Expressive writing in dialysis patients

Student thesis: Doctoral ThesisDoctor of Clinical Psychology


Previous research has identified that distress is common in patients with kidney failure who undergo dialysis treatment and that this is associated with poor outcomes (Chilcot, Davenport, Wellsted, Firth, & Farrington, 2011a). Few studies have examined the effectiveness of psychological interventions aimed at improving psychological distress in this patient group. Expressive Writing (EW) is a therapeutic technique that typically involves participants writing about a stressful or traumatic event for 15-20 minutes on 3-5 consecutive days (Pennebaker & Buell, 1986) and has been associated with improvements in psychological (e.g. well-being) and clinical (e.g., immune function) outcomes in several populations, including breast cancer patients (Craft, Davis & Paulson, 2012). The aims of the current study were to establish feasibility of using EW with this patient group. This was done by identifying the factors associated with distress, gauging acceptability and safety of the intervention, recording recruitment and retention rates and by establishing its potential clinical efficacy. The study consisted of two phases; a screening phase which used a cross-sectional questionnaire survey of 97 patients, and a trial phase which randomised 30 patients into two groups (EW or control), with a 3-month follow-up. Results indicated that self-reported symptoms of fatigue and pain, and illness perceptions predicted a significant amount of variance (35%) in distress, above demographic and clinical variables. The EW intervention was found to be feasible in terms of uptake and agreement to randomisation. However, retention rates were lower than some previous EW studies suggesting that modifications are needed to the writing protocol in order to increase adherence. Despite poor retention, results indicated improvements in distress (d=0.23) and systolic blood pressure (d=0.71) for the EW group, when compared to the control group at followup. This suggests that, with modification, EW may be cost effective way to reduce distress in dialysis patients. These findings are discussed with reference to limitations and future research, as well as implications for clinical practice.
Date of Award2014
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorJoseph Chilcot (Supervisor) & Rona Moss-Morris (Supervisor)

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