Paudyal Priyamvada, Hine Paul, Theadom Alice, Apfelbacher Christian J, Jones Christina J, Yorke Janelle, Hankins Matthew, Smith Helen E
Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
Cochrane Database Syst Rev. 2014 May 19;2014(5):CD007676. doi: 10.1002/14651858.CD007676.pub2.
Psychological stress has been widely implicated in asthma exacerbation. Evidence suggests that written emotional disclosure, an intervention that involves writing about traumatic or stressful experiences, helps to reduce stress and promote physical and psychological well-being. Written emotional disclosure may have a role in the management of asthma.
This review aims to determine the effectiveness of written emotional disclosure for people with asthma, specifically, to assess:1. overall efficacy of emotional disclosure compared with emotionally neutral writing on self reported quality of life in people with asthma;2. overall efficacy of emotional disclosure compared with emotionally neutral writing on objective measures of health outcome in people with asthma; and3. comparative efficacy of different types of emotional disclosure for people with asthma.
Trials were identified from the Cochrane Airways Group Specialised Register of trials, CENTRAL, MEDLINE, EMBASE, CINAHL, AMED and PsycINFO. The latest search was conducted in January 2014.
Randomised controlled trials published in any language comparing written emotional disclosure intervention versus a control writing (emotionally neutral) intervention in participants with asthma were included in the review.
Two review authors independently assessed studies against predetermined inclusion criteria and extracted the data. Corresponding authors were contacted when necessary to provide additional information.
Four studies, involving a total of 414 participants, met the inclusion criteria. Three studies were conducted in adult participants and one in adolescents. The average age of participants ranged from 14 to 43 years. The trials lasted between two months and 12 months. The interventions were based on Pennebaker's method. The risk of bias across most domains of the studies was generally considered to be low, however three of four studies were considered at high risk of bias due to lack of assessor blinding and one study was at high risk of bias for selective reporting. The interpretation of these studies was limited by diverse outcome measurements, measurement tools, control group techniques, and number and/or times of follow-up. A pooled result from the four studies, including a total of 146 intervention and 135 control participants, indicated uncertain effect in forced expiratory volume in one second (FEV1) % predicted between the disclosure group and the control group (mean difference (MD) 3.43%, 95% confidence interval (CI) -0.61% to 7.47%; very low-quality evidence) at ≤ three months' follow-up. Similarly, evidence from two studies indicated that written emotional disclosure found uncertain effect on forced vital capacity (FVC) (standardised mean difference (SMD) -0.02, 95% CI -0.30 to 0.26; low-quality evidence) and asthma symptoms (SMD -0.22, 95% CI -0.52 to 0.09; low-quality evidence) but may result in improved asthma control at ≤ three months' follow-up (SMD 0.29, 95% CI 0.01 to 0.58; low-quality evidence). We were unable to pool the data for other outcomes. Results from individual trials did not reveal a significant benefit of written emotional disclosure for quality of life, medication use, healthcare utilisation or psychological well-being. Evidence from one trial suggests a significant reduction in beta agonist use (MD -1.62, 95% CI -2.62 to -0.62; low-quality evidence) at ≤ three months' follow-up in the disclosure group compared with controls. The review did not address any adverse effects of emotional writing.
AUTHORS' CONCLUSIONS: Evidence was insufficient to show whether written emotional disclosure compared with writing about non-emotional topics had an effect on the outcomes included in this review. Evidence is insufficient to allow any conclusions as to the role of disclosure in quality of life, psychological well-being, medication use and healthcare utilisation. The evidence presented in this review is generally of low quality. Better designed studies with standardised reporting of outcome measurement instruments are required to determine the effectiveness of written emotional disclosure in the management of asthma.
心理压力与哮喘急性发作密切相关。有证据表明，书面情感表露（一种涉及书写创伤性或压力性经历的干预措施）有助于减轻压力，促进身心健康。书面情感表露可能在哮喘管理中发挥作用。
本综述旨在确定书面情感表露对哮喘患者的有效性，具体而言，评估：1. 与书写非情感性内容相比，情感表露对哮喘患者自我报告的生活质量的总体疗效；2. 与书写非情感性内容相比，情感表露对哮喘患者健康结局客观指标的总体疗效；3. 不同类型的情感表露对哮喘患者的相对疗效。
从Cochrane Airways Group专业试验注册库、Cochrane系统评价数据库、MEDLINE、EMBASE、护理学与健康领域数据库、联合和补充医学数据库以及心理学文摘数据库中检索试验。最近一次检索于2014年1月进行。
纳入以任何语言发表的随机对照试验，这些试验比较了书面情感表露干预与对照书写（非情感性）干预对哮喘参与者的影响。
两位综述作者根据预先确定的纳入标准独立评估研究并提取数据。必要时联系通讯作者以提供额外信息。
四项研究共纳入414名参与者，符合纳入标准。三项研究针对成年参与者，一项针对青少年。参与者的平均年龄在14至43岁之间。试验持续时间为两个月至12个月。干预措施基于彭尼贝克的方法。大多数研究领域的偏倚风险通常被认为较低，然而，四项研究中有三项因缺乏评估者盲法而被认为存在高偏倚风险，一项研究因选择性报告而存在高偏倚风险。这些研究的解读受到多种结局测量、测量工具、对照组技术以及随访次数和/或时间的限制。四项研究的汇总结果（包括146名干预组参与者和135名对照组参与者）表明，在随访≤三个月时，表露组与对照组之间一秒用力呼气量（FEV1）占预计值的百分比差异不确定（平均差（MD）3.43%，95%置信区间（CI）-0.61%至7.47%；极低质量证据）。同样，两项研究的证据表明，书面情感表露对用力肺活量（FVC）（标准化平均差（SMD）-0.02，95%CI -0.30至0.26；低质量证据）和哮喘症状（SMD -0.22，95%CI -0.52至0.09；低质量证据）的影响不确定，但在随访≤三个月时可能会改善哮喘控制（SMD 0.29，95%CI 0.01至0.58；低质量证据）。我们无法汇总其他结局的数据。个别试验的结果未显示书面情感表露对生活质量、药物使用、医疗保健利用或心理健康有显著益处。一项试验的证据表明，在随访≤三个月时，表露组与对照组相比，β受体激动剂的使用显著减少（MD -1.62，95%CI -2.62至-0.62；低质量证据）。本综述未涉及情感书写的任何不良反应。
证据不足，无法表明与书写非情感性主题相比，书面情感表露是否对本综述中纳入的结局有影响。证据不足，无法就表露在生活质量、心理健康、药物使用和医疗保健利用方面的作用得出任何结论。本综述中呈现的证据总体质量较低。需要设计更完善的研究，并对结局测量工具进行标准化报告，以确定书面情感表露出在哮喘管理中的有效性。
