The dynamic relationship of negative emotional content in the context of trauma-focused writing interventions on improvements in cognitive reappraisal: A pilot study.

Abstract

Objective: Writing about traumatic experiences is beneficial for the reduction of posttraumatic stress symptoms, yet little research has examined the linguistic content of trauma-focused writing interventions. The current pilot study had two aims (a) characterize changes in linguistic features in two trauma-focused writing interventions; and (b) examine how changes in linguistic content may be associated with proposed mechanisms of change in trauma treatment (i.e., emotion regulation, cognitive reappraisal, and experiential avoidance). Method: Data were a secondary analysis of a proof-of-concept trial of written exposure therapy (WET) compared to trauma-focused expressive writing. Participants (N = 33, 76% female) completed five virtual sessions and measures of emotion regulation, posttraumatic cognitions, and experiential avoidance. Reliable change was calculated for each mechanism pre/postintervention. Linguistic inquiry and word count (Boyd et al., 2022) was used to analyze linguistic content (i.e., negative emotion words, past tense, cognitive processing, and death-related content). Results: Group differences emerged in slopes of narrative content across time for negative emotion words (b = 0.3, p = .008), past tense (b = −1.45, p , .01), and causal language (b = 0.39, p = .002). Contrary to expectations, only the slope of change in negative emotion words was associated with reliable changes in posttraumatic cognitions (b = −0.59, p = .023). Conclusions: Findings contribute evidence to support the use of negative emotion words early in treatment as a potentially influential target for improving posttraumatic cognitions in WET. Clinical Impact StatementThe current study findings offer preliminary evidence to suggest the use of negative emotions is important in the early sessions of written exposure therapy (WET) for improvements in posttraumatic cognitions to be seen over the course of treatment. These findings bolster current recommendations for feedback on emotional narrative content in the context of WET early in treatment and less emphasis on emotional content in later sessions.