Expressive Writing for Postpartum PTSD

(CARES Trial)

Overseen By Sharon Dekel, Ph.D. M.Phil., M.S.

Age: 18 - 65

Sex: Female

Trial Phase: Academic

Sponsor: Massachusetts General Hospital

Disqualifiers: Preterm delivery, Psychotic disorder, others

Compensation: Varies

Number of Visits: 4

136 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests a psychological approach to prevent post-traumatic stress disorder (PTSD) after childbirth. Participants will engage in Expressive Writing about Childbirth, writing about their childbirth experience, or in Neutral Writing, writing about a neutral event, for three days to see if this improves their mental health and bond with their baby. Women who gave birth at Massachusetts General Hospital and experienced a stressful delivery might be a good fit. As an unphased trial, this study offers a unique opportunity to explore innovative methods for enhancing mental health after childbirth.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It is best to discuss this with the trial coordinators or your healthcare provider.

What prior data suggests that this psychological intervention is safe for postpartum individuals?

Research has shown that expressive writing is generally safe and well-tolerated by participants. Studies have found that writing about personal experiences can help reduce symptoms of PTSD (post-traumatic stress disorder), even in complex cases. Reports of harmful side effects from expressive writing are rare. Most people find it manageable and helpful. Overall, expressive writing has a strong safety record, making it a promising option for those interested in trials to improve mental health after childbirth. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about expressive writing for postpartum PTSD because it offers a novel, non-pharmacological approach to managing this condition. Unlike traditional treatments like therapy and medication, this method empowers new mothers to process their childbirth experiences through structured writing exercises. This technique is promising because it could be easily accessible, low-cost, and reduce stigma associated with seeking mental health support.

What evidence suggests that expressive writing might be an effective treatment for postpartum PTSD?

Research has shown that expressive writing can greatly reduce symptoms of post-traumatic stress disorder (PTSD). In this trial, participants will divide into two groups: one will engage in Expressive Writing about Childbirth, while the other will participate in Neutral Writing about daily events. One study found that women who practiced expressive writing experienced less postpartum depression and stress than those who received standard care or wrote about neutral topics. This type of writing helps individuals process their emotions and experiences, which can lower stress. Studies on trauma-focused therapies also support their effectiveness in helping new mothers heal emotionally. Overall, expressive writing appears promising in reducing emotional distress after childbirth. ^{3 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for women who recently gave birth at Massachusetts General Hospital and are at risk of developing postpartum PTSD, as indicated by a specific distress score. Participants must understand English and be between the ages of 18-50 without severe mental health conditions, substance abuse issues, or recent psychological treatments.

Inclusion Criteria

Women who are at risk for developing CB-PTSD based on their scoring of >16 on the Peritraumatic Distress Inventory (PDI)

Women who recently delivered at Massachusetts General Hospital (MGH)

Exclusion Criteria

My newborn has Down's Syndrome or another serious genetic condition or birth defect.

I will undergo surgery with general anesthesia.

Preterm delivery (<37 week gestation) or stillbirth

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Intervention

Participants engage in expressive writing about their childbirth experience or a neutral event for three consecutive days, 15 minutes each day.

3 days

3 visits (in-person or virtual)

Post-Intervention Assessment

Participants complete a short survey about their birth experience and mental health.

1 day

Follow-up

Participants undergo mental health and physiological assessments, and a brief play session with their infant.

2 months postpartum

1 visit (in-person)

What Are the Treatments Tested in This Trial?

Interventions

• Expressive Writing about Childbirth
• Neutral Writing

Trial Overview The study tests if writing about childbirth (expressive writing) or a neutral topic can prevent PTSD after giving birth. Women will write for three days post-childbirth and complete surveys on their experience and mental health before and after this intervention.

How Is the Trial Designed?

Group I: Expressive Writing about Childbirth Active Control 1 Intervention

Subgroup of participants will write about their recent childbirth.

Group II: Neutral Writing Placebo Group 1 Intervention

Subgroup of participants will write about neutral daily events.

Who Is Running the Clinical Trial?

Massachusetts General Hospital

Lead Sponsor

Trials

3,066

Recruited

13,430,000+

Published Research Related to This Trial

A study analyzing therapeutic texts from 51 PTSD patients revealed that writing about trauma exposure led to a significant increase in the use of negative emotional words like fear and depression compared to writing about biographical experiences.

Cognitive restructuring texts showed the highest emotional intensity, containing both negative and positive affective words, indicating that this component of writing therapy may be particularly effective in addressing a range of emotions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Courses of affects in an internet-based writing therapy for elderly war trauma survivors. A content analytic approach]. Böttche, M., Berth, H., Knaevelsrud, C., et al.[2021]

The study involving 854 postpartum women found that while expressive writing was generally acceptable to those who completed it, the overall feasibility of the intervention was low, with only 10.7% recruitment and high attrition rates (68.1% by six months).

Despite low adherence to the writing task (only 29.3% wrote for the recommended duration), many women reported positive and negative feelings about the experience, indicating that while the intervention may not be widely adopted, it could still provide benefits for those who engage with it.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility and acceptability of expressive writing with postpartum women: a randomised controlled trial. Crawley, R., Ayers, S., Button, S., et al.[2021]

Expressive writing, which involves disclosing thoughts and emotions about significant topics, has been shown to positively impact well-being and psychological health, particularly after stressful or traumatic events.

The effectiveness of expressive writing as a therapeutic intervention for posttraumatic stress disorder (PTSD) varies based on the structure and content of the writing, with mechanisms like emotion regulation and narrative construction playing key roles in its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Writing therapy after traumatic events: therapeutic approaches and mechanisms of change]. Knaevelsrud, C., Böttche, M.[2013]

A randomized controlled trial involving 564 postpartum women found that while expressive writing did not significantly improve overall psychological or physical health compared to control groups, it did lead to a notable reduction in stress immediately after the writing task.

Women who engaged in expressive writing had lower healthcare costs and better cost-effectiveness in terms of quality of life improvements, suggesting potential benefits for specific high-risk groups rather than as a universal intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of expressive writing for postpartum health: a randomised controlled trial. Ayers, S., Crawley, R., Button, S., et al.[2019]

In a study of 113 women assessed after childbirth, those who engaged in Expressive Writing showed significantly lower levels of depression and posttraumatic stress symptoms three months later compared to those who did neutral writing.

The Expressive Writing intervention was effective across various levels of baseline depression and PTSD, suggesting it is a beneficial and low-cost approach to help prevent postpartum distress.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

THE EFFECTS OF EXPRESSIVE WRITING ON POSTPARTUM DEPRESSION AND POSTTRAUMATIC STRESS SYMPTOMS. Blasio, PD., Camisasca, E., Caravita, SC., et al.[2015]

In a study involving 1090 perinatal women affected by Hurricane Harvey, expressive writing did not show any significant improvement in post-traumatic stress symptoms compared to neutral writing or no writing.

Interestingly, participants who engaged in expressive writing reported increased feelings of anxiety and sadness during the intervention, suggesting that it may have worsened post-traumatic stress symptoms for some individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Unexpected effects of expressive writing on post-disaster distress in the Hurricane Harvey Study: a randomized controlled trial in perinatal women. Paquin, V., Bick, J., Lipschutz, R., et al.[2021]

Citations

1. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0165178119314970

Effects of expressive writing intervention for women's PTSD ... Expressive writing (EW) as a psychological intervention could significantly alleviate the severity of post-traumatic stress disorder.

2. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/39651593

Effectiveness of expressive writing therapy for postpartum ... Expressive writing therapy was more effective than standard care or controlled writing in reducing postpartum depression and stress among women with ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6255986/

Effectiveness of Trauma-Focused Psychological Therapies for ... This study aims to examine the effectiveness of trauma-focused psychological interventions (TFPT), for postnatal women.

4. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0005796711000374

A test of written emotional disclosure as an intervention for ... The present study examined the efficacy of a brief, written exposure therapy (WET) for posttraumatic stress disorder (PTSD). Participants were 46 adults ...

5. psychiatryinvestigation.org psychiatryinvestigation.org/m/journal/view.php?number=1724

Effects of Narrative Exposure Therapy for Treating ... This analysis showed that NET can alleviate depression and anxiety. It may thus be used in clinical settings to alleviate patients' negative feelings and aid ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC10475481/

Expressive writing treatments to reduce PTSD symptom ... This mixed-method pilot trial will inform the first fully powered, self-administered, brief web-based treatment to reduce PTSD symptom severity and negative ...

7. ptsd.va.gov ptsd.va.gov/professional/treat/txessentials/written_exposure_therapy.asp

Written Exposure Therapy for PTSD - PTSD: National ... A growing number of studies indicate that WET is effective for PTSD, even among patients with complicated presentations and other comorbid disorders.

8. istss.org istss.org/written-exposure-therapy-vs-expressive-writing-via-telehealth-in-undergraduates-ellis-darnell-orcutt/

Written Exposure Therapy vs. Expressive Writing via ... We provide preliminary evidence that WET is advantageous over trauma-focused expressive writing for reducing PTSD symptoms.

9. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC3904430/

Cognitive Emotion Regulation and Written Exposure Therapy ... We examined the extent to which cognitive emotion-regulation (ER) strategies moderated posttraumatic stress disorder (PTSD) treatment outcome.