Feasibility and Acceptability of an Expressive Writing Intervention to Address Substance Use and HIV Risk Behavior

Introduction: Expressive writing has demonstrated feasibility, acceptability, and efficacy in addressing a variety of mental health issues (Clyman & Pachankis, 2013; Frisina, Borod, & Lepore, 2004) and some evidence in effecting behavior change (Francis & Pennebaker, 1992; Mosher, et al., 2011).

Methods: In this pilot study, expressive writing was utilized in a sample of 75 young gay and bisexual men who reported substance use and unprotected anal sex. After completing a baseline computerized survey and assessment of recent sexual behavior and substance use, participants in the expressive writing condition were told to write about their sexuality, sexual behavior, relationships, and the ways in which substance use played a role in their sexuality and sexual behavior. Participants in the control condition wrote about their day, per standard control condition writing instructions. In a modified writing timing paradigm, participants wrote for three 15-minute increments, separated by a 10-minute break between writing sessions. Follow-up assessments are conducted two months after the initial assessment and writing exercise. Thus far, 63 of 75 participants have enrolled.

Results: Preliminary analyses indicate high levels of feasibility and acceptability of expressive writing to address sexual behavior and substance use. Notably, retention in two-month follow-up assessments is currently at 100% (with 31 follow-up assessments completed), indicating high levels of engagement in the intervention. When rating their writing experience (using a scale of 1-7), individuals in the EW condition indicated that the experiment was more meaningful to them than those in the control condition (5.47 vs. 4.55, t(61) = 2.72, p = .008), that their essays were more personal (6.22 vs. 5.42, t(61) = 2.61, p = .011), and that they revealed more emotion in their writing (5.78 vs. 2.68, t(61) = 8.01, p < .001). Preliminary analyses of linguistic data support self-report ratings, with men in the expressive writing condition using more affective process words and more cognitive process words than men in the control condition (5.62 vs. 3.44, t(61) =  7.10, p < .001  ; 20.78 vs. 16.71, t(61) = 6.0, p < .001).

Conclusions: Results indicate that feasibility and acceptability of expressive writing to address substance use and sexual behavior was high, indicating the potential of this intervention modality. Future research will examine preliminary indices of efficacy in preparation for a larger trial of expressive writing to address substance use, sexual risk behavior, and their combination.