Effects of guided written disclosure of stressful experiences on clinic visits and symptoms in frequent clinic attenders

• Published in: Family practice 2002-04, Vol.19 (2), p.161-166
• Main Authors: Gidron, Yori, Duncan, Elaine, Lazar, Alon, Biderman, Aya, Tandeter, Howard, Shvartzman, Pesach
• Format: Article
• Language: English
• Subjects: Adult; Analysis of Variance; Be'er Sheeba; Chi-Square Distribution; Clinic visits; Community based clinics; Consultation; Disclosure; Explicit memory; Female; frequent attenders; General practice; Humans; Implicit memory; Israel; Male; memory shift; Outcomes; Patient Satisfaction; Patients; Primary health care; Primary Health Care - methods; Primary Health Care - statistics & numerical data; Prospective Studies; Psychological trauma; Self Disclosure; somatization; Somatoform Disorders - psychology; Stress; Stress, Psychological - psychology; Studies; Writing; written disclosure; Written statements
• ISSN: 0263-2136; 1460-2229; 1460-2229
• DOI: 10.1093/fampra/19.2.161

Background. Psychosocial variables such as major stressful life events/daily stressful events have been associated with health care utilization. Objective. Our aim was to examine the effects of a guided disclosure protocol (GDP) of past traumas on symptoms and clinic visits among frequent clinic attenders. Methods. Forty-one frequent clinic attenders (≥2 visits/3 months) took part. Patients were randomly assigned individually to either a casual content writing control group (n = 19) or a trauma content writing experimental GDP group (n = 22). GDP patients wrote about an upsetting event chronologically (day 1), verbally described their thoughts and feelings and descibed the event's impact on life (day 2), and finally wrote about their current perspective on and future coping with the event (day 3). Three months later, patients were reassessed blindly for symptoms and clinic visits, and an average of 15 months later they were assessed blindly for clinic visits again. Results. Compared with controls, GDP patients reported lower symptom levels at 3 months (2.3 versus 5.2), and made fewer clinic visits during the 3 (1.3 versus 3.0) and 15 month (5.1 versus 9.7) follow-ups. The percentage of GDP patients making ≥10 visits during the 15 month follow-up was smaller (10%) than among controls (33%). Conclusions. The findings extend previous findings to frequent clinic users, using a new form of written disclosure aimed at shifting trauma from implicit to explicit memory. The GDP may be an inexpensive additional intervention in primary care for reducing symptoms and clinic visits among frequent clinic users.