Expressive Writing for Reducing Stress and Diabetic Symptoms in Diabetes Patients

Diabetes is one of the leading causes of blindness, kidney failure, and nontraumatic lower
extremity amputation in the United States. Conditions such as stress and depression have
been shown to worsen diabetic symptoms. Data indicate that expressive writing (an activity
during which individuals deal with stressful experiences by writing about them on paper) has
beneficial effects on psychological and physiological outcomes. This study will determine
whether diabetes patients can benefit from expressive writing. This study will also
determine the duration of the benefits and the effectiveness of booster sessions in
improving their diabetic symptoms.

Participants will be randomly assigned to engage in expressive writing or neutral writing
for 18 months. Participants in the expressive writing group will write about traumatic or
stressful events; participants in the neutral writing group will write about neutral topics
that do not affect them emotionally. Some participants in the expressive writing group will
receive an additional 4 months of booster sessions of expressive writing. All participants
will undergo interviews, blood collection, physical exams and complete clinical scales on
their disease status, quality of life, and psychological well-being; these assessments will
occur at study entry, every 4 months during the study, and at the end of the study.

Inclusion Criteria:

- Diagnosis of diabetes mellitus made after age 24

Exclusion Criteria:

- Diabetes-related emergency room visit within 3 months prior to study entry

- Use of psychiatric medication within 3 months prior to study entry

- Visual or manual limitations that preclude reading and writing

- Use of insulin within the first year of diabetes diagnosis

- Pregnancy or plan to become pregnant