A pragmatic randomized controlled trial of self-directed online writing interventions for posttraumatic stress symptoms in a real-world digital setting.

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Original abstract

<b>Background:</b> Public health and other large-scale crises, such as the COVID-19 pandemic, have intensified the global mental health burden, creating unprecedented demand for accessible interventions for posttraumatic stress symptoms (PTSS).<b>Objective:</b> We evaluated the feasibility and effectiveness of two self-directed online writing interventions embedded within China's WeChat ecosystem during the COVID-19 pandemic through a pragmatic randomised controlled trial.<b>Methods:</b> Between December 2021 and August 2022, 1,526 adults were screened for PTSS via a Tencent Medinfo Mini-Program. Eligible participants (<i>n</i> = 211) were randomised to Guided Narrative Technique-Writing (GNT-W, <i>n</i> = 100) or Expressive Writing (EW, <i>n</i> = 111). Both interventions comprised three self-directed daily writing sessions delivered entirely online without human support. Primary outcome was PTSD symptom severity (PTSD Checklist-Short), assessed at baseline, post-intervention, 2-week, and 1-month follow-ups.<b>Results:</b> While initial engagement followed typical digital health patterns (64.5% overall attrition), participants who initiated treatment showed strong adherence (77% completion). Both interventions were associated with significant within-group reductions in PTSS severity (GNT-W: <i>b</i> = -0.43, <i>p</i> = .023, <i>d</i> = -0.43; EW: <i>b</i> = -0.60, <i>p</i> = .001, <i>d</i> = -0.58), with no significant between-group difference (group × time: <i>b</i> = 0.18, <i>p</i> = .48). GNT-W did not confer additional benefit over EW protocol on PTSS severity.<b>Conclusions:</b> Both self-directed writing interventions were associated with within-group reductions in PTSS; without an inactive control condition, however, these changes cannot be firmly attributed to the interventions. GNT-W showed no advantage over the simpler EW protocol. These findings offer preliminary support for embedding scalable, low-barrier writing interventions in widely used digital platforms.<b>Chinese Clinical Trial Registry:</b> ChiCTR2000034836.

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