An experimental test of instructional manipulations in expressive writing interventions: Examining processes of change

Expressive writing (EW) interventions increasingly use altered instructions to promote presumptively therapeutic processes (e.g., to enhance cognitive processing). We experimentally examined altered EW instructions to investigate if such alterations produce intended responses. Community and student participants (n = 204) were randomized to 1 of 6 EW instructions: cognitive-processing, exposure, self-regulation, and benefit-finding; each modified group was compared with a standard EW and control group. Dependent variables included the writing samples (content) and changes pre-post writing in mood and salivary cortisol. As expected, experimental groups reliably differed from the control group. Altered instructions produced both expected and unexpected responses compared to standard EW instructions. Exposure-based instructions produced the anticipated increase in emotional habituation over time (p = .04), but also the unanticipated response of greater cognitive-processing (p = .04). Cognitive-processing-based instructions lead to more cognitive-processing over time (p = .005), instructions that promoted self-regulation produced more positive affect (p < .0001), and benefit-finding instructions used more positive emotion words over time (p = .001). Expected differences were not found in salivary cortisol for any instructional set. Altering EW instructions to target specific processes can be used to enhance some change mechanisms; however, instructions may also elicit a wider range of responses than those presumed to be unique to an instructional set.