PhD in Nursing Science Program

Lois Jean Wagner

Moderating Effects of Cognitive Adaptability on Expressive Writing Outcomes Among Persons Infected with Human Immunodeficiency Virus


Dissertation under the direction of Professor Kenneth A. Wallston


This study explored the effects of expressive writing on psychological well-being, health status, and adherence among persons with Human Immunodeficiency Virus (HIV) infection. It further explored the moderating effects of cognitive adaptability on these outcomes. Thirty-seven participants were randomized to write weekly for 20 minutes on each of four days, either about stressful/traumatic life experiences (experimental) or trivial, non-emotional topics (control). Dependent measures obtained at baseline were repeated one month after writing. Higher cognitive adaptability (dispositional optimism coupled with perceived competence) was associated with improvements in positive affect, global sense of meaning, HIV-cognitive adaptability, HIV-quality of life, and HIV physical functioning among expressive writers. In contrast, trivial writers remained either unchanged or declined on these outcomes. No effects were found for changes in negative affect, perceived stress, HIV-specific meaning, HIV symptom reports, illness visits, or medication and appointment adherence. Expressive writing was well tolerated among persons with HIV infection. Additional studies are warranted.