Defense Date


Document Type


Degree Name

Doctor of Philosophy



First Advisor

Dace Svikis


Women with Substance Use Disorders (SUD) have high rates of trauma and PTSD, which is linked to greater physical and mental health problems and poorer SUD treatment outcomes. While research affirms trauma should be addressed during SUD treatment, the majority of addiction programs do not offer such services. One promising intervention is Pennebaker’s expressive writing paradigm, which includes disclosure of traumatic/stressful experiences through 20-minute writing sessions over 3-5 consecutive days. While expressive writing has been linked to improvements in mental and physical health, the intervention has not been studied in persons with SUDs. The present study was a randomized clinical trial comparing expressive writing to control (neutral topic) writing. Conducted in a residential SUD program for women, the study: 1) compared psychological and physical health profiles in SUD women with and without co-morbid PTSD and/or trauma; 2) compared 2-week and 1-month outcomes for the experimental and control groups; and 3) examined immediate and more distal levels of psychological distress following expressive writing. Study participants were N=149 women randomized to either the expressive writing or control writing condition. All women completed 20-minute writing sessions daily for 4 consecutive days. As predicted, SUD women reported high rates of trauma and PTSD, and those with such co-morbidities had more severe psychological and physical health problems. At 2-week follow-up, expressive writing participants showed greater reductions in post-traumatic symptom severity and anxiety scores than control writing participants. While no group differences were found at 1-month follow-up, this was due largely to significant improvements for both groups over the course of residential treatment. Finally, expressive writing participants showed increased negative affect immediately after each writing session, but there were no differences in pre-writing negative affect scores between groups the following day. By the final writing session, participants were able to write about traumatic/stressful events without having a spike in negative affect. Study results suggest expressive writing may be a brief, cost effective, adjunct to SUD treatment. Furthermore, expressive writing, when implemented in a residential SUD setting, appears safe, and warrants further study as a strategy for addressing trauma and PTSD in tandem with SUD treatment.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

December 2009

Included in

Psychology Commons