Expressive Writing for Heart Healing (WrittenHeart)

• SF12 [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  The SF12 is a generic measure of both physical and emotional components of health-related quality of life
• BDI-II [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  The Beck Depression Inventory is a measure of depressive symptoms
• BDI [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  The Beck Anxiety Inventory is a measure of cognitive and somatic symptoms of anxiety
• Brief-PTGI [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  The Brief Post-Traumatic Growth Inventory is a measure of positive growth following adversity

• BMI [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  Body Mass Index (BMI) is a measure of obesity and is calculated as weight in kilograms divided by height in meters squared
• Multiple Coronary Risk Factors [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  Hypertension, HDL, LDL,
• METs [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  Metabolic equivalents are a measure of exercise capacity. 1 MET represents the amount of oxygen consumed at rest and is equal to approximately 3.5 ml O2 kg-1 min-1

This study will determine whether the psychological and physical benefits of expressive writing extend to obese in-patients with Ischemic Heart Disease (IHD)referred to cardiac rehabilitation

Expressive writing, for as little as 3-5 sessions of 20 minutes, has been found to improve both physical and psychological health based on health outcome measures such as number of doctor's visits and hospital days, blood pressure control, lung and immune function, pain, anxiety and depression. Given its simplicity and obvious advantages in terms of cost-effectiveness, expressive writing has great potential as a therapeutic tool or as a means of self-help, either alone or as an adjunct to traditional therapies. This modality has not been studied in obese patients with Ischemic Heart Disease.

• Ischemic Heart Disease
• Obesity

• Behavioral: Disease-related Expressive writing
  Participants in the disease-related expressive writing condition write about their feelings about cardiac disease four times, for at least 20 minutes each time, during a two week period.
• Behavioral: Active Comparator: Traditional expressive writing
  Participants in the traditional expressive writing condition write about their feelings about one or more stressful experiences they lived in the past, for at least 20 minutes each time, during a two week period
• Behavioral: Sham Comparator: Neutral writing
  Participants in the neutral writing condition write about the facts about cardiac disease, for at least 20 minutes each time, during a two week period

• Experimental: Disease-related expressive writing
  Participants in the disease-related expressive writing condition write about their feelings about cardiac disease four times, for at least 20 minutes each time, during a two week period
  Intervention: Behavioral: Disease-related Expressive writing
• Active Comparator: Traditional expressive writing
  Participants in the traditional expressive writing condition write about their feelings about one or more stressful experiences they lived in the past, for at least 20 minutes each time, during a two week period
  Intervention: Behavioral: Active Comparator: Traditional expressive writing
• Sham Comparator: Neutral writing
  Participants in the neutral writing condition write about the facts about cardiac disease, for at least 20 minutes each time, during a two week period
  Intervention: Behavioral: Sham Comparator: Neutral writing
• No Intervention: Control condition
  Participants in the control condition do not receive any intervention and complete only the assessments

• Frattaroli J. Experimental disclosure and its moderators: a meta-analysis. Psychol Bull. 2006 Nov;132(6):823-65.
• Manzoni GM, Castelnuovo G, Molinari E. The WRITTEN-HEART study (expressive writing for heart healing): rationale and design of a randomized controlled clinical trial of expressive writing in coronary patients referred to residential cardiac rehabilitation. Health Qual Life Outcomes. 2011 Jul 8;9:51.

Inclusion Criteria:

• obesity
• Ischemic Heart disease
• Signed informed consent

Exclusion Criteria:

• Visual or manual limitations that preclude reading and writing
• Unwilling to participate