The Effects of Expressive Writing on Lung Function, Quality of Life, Medication Use, and Symptoms in Adults With Asthma: A Randomized Controlled Trial Helen E. Smith, DM, FFPHM, Christina J. Jones, PhD, Matthew Hankins, PhD, Andy Field, DPhil, Alice Theadom, PhD, Richard Bowskill, MRCPsych, Rob Horne, PhD, FRPharmS, and Anthony J. Frew, MD, FRCP ABSTRACT Objectives: Asthma is a chronic condition affecting 300 million people worldwide. Management involves adherence to pharmacological treatments such as corticosteroids and β-agonists, but residual symptoms persist. As asthma symptoms are exacerbated by stress, one possible adjunct to pharmacological treatment is expressive writing (EW). EW involves the disclo- sure of traumatic experiences which is thought to facilitate cognitive and emotional processing, helping to reduce physiological stress associated with inhibiting emotions. A previous trial reported short-term improvements in lung function. This study aimed to assess whether EW can improve lung function, quality of life, symptoms, and medication use in patients with asthma. Methods: Adults (18–45 years) diagnosed as having asthma requiring regular inhaled corticosteroids were recruited from 28 general practices in South East England (n = 146). In this double-blind randomized controlled trial, participants were allocated either EW or nonemotional writing instructions and asked to write for 20 minutes for 3 consecutive days. Lung function (forced expired volume in 1 second [FEV 1 ]% predicted), quality of life (Mark's Asthma Quality of Life Question- naire), asthma symptoms (Wasserfallen Symptom Score Questionnaire), and medication use (inhaled corticosteroids and β-agonist) were recorded at baseline, 1, 3, 6, and 12 months. Results: Hierarchical linear modeling indicated no significant main effects between time and condition on any outcomes. Post hoc analyses revealed that EW improved lung function by 14% for 12 months for participants with less than 80% FEV 1 % predicted at baseline (β = 0.93, p = .002) whereas no improvement was observed in the control condition (β = 0.10, p = .667). Conclusions: EW seems to be beneficial for patients with moderate asthma (<80% FEV 1 % predicted). Future studies of EW require stratification of patients by asthma severity. Trial Registration: ISRCTN82986307 Key words: asthma, psychological intervention, expressive writing, written emotional disclosure. INTRODUCTION I t is widely recognized that addressing the psychological needs of individuals can produce improvements in both mental and physical health. In the last decade, several research studies have demonstrated that writing about emo- tionally traumatic experiences has surprisingly beneficial Supplemental Content From the Division of Public Health & Primary Care (Smith, Jones), Brighton & Sussex Medical School, Brighton, United Kingdom; Real-World Evidence Solutions (Hankins), IMS Health, London, United Kingdom; School of Psychology (Field), University of Sussex, Brighton, United Kingdom; National Institute for Stroke and Applied Neurosciences (Theadom), Auckland University of Technology, Auckland, New Zealand; Mill View Hospital (Bowskill), Sussex Partnership Trust, East Sussex, United Kingdom; Department of Practice & Policy (Horne), School of Pharmacy, University of London, Centre for Behavioural Medicine, London, United Kingdom; and Department of Respiratory Medicine (Frew), Royal Sussex County Hospital, Brighton & Sussex University Hospitals Trust, Brighton, United Kingdom. Address correspondence and reprint requests to Christina J. Jones, PhD, Brighton & Sussex Medical School, Room 321, Mayfield House, Brighton BN1 9PH, United Kingdom. E-mail: c.jones@bsms.ac.uk Received for publication January 7, 2014; revision received November 16, 2014. DOI: 10.1097/PSY.0000000000000166 Copyright © 2015 by the American Psychosomatic Society EW = expressive writing, FEV 1 = forced expired volume in 1 second, LIWC = Linguistic Inquiry Word Count ORIGINAL ARTICLE Psychosomatic Medicine, V 77 • 429-437 429 May 2015 Copyright © 2015 by the American Psychosomatic Society. Unauthorized reproduction of this article is prohibited.