Defense Date


Document Type


Degree Name

Doctor of Philosophy


Clinical Psychology

First Advisor

Scott Vrana


Writing about a personal traumatic event has been found to have psychological and physical health benefits. Focusing on traumatic memories in writing may be a form of exposure. In imagery exposure and trauma writing, greater physiological reactivity was predictive of better outcomes. Given the importance of physiological output in emotional processing, response training was developed and found to be effective in increasing appropriate physiological reactivity in imagery exposure. If response training amplifies physiological reactivity and the benefits of writing, the hypothesis that writing is a form of exposure would be strengthened, and training may be a valuable tool to improve the efficacy of psychotherapy approaches that use writing as a form of exposure. The present study examined whether response training enhances the benefits of trauma writing. In this study, participants wrote for 20 minutes on three occasions about a personal traumatic event (n = 113) or a trivial topic (n = 133) and received response imagery training (n = 79), stimulus imagery training (n = 84) or no training (n = 83). Heart rate and skin conductance were recorded in sessions one and three throughout a 10-minute baseline, writing, and a ten-minute recovery period. Self-reported trauma symptoms and emotion were assessed in each session. One month after completing the sessions, participants completed follow-up assessments of psychological and physical health outcomes. As predicted, trauma writing elicited greater physiological reactivity and self-reported trauma symptoms and emotion than neutral writing. Response training amplified physiological reactivity to trauma writing more than neutral writing, without amplifying levels of self-reported emotion or trauma symptoms. The physiological reactivity and self-reported emotion elicited by trauma writing habituated across sessions and response training enhanced these effects. Finally, increased heart rate predicted better outcomes for all trauma writers; however, response trained trauma writers who evidenced greater heart rate showed the greatest reductions in trauma, depression and physical illness symptoms at follow-up. These results support previous research which found that greater physiological reactivity was predictive of writing outcomes. The findings are the first to demonstrate that response training facilitates emotional processing and thus may be a beneficial adjunct to trauma writing.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

December 2011