fact control condition. Whether individual differences regarding emotional nonexpressiveness, i.e., alexithymia or emotional suppression, are related to changes in stress, PTSD symptoms, QOL and affect in the experimental writing group were also assessed. Findings: Forty-eight kidney transplant recipients participated. Internet-based expressive writing was found to be feasible, safe and effective for kidney transplant recipients. Participants reported no harmful consequences of participating in the study and those who wrote about their thoughts and emotions in the experimental group experienced significantly less stress, better QOL and increased positive affect. In addition, characteristics of emotional non-expressiveness were found to be important factors in determining who will most benefit from expressive writing post-transplant. Individuals who normally suppress their emotions can benefit more while alexithymic individuals may benefit less. The current study provides support for recommending expressive writing tasks to kidney transplant recipients according to specific individual differences and pursuing further research into internet-based expressive writing for medical population.