The effect of expressive writing on wound healing: Immunohistochemistry analysis of skin tissue two weeks after punch biopsy wounding

Robinson, Hayley; Jarrett, Paul; Vedhara, Kavita; Tarlton, John; Whiting, Christine; Law, Mikaela; Broadbent, Elizabeth

Abstract

Objective: To investigate the effects of expressive writing and its timing (pre or post wounding) on re-epithelialisation and leucocyte subsets within healing tissue. We previously showed expressive writing pre-wounding improved re-epithelialisation. Here we investigate cellular processes in the wound. Methods: In a 2(writing content) x 2(writing timing) randomized trial, 122 participants were randomized to perform either expressive or control writing, before or after a 4 mm punch biopsy wound. On day 14 post-wounding, participants had a 5 mm punch biopsy of the initial wound. Seven of 16 primary registered outcomes were analysed, including re-epithelialisation from two photographs of the 4 mm biopsy (previously reported). This paper reports immunohistochemistry analysis of five primary outcomes - Langerhans cells, immune cell activation (HLA and CD3+), and macrophages (CD68 and MPO) - in the 5 mm biopsies in a random sample of 96 participants. Results: Participants who performed either writing task pre-wounding had greater Langerhans cell infiltration, than those who wrote post-wounding (F(1,85) = 7.86, p = .006, ηp2 = 0.08). Those who performed expressive writing also had greater Langerhans cell infiltration than those who performed control writing (F(1,85) = 4.00, p = .049, ηp2 = 0.04). There were no significant group or interaction effects on immune cell activation or macrophages. Healed wounds on day 10 had lower levels of macrophages (z = −1.96, p = .050), and CD3+ cells (z = −1.99, p = .046) than non-healed wounds. Conclusion: Langerhans cells in the healing skin are affected by the timing and topic of writing. More research is needed to further explore timing and corroborate these results. Clinical Trials Registration: Registered at https://www.anzctr.org.au/ (Trial ID: ACTRN12614000971639).

Citation

Robinson, H., Jarrett, P., Vedhara, K., Tarlton, J., Whiting, C., Law, M., & Broadbent, E. (2022). The effect of expressive writing on wound healing: Immunohistochemistry analysis of skin tissue two weeks after punch biopsy wounding. Journal of Psychosomatic Research, 161, Article 110987. https://doi.org/10.1016/j.jpsychores.2022.110987

• Journal Article Type: Article
• Acceptance Date: Jul 7, 2022
• Online Publication Date: Jul 30, 2022
• Publication Date: Oct 1, 2022
• Deposit Date: Aug 16, 2022
• Publicly Available Date: Jul 31, 2023
• Journal: Journal of Psychosomatic Research
• Print ISSN: 0022-3999
• Electronic ISSN: 1879-1360
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 161
• Article Number: 110987
• DOI: https://doi.org/10.1016/j.jpsychores.2022.110987
• Keywords: Psychiatry and Mental health; Clinical Psychology
• Public URL: https://nottingham-repository.worktribe.com/output/10076532
• Publisher URL: https://www.sciencedirect.com/science/article/abs/pii/S0022399922002720
• Additional Information: This article is maintained by: Elsevier; Article Title: The effect of expressive writing on wound healing: Immunohistochemistry analysis of skin tissue two weeks after punch biopsy wounding; Journal Title: Journal of Psychosomatic Research; CrossRef DOI link to publisher maintained version: https://doi.org/10.1016/j.jpsychores.2022.110987