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Robinson H, Jarrett P, Vedhara K, Tarlton J, Whiting C, Law M, Broadbent E. The effect of expressive writing on wound healing: Immunohistochemistry analysis of skin tissue two weeks after punch biopsy wounding. J Psychosom Res 2022; 161:110987. [PMID: 35917660 DOI: 10.1016/j.jpsychores.2022.110987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022]
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).
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Affiliation(s)
- Hayley Robinson
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92109, Auckland 1142, New Zealand
| | - Paul Jarrett
- Department of Dermatology, Counties Manukau District Health Board, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand; Department of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92109, Auckland 1142, New Zealand
| | - Kavita Vedhara
- Centre for Academic Primary Care, School of Medicine, Faculty of Medical and Health Sciences, The University of Nottingham, Nottingham NG7 2RD, UK
| | - John Tarlton
- School of Veterinary Science, University of Bristol, Langford, Bristol BS40 5DU, UK
| | - Christine Whiting
- School of Veterinary Science, University of Bristol, Langford, Bristol BS40 5DU, UK
| | - Mikaela Law
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92109, Auckland 1142, New Zealand
| | - Elizabeth Broadbent
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92109, Auckland 1142, New Zealand.
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Forster M, Kuhbandner C. The promotion of functional expected teaching-related emotions through expressive writing. PLoS One 2022; 17:e0267905. [PMID: 35500019 PMCID: PMC9060328 DOI: 10.1371/journal.pone.0267905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 04/19/2022] [Indexed: 11/28/2022] Open
Abstract
The aim of the present preregistered study was to examine whether expressive writing can help teacher students to develop functional expected teaching-related emotions. In a variation of James W. Pennebaker´s expressive writing paradigm, 129 teacher students were randomly assigned to write on three consecutive days either about the future teaching-related events that personally trigger the greatest fear and joy (treatment group: n = 67) or about a walk in a forest and a city park (control group: n = 62). In both groups, expected teaching-related positive emotions increased and expected teaching-related negative emotions decreased with increased writing sessions. After the writing sessions, the treatment group reported a stronger change in their view about their future professional life as a teacher, a more active personal involvement with their future professional life, and an increased motivation to use expressive writing in the future. These results demonstrate that expressive writing is a promising tool to promote teacher students’ expected teaching-related emotions.
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Affiliation(s)
- Markus Forster
- Department of Human Sciences, University of Regensburg, Regensburg, Germany
- * E-mail:
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Valtonen J. The Health Benefits of Autobiographical Writing: An Interdisciplinary Perspective. THE JOURNAL OF MEDICAL HUMANITIES 2021; 42:1-19. [PMID: 32440974 PMCID: PMC8664792 DOI: 10.1007/s10912-020-09631-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
A large body of experimental evidence in the empirical sciences shows that writing about life experiences can be beneficial for mental and physical health. While empirical data regarding the health benefits of writing interventions have been collected in numerous studies in psychology and biomedicine, this literature has remained almost entirely disconnected from scholarship in the humanities and cognitive neuropsychology. In this paper, I review the literature from psychological and biomedical writing interventions, connect these findings to views from philosophy, cognitive neuropsychology and narratology and argue that examining established regularities in how narratives are structured can shed further light on the psychological processes engaged during writing interventions. In particular, I argue that the narratological concept of conflict can be applied to resolve patterns of seemingly conflicting empirical findings in psychological studies. More generally, I propose that an interdisciplinary perspective can provide a broader theoretical basis for understanding the psychological processes underlying the health benefits of autobiographical writing and provide directions for future research in psychology and biomedicine.
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Affiliation(s)
- Jussi Valtonen
- Department of Psychology, New York University, 6 Washington Place, New York, NY, 10003, USA.
- Theatre Academy, University of the Arts Helsinki, P.O. Box 20, FI-00097, Helsinki, Finland.
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, P.O. Box 21, FI-00014, Helsinki, Finland.
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Saldanha MF, Barclay LJ. Finding meaning in unfair experiences: Using expressive writing to foster resilience and positive outcomes. Appl Psychol Health Well Being 2021; 13:887-905. [PMID: 33890715 DOI: 10.1111/aphw.12277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 01/07/2023]
Abstract
Decades of research have demonstrated that experiencing workplace unfairness can result in profound negative consequences for employees. Integrating conservation of resources theory with meaning-finding perspectives, we argue that engaging in meaning-finding in the aftermath of unfairness can foster state resilience and promote positive outcomes. To promote meaning-finding, we develop and test a new expressive writing intervention (i.e. a guided writing technique that facilitates the processing of negative experiences). Results indicate that the meaning-finding expressive writing intervention is associated with higher resilience than traditional expressive writing. Moreover, resilience mediates the relationship between meaning-finding (vs. traditional) expressive writing and willingness to reconcile, positive relationships with others, and life satisfaction. Theoretically, our findings highlight that engaging in meaning-finding can transform aversive experiences into opportunities to foster resilience and positive outcomes. Practically, meaning-finding expressive writing provides an effective, simple, and cost-effective tool that can be used by employees and counseling programs to promote recovery.
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Affiliation(s)
- Maria Francisca Saldanha
- Católica-Lisbon School of Business and Economics, Universidade Católica Portuguesa, Lisbon, Portugal
| | - Laurie J Barclay
- Lazaridis School of Business and Economics, Wilfrid Laurier University, Waterloo, ON, Canada
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Laird KT, Stanton AL. Written expressive disclosure in adults with irritable bowel syndrome: A randomized controlled trial. Complement Ther Clin Pract 2021; 43:101374. [PMID: 33826992 DOI: 10.1016/j.ctcp.2021.101374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/15/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The benefits of written expressive disclosure (WED) to health are documented in a variety of healthy and clinical populations. This study investigates the effect of WED on health-related outcomes in irritable bowel syndrome (IBS). METHODS Adults (N = 189) meeting Rome III criteria for IBS were randomly assigned to write about their: (1) deepest thoughts and feelings about the most stressful life event of the past five years (n = 67), (2) deepest thoughts and feelings about their IBS (n = 61) or (3) daily activities in an objective manner (control condition; n = 61). Participants completed four 20-min writing sessions over 2-6 weeks. Gastrointestinal (GI) symptoms, healthcare utilization, health-related quality of life (HR-QOL), pain catastrophizing, and pain self-efficacy were assessed at baseline, one month post-writing completion, and three months post-writing completion. RESULTS A significant group (combined WED vs. control) X time interaction was detected for healthcare utilization, F(1,147) = 6.16, p = 0.014, η2 = 0.04. Specifically, number of GI-related medical appointments significantly increased from baseline to 3-month follow-up in the control group, while no significant change was observed in the combined WED group. Among the WED group, individuals assigned to write about their IBS experienced greater improvements in pain self-efficacy than those assigned to write about a life stressor, F(1,92) = 3.89, p = 0.024, η2 = 0.08. GI symptom severity, HR-QOL, and pain catastrophizing improved significantly across groups over time, with no significant between-group differences. CONCLUSION Writing about one's deepest thoughts and feelings about IBS may increase pain self-efficacy and reduce healthcare utilization compared to control writing in adults with IBS.
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Affiliation(s)
- Kelsey T Laird
- Department of Psychiatry & Biobehavioral Sciences, Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA; School of Professional Psychology and Health, California Institute of Integral Studies, San Francisco, CA, 94103, USA.
| | - Annette L Stanton
- Department of Psychology, University of California, Los Angeles, USA.
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Wu Y, Liu L, Zheng W, Zheng C, Xu M, Chen X, Li W, Xie L, Zhang P, Zhu X, Zhan C, Zhou C. Effect of prolonged expressive writing on health outcomes in breast cancer patients receiving chemotherapy: a multicenter randomized controlled trial. Support Care Cancer 2020; 29:1091-1101. [PMID: 32601853 DOI: 10.1007/s00520-020-05590-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 06/23/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE This study aims to evaluate the effects of prolonged expressive writing on health outcomes in breast cancer patients undergoing chemotherapy to help understand how the dosage of an expressive writing intervention might moderate its effects. METHODS A total of 112 breast cancer patients undergoing chemotherapy were randomly allocated to the expressive writing group (n = 56) or the prolonged expressive writing group (n = 56). The expressive writing group received the standard expressive writing intervention based on Pennebaker's prompt to write for at least 20 min over four consecutive days (4 sessions). The prolonged expressive writing group used a modified prompt: write for at least 20 min 3 times a week over a 4-week period (12 sessions); patients could choose whether to write on consecutive days or not. All participants were required to write about their stressor-related upsetting or traumatic feelings about breast cancer. Outcomes were assessed and compared at baseline, as well as 1 month, 3 months, and 6 months postintervention. RESULTS There was no significant difference in the patients' quality of life, or physical and psychological wellbeing between the expressive writing group and the prolonged expressive writing group at any time point (all p > .05). The quality of life of breast cancer patients significantly decreased in the two groups over time (F = 40.64, p < .001). CONCLUSION Our findings suggest that the writing dosage does not moderate the effects of expressive writing on breast cancer patients undergoing chemotherapy. TRIAL REGISTRATION ChiCTR1800016278.
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Affiliation(s)
- Yanni Wu
- Nanfang Hospital, Southern Medical University, NO.1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, China
| | - Liping Liu
- Nanfang Hospital, Southern Medical University, NO.1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, China
| | - Wanting Zheng
- Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
| | - Chunrao Zheng
- Shenzhen People's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Min Xu
- Cancer Center of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Xiaohong Chen
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China
| | - Wenji Li
- Nanfang Hospital, Southern Medical University, NO.1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, China
| | - Lijun Xie
- Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, People's Republic of China
| | - Pengyan Zhang
- Shenzhen People's Hospital, Shenzhen, Guangdong, People's Republic of China
| | - Xiaoli Zhu
- Cancer Center of Guangzhou Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Chuanglian Zhan
- The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, People's Republic of China
| | - Chunlan Zhou
- Nanfang Hospital, Southern Medical University, NO.1838 North Guangzhou Avenue, Baiyun District, Guangzhou City, Guangdong Province, China.
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Troia GA, Olinghouse NG. The Common Core State Standards and Evidence-Based Educational Practices: The Case of Writing. SCHOOL PSYCHOLOGY REVIEW 2019. [DOI: 10.1080/02796015.2013.12087478] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Sabo Mordechay D, Nir B, Eviatar Z. Expressive writing - Who is it good for? Individual differences in the improvement of mental health resulting from expressive writing. Complement Ther Clin Pract 2019; 37:115-121. [DOI: 10.1016/j.ctcp.2019.101064] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 02/04/2023]
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A methodological review of meta-analyses of the effectiveness of clinical psychology treatments. Behav Res Methods 2019; 50:2057-2073. [PMID: 29052165 DOI: 10.3758/s13428-017-0973-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article presents a methodological review of 54 meta-analyses of the effectiveness of clinical psychological treatments, using standardized mean differences as the effect size index. We statistically analyzed the distribution of the number of studies of the meta-analyses, the distribution of the sample sizes in the studies of each meta-analysis, the distribution of the effect sizes in each of the meta-analyses, the distribution of the between-studies variance values, and the Pearson correlations between effect size and sample size in each meta-analysis. The results are presented as a function of the type of standardized mean difference: posttest standardized mean difference, standardized mean change from pretest to posttest, and standardized mean change difference between groups. These findings will help researchers design future Monte Carlo and theoretical studies on the performance of meta-analytic procedures, based on the manipulation of realistic model assumptions and parameters of the meta-analyses. Furthermore, the analysis of the distribution of the mean effect sizes through the meta-analyses provides a specific guide for the interpretation of the clinical significance of the different types of standardized mean differences within the field of the evaluation of clinical psychological interventions.
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Ayers S, Crawley R, Button S, Thornton A, Field AP, Flood C, Lee S, Eagle A, Bradley R, Moore D, Gyte G, Smith H. Evaluation of expressive writing for postpartum health: a randomised controlled trial. J Behav Med 2018; 41:614-626. [PMID: 30291538 PMCID: PMC6209049 DOI: 10.1007/s10865-018-9970-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 04/20/2018] [Indexed: 02/07/2023]
Abstract
Pregnancy, birth and adjusting to a new baby is a potentially stressful time that can negatively affect the health of women. There is some evidence that expressive writing can have positive effects on psychological and physical health, particularly during stressful periods. The current study aimed to evaluate whether expressive writing would improve women's postpartum health. A randomized controlled trial was conducted with three conditions: expressive writing (n = 188), a control writing task (n = 213), or normal care (n = 163). Measures of psychological health, physical health and quality of life were measured at baseline (6-12 weeks postpartum), 1 and 6 months later. Ratings of stress were taken before and after the expressive writing task. Intent-to-treat analyses showed no significant differences between women in the expressive writing, control writing and normal care groups on measures of physical health, anxiety, depression, mood or quality of life at 1 and 6 months. Uptake and adherence to the writing tasks was low. However, women in the expressive writing group rated their stress as significantly reduced after completing the task. Cost analysis suggest women who did expressive writing had the lowest costs in terms of healthcare service use and lowest cost per unit of improvement in quality of life. Results suggest expressive writing is not effective as a universal intervention for all women 6-12 weeks postpartum. Future research should examine expressive writing as a targeted intervention for women in high-risk groups, such as those with mild or moderate depression, and further examine cost-effectiveness.Clinical trial registration number ISRCTN58399513 www.isrctn.com.
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Affiliation(s)
- Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK.
| | - Rosalind Crawley
- School of Psychology, University of Sunderland, Chester Road, Sunderland, SR2 7PT, UK
| | - Susan Button
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Alexandra Thornton
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Andy P Field
- School of Psychology, University of Sussex, Brighton, BN1 9QH, UK
| | - Chris Flood
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Suzanne Lee
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Andrew Eagle
- Central and North West London NHS Foundation Trust, London, W10 6DZ, UK
| | - Robert Bradley
- Brighton and Sussex University Hospital NHS Trust, Eastern Road, Brighton, BN2 5BE, UK
| | - Donna Moore
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Gill Gyte
- National Childbirth Trust, 30 Euston Square, London, NW1 2FB, UK
| | - Helen Smith
- Division of Public Health and Primary Care, Brighton and Sussex Medical School, Brighton, BN1 9PH, UK.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232, Singapore
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Tielman ML, Neerincx MA, van Meggelen M, Franken I, Brinkman WP. How should a virtual agent present psychoeducation? Influence of verbal and textual presentation on adherence. Technol Health Care 2018; 25:1081-1096. [PMID: 28800346 PMCID: PMC5814660 DOI: 10.3233/thc-170899] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE With the rise of autonomous e-mental health applications, virtual agents can play a major role in improving trustworthiness, therapy outcome and adherence. In these applications, it is important that patients adhere in the sense that they perform the tasks, but also that they adhere to the specific recommendations on how to do them well. One important construct in improving adherence is psychoeducation, information on the why and how of therapeutic interventions. In an e-mental health context, this can be delivered in two different ways: verbally by a (virtual) embodied conversational agent or just via text on the screen. The aim of this research is to study which presentation mode is preferable for improving adherence. METHODS This study takes the approach of evaluating a specific part of a therapy, namely psychoeducation. This was done in a non-clinical sample, to first test the general constructs of the human-computer interaction. We performed an experimental study on the effect of presentation mode of psychoeducation on adherence. In this study, we took into account the moderating effects of attitude towards the virtual agent and recollection of the information. Within the paradigm of expressive writing, we asked participants (n= 46) to pick one of their worst memories to describe in a digital diary after receiving verbal or textual psychoeducation. RESULTS AND CONCLUSION We found that both the attitude towards the virtual agent and how well the psychoeducation was recollected were positively related to adherence in the form of task execution. Moreover, after controlling for the attitude to the agent and recollection, presentation of psychoeducation via text resulted in higher adherence than verbal presentation by the virtual agent did.
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Affiliation(s)
| | - Mark A Neerincx
- Delft University of Technology, Delft, The Netherlands.,TNO Perceptual and Cognitive Systems, Soesterberg, The Netherlands
| | | | - Ingmar Franken
- Erasmus University Rotterdam, Rotterdam, The Netherlands
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Kupeli N, Schmidt UH, Campbell IC, Chilcot J, Roberts CJ, Troop NA. The impact of an emotionally expressive writing intervention on eating pathology in female students. Health Psychol Behav Med 2018; 6:162-179. [PMID: 30009092 PMCID: PMC6030678 DOI: 10.1080/21642850.2018.1491797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/23/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction: Previous research demonstrating emotional influences on eating and weight suggest that emotionally expressive writing may have a significant impact on reducing risk of eating pathology. This study examined the effects of writing about Intensely Positive Experiences on weight and disordered eating during a naturalistic stressor. Method: Seventy-one female students completed an expressive or a control writing task before a period of exams. Both groups were compared on BMI (kg/m2) and the Eating Disorder Examination – Questionnaire (EDE-Q) before the writing task and at 8-week follow-up. A number of secondary analyses were also examined (to identify potential mediators) including measures of attachment, social rank, self-criticism and self-reassurance, stress and mood. Results: There was a significant effect of intervention on changes in the subscales of the EDE-Q (p = .03). Specifically, expressive writers significantly reduced their dietary restraint while those in the control group did not. There was no significant effect of the intervention on changes in BMI or the other subscales of the EDE-Q (Eating, Weight and Shape Concern). There was also no effect of writing on any of the potential mediators in the secondary analyses. Discussion: Emotionally expressive writing may reduce the risk of dietary restraint in women but these findings should be accepted with caution. It is a simple and light touch intervention that has the potential to be widely applied. However, it remains for future research to replicate these results and to identify the mechanisms of action.
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Affiliation(s)
- N Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - U H Schmidt
- Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - I C Campbell
- Section of Eating Disorders, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - J Chilcot
- Health Psychology Section, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - C J Roberts
- School of Health and Social Science, London South Bank University, London, UK
| | - N A Troop
- Department of Psychology and Sport Sciences, University of Hertfordshire, UK
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Schubiner H. Emotional Awareness for Pain. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00102-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hazell CM, Jones CJ, Hayward M, Bremner SA, O'Connor DB, Pinfold V, Smith HE. Caring for Caregivers (C4C): study protocol for a pilot feasibility randomised control trial of Positive Written Disclosure for older adult caregivers of people with psychosis. Pilot Feasibility Stud 2017; 3:63. [PMID: 29201390 PMCID: PMC5697360 DOI: 10.1186/s40814-017-0206-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 10/31/2017] [Indexed: 12/02/2022] Open
Abstract
Background The caregivers of people who experience psychosis are themselves at risk of developing physical and mental health problems. This risk is increased for older adult caregivers who also have to manage the lifestyle and health changes associated with ageing. As a consequence, older adult caregivers are in particular need of support; we propose a Written Emotional Disclosure (WED) intervention, called Positive Written Disclosure (PWD). Methods/design This is a pilot randomised controlled trial of PWD compared to a neutral writing control and a no writing condition. We aim to recruit 60 participants, 20 in each arm. This study will utilise a mixed-methods approach and collect quantitative (questionnaires) and qualitative (interviews) data. Quantitative data will be collected at baseline and 1, 3, and 6 months post baseline. Participants who complete a writing task (PWD or neutral writing control) will be invited to complete an exit interview to discuss their experiences of the intervention and study. The study is supported by a patient and public involvement group. Discussion The results of this trial will determine whether a definitive trial is justified. If so, the quantitative and qualitative findings will be used to refine the intervention and study protocols. Trial registration ISRCTN, ISRCTN79116352. Registered on 23 January 2017 Electronic supplementary material The online version of this article (10.1186/s40814-017-0206-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cassie M Hazell
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, Village Way, Falmer, BN1 9PH UK
| | - Christina J Jones
- Department of Clinical Medicine, Royal Alexandra Children's Hospital, University of Sussex, Eastern Road, Brighton, BN2 5BE UK
| | - Mark Hayward
- Sussex Partnership NHS Foundation Trust, Research and Development Department, Sussex Education Centre, Nevill Avenue, Hove, BN3 7HZ UK
| | - Stephen A Bremner
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, Village Way, Falmer, BN1 9PH UK
| | | | - Vanessa Pinfold
- The McPin Foundation, 32-36 Loman Street, London, SE1 0EH UK
| | - Helen E Smith
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, Mayfield House, Village Way, Falmer, BN1 9PH UK.,Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Novena Campus, 11 Mandalay Road, Singapore, 308232 Singapore
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Abstract
The 1997 Psychological Science paper "Writing About Emotional Experiences as a Therapeutic Process" summarized the results of several expressive writing studies. Since the publication of the first expressive writing study in 1986, a number of discoveries had emerged that had both theoretical and clinical implications. The scientific and personal backstories of the research are discussed. Finally, several possible reasons are advanced to explain why this particular paper has been cited as much as it has.
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Bourassa KJ, Manvelian A, Boals A, Mehl MR, Sbarra DA. Tell Me a Story: The Creation of Narrative as a Mechanism of Psychological Recovery Following Marital Separation. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2017. [DOI: 10.1521/jscp.2017.36.5.359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Crawford J, Wilhelm K, Robins L, Proudfoot J. Writing for Health: Rationale and Protocol for a Randomized Controlled Trial of Internet-Based Benefit-Finding Writing for Adults With Type 1 or Type 2 Diabetes. JMIR Res Protoc 2017; 6:e42. [PMID: 28292741 PMCID: PMC5373675 DOI: 10.2196/resprot.7151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 01/15/2017] [Accepted: 01/16/2017] [Indexed: 11/30/2022] Open
Abstract
Background Diabetes mellitus is Australia’s fastest growing chronic disease, and has high comorbidity with depression. Both subthreshold depression and diabetes distress are common amongst people with type 1 or type 2 diabetes, and are associated with poorer diabetes self-care. A need exists for low-intensity self-help interventions for large numbers of people with diabetes and diabetes distress or subthreshold depression, as part of a stepped-care approach to meeting the psychological needs of people with diabetes. Benefit-finding writing is a very brief intervention that involves writing about any positive thoughts and feelings about a stressful experience, such as an illness. Benefit-finding writing has been associated with increases in positive affect and positive growth, and has demonstrated promising results in trials amongst other clinical populations. However, benefit-finding writing has not yet been examined in people with diabetes. Objective The aim of this randomized controlled trial (RCT) is to evaluate the efficacy of an Internet-based benefit-finding writing (iBFW) intervention for adults with type 1 or type 2 diabetes (compared to a control writing condition) for reducing diabetes distress and increasing benefit-finding in diabetes, and also improving a range of secondary outcomes. Methods A two-arm RCT will be conducted, using the online program Writing for Health. Adults with type 1 or type 2 diabetes living in Australia will be recruited using diabetes-related publications and websites, and through advertisements in diabetes services and general practitioners’ offices. Potential participants will be referred to the study-specific website for participant information and screening. All data will be collected online. Participants will be randomized to either iBFW about diabetes, or a control writing condition of writing about use-of-time. Both conditions involve three daily sessions (once per day for three consecutive days) of 15-minute online writing exercises. Outcome measures will be administered online at baseline, one-month, and three-month follow-ups. Results This trial is currently underway. The primary outcomes will be diabetes distress and benefit-finding in diabetes. Secondary outcomes will be depression, anxiety, diabetes self-care, perceived health, and health care utilization. We aim to recruit 104 participants. All stages of the study will be conducted online using the Writing for Health program. Group differences will be analyzed on an intention-to-treat basis using mixed models repeated measures. Linguistic analyses of the writing exercise scripts, and examinations of the immediate emotional responses to the writing exercises, will also be undertaken. Conclusions This RCT will be the first study to examine iBFW for adults with type 1 or type 2 diabetes. If iBFW is found to be efficacious in reducing diabetes distress and improving diabetes self-care and other outcomes, iBFW may offer the potential to be a low-cost, easily accessible self-help intervention to improve the wellbeing of adults with diabetes. Trial Registration Australia and New Zealand Clinical Trials Registry (ACTRN12615000241538)
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Affiliation(s)
- Joanna Crawford
- Faces in the Street, Urban Mental Health Research Institute, St. Vincent's Health Australia, Sydney, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Kay Wilhelm
- Faces in the Street, Urban Mental Health Research Institute, St. Vincent's Health Australia, Sydney, Australia.,School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Consultation Liaison Psychiatry, St. Vincent's Health Australia, Sydney, Australia
| | - Lisa Robins
- Faces in the Street, Urban Mental Health Research Institute, St. Vincent's Health Australia, Sydney, Australia.,Consultation Liaison Psychiatry, St. Vincent's Health Australia, Sydney, Australia
| | - Judy Proudfoot
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.,Black Dog Institute, Sydney, Australia
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Nyssen OP, Taylor SJC, Wong G, Steed E, Bourke L, Lord J, Ross CA, Hayman S, Field V, Higgins A, Greenhalgh T, Meads C. Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic considerations. Health Technol Assess 2017; 20:vii-xxxvii, 1-367. [PMID: 27071807 DOI: 10.3310/hta20270] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Writing therapy to improve physical or mental health can take many forms. The most researched model of therapeutic writing (TW) is unfacilitated, individual expressive writing (written emotional disclosure). Facilitated writing activities are less widely researched. DATA SOURCES Databases, including MEDLINE, EMBASE, PsycINFO, Linguistics and Language Behaviour Abstracts, Allied and Complementary Medicine Database and Cumulative Index to Nursing and Allied Health Literature, were searched from inception to March 2013 (updated January 2015). REVIEW METHODS Four TW practitioners provided expert advice. Study procedures were conducted by one reviewer and checked by a second. Randomised controlled trials (RCTs) and non-randomised comparative studies were included. Quality was appraised using the Cochrane risk-of-bias tool. Unfacilitated and facilitated TW studies were analysed separately under International Classification of Diseases, Tenth Revision chapter headings. Meta-analyses were performed where possible using RevMan version 5.2.6 (RevMan 2012, The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark). Costs were estimated from a UK NHS perspective and three cost-consequence case studies were prepared. Realist synthesis followed Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. OBJECTIVES To review the clinical effectiveness and cost-effectiveness of TW for people with long-term conditions (LTCs) compared with no writing, or other controls, reporting any relevant clinical outcomes. To conduct a realist synthesis to understand how TW might work, and for whom. RESULTS From 14,658 unique citations, 284 full-text papers were reviewed and 64 studies (59 RCTs) were included in the final effectiveness reviews. Five studies examined facilitated TW; these were extremely heterogeneous with unclear or high risk of bias but suggested that facilitated TW interventions may be beneficial in individual LTCs. Unfacilitated expressive writing was examined in 59 studies of variable or unreported quality. Overall, there was very little or no evidence of any benefit reported in the following conditions (number of studies): human immunodeficiency virus (six); breast cancer (eight); gynaecological and genitourinary cancers (five); mental health (five); asthma (four); psoriasis (three); and chronic pain (four). In inflammatory arthropathies (six) there was a reduction in disease severity [n = 191, standardised mean difference (SMD) -0.61, 95% confidence interval (CI) -0.96 to -0.26] in the short term on meta-analysis of four studies. For all other LTCs there were either no data, or sparse data with no or inconsistent, evidence of benefit. Meta-analyses conducted across all of the LTCs provided no evidence that unfacilitated emotional writing had any effect on depression at short- (n = 1563, SMD -0.06, 95% CI -0.29 to 0.17, substantial heterogeneity) or long-term (n = 778, SMD -0.04 95% CI -0.18 to 0.10, little heterogeneity) follow-up, or on anxiety, physiological or biomarker-based outcomes. One study reported costs, no studies reported cost-effectiveness and 12 studies reported resource use; and meta-analysis suggested reduced medication use but no impact on health centre visits. Estimated costs of intervention were low, but there was insufficient evidence to judge cost-effectiveness. Realist synthesis findings suggested that facilitated TW is a complex intervention and group interaction contributes to the perception of benefit. It was unclear from the available data who might benefit most from facilitated TW. LIMITATION Difficulties with developing realist synthesis programme theory meant that mechanisms operating during TW remain obscure. CONCLUSIONS Overall, there is little evidence to support the therapeutic effectiveness or cost-effectiveness of unfacilitated expressive writing interventions in people with LTCs. Further research focused on facilitated TW in people with LTCs could be informative. STUDY REGISTRATION This study is registered as PROSPERO CRD42012003343. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Olga P Nyssen
- Gastroenterology Unit, Hospital Universitario de la Princesa, Instituto de Investigación, Sanitaria Princesa (IP), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Stephanie J C Taylor
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Elizabeth Steed
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Liam Bourke
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - Joanne Lord
- Southampton Health Technology Assessment Centre, University of Southampton, Southampton, UK
| | - Carol A Ross
- Cumbria Partnership NHS Foundation Trust, Penrith, UK
| | - Sheila Hayman
- Medical Foundation for the Care of Victims of Torture, London, UK
| | - Victoria Field
- Freelance experienced therapeutic writing practitioner, International Federation for Biblio/Poetry Therapy, Steamboat Springs, CO, USA
| | - Ailish Higgins
- Health Economics Research Group, Brunel University, London, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Frederiksen Y, O'Toole MS, Mehlsen MY, Hauge B, Elbaek HO, Zachariae R, Ingerslev HJ. The effect of expressive writing intervention for infertile couples: a randomized controlled trial. Hum Reprod 2016; 32:391-402. [PMID: 28007790 DOI: 10.1093/humrep/dew320] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 10/29/2016] [Accepted: 11/22/2016] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION Is expressive writing intervention (EWI) efficacious in reducing distress and improving pregnancy rates for couples going through ART treatment? SUMMARY ANSWER Compared to controls, EWI statistically significantly reduced depressive symptoms but not anxiety and infertility-related distress. WHAT IS KNOWN ALREADY ART treatment is considered stressful. So far, various psychological interventions have been tested for their potential in reducing infertility-related distress and the results are generally positive. It remains unclear whether EWI, a brief and potentially cost-effective intervention, could be advantageous. STUDY DESIGN SIZE, DURATION Between November 2010 and July 2012, a total of 295 participants (163 women, 132 men) were randomly allocated to EWI or a neutral writing control group. PARTICIPANTS/MATERIALS, SETTING, METHODS Participants were couples undergoing IVF/ICSI treatment. Single women and couples with Preimplantation Genetic Diagnosis or acute change of procedure from insemination to IVF, were excluded. EWI participants participated in three 20-min home-based writing exercises focusing on emotional disclosure in relation to infertility/fertility treatment (two sessions) and benefit finding (one session). Controls wrote non-emotionally in three 20-min sessions about their daily activities. The participants completed questionnaires at the beginning of treatment (t1), prior to the pregnancy test (t2), and 3 months later (t3). In total, 26.8% (79/295) were lost to follow-up. Mixed linear models were chosen to compare the two groups over time for psychological outcomes (depression, anxiety and infertility-related distress), and a Chi2 test was employed in order to examine group differences in pregnancy rates MAIN RESULTS AND THE ROLE OF CHANCE: One hundred and fifty-three participants received EWI (women = 83; men = 70) and 142 participants were allocated to the neutral writing control group (women = 83; men = 62). Both women and partners in the EWI group exhibited greater reductions in depressive symptoms compared with controls (P = 0.049; [CI 95%: -0.04; -0.01] Cohen's d = 0.27). The effect of EWI on anxiety did not reach statistical significance. Overall infertility-related distress increased marginally for the partners in the EWI group compared to the partners in the control group (P = 0.06; Cohen's d = 0.17). However, in relation to the personal subdomain, the increase was statistically significant (P = 0.01; Cohen's d = 0.24). EWI had no statistically significant effect on pregnancy rates with 42/83 (50.6%) achieving pregnancy in the EWI group compared with 40/80 (49.4%) in the control group (RR = 0.99 [CI 95% = 0.725, 1.341]; P = 0.94). LIMITATIONS, REASONS FOR CAUTION The results for depressive symptoms corresponded to a small effect size and the remaining results failed to reach statistical significance. This could be due to sample characteristics leading to a possible floor-effect, as we did not exclude participants with low levels of emotional distress at baseline. Furthermore, men showed increased infertility-related distress over time. WIDER IMPLICATIONS OF THE FINDINGS EWI is a potentially cost-effective and easy to implement home-based intervention, and even small effects may be relevant. When faced with infertility, EWI could thus be a relevant tool for alleviating depressive symptoms by allowing the expression of feelings about infertility that may be perceived as socially unacceptable. However, the implications do not seem to be applicable for men, who presented with increased infertility-related distress over time. STUDY FUNDING/COMPETING INTERESTS The present study was supported by research grants from Merck Sharpe and Dohme and The Danish Agency for Science Technology and Innovation as part of a publicly funded PhD. The funding bodies had no influence on the data collection, analysis or conclusions of the study. None of the authors have any conflicts of interest to declare. TRIAL REGISTRATION NUMBER Clinicaltrials.gov, trial no. NCT01187095. TRIAL REGISTRATION DATE 7th September 2010 DATE OF FIRST PATIENT'S ENROLMENT: 23rd November 2010.
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Affiliation(s)
- Yoon Frederiksen
- Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark
| | - Mia Skytte O'Toole
- Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark
| | - Mimi Y Mehlsen
- Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark
| | - Benedicte Hauge
- Horsens Fertility Clinic, Horsens Hospital, 8700 Horsens, Denmark
| | | | - Robert Zachariae
- Department of Psychology and Behavioral Sciences, Aarhus University, 8000 Aarhus, Denmark.,Department of Oncology, Aarhus University Hospital, 8000 Aarhus Denmark
| | - Hans Jakob Ingerslev
- Center for Preimplantation Genetic Diagnosis/the Fertility Clinic, Aarhus University Hospital, 8200 Aarhus N, Denmark.,Health, Aarhus University, 8000 Aarhus, Denmark
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20
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Horsch A, Tolsa JF, Gilbert L, du Chêne LJ, Müller-Nix C, Bickle Graz M. Improving Maternal Mental Health Following Preterm Birth Using an Expressive Writing Intervention: A Randomized Controlled Trial. Child Psychiatry Hum Dev 2016; 47:780-91. [PMID: 26659113 DOI: 10.1007/s10578-015-0611-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Evaluations of evidence-based, easily accessible, psychological interventions to improve maternal mental health following very preterm birth are scarce. This study investigated the efficacy and acceptability of the expressive writing paradigm for mothers of very preterm infants. The level of maternal posttraumatic stress and depressive symptoms was the primary outcome. Participants were 67 mothers of very preterm babies who were randomly allocated into the intervention (expressive writing; n = 33) or control group (treatment-as-usual; n = 32) when their infant was aged 3 months (corrected age, CA). Measurements were taken at 3 months (pre-intervention), 4 months (post-intervention), and 6 months CA (follow-up). Results showed reduced maternal posttraumatic stress (d = 0.42), depressive symptoms (d = 0.67), and an improved mental health status (d = 1.20) in the intervention group, which were maintained at follow-up. Expressive writing is a brief, cost-effective, and acceptable therapeutic approach that could be offered as part of the NICU care.
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Affiliation(s)
- Antje Horsch
- Clinic of Neonatology, University Hospital Lausanne, Avenue Pierre-Decker 2, 1011, Lausanne, Switzerland. .,Department of Gynecology and Obstetrics, University Hospital Lausanne, Lausanne, Switzerland. .,Department of Child and Adolescent Psychiatry, University Hospital Lausanne, Lausanne, Switzerland.
| | - Jean-François Tolsa
- Clinic of Neonatology, University Hospital Lausanne, Avenue Pierre-Decker 2, 1011, Lausanne, Switzerland
| | - Leah Gilbert
- Clinic of Neonatology, University Hospital Lausanne, Avenue Pierre-Decker 2, 1011, Lausanne, Switzerland
| | - Lauranne Jan du Chêne
- Clinic of Neonatology, University Hospital Lausanne, Avenue Pierre-Decker 2, 1011, Lausanne, Switzerland
| | - Carole Müller-Nix
- Department of Child and Adolescent Psychiatry, University Hospital Lausanne, Lausanne, Switzerland
| | - Myriam Bickle Graz
- Clinic of Neonatology, University Hospital Lausanne, Avenue Pierre-Decker 2, 1011, Lausanne, Switzerland
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21
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Gripsrud BH, Brassil KJ, Summers B, Søiland H, Kronowitz S, Lode K. Capturing the Experience: Reflections of Women With Breast Cancer Engaged in an Expressive Writing Intervention. Cancer Nurs 2016; 39:E51-60. [PMID: 26390074 PMCID: PMC4798919 DOI: 10.1097/ncc.0000000000000300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Expressive writing has been shown to improve quality of life, fatigue, and posttraumatic stress among breast cancer patients across cultures. Understanding how and why the method may be beneficial to patients can increase awareness of the psychosocial impact of breast cancer and enhance interventional work within this population. Qualitative research on experiential aspects of interventions may inform the theoretical understanding and generate hypotheses for future studies. AIM The aim of the study was to explore and describe the experience and feasibility of expressive writing among women with breast cancer following mastectomy and immediate or delayed reconstructive surgery. METHODS Seven participants enrolled to undertake 4 episodes of expressive writing at home, with semistructured interviews conducted afterward and analyzed using experiential thematic analysis. RESULTS Three themes emerged through analysis: writing as process, writing as therapeutic, and writing as a means to help others. CONCLUSIONS Findings illuminate experiential variations in expressive writing and how storytelling encourages a release of cognitive and emotional strains, surrendering these to reside in the text. The method was said to process feelings and capture experiences tied to a new and overwhelming illness situation, as impressions became expressions through writing. Expressive writing, therefore, is a valuable tool for healthcare providers to introduce into the plan of care for patients with breast cancer and potentially other cancer patient groups. IMPLICATIONS FOR PRACTICE This study augments existing evidence to support the appropriateness of expressive writing as an intervention after a breast cancer diagnosis. Further studies should evaluate its feasibility at different time points in survivorship.
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Affiliation(s)
- Birgitta Haga Gripsrud
- Author Affiliations: Departments of Research (Drs Gripsrud and Lode) and Breast and Endocrine Surgery (Dr Søiland), Stavanger University Hospital, Stavanger; and Department of Clinical Science, University of Bergen, Bergen, Norway (Dr Søiland); Division of Nursing (Drs Brassil and Summers); and Department of Plastic Surgery (Dr Kronowitz), The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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22
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Korotana LM, Dobson KS, Pusch D, Josephson T. A review of primary care interventions to improve health outcomes in adult survivors of adverse childhood experiences. Clin Psychol Rev 2016; 46:59-90. [DOI: 10.1016/j.cpr.2016.04.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 02/18/2016] [Accepted: 04/17/2016] [Indexed: 12/18/2022]
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23
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Wang F, Wang C, Yin Q, Wang K, Li D, Mao M, Zhu C, Huang Y. Reappraisal writing relieves social anxiety and may be accompanied by changes in frontal alpha asymmetry. Front Psychol 2015; 6:1604. [PMID: 26539146 PMCID: PMC4612649 DOI: 10.3389/fpsyg.2015.01604] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/05/2015] [Indexed: 11/26/2022] Open
Abstract
It is widely reported that expressive writing can improve mental and physical health. However, to date, the neural correlates of expressive writing have not been reported. The current study examined the neural electrical correlates of expressive writing in a reappraisal approach. Three groups of participants were required to give a public speech. Before speaking, the reappraisal writing group was asked to write about the current stressful task in a reappraisal manner. The irrelevant writing group was asked to write about their weekly plan, and the non-writing group did not write anything. It was found that following the experimental writing manipulation, both reappraisal and irrelevant writing conditions decreased self-reported anxiety levels. But when re-exposed to the stressful situation, participants in the irrelevant writing group showed increased anxiety levels, while anxiety levels remained lower in the reappraisal group. During the experimental writing manipulation period, participants in the reappraisal group had lower frontal alpha asymmetry scores than those in the irrelevant writing group. However, following re-exposure to stress, participants in the reappraisal group showed higher frontal alpha asymmetry scores than those in the irrelevant writing group. Self-reported anxiety and frontal alpha asymmetry of the non-writing condition did not change significantly across these different stages. It is noteworthy that expressive writing in a reappraisal style seems not to be a fast-acting treatment but may instead take effect in the long run.
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Affiliation(s)
- Fen Wang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal UniversityBeijing, China
| | - Changming Wang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
- Beijing Anding Hospital, Capital Medical UniversityBeijing, China
- Beijing Key Laboratory of Mental DisordersBeijing, China
- Beijing Institute for Brain DisordersBeijing, China
| | - Qin Yin
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal UniversityBeijing, China
| | - Kui Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of SciencesBeijing, China
| | - Dongdong Li
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal UniversityBeijing, China
| | - Mengchai Mao
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal UniversityBeijing, China
| | - Chaozhe Zhu
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal UniversityBeijing, China
| | - Yuxia Huang
- State Key Laboratory of Cognitive Neuroscience and Learning and IDG/McGovern Institute for Brain Research, Beijing Normal UniversityBeijing, China
- Center for Collaboration and Innovation in Brain and Learning Sciences, Beijing Normal UniversityBeijing, China
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Abstract
Abstract. The last several decades have witnessed a substantial increase in the number of individuals suffering from both diagnosable and subsyndromal mental health problems. Consequently, the development of cost-effective treatment methods, accessible to large populations suffering from different forms of mental health problems, became imperative. A very promising intervention is the method of expressive writing (EW), which may be used in both clinically diagnosable cases and subthreshold symptomatology. This method, in which people express their feelings and thoughts related to stressful situations in writing, has been found to improve participants’ long-term psychological, physiological, behavioral, and social functioning. Based on a thorough analysis and synthesis of the published literature (also including most recent meta-analyses), the present paper presents the expressive writing method, its short- and long-term, intra-and interpersonal effects, different situations and conditions in which it has been proven to be effective, the most important mechanisms implied in the process of recovery, advantages, disadvantages, and possible pitfalls of the method, as well as variants of the original technique and future research directions.
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Affiliation(s)
- Éva Kállay
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
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25
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Zhou C, Wu Y, An S, Li X. Effect of Expressive Writing Intervention on Health Outcomes in Breast Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. PLoS One 2015; 10:e0131802. [PMID: 26151818 PMCID: PMC4494859 DOI: 10.1371/journal.pone.0131802] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 06/05/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Numerous randomized controlled trials (RCTs) have arrived at conflicting conclusions on expressive writing (EW) as an intervention for breast cancer (BC) patients, but there has been no meta-analysis of these studies to assess the effectiveness of EW in BC population. METHODS PubMed, Web of Science, The Cochrane Library, EMBASE, and CINAHL and the www.clinicaltrial.gov database on ongoing clinical trials were searched to identify all the RCTs investigating efficacy of EW on the physical and psychological health in BC patients. The risk of bias of the original studies was assessed using the Cochrane Collaboration's tool. Our primary outcomes for physical and psychological health were respectively negative somatic symptoms and negative mood which were stratified by emotional, benefit-finding and multiple prompts in sub-group analyses. The data were analyzed using Review Manager 5.2 and Stata version 12.0 statistical software. RESULTS Of the 5,232 titles screened, we identified 11 RCTs with a total of 1,178 participants. The pooled results showed a significant effect of EW using either an emotional prompt or a benefit-finding prompt on reducing negative somatic symptoms in BC patients in the ≤3-month follow-up group [Mean Difference (MD), -13.03, 95% CI, -19.23 to -6.83, P<0.0001; MD, -9.18, 95% CI, -15.57 to -2.79, P = 0.005]. There was no significant effect of EW on physical health in the >3-month follow-up group. There were no significant differences regarding psychological health indexes between EW intervention and control groups at any of the follow-up time-points (P>0.05). CONCLUSION This systematic review and meta-analysis reveals that EW intervention may have a significantly positive impact on the physical health but not the psychological health in BC patients, but this benefit may not last long. However, further high-quality studies with more homogeneity are needed to confirm the current findings.
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Affiliation(s)
- Chunlan Zhou
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Yanni Wu
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Shengli An
- Department of Bio-Statistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, Guangdong, PR China
| | - Xiaojin Li
- Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, PR China
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26
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Travagin G, Margola D, Revenson TA. How effective are expressive writing interventions for adolescents? A meta-analytic review. Clin Psychol Rev 2015; 36:42-55. [PMID: 25656314 DOI: 10.1016/j.cpr.2015.01.003] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 01/04/2015] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
Abstract
This meta-analysis evaluated the effects of the expressive writing intervention (EW; Pennebaker & Beall, 1986) among adolescents. Twenty-one independent studies that assessed the efficacy of expressive writing on youth samples aged 10-18 ears were collected and analyzed. Results indicated an overall mean g-effect size that was positive in direction but relatively small (0.127), as well as significant g-effect sizes ranging from 0.107 to 0.246 for the outcome domains of Emotional Distress, Problem Behavior, Social Adjustment, and School Participation. Few significant effects were found within specific outcome domains for putative moderator variables that included characteristics of the participants, intervention instructions, or research design. Studies involving adolescents with high levels of emotional problems at baseline reported larger effects on school performance. Studies that implemented a higher dosage intervention (i.e., greater number and, to some extent, greater spacing of sessions) reported larger effects on somatic complaints. Overall, the findings suggest that expressive writing tends to produce small yet significant improvements on adolescents' well-being. The findings highlight the importance of modifying the traditional expressive writing protocol to enhance its efficacy and reduce potential detrimental effects. At this stage of research the evidence on expressive writing as a viable intervention for adolescents is promising but not decisive.
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27
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Otake K. Subjective happiness and autobiographical memory: Differences in the ratio of positive events and transmission as emotional expression. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015. [DOI: 10.1016/j.paid.2014.08.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Lumley MA, Keefe FJ, Mosley-Williams A, Rice JR, McKee D, Waters SJ, Partridge RT, Carty JN, Coltri AM, Kalaj A, Cohen JL, Neely LC, Pahssen JK, Connelly MA, Bouaziz YB, Riordan PA. The effects of written emotional disclosure and coping skills training in rheumatoid arthritis: a randomized clinical trial. J Consult Clin Psychol 2014; 82:644-58. [PMID: 24865870 DOI: 10.1037/a0036958] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Two psychological interventions for rheumatoid arthritis (RA) are cognitive-behavioral coping skills training (CST) and written emotional disclosure (WED). These approaches have developed independently, and their combination may be more effective than either one alone. Furthermore, most studies of each intervention have methodological limitations, and each needs further testing. METHOD We randomized 264 adults with RA in a 2 × 2 factorial design to 1 of 2 writing conditions (WED vs. control writing) followed by 1 of 2 training conditions (CST vs. arthritis education control training). Patient-reported pain and functioning, blinded evaluations of disease activity and walking speed, and an inflammatory marker (C-reactive protein) were assessed at baseline and 1-, 4-, and 12-month follow-ups. RESULTS Completion of each intervention was high (>90% of patients), and attrition was low (10.2% at 12-month follow-up). Hierarchical linear modeling of treatment effects over the follow-up period, and analyses of covariance at each assessment point, revealed no interactions between writing and training; however, both interventions had main effects on outcomes, with small effect sizes. Compared with control training, CST decreased pain and psychological symptoms through 12 months. The effects of WED were mixed: Compared with control writing, WED reduced disease activity and physical disability at 1 month only, but WED had more pain than control writing on 1 of 2 measures at 4 and 12 months. CONCLUSIONS The combination of WED and CST does not improve outcomes, perhaps because each intervention has unique effects at different time points. CST improves health status in RA and is recommended for patients, whereas WED has limited benefits and needs strengthening or better targeting to appropriate patients.
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Affiliation(s)
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | | | - John R Rice
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Daphne McKee
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Sandra J Waters
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | | | | | | | | | | | | | | | - Mark A Connelly
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Yelena B Bouaziz
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - Paul A Riordan
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
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Meads C, Nyssen OP, Wong G, Steed L, Bourke L, Ross CA, Hayman S, Field V, Lord J, Greenhalgh T, Taylor SJC. Protocol for an HTA report: Does therapeutic writing help people with long-term conditions? Systematic review, realist synthesis and economic modelling. BMJ Open 2014; 4:e004377. [PMID: 24549165 PMCID: PMC3932001 DOI: 10.1136/bmjopen-2013-004377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Long-term medical conditions (LTCs) cause reduced health-related quality of life and considerable health service expenditure. Writing therapy has potential to improve physical and mental health in people with LTCs, but its effectiveness is not established. This project aims to establish the clinical and cost-effectiveness of therapeutic writing in LTCs by systematic review and economic evaluation, and to evaluate context and mechanisms by which it might work, through realist synthesis. METHODS Included are any comparative study of therapeutic writing compared with no writing, waiting list, attention control or placebo writing in patients with any diagnosed LTCs that report at least one of the following: relevant clinical outcomes; quality of life; health service use; psychological, behavioural or social functioning; adherence or adverse events. Searches will be conducted in the main medical databases including MEDLINE, EMBASE, PsycINFO, The Cochrane Library and Science Citation Index. For the realist review, further purposive and iterative searches through snowballing techniques will be undertaken. Inclusions, data extraction and quality assessment will be in duplicate with disagreements resolved through discussion. Quality assessment will include using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data synthesis will be narrative and tabular with meta-analysis where appropriate. De novo economic modelling will be attempted in one clinical area if sufficient evidence is available and performed according to the National Institute for Health and Care Excellence (NICE) reference case.
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Affiliation(s)
- C Meads
- Health Economics Research Group, Brunel University, Middlesex, UK
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30
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Zhang Y, Zhao Y, Mao S, Li G, Yuan Y. Investigation of health anxiety and its related factors in nursing students. Neuropsychiatr Dis Treat 2014; 10:1223-34. [PMID: 25045266 PMCID: PMC4094631 DOI: 10.2147/ndt.s61568] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To explore health anxiety in a sample of nursing students to determine the relationships between health anxiety and life satisfaction, personality, and alexithymia. METHODS Two thousand and eighty-six nursing students in junior college, which were divided into five groups, were evaluated by questionnaires, including the Life Satisfaction Scales Applicable to College Students, the Chinese version of the Short Health Anxiety Inventory, the Toronto Alexithymia Scale (TAS-20), and the Eysenck Personality Questionnaire. RESULTS The mean age, whether the individual was an only child, residence (urban or rural), and were significantly different between the groups. The self-assessment scores were also significantly different between the groups. The Short Health Anxiety Inventory total score and the factor of fearing the likelihood of becoming ill were significantly negatively correlated with the Life Satisfaction Scales Applicable to College Students total score and its two factors, but were significantly positively correlated with psychoticism, neuroticism, and TAS-20 total scores and its scores of the three TAS-20 factors. The negative consequence scale of Short Health Anxiety Inventory was not significantly correlated with externally oriented thinking, but was significantly negatively correlated with extraversion. A hierarchical multiple regression analysis indicted that objective satisfaction, subjective satisfaction, neuroticism, and the three factors of TAS-20 were predictors of health anxiety. CONCLUSION Health anxiety was correlated with life satisfaction, personality, and alexithymia in junior college nursing students. Subjective and objective satisfaction, neuroticism, and the identification and expression of emotions may be predictors of health anxiety in nursing students.
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Affiliation(s)
- Yuqun Zhang
- Department of Psychosomatics and Psychiatry, Affiliated Zhongda Hospital, Medical School of Southeast University, Nanjing, People's Republic of China ; Nursing Faculty of Southeast University, Nanjing, People's Republic of China
| | - Yueqiu Zhao
- Nanjing Health School, Nanjing, People's Republic of China
| | - Shengqin Mao
- Department of Psychosomatics and Psychiatry, Affiliated Zhongda Hospital, Medical School of Southeast University, Nanjing, People's Republic of China
| | - Guohong Li
- Nursing Department, Affiliated Zhongda Hospital, Medical School of Southeast University, Nanjing, People's Republic of China
| | - Yonggui Yuan
- Department of Psychosomatics and Psychiatry, Affiliated Zhongda Hospital, Medical School of Southeast University, Nanjing, People's Republic of China
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Targeting writing interventions to emotional processing level: a factorial experimental design. ACTA ACUST UNITED AC 2013. [DOI: 10.1007/s11135-013-9933-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lumley MA, Sklar ER, Carty JN. Emotional disclosure interventions for chronic pain: from the laboratory to the clinic. Transl Behav Med 2013; 2:73-81. [PMID: 22905067 DOI: 10.1007/s13142-011-0085-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Life stress and the avoidance of negative emotions may contribute to chronic pain. The technique of written or spoken emotional disclosure can reverse emotional avoidance and improve health, and 18 randomized studies have tested it among people with chronic pain. We review these studies to provide guidance for the clinical use of this technique. The benefits of emotional disclosure for chronic pain are quite modest overall. Studies in rheumatoid arthritis show very limited effects, but two studies in fibromyalgia suggest that disclosure may be beneficial. Effects in other populations (headaches, cancer pain, pelvic pain, abdominal pain) are mixed. Moderator findings suggest that some patients are more likely to benefit than others. Emotional disclosure has been tested in well-controlled efficacy trials, leaving many unanswered questions related to translating this technique to practice. Issues needing further study include determining disclosure's effects outside of randomized controlled trials, identifying the optimal pain populations and specific individuals to target for disclosure, presenting a valid rationale for disclosure, selecting the location and method of disclosure, and choosing between cognitive-behavioral or emotional disclosure techniques.
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Affiliation(s)
- Mark A Lumley
- Department of Psychology, Wayne State University, 5057 Woodward Ave., 7th Floor, Detroit, MI 48202 USA
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Heimes S. Hat Expressives Schreiben über eine positiv imaginierte Zukunft Einfluss auf Affekt, Copingstrategien und Selbstwirksamkeit? ACTA ACUST UNITED AC 2013. [DOI: 10.1026/0933-6885/a000125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Das Expressive Schreiben (ES) hat sich in verschiedenen Untersuchungen als hilfreich bei der Verarbeitung belastender Ereignisse erwiesen und es haben sich mehr oder weniger deutliche positive Auswirkungen auf den psychologischen und physiologischen Gesundheitszustand gezeigt. Zunehmend beschäftigen sich Wissenschaftler mit der Frage, ob das ES bei der Formulierung von Lebenszielen zur Verbesserung von Selbstwirksamkeit und Affekt und als Copingstrategie geeignet sein könnte. 31 Studierende der Kunsttherapie und des Coachings wurden randomisiert zwei Gruppen zugeteilt, die beide an drei aufeinanderfolgenden Tagen für zwanzig Minuten entweder über eine positiv imaginierte Zukunft oder ein neutrales Thema schrieben. Untersucht wurden über einen Zeitraum von acht Wochen der positive und negative Affekt (PANAS), die Copingfähigkeiten (COPE) und die Selbstwirksamkeitserwartungen (SWE). In der Experimentalgruppe (EG) kam es nach der Schreibintervention zu einer Zunahme positiver Affekte im Vergleich zu den Ausgangswerten und zur Kontrollgruppe (KG), der sich im Follow-up allerdings verlor. In beiden Gruppen hatte das Schreiben keinen signifikanten Einfluss auf den negativen Affekt, die Copingfähigkeiten und die Selbstwirksamkeitserwartung. Schreiben über eine positiv imaginierte Zukunft vermag den positiven Affekt kurzzeitig zu steigern. Zur langfristigen Stimmungsverbesserung, einer Verbesserung der Copingfähigkeiten und einer Zunahme der Selbstwirksamkeitserwartung bedarf es möglicherweise einer längerdauernden Intervention und eines längeren Nachbeobachtungszeitraums.
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Sbarra DA, Boals A, Mason AE, Larson GM, Mehl MR. Expressive Writing Can Impede Emotional Recovery Following Marital Separation. Clin Psychol Sci 2013; 1:120-134. [PMID: 25606351 PMCID: PMC4297672 DOI: 10.1177/2167702612469801] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Marital separation and divorce are common life events that increases risk for poor health outcomes, yet few intervention studies explore how to mitigate this increased risk. This study implemented an expressive writing (EW; see Pennebaker, 1997) intervention for adults who experienced a recent marital separation. Ninety participants (32 men) were randomly assigned to and completed one of three experimental writing tasks: traditional EW, a novel (narrative-based) type of EW or control writing. Up to nine months after this writing, participants judged to be actively engaged in a search for meaning concerning their separation reported significantly worse emotional outcomes when assigned to either EW condition relative to control writing. Within the control condition, those participants actively engaged in a search for meaning reported the lowest levels of separation-related disturbance. We discuss these results in terms of the factors that may limit and promote psychological recovery following marital separation.
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Affiliation(s)
| | - Adriel Boals
- Department of Psychology, University of North Texas
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35
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Rossi A, Cetrano G, Pertile R, Rabbi L, Donisi V, Grigoletti L, Curtolo C, Tansella M, Thornicroft G, Amaddeo F. Burnout, compassion fatigue, and compassion satisfaction among staff in community-based mental health services. Psychiatry Res 2012; 200:933-8. [PMID: 22951335 DOI: 10.1016/j.psychres.2012.07.029] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Revised: 06/25/2012] [Accepted: 07/20/2012] [Indexed: 11/26/2022]
Abstract
Providing care to individuals with complex mental health needs can be stressful. However, little research has focused on the emotional, cognitive, and physical consequences of providing mental health care. The aim of this study is to assess burnout (BO), compassion fatigue (CF) and compassion satisfaction (CS) among staff at the four community-based mental health services (CMHS) of Verona, Italy. All staff were asked to complete anonymously the Professional Quality of Life Scale, the General Health Questionnaire, and a socio-demographic questionnaire. In total 260 staff participated (a response rate of 84%). Psychiatrists and social workers were the professionals with the highest levels of BO and CF. Workers with psychological distress reported both higher BO and CF scores, and lower levels of CS. A significant increase in the BO and CF scores was also detected for each extra year spent working in a CMHS. A higher level of CF was associated with female and having been experienced one negative life event in the previous year. These findings are useful for health managers and team leaders to identify factors affecting the professional quality of life of mental healthcare staff, and can provide a rationale for detecting staff at risk for developing negative work-related outcomes.
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Affiliation(s)
- Alberto Rossi
- Department of Public Health and Community Medicine, Section of Psychiatry, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy.
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36
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Ironson G, O'Cleirigh C, Leserman J, Stuetzle R, Fordiani J, Fletcher M, Schneiderman N. Gender-specific effects of an augmented written emotional disclosure intervention on posttraumatic, depressive, and HIV-disease-related outcomes: a randomized, controlled trial. J Consult Clin Psychol 2012; 81:284-98. [PMID: 23244367 DOI: 10.1037/a0030814] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Trauma histories and symptoms of PTSD occur at very high rates in people with HIV and are associated with poor disease management and accelerated disease progression. The authors of this study examined the efficacy of a brief written trauma disclosure intervention on posttraumatic stress, depression, HIV-related physical symptoms, and biological markers of HIV disease progression. METHOD HIV-infected men and women were randomized to four 30-min expressive writing sessions in either a treatment (trauma writing) or an attention control (daily events writing) condition. The disclosure intervention augmented the traditional emotional disclosure paradigm with probes to increase processing by focusing on trauma appraisals, self-worth, and problem solving. Outcomes were assessed at baseline, 1-, 6-, and 12-month follow-up. RESULTS Hierarchical linear modeling (N = 244, intent-to-treat analyses) revealed no significant treatment effects for the group as a whole. Gender by treatment group interactions were significant such that women in the trauma-writing group had significantly reduced posttraumatic stress disorder (PTSD) symptoms (p = .017), depression (p = .009), and HIV-related symptoms (p = .022) compared with their controls. In contrast, men in the trauma-treatment condition did not improve more than controls on any outcome variables. Unexpectedly, men in the daily-event-writing control group had significantly greater reductions in depression then men in the trauma-writing group. Treatment effects were magnified in women when the analysis was restricted to those with elevated PTSD symptoms at baseline. CONCLUSIONS A brief (4-session) guided written emotional disclosure intervention resulted in significant and meaningful reductions in PTSD, depression, and physical symptoms for women with HIV, but not for men.
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Affiliation(s)
- Gail Ironson
- Department of Psychology, University of Miami, FL 33146, USA.
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37
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Martino ML, Freda MF, Camera F. Effects of Guided Written Disclosure Protocol on mood states and psychological symptoms among parents of off-therapy acute lymphoblastic leukemia children. J Health Psychol 2012. [DOI: 10.1177/1359105312462434] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study assesses the effects of Guided Written Disclosure Protocol on psychological distress in mothers and fathers of off-therapy acute lymphoblastic leukemia children. An experimental group participated in the writing intervention with a control group subject only to test-taking standards. The Symptom Questionnaire and Profile of Mood States were administered at baseline, post-intervention, and follow-up. Guided Written Disclosure Protocol had significant effects on the progressive reduction of anxiety, depression, somatic symptoms, hostility, tension–anxiety, and fatigue–inertia within the experimental group. However, the control group distress levels tended to worsen over time. The mediating role of emotional processing was highlighted.
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38
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Schutte NS, Searle T, Meade S, Dark NA. The effect of meaningfulness and integrative processing in expressive writing on positive and negative affect and life satisfaction. Cogn Emot 2012; 26:144-52. [PMID: 22176598 DOI: 10.1080/02699931.2011.562881] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Meaningfulness and integrative processing of expressive writing may influence the effect of expressive writing. Participants completed measures of positive affect, negative affect and life satisfaction before and after an expressive writing intervention. Participants were randomly assigned to one of four expressive writing instruction conditions, which combined higher and lower levels of meaning and integrative processing instructions. Meaningfulness and integrative processing instructions had significant effects in increasing positive affect and there was a significant interaction between meaningfulness instructions and integrative processing instructions; participants in the high meaningfulness and high integrative processing instruction condition showed the greatest increase in positive affect. Meaningfulness had a significant effect in decreasing negative affect. The intervention did not influence life satisfaction. Both meaningfulness and integrative processing instructions led to more self-reported personal meaningfulness of the writing and more cognitive, emotional, behavioural and situational changes. More self-reported meaningfulness of the writing and more cognitive, emotional, behavioural and situational changes made as a result of the writing were in turn associated with greater increases in positive affect. The results of the study affirm the importance of meaningfulness and processing in expressive writing and potentially provide information regarding how to increase the effectiveness of expressive writing.
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Affiliation(s)
- Nicola S Schutte
- Psychology Department, University of New England, Armidale, NSW, Australia.
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39
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40
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Schubiner H. Emotional Awareness for Pain. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00084-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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41
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MacReady DE, Cheung RM, Kelly AE, Wang L. Can Public Versus Private Disclosure Cause Greater Psychological Symptom Reduction? JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2011. [DOI: 10.1521/jscp.2011.30.10.1015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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42
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Lumley MA, Leisen JCC, Partridge TR, Meyer TM, Radcliffe AM, Macklem DJ, Naoum LA, Cohen JL, Lasichak LM, Lubetsky MR, Mosley-Williams AD, Granda JL. Does emotional disclosure about stress improve health in rheumatoid arthritis? Randomized, controlled trials of written and spoken disclosure. Pain 2011; 152:866-877. [PMID: 21315515 DOI: 10.1016/j.pain.2011.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Revised: 11/06/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
Abstract
Studies of the effects of disclosing stressful experiences among patients with rheumatoid arthritis (RA) have yielded inconsistent findings, perhaps due to different disclosure methods--writing or speaking--and various methodological limitations. We randomized adults with RA to a writing (n=88) or speaking (to a recorder) sample (n=93), and within each sample, to either disclosure or 1 of 2 control groups (positive or neutral events), which conducted four 20-minute, at-home sessions. Follow-up evaluations at 1, 3, and 6 months included self-reported, behavioral, physiological, and blinded physician-assessed outcomes. In both writing and speaking samples, the disclosure and control groups were comparably credible, and the linguistic content differed as expected. Covariance analyses at each follow-up point indicated that written disclosure had minimal effects compared with combined controls--only pain was reduced at 1 and 6 months, but no other outcomes improved. Spoken disclosure led to faster walking speed at 3 months, and reduced pain, swollen joints, and physician-rated disease activity at 6 months, but there were no effects on other outcomes. Latent growth curve modeling examined differences in the trajectory of change over follow-up. Written disclosure improved affective pain and walking speed; spoken disclosure showed only a marginal benefit on sensory pain. In both analyses, the few benefits of disclosure occurred relative to both positive and neutral control groups. We conclude that both written and spoken disclosure have modest benefits for patients with RA, particularly at 6 months, but these effects are limited in scope and consistency.
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Affiliation(s)
- Mark A Lumley
- Wayne State University, Detroit, MI, USA Henry Ford Health System, Detroit, MI, USA Oakland University, Rochester, MI, USA Boise State University, Boise, Idaho, USA Chelsea Community Hospital, Chelsea, MI, USA John D. Dingell Veterans Affairs Medical Center, MI, USA Kamil Orthopedic Group, West Bloomfield, MI, USA
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Seih YT, Chung CK, Pennebaker JW. Experimental manipulations of perspective taking and perspective switching in expressive writing. Cogn Emot 2011; 25:926-38. [PMID: 21824030 DOI: 10.1080/02699931.2010.512123] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Previous studies suggest that those who naturally vary their pronoun use over the course of expressive writing subsequently report the greatest improvements in physical and mental health. To explore possible perspective taking or perspective switching effects, two studies manipulated writing perspectives about emotional events from either a first-person, second-person, or third-person perspective. In Study 1, 55 students were randomly assigned to one of the three writing perspectives and were asked to write from the same perspective for three 5-minute writing sessions. In Study 2, 129 students wrote for three 5-minute sessions, one from each perspective in a counterbalanced order. The results showed that writing from a first-person perspective conferred more perceived benefits and was associated with using more cognitive mechanism words, whether engaged in perspective taking or perspective switching.
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Affiliation(s)
- Yi-Tai Seih
- Department of Psychology A8000, University of Texas, Austin, Texas 78712, USA
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Les effets de l’écriture expressive sur la santé physique et psychologique des rédacteurs : un bilan, des perspectives de recherches. EUROPEAN REVIEW OF APPLIED PSYCHOLOGY-REVUE EUROPEENNE DE PSYCHOLOGIE APPLIQUEE 2011. [DOI: 10.1016/j.erap.2010.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Benito Oliver E, de Albornoz PAC, López HC. Herramientas para el autocuidado del profesional que atiende a personas que sufren. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/s1134-2072(11)70023-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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46
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Slavin-Spenny OM, Cohen JL, Oberleitner LM, Lumley MA. The effects of different methods of emotional disclosure: differentiating post-traumatic growth from stress symptoms. J Clin Psychol 2010; 67:993-1007. [PMID: 21905025 DOI: 10.1002/jclp.20750] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Research on emotional disclosure should test the effects of different disclosure methods and whether symptoms are affected differently than post-traumatic growth. We randomized 214 participants with unresolved stressful experiences to four disclosure conditions (written, private spoken, talking to a passive listener, talking to an active facilitator) or two control conditions. All groups had one 30-minute session. After 6 weeks, disclosure groups reported more post-traumatic growth than controls, and disclosure conditions were similar in this effect. All groups decreased in stress symptoms (intrusions, avoidance, psychological and physical symptoms), but disclosure did not differ from control. We conclude that 30 minutes of disclosure leads to post-traumatic growth but not necessarily symptom reduction, and various disclosure methods have similar effects. Research on the effects of disclosure should focus on the benefits of growth as well as symptom reduction.
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Halpert A, Rybin D, Doros G. Expressive writing is a promising therapeutic modality for the management of IBS: a pilot study. Am J Gastroenterol 2010; 105:2440-8. [PMID: 20551938 DOI: 10.1038/ajg.2010.246] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES We sought to test the effectiveness of expressive writing about irritable bowel syndrome (IBS) on disease severity, IBS-related cognition (perceived control over the illness or adaptive cognition), and IBS-specific quality of life. METHODS This was an exploratory pilot study, during which subjects with IBS were asked to write at an online portal for 30 min on 4 consecutive days about their deepest thoughts, emotions, and beliefs regarding the disease and their perception of its effects (writing group). The IBS severity scale (IBSSS), functional bowel disease-related cognition (CG-FBD), catastrophizing/coping (CT3), and IBS-specific quality of life (IBS-QOL) were measured at baseline and at 1 and 3 months' follow-up. Subjects who did not start writing for 3 weeks were asked to complete questionnaires without writing (non-writers group). Within-group comparisons pre- and post-assessment were compared. In addition, the writing and non-writers groups were compared. Linear mixed-effects models were used to assess the outcome measures over time (1 and 3 months). RESULTS A total of 103 subjects were enrolled in the study (writing group, n=82; non-writers group, n=21). The mean age of all participants was 43 years (s.d. ±12), and the majority (91%) were female. The mean duration of IBS was 6.8 years (s.d. ±3.5); 102 subjects (99‰) had received physician-directed care for the disease. There were no significant differences between the writing and non-writers groups in baseline measurements. For the writing group at 1 and 3 months, the IBSSS improved significantly (+37.4 (±10.8), P=0.0012 and +53.8 (±13), P=0.0002, respectively) and this was not seen in the non-writers group. Similarly, the CG-FBD improved in the writing group by 0.58 (±0.2, P=0.006) at 3 months, although the changes in IBS-QOL did not reach clinical or statistical significance. CONCLUSIONS In this exploratory study, expressive writing improved IBS disease severity and cognition in subjects with longer-term duration of the disease. A large, controlled study is warranted to evaluate the therapeutic potential of this novel modality for adjunctive management of IBS in the outpatient setting.
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Affiliation(s)
- Albena Halpert
- Section of Gastroenterology and Hepatology, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
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Nazarian D, Smyth JM. Context Moderates the Effects of an Expressive Writing Intervention: A Randomized Two-Study Replication and Extension. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2010. [DOI: 10.1521/jscp.2010.29.8.903] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Danoff-Burg S, Mosher CE, Seawell AH, Agee JD. Does narrative writing instruction enhance the benefits of expressive writing? ANXIETY STRESS AND COPING 2010; 23:341-52. [PMID: 19705310 DOI: 10.1080/10615800903191137] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We examined whether instructing participants to write in a narrative fashion about stressful life events would produce superior physical and psychological health benefits relative to standard expressive writing instructions that do not specify the essay's structure. Undergraduates (N=101) were randomly assigned to engage in two, 20-minute narrative writing, standard expressive writing, or control writing tasks. Follow-up data were obtained one month later. The essays of the narrative writing group evidenced higher levels of narrative structure than did those of the expressive writing group. Greater narrative structure was associated with mental health gains, and self-rated emotionality of the essays was associated with lesser perceived stress at follow-up. In addition, the narrative and expressive writing groups reported lower levels of perceived stress and depressive symptoms relative to controls but did not differ from each other with regard to these outcomes. Health care utilization at follow-up did not vary by group assignment. Findings suggest that both emotional expression and narrative structure may be key factors underlying expressive writing's mental health benefits. Results also suggest that, among college students, instruction in narrative formation does not increase the positive effects of expressive writing relative to standard expressive writing instructions.
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Affiliation(s)
- Sharon Danoff-Burg
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA
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Range LM, Jenkins SR. Who Benefits from Pennebaker’s Expressive Writing Paradigm? Research Recommendations from Three Gender Theories. SEX ROLES 2010. [DOI: 10.1007/s11199-010-9749-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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