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.
Expressive writing in dialysis patients
Hunt, J. R. (Author). 2014
Student thesis: Doctoral Thesis › Doctor of Clinical Psychology