In addition, in order to make sure that participants completed the PTGI and the IES-R at follow-up with respect to the same stressor they referenced at baseline, participants wrote their stressor on a card, sealed it in an envelope, and this sealed envelope was given to them at follow-up, with instructions to open it privately and complete these two scales about that stressor. == Psychological symptoms == The 53-item Brief Symptom Inventory (BSI;Derogatis & Melisaratos, 1983) assesses a range of symptom domains (e.g., PTGER2 anxiety, depression, interpersonal sensitivity, hostility) Participants rated each item for the past 2 weeks on a 5-point scale (0 =not at allto 4 =extremely). as written emotional disclosure, was first tested byPennebaker and Beall (1986). In the standard expressive writing paradigm, participants are randomized to write emotionally about a stressful experience (disclosure condition) or non-emotionally about a neutral topic. Writing is typically conducted in private for three to four sessions of 1520 minutes each, and there is no interaction or feedback about the content and process ARN19874 of disclosure. Health status is assessed at baseline and then at follow-up, which is typically several weeks to months after the intervention. Since the mid-1980s, emotional disclosure has been tested in many studies, with overall mixed results. An early meta-analysis revealed moderate effect-size improvement in the disclosure group over the control group in psychological symptoms, immune function, health care visits, and academic performance (Smyth, 1998). More recent meta-analyses include more studies on various populations but provide less support for health benefits (Harris, 2006;Meads & Nouwen, 2005), indicate that the effects are present but quite small (Frattaroli, 2006), and suggest that the effects are weaker for psychological symptoms than physical health indices (Frisina, Borod, & Lepore, 2004). Thus, it is important to test methods to enhance the efficacy of this technique and to examine outcomes other than health symptoms. == Different Methods of Eliciting Disclosure == Although the vast majority of disclosure studies have tested writing conducted in private, emotional expression and processing can occur in a range of ways, including mental imagery, bodily expression, typing, talking privately out loud, speaking ARN19874 to a passive listener, and speaking to a active facilitator. It is noteworthy that the most of the original studies in the ARN19874 disclosure literature focused on the effects of talking about stressful experiences (Pennebaker, Barger, & Tiebout, 1989;Pennebaker, Hughes, & OHeeron, 1987;Pennebaker & OHeeron, 1984), which is a more common form of emotional disclosure than writing for most people. This early interest in talking, however, waned in favor of writing about stressors, apparently to enhance experimental control by eliminating the possible awkwardness of talking to a tape recorder or the potential complications of the presence of a listener (Pennebaker et al., 1987). As a result, only a few experiments have tested the effects of disclosure by privately talking. Some of these studies have shown benefits (Kelley, Lumley, & Leisen, 1997), whereas others have had mixed results (van Middendorp, Geenen, Sorbi, van Doornen, & Bijlsma, 2009;Wetherell et al., 2005), or null effects (Keefe et al., 2008). Furthermore, direct comparisons of the effects of private writing and talking are quite rare.Murray and Segal (1994)found that spoken and written expression about a traumatic event for several sessions were equally effective in reducing distress and more effective than control writing or talking.Lyubomirsky, Sousa, and Dickerhoof (2006)found similar effects for writing and talking privately.Esterling, Antoni, Fletcher, Margulies, and Schneiderman (1994)reported that talking about stressful events for three sessions led to better immune status than writing about stress, which was better than a control condition. Aside from these few studies, however, comparisons of private written versus spoken disclosure have not been published. Spoken disclosure to a listener is more naturaland far more commonthan speaking into a tape recorder, and research shows that the vast majority of people talk about emotional experiences to other people (Rim, Herbette, & Corsini, 2004). ARN19874 Of course, verbally sharing with an empathic listener is the cornerstone of many forms of effective psychotherapy. The literature on the effects of disclosure to a listener, however, is quite mixed. For example, the benefits of brief or single episodes of disclosure to another person may be temporary or limited.Zech and Rime (2005)demonstrated that sharing stressful experiences with others leads to immediate relief, but not to.