Expressive Writing for Postpartum PTSD

(CARES Trial)

Age: 18 - 65

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: Massachusetts General Hospital

Disqualifiers: Preterm delivery, Psychotic disorder, others

Trial Summary

What is the purpose of this trial?

This trial tests if writing about childbirth can help women who had a stressful delivery. The goal is to prevent PTSD and improve bonding with their babies. Writing helps by allowing them to process their emotions and reduce stress.

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 data supports the effectiveness of the treatment Expressive Writing for Postpartum PTSD?

Research shows that expressive writing can reduce depression and posttraumatic stress symptoms in postpartum women, making it a helpful and low-cost intervention to prevent postpartum distress. Additionally, expressive writing has been associated with improved psychological health and well-being after stressful or traumatic events. ^{1 2 3 4 5}

Is expressive writing safe for postpartum PTSD?

Expressive writing has been studied for various conditions and is generally considered safe for humans. It involves writing about stressful events and has been associated with improved mental health without significant safety concerns. ^{1 2 3 4 5}

How does the treatment Expressive Writing for Postpartum PTSD differ from other treatments for this condition?

Expressive Writing for Postpartum PTSD is unique because it involves writing about stressful events related to childbirth for a short period over several days, which can help reduce stress and improve mental health. Unlike other treatments, it is a low-cost, self-administered therapy that can be done at home, making it accessible and convenient for new mothers. ^{1 2 3 4 6}

Research Team

Eligibility Criteria

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

Trial Timeline

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)

Treatment Details

Interventions

• Expressive Writing about Childbirth (Behavioural Intervention)
• Neutral Writing (Behavioural Intervention)

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.

Participant Groups

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+

Dr. William Curry

Massachusetts General Hospital

Chief Medical Officer

MD from Harvard Medical School

Dr. Anne Klibanski

Massachusetts General Hospital

Chief Executive Officer since 2019

MD from Harvard Medical School

Findings from Research

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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

THE EFFECTS OF EXPRESSIVE WRITING ON POSTPARTUM DEPRESSION AND POSTTRAUMATIC STRESS SYMPTOMS. [2015]

2. Germany pubmed.ncbi.nlm.nih.gov

[Courses of affects in an internet-based writing therapy for elderly war trauma survivors. A content analytic approach]. [2021]

3. England pubmed.ncbi.nlm.nih.gov

Feasibility and acceptability of expressive writing with postpartum women: a randomised controlled trial. [2021]

4. England 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. [2021]

5. Germany pubmed.ncbi.nlm.nih.gov

[Writing therapy after traumatic events: therapeutic approaches and mechanisms of change]. [2013]

6. United States pubmed.ncbi.nlm.nih.gov

Evaluation of expressive writing for postpartum health: a randomised controlled trial. [2019]