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

Muyang Li·Jiamin Bao·Tianchen Ni·Yinyin Zang
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Abstract

Background: 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).Objective: 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.Methods: Between December 2021 and August 2022, 1,526 adults were screened for PTSS via a Tencent Medinfo Mini-Program. Eligible participants (n = 211) were randomised to Guided Narrative Technique-Writing (GNT-W, n = 100) or Expressive Writing (EW, n = 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.Results: 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: b = -0.43, p = .023, d = -0.43; EW: b = -0.60, p = .001, d = -0.58), with no significant between-group difference (group × time: b = 0.18, p = .48). GNT-W did not confer additional benefit over EW protocol on PTSS severity.Conclusions: 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.Chinese Clinical Trial Registry: ChiCTR2000034836.

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HumansStress Disorders, Post-TraumaticFemaleWritingAdultMaleMiddle AgedChinaCOVID-19InternetPosttraumatic stress disorderTrastorno de estrés postraumáticoecological validityensayo controlado aleatorizadoescritura expresivaexpressive writinginternet-based treatmentrandomised controlled trialtratamiento basado en internetvalidez ecológicaJournal ArticleRandomized Controlled TrialPragmatic Clinical Trial

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Muyang Li, Jiamin Bao, Tianchen Ni, Yinyin Zang. 2026-08-24. A pragmatic randomized controlled trial of self-directed online writing interventions for posttraumatic stress symptoms in a real-world digital setting.. https://doi.org/10.1080/20008066.2026.2710001

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Adult subjectCOVID-19 subjectChina subjectFemale subjectHumans subjectInternet subjectJournal Article subjectJournal Article; Randomized Controlled Trial; Pragmatic Clinical Trial resourceMale subjectMiddle Aged subjectRandomized controlled trials studyecological validity subjectensayo controlado aleatorizado subjectescritura expresiva subjectexpressive writing subjectinternet-based treatment subject

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