Visual feedback in written imaginal exposure for posttraumatic stress: a preliminary study

This study investigated the visual feedback hypothesis, which states that visual feedback from written trauma narratives contributes to the efficacy of written imaginal exposure in reducing posttraumatic stress, as visual feedback allows for the reuptake of traumatic content during the production of the trauma narrative. The hypothesis was tested in a college sample (n = 61) with clinically elevated levels of posttraumatic stress as measured with the Impact of Events Scale. Participants were randomly assigned to a writing with visual feedback condition, a writing without visual feedback condition, or a control condition. The hypothesis was not supported by our study findings: Writing with visual feedback and writing without visual feedback resulted in equal reductions of intrusion and avoidance symptoms. Exploratory analyses, however, showed an increase of intrusion symptoms immediately after writing with visual feedback, which was in contrast with decreases of symptom levels observed in the other study conditions. These findings are in line with previous findings regarding immediate symptom development following writing interventions for posttraumatic stress (e.g., Murray & Segal, 1994), and call for further exploration of the visual feedback hypothesis.