Joshua M. Smyth - US grants

DESCRIPTION (investigator's abstract): The overall aim of this application is to extend work on a new psychological phenomenon that may have direct clinical relevance for a variety of somatic diseases. The basic finding of interest relates to observed relationships between a brief writing task that creates emotional expression about past traumas, and salutary effects on some affective, psychophysiological, physiological, and symptom outcome measures. Participants examined in the majority of previous studies were typically healthy. In one previous study, however, the writing task produced reductions in symptoms in patients with asthma or rheumatoid arthritis. The proposed experiment attempts to extend such work as such a demonstration could suggest that treatment procedures based on the writing task be developed and employed in these and other medical conditions. A shift in affect, and presumably cognitive processes as well, apparently occurs in the interval between the written emotional expression and subsequent assessments. Current theorizing about this observation focuses on the idea that the cognitive representation of traumatic memories is altered in this period, resulting in reductions in negative affect and physiological arousal although there is no documentation of any such process. The primary goals of the study are to (1) determine the effect of written emotional expression on subsequent symptomatology, mood, and disease status in patients with asthma or rheumatoid arthritis, and (2) establish what psychological and/or social pathway(s) the manipulation may be operating through. Patients with asthma or rheumatoid arthritis will be assigned randomly to either experimental (writing about the most traumatic or stressful event they remember) or control condition (writing about neutral topics). Affect, cognition, social contacts, and symptoms will be assessed several times a day using palm top computers for one week prior to and two weeks following the manipulation. Disease status will be measured every six months for a period of two years, and quality of life measures will also be taken.

DESCRIPTION (provided by applicant): Expressive writing about stressful experiences has beneficial effects on some psychological, physiological, and symptom outcome measures. Recently, this intervention has been demonstrated to produce disease improvement in patients with organic disease. We propose to examine expressive writing as complementary treatment for individuals with diabetes mellitus. An estimated 16 million people have diabetes, with a 33% increase in the prevalence of diabetes between 1990 and 1998. Diabetes remains a leading cause in the US of blindness, end-stage renal failure and nontraumatic lower extremity amputation. This study addresses the following questions: 1) Does the benefit of expressive writing extend to patients with diabetes? 2) What are the potential mediators and moderators of any observed effects? 3) What is the duration of any observed improvements? 4) Does the application of additional expressive writing "booster" sessions lead to greater improvement and/or a more sustained improvement? The study is a multi-site, prospective, randomized experimental design. Patients (n=225) with diabetes will be recruited from three geographically distinct areas, and randomly assigned to the control group (neutral writing) or one of two experimental conditions (expressive writing or expressive writing plus booster). Participants in the experimental conditions complete a written expression exercise, writing for several sessions about traumatic or stressful events, while control group participants write about neutral topics. One experimental group will receive "booster" sessions of additional writing at 4-month intervals. All participants will have disease status, quality of life, and psychological factors monitored every 4 months for a period of two years

? DESCRIPTION (provided by applicant): Stress is a documented risk factor for cardiac, metabolic, and neurological disease. How individuals respond to everyday stressors can interfere with whether they meet national guidelines for health behaviors such as exercise and sleep. The overarching goal of this project is to utilize an experimental medicine approach to develop an efficient, ecologically valid, within-person approach to measuring and intervening on the deleterious effects of everyday stress on meeting recommended levels of two health behaviors: physical activity and sleep patterns. In Phase 1, we will develop, validate and deliver a stress assay that assesses malleable components of the stress process that drive health behavior decisions and enactment as they unfold, in real-time and in individuals' natural environments. In Phase 2, we will use this assay to evaluate just-in-time intervention approaches that target specific stress response components at times and in contexts when they are most malleable and can positively impact health behaviors. In contrast to previous daily stress studies, we will conduct coordinated analyses in 10 intensive longitudinal datasets separating effects of stressor reactivity, recovery and pile-up on health behaviors. By replicating the results across 10 studies we will ensure identification of the most reliable and potent targets for intervention. The central hypothesis, drawn from stress theory, is that larger initial stressor reactivity, incomplete or slow recovery, and more frequent stress responses will negatively impact health behavior engagement. The rationale for the proposed research is that by identifying the strongest predictors of these health behaviors, stress interventions will be more effective in increasing physical activity and sleep to meet current guidelines (e.g. Center for Disease Control- promoted clinical recommendations). Specific aims extended from this hypothesis include: 1) Test the prediction across 10 intensive longitudinal datasets that stressor reactivity, recovery and pile-up can be identified and are more useful than traditional stress indices, 2) Test the prediction that these three components predict daily physical activity and sleep, 3) Identify characteristics of people who are either more at-risk (or resilient) to these stress interfering with health behaviors, 4) Validate these components in a novel sample, and 5) Test just-in-time interventions tied to times when individuals are vulnerable to the effects of stress. The research team has a history 10+ years collaboration and represents experts in theory, design, and analysis of daily stress and health behavior intervention. The approach is innovative because it tests theory- based predictions for health behaviors, will replicate effects across 10 datasets, and will develop and test novel and empirically-based just-in-time interventions from these results. The proposed research is significant by advancing our understanding of how stress influences the development of disease and by using interventions grounded in precision medicine to improve daily health behaviors to achieve their recommended levels.