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Expressive Writing and Wound Healing in Older Adults: A Randomized Controlled Trial

Koschwanez, Heidi E. PhD; Kerse, Ngaire MBChB, PhD; Darragh, Margot MSc; Jarrett, Paul FRCP, FRACP; Booth, Roger J. PhD; Broadbent, Elizabeth PhD

doi: 10.1097/PSY.0b013e31829b7b2e
Review Article

Objective To investigate whether expressive writing could speed wound reepithelialization in healthy, older adults.

Methods In this randomized controlled trial, 49 healthy older adults aged 64 to 97 years were assigned to write for 20 minutes a day either about upsetting life events (Expressive Writing) or about daily activities (Time Management) for 3 consecutive days. Two weeks postwriting, 4-mm punch biopsy wounds were created on the inner, upper arm. Wounds were photographed routinely for 21 days to monitor wound reepithelialization. Perceived stress, depressive symptoms, health-related behaviors, number of doctor visits, and lipopolysaccharide-stimulated proinflammatory cytokine production were also measured throughout the study.

Results Participants in the Expressive Writing group had a greater proportion of fully reepithelialized wounds at Day 11 postbiopsy compared with the Time Management group, with 76.2% versus 42.1% healed, χ2(1, n = 40) = 4.83, p = .028. Ordinal logistic regression showed more sleep in the week before wounding also predicted faster healing wounds. There were no significant group differences in changes to perceived stress, depressive symptoms, health-related behaviors, lipopolysaccharide-induced proinflammatory cytokine production, or number of doctor visits over the study period.

Conclusions This study extends previous research by showing that expressive writing can improve wound healing in older adults and women. Future research is needed to better understand the underlying cognitive, psychosocial, and biological mechanisms contributing to improved wound healing from these simple, yet effective, writing exercises.

Trial Registration: Australian New Zealand Clinical Trials Registry (trial number 343095)

From the Departments of Psychological Medicine (H.E.K., M.D., E.B.) and Molecular Medicine and Pathology, (R.J.B.), and General Practice and Primary Health Care (N.K.), The University of Auckland, Auckland, New Zealand; Department of Dermatology (P.J.), Counties Manukau District Health Board, Auckland, New Zealand.

Address correspondence and reprint requests to Elizabeth Broadbent, PhD, Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand. E-mail:

Received for publication June 17, 2012; revision received March 28, 2013.

Copyright © 2013 by American Psychosomatic Society
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