Effects of emotional disclosure on psychological and physiological outcomes in patients with rheumatoid arthritis: an exploratory home-based study
Abstract
The effects of an exploratory, home-based emotional disclosure intervention on psychological and physiological outcomes were assessed in patients with rheumatoid arthritis. Patients were randomly assigned to a disclosure group (n = 19) in which they wrote/talked about traumatic personal experiences, or to a control group (n = 15) in which they wrote/talked about the events of a particular day. Participants undertook these tasks for periods of 20 minutes on 4 consecutive days. The disclosure group demonstrated increases in negative mood and objective markers of disease activity at 1 week post-intervention. However, there were significant trends for the disclosure group to demonstrate minor improvements in mood and stability in disease activity, compared with the control group. These group differences appeared to be due to deteriorations in the control group more than improvements in the disclosure group.
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Previous research reports consistently short-term increases in emotional distress, negative mood and physical symptoms immediately after writing prior to longer term physical and mental health benefits.
“Previous research reports consistently short-term increases in emotional distress, negative mood and in physical symptoms immediately after writing prior to longer term physical and mental health benefits (Baikie and Wilhelm, 2005; McGuire et al., n.d.; Wetherell et al., 2005; Frisina et al., n.d.; Frattaroli, 2006; Bell-Pringle et al., 2004).”
From Feasibility of a Software agent providing a brief Intervention for Self-help to Uplift psychological wellbeing (“SISU”). A single-group pretest-posttest trial investigating the potential of SISU to act as therapeutic agent (2021) · cites this paper as Wetherell et al., 2005
Therapeutic writing is often followed by an immediate increase of negative mood.
“The latter is being implemented to account for the well-established finding, that therapeutic writing is often followed by an immediate increase of negative mood (Baikie et al., 2012; McGuire et al., n.d.; Wetherell et al., 2005; Frattaroli, 2006; Nyssen et al., 2016).”
From Feasibility of a Software agent providing a brief Intervention for Self-help to Uplift psychological wellbeing (“SISU”). A single-group pretest-posttest trial investigating the potential of SISU to act as therapeutic agent (2021) · cites this paper as Wetherell et al., 2005
These results are in line with frequent findings from therapeutic writing interventions.
“These results are in line with frequent findings from therapeutic writing interventions (Baikie and Wilhelm, 2005; McGuire et al., n.d.; Wetherell et al., 2005; Frisina et al., n.d.; Frattaroli, 2006; Bell-Pringle et al., 2004).”
From Feasibility of a Software agent providing a brief Intervention for Self-help to Uplift psychological wellbeing (“SISU”). A single-group pretest-posttest trial investigating the potential of SISU to act as therapeutic agent (2021) · cites this paper as Wetherell et al., 2005
Cites
Confronting a traumatic event: Toward an understanding of inhibition and disease.
Pennebaker, J. W., & Beall, S. K. (1986) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.95.3.274 · Cited by 1,898 · see citing works
Short Form of the Profile of Mood States (POMS-SF): Psychometric information.
Curran, S. L., Andrykowski, M. A., & Studts, J. L. (1995) · Psychological Assessment · doi:10.1037//1040-3590.7.1.80 · Cited by 808 · see citing works
Accelerating the coping process.
Pennebaker, J., Colder, M., & Sharp, L. (1990) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.58.3.528 · Cited by 778 · see citing works
The intrusive past: The flexibility of memory and the engraving of trauma.
van der Kolk, B. A., & van der Hart, O. (1991) · American imago · Cited by 648 · see citing works
An inventory for the measurement of self‐reported stress and arousal
Mackay, C., Cox, T., Burrows, G., & Lazzerini, T. (1978) · British Journal of Social and Clinical Psychology · doi:10.1111/j.2044-8260.1978.tb00280.x · Cited by 533 · see citing works
Accelerating the coping process.
Pennebaker, J. W., Colder, M., & Sharp, L. K. (1990) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.58.3.528 · Cited by 525 · see citing works
Stress, intrusive imagery, and chronic distress.
Baum, A. E. (1990) · Health Psychology · doi:10.1037/0278-6133.9.6.653 · Cited by 457 · see citing works
Disclosure of trauma and immune response to a hepatitis B vaccination program.
Petrie, K. J., Booth, R. J., Pennebaker, J. W., Davison, K. P., & al, E. (1995) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.63.5.787 · Cited by 397 · see citing works
Emotional expression and physical health: Revising traumatic memories or fostering self-regulation?
Greenberg, M. A., Wortman, C. B., & Stone, A. A. (1996) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.71.3.588 · Cited by 352 · see citing works
Greenberg, M. A., & Stone, A. A. (1992) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.63.1.75 · Cited by 346 · see citing works
Esterling, B. A., Antoni, M. H., FLETCHER, M. A., Margulies, S., & al, E. (1994) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.62.1.130 · Cited by 311 · see citing works
Greenberg, M. A., & Stone, A. A. (1992) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.63.1.75 · Cited by 301 · see citing works
Disclosure of trauma and immune response to a hepatitis B vaccination program.
Petrie, K. J., Booth, R. J., Pennebaker, J. W., et al. (1995) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.63.5.787 · Cited by 283 · see citing works
Emotional expression and physical health: Revising traumatic memories or fostering self-regulation?
Greenberg, M. A., Wortman, C. B., & Stone, A. A. (1996) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.71.3.588 · Cited by 247 · see citing works
Health effects of emotional disclosure in rheumatoid arthritis patients.
Kelley, J. E., Lumley, M. A., & Leisen, J. C. C. (1997) · Health Psychology · doi:10.1037/0278-6133.16.4.331 · Cited by 217 · see citing works
Health effects of emotional disclosure in rheumatoid arthritis patients.
Kelley, J. E., Lumley, M. A., & Leisen, J. C. C. (1997) · Health Psychology · doi:10.1037//0278-6133.16.4.331 · Cited by 216 · see citing works
Wolfe, F. (1997) · PubMed · Cited by 201 · see citing works
Esterling, B. A., Antoni, M. H., FLETCHER, M. A., et al. (1994) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.62.1.130 · Cited by 201 · see citing works
C‐reactive protein in rheumatology
Kushner, I. (1991) · Arthritis & Rheumatism · doi:10.1002/art.1780340819 · Cited by 152 · see citing works
Short-term immunological effects of induced emotion.
Knapp, P. H., Levy, E. M., Giorgi, R. G., Black, P. H., Fox, B. H., & Heeren, T. (1992) · Psychosomatic Medicine · doi:10.1097/00006842-199203000-00002 · Cited by 133 · see citing works
CHANGES IN CIRCULATING LYMPHOCYTE NUMBERS FOLLOWING EMOTIONAL DISCLOSURE: EVIDENCE OF BUFFERING?
Booth, R. J., Petrie, K. J., & Pennebaker, J. W. (1997) · Stress Medicine · doi:10.1002/(sici)1099-1700(199701)13:1 · Cited by 90 · see citing works
Emotional and Cognitive Processing in a Trauma Disclosure Paradigm
Lutgendorf, S. K., & Antoni, M. H. (1999) · Cognitive Therapy and Research · doi:10.1023/a:1018760118863 · Cited by 59 · see citing works
Field Research on the Relationship between Stress and Disease Activity in Rheumatoid Arthritisa
Zautra, A., Hamilton, N. A., Potter, P. T., & Smith, B. W. (1999) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1999.tb07664.x · Cited by 52 · see citing works
The use of the disease activity score in the analysis of clinical trials in rheumatoid arthritis.
Ha, F. (1993) · PubMed · Cited by 43 · see citing works
Smyth, J. M., Stone, A. A., Hurewitz, A., & Kaell, A. (1999) · JAMA · doi:10.1001/jama.281.14.1304 · Cited by 39 · see citing works
The erythrocyte sedimentation rate--time honored and tradition bound.
Weinstein, A., & Giudice, J. D. (1994) · PubMed · Cited by 13 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Experimental disclosure and its moderators: A meta-analysis.
Frattaroli, J. (2006) · Psychological Bulletin · doi:10.1037/0033-2909.132.6.823 · Cited by 1,502 · see citing works
Pain and emotion: a biopsychosocial review of recent research
Lumley, M. A., Cohen, J. L., Borszcz, G. S., Cano, A., Radcliffe, A. M., Porter, L. S., Schubiner, H., & Keefe, F. J. (2011) · Journal of Clinical Psychology · doi:10.1002/jclp.20816 · Cited by 836 · see citing works
Psychological adjustment to chronic disease
de Ridder, D., Geenen, R., Kuijer, R., & van Middendorp, H. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61078-8 · Cited by 759 · see citing works
Hollingworth, W., Metcalfe, C. D., Mancero, S., Harris, S., Campbell, R. M., Biddle, L., McKell-Redwood, D., & Brennan, J. (2013) · Journal of Clinical Oncology · doi:10.1200/jco.2012.48.3040 · Cited by 118 · see citing works
The personal impact of rheumatoid arthritis on patients' identity: a qualitative study
Lempp, H. K., Scott, D. L., & Kingsley, G. H. (2006) · Chronic Illness · doi:10.1177/17423953060020020601 · Cited by 116 · see citing works
Nyssen, O. P., Taylor, S. J., Wong, G., Steed, E., Bourke, L., Lord, J., Ross, C. A., Hayman, S., Field, V., Higgins, A., et al. (2016) · Health Technology Assessment · doi:10.3310/hta20270 · Cited by 115 · see citing works
D’Souza, P. J., Lumley, M. A., Kraft, C. A., & Dooley, J. A. (2008) · Annals of Behavioral Medicine · doi:10.1007/s12160-008-9046-7 · Cited by 109 · see citing works
McCray, C. J., & Agarwal, S. K. (2010) · Immunology and Allergy Clinics of North America · doi:10.1016/j.iac.2010.09.004 · Cited by 102 · see citing works
Psychosocial interventions for managing pain in older adults: outcomes and clinical implications
Keefe, F. J., Porter, L. S., Somers, T. J., Shelby, R. A., & Wren, A. A. (2013) · British Journal of Anaesthesia · doi:10.1093/bja/aet129 · Cited by 101 · see citing works
Siegel, P., Tencza, M., Apodaca, B., & Poole, J. L. (2016) · American Journal of Occupational Therapy · doi:10.5014/ajot.2017.023176 · Cited by 98 · see citing works
Benefit finding and expressive writing in adults with lupus or rheumatoid arthritis
Danoff‐Burg, S., Agee, J. D., Romanoff, N. R., Kremer, J. M., & Strosberg, J. M. (2006) · Psychology and Health · doi:10.1080/14768320500456996 · Cited by 88 · see citing works
Gellaitry, G., Peters, K., Bloomfield, D. J., & Horne, R. (2009) · Psycho-Oncology · doi:10.1002/pon.1532 · Cited by 73 · see citing works
Rodham, K., McCabe, C., & Blake, D. R. (2008) · Psychology and Health · doi:10.1080/08870440802563245 · Cited by 72 · see citing works
Expressive Writing and Wound Healing in Older Adults
Koschwanez, H. E., Kerse, N. M., Darragh, M., Jarrett, P., Booth, R. J., & Broadbent, E. (2013) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31829b7b2e · Cited by 67 · see citing works
Emotional disclosure interventions for chronic pain: from the laboratory to the clinic
Lumley, M. A., Sklar, E. R., & Carty, J. N. (2011) · Translational Behavioral Medicine · doi:10.1007/s13142-011-0085-4 · Cited by 63 · see citing works
Psychologic Interventions and Lifestyle Modifications for Arthritis Pain Management
Keefe, F. J., Somers, T. J., & Martire, L. M. (2008) · Rheumatic Disease Clinics of North America · doi:10.1016/j.rdc.2008.03.001 · Cited by 60 · see citing works
Slavin‐Spenny, O. M., Cohen, J. L., Oberleitner, L., & Lumley, M. A. (2010) · Journal of Clinical Psychology · doi:10.1002/jclp.20750 · Cited by 55 · see citing works
Draper, C., & O’Donohue, W. (2010) · Springer eBooks · doi:10.1007/978-1-4419-6510-3 · Cited by 54 · see citing works
Lee, E., Taylor, J. S., & Raitt, F. E. (2011) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2010.05548.x · Cited by 53 · see citing works
Living with Ankylosing Spondylitis
Hamilton-West, K. E., & Quine, L. (2009) · Journal of Health Psychology · doi:10.1177/1359105309341394 · Cited by 48 · see citing works
Lumley, M. A., Keefe, F. J., Mosley-Williams, A., Rice, J. R., McKee, D., Waters, S. J., Partridge, R. T., Carty, J. N., Coltri, A. M., Kalaj, A., et al. (2014) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0036958 · Cited by 41 · see citing works
van Middendorp, H., Geenen, R., Sorbi, M. J., van Doornen, L. J. P., & Bijlsma, J. W. J. (2009) · Psychotherapy and Psychosomatics · doi:10.1159/000206868 · Cited by 43 · see citing works
Vedhara, K., Moss-Morris, R. E., Booth, R. J., Horgan, M., Lawrence, M., & Birchall, N. M. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2006.12.017 · Cited by 41 · see citing works
O'Connor, D. B., & Ashley, L. (2007) · British Journal of Health Psychology · doi:10.1348/135910707x224496 · Cited by 37 · see citing works
Keefe, F. J., Anderson, T., Lumley, M. A., Caldwell, D. S., Stainbrook, D., McKee, D. C., Waters, S. J., Connelly, M., Affleck, G. G., Pope, M. S., et al. (2007) · Pain · doi:10.1016/j.pain.2007.08.031 · Cited by 37 · see citing works
Lumley, M. A., Leisen, J. C. C., Partridge, T., Meyer, T. M., Radcliffe, A. M., Macklem, D. J., Naoum, L. A., Cohen, J. L., Lasichak, L. M., Lubetsky, M. R., et al. (2011) · Pain · doi:10.1016/j.pain.2011.01.003 · Cited by 34 · see citing works
Tillmann, T., Krishnadas, R., Cavanagh, J., & Petrides, K. (2013) · Arthritis Research & Therapy · doi:10.1186/ar4204 · Cited by 33 · see citing works
Immune responses to stress after stress management training in patients with rheumatoid arthritis
de Brouwer, S. J. M., van Middendorp, H., Kraaimaat, F. W., Radstake, T. R. D. J., Joosten, I., Donders, A. R. T., Eijsbouts, A. M. M., Koulil, S. S., van Riel, P. L. C. M., & Evers, A. W. M. (2013) · Arthritis Research & Therapy · doi:10.1186/ar4390 · Cited by 31 · see citing works
Enduring injustice: a case study of retirement from professional rugby union
McKenna, J., & Thomas, H. (2007) · Sport, Education and Society · doi:10.1080/13573320601081500 · Cited by 44 · see citing works
Lovell, B., Moss, M. C., & Wetherell, M. A. (2015) · Journal of Family Studies · doi:10.1080/13229400.2015.1020987 · Cited by 30 · see citing works
Willmott, L., Harris, P. R., Gellaitry, G., Cooper, V., & Horne, R. (2011) · Health Psychology · doi:10.1037/a0023519 · Cited by 29 · see citing works
Bendig, E., Erb, B., Meißner, E., Bauereiß, N., & Baumeister, H. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100377 · Cited by 24 · see citing works
Systematic Review of Educational Interventions for Rheumatoid Arthritis
Carandang, K. M., Pyatak, E. A., & Vigen, C. L. P. (2016) · American Journal of Occupational Therapy · doi:10.5014/ajot.2016.021386 · Cited by 28 · see citing works
Tabolli, S., Naldi, L., Pagliarello, C., Sampogna, F., Pietro, C. D., Spagnoli, A., ABENI, D. D., & The Italian Writing Exercise Study Group (2012) · British Journal of Dermatology · doi:10.1111/j.1365-2133.2012.11147.x · Cited by 18 · see citing works
Effects of written emotional disclosure on health outcomes in patients with ankylosing spondylitis
Hamilton-West, K. E., & Quine, L. (2007) · Psychology and Health · doi:10.1080/14768320601020246 · Cited by 18 · see citing works
Coping, social support, and anxiety in people with mast cell disorders
Nicoloro‐SantaBarbara, J. M., Carroll, J., & Lobel, M. (2021) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2021.06.014 · Cited by 16 · see citing works
van Middendorp, H., Sorbi, M. J., van Doornen, L. J. P., Bijlsma, J. W. J., & Geenen, R. (2007) · Patient Education and Counseling · doi:10.1016/j.pec.2006.11.009 · Cited by 16 · see citing works
Drinking behaviors by stress level in Korean university students
Chung, H.-K., & Lee, H. (2012) · Nutrition Research and Practice · doi:10.4162/nrp.2012.6.2.146 · Cited by 15 · see citing works
Emotional disclosure in rheumatoid arthritis: Participants’ views on mechanisms∗
Byrne-Davis, L. M. T., Wetherell, M. A., Dieppe, P. A., Weinman, J. A., Byron, M., Donovan, J., Horne, R., BROOKES, S. T., & Vedhara, K. (2006) · Psychology and Health · doi:10.1080/14768320500444315 · Cited by 14 · see citing works
Relations of Drinking Motives and Alcohol Consumption in Korean Male Office Workers
Kim, O., & Jeon, H. O. (2012) · Psychological Reports · doi:10.2466/18.06.13.pr0.111.6.963-970 · Cited by 14 · see citing works
Hoult, L. M., Wetherell, M. A., Edginton, T. L., & Smith, M. (2025) · PLoS ONE · doi:10.1371/journal.pone.0308928 · Cited by 12 · see citing works
Mercer, V. (2010) · Springer eBooks · doi:10.1007/978-1-4419-6510-3_9 · Cited by 10 · see citing works
Lempp, H. K., & Kingsley, G. H. (2007) · Best Practice & Research Clinical Rheumatology · doi:10.1016/j.berh.2007.05.002 · Cited by 9 · see citing works
Vedhara, K., Brant, H., Adamopoulos, E., Byrne-Davis, L. M. T., Mackintosh, B., Hoppitt, L., Tovée, M. J., Miles, J. E., & Pennebaker, J. W. (2010) · International Journal of Behavioral Medicine · doi:10.1007/s12529-009-9072-2 · Cited by 7 · see citing works
Emotional Expression and Disclosure
Booth, R. J. (2012) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780195394399.013.0007 · Cited by 5 · see citing works
Managing the impact of ankylosing spondylitis on the patient and society
Hamilton-West, K. E. (2010) · International Journal of Clinical Rheumatology · doi:10.2217/ijr.10.56 · Cited by 5 · see citing works
O'Connor, D. B., Ashley, L., Jones, F. A., & Ferguson, E. (2014) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2014.973881 · Cited by 3 · see citing works
Cognitive coping strategies in pain management
Pence, L. E., Thorn, B. E., & Davis, A. (2011) · Cambridge University Press eBooks · doi:10.1017/cbo9780511781445.014 · Cited by 3 · see citing works
Zhang, L., Zhu, W., & Liu, S. (2025) · Psychology Health & Medicine · doi:10.1080/13548506.2025.2482949 · Cited by 2 · see citing works
Differences in SBP, BMI, and Stress with AUDIT Score in Adolescents
Cho, M., & Kim, M. Y. (2018) · The Open Nursing Journal · doi:10.2174/1874434601812010228 · Cited by 2 · see citing works
Variables psicológicas relevantes en fibromialgia
López‐Chicheri, I. (2012) · Institutional Repository of the University of Granada (University of Granada) · Cited by 1 · see citing works
THE EFFECT OF THE GUIDED DISCLOSURE PROTOCOL ON DAILY STRESS, MOOD AND COPING
Eldridge, F. (2010) · White Rose eTheses Online (University of Leeds, The University of Sheffield, University of York)
Lovell, B. (2014) · Northumbria Research Link (Northumbria University)
Barlow, J. H. (2009) · doi:10.1002/9781444308075.refs
(2011) · Elsevier eBooks · doi:10.1016/b978-0-7295-3908-1.10036-3
Salikka, T., Kylmä, J., & Fröjd, S. A. (2026) · European Journal of Pain · doi:10.1002/ejp.70235
- Authors
- Wetherell, M. A., Byrne-Davis, L., Dieppe, P., Donovan, J., Brookes, S., Byron, M., Vedhara, K., Horne, R., Weinman, J., & Miles, J.
- Affiliations
- University of Bristol (GB)
- University of Brighton (GB)
- Guy's Hospital (GB)
- University of York (GB)
- ORCID
- Venue
- Journal of Health Psychology
- Publisher
- SAGE Publications
- Published
- 2005-03
- Volume
- 10
- Issue
- 2
- Pages
- 277-285
- ISSN
- 1359-1053 (ISSN-L)
- 1461-7277
- OpenAlex
- W1977898312
- Cited by
- 57
- References
- 21
- Citations by year
- 2026: 1 · 2025: 2 · 2021: 2 · 2018: 1 · 2016: 3 · 2015: 2 · 2014: 3 · 2013: 5 · 2012: 5
- FWCI
- 6.68
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Health Psychology (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion)
- Bristol Research (University of Bristol) (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Northumbria Research Link (Northumbria University) (submittedVersion)
- University of Brighton Repository (University of Brighton) (submittedVersion)
- Explore Bristol Research (submittedVersion)
- Funders
- Economic and Social Research Council (PTA-026-27-0025)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health via Writing
- Health Sciences › Medicine › Rheumatology › Rheumatoid Arthritis Research and Therapies
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- emotional disclosure, rheumatoid arthritis, traumatic events, home-based intervention, negative mood, disease activity, physiological outcomes, psychological outcomes, expressive writing
- MeSH terms
- Activities of Daily Living, Affect, Arthritis, Rheumatoid, Depression, Disability Evaluation, Female, Humans, Life Change Events, Male, Middle Aged, Disclosure
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