Who Benefits from Pennebaker’s Expressive Writing Paradigm? Research Recommendations from Three Gender Theories

Broadening the Perspective on the Dynamics of Men's Suicide: Thought Suppression as a Mediator between Men's Self-Reliance and Suicidality

OBJECTIVE

In most countries, men are at higher risk than women for suicide death. Research focused on masculinity and men's mental health increasingly demonstrates that relationships between gender and various health outcomes, including suicidality, is complex as these relationships can be further explained by certain psychological processes or health behaviors. The objective of this study was to extend this area of research in a national sample of US men (n = 785) by investigating if their adherence to certain hegemonic masculine gender role norms (toughness and self-reliance through mechanical skills) is associated with the suppression of distressing thoughts and if thought suppression then increases their risk for suicidal thoughts and behaviors.

METHODS

Men in the US who have recently experienced a stressful life event completed an anonymous online survey. Structural Equational Modeling (SEM) was used to test for direct and indirect effects (i.e., mediation) between variables.

RESULTS

Men's engagement in thought suppression mediated the relationship between self-reliance and suicidality. The norm of toughness was both directly related to suicidality and mediated by thought suppression.

CONCLUSIONS

Thought suppression appears to be a process that provides some explanation for the relationships between hegemonic masculine norms and suicidality in men, though this study indicated it may play only a small role. Research continues to build that certain masculine norms, such as self-reliance and toughness, are particularly concerning for men's health.HIGHLIGHTSMen's thought suppression mediates the relationship between self-reliance and suicidalityMen's toughness impacts suicidality both directly and via engagement in thought suppressionThese findings have implications for interventions that help men manage distressing thoughts.

Write and Let Go: An Online Writing Program for University Students

Background

There are a plethora of studies on expressive writing and positive writing interventions, but few have addressed the combination of both paradigms. Additionally, research on the role of ambivalence toward change in the context of writing-based interventions is lacking. Ambivalence toward change is a natural movement of approaching and avoiding change that may occur in various situations. In psychotherapy, its resolution is associated with successful outcomes.

Aim

This study tested the efficacy of a combination of expressive and positive writing paradigms in an internet-based intervention to improve university students' mental health. Additionally, focusing participants on a current, unresolved problem allowed us to explore the possible role of ambivalence toward change as a mediator of the intervention's results.

Methods

We recruited 172 participants who were randomly divided into experimental (n = 85) and control (n = 87) groups. The intervention consisted of the identification of a current problem and four writing tasks on consecutive days. Assessment was conducted at baseline and posttest in both groups and at follow-up in the experimental group. Participants in the experimental condition were also assessed after each task. Measures of anxiety, depression, rumination, ambivalence toward change, distress, and wellbeing (optimism, affect, and satisfaction with life) were collected.

Results

Multivariate analysis of variance (MANOVA) showed that participants in the experimental group had a significant decrease from baseline to posttest in ambivalence toward change and rumination when compared with the control group. These results were maintained at follow-up. No differences were found in the remaining measures. Within the experimental group, ambivalence toward change, rumination, and distress significantly decreased throughout the intervention and the exploratory mediation analysis indicated that ambivalence toward change partially mediated the improvements in rumination and distress.

Discussion

Considering different perspectives about a current problem and using a combination of expressive and positive writing fostered the reduction of ambivalence toward change and rumination. Ambivalence toward change reduction after the second writing task may have created optimal conditions for the subsequent decrease in rumination and distress. Future studies should replicate this finding and dismantle the components that are more adequate in changing these variables.

Self-Compassion and Reactions to a Recalled Exercise Lapse: The Moderating Role of Gender-Role Schemas

Exercise is good for health and well-being, yet people experience lapses when trying to adhere to exercise. Self-compassion may help people cope with exercise lapses. Most research on self-compassion and exercise has been conducted with women; men may also benefit from self-compassion. No research has examined whether gender-role schema influences responses to exercise lapses. The authors examined both male and female adult exercisers (N = 220) who reported their self-compassion, recalled an exercise lapse, their reactions to the lapse, and their self-identification of masculinity and femininity. After controlling for self-esteem, age, and lapse importance, self-compassion negatively related to emotional responses (p < .001), rumination (p < .001), extrinsic motivation (p = .004), and positively related to intrinsic motivation (p < .001). Masculinity moderated the relationships between self-compassion and amotivation (p = .006), and identified regulation (p = .01). Self-compassion may be an effective resource for exercisers, especially those who identify as highly masculine.

Narrative identity informs psychological adjustment: Considering three themes captured across five time points and two event valences

OBJECTIVES

How narrative identity and well-being are intertwined as emerging adults process their lived experiences remains a critical theoretical and empirical question. We studied narrative identity among US emerging adults in a multiphase study. We aimed to test (1) if and how narrative identity themes (i.e., coherence, agency, growth) change rapidly across repeated narrations; (2) are related to reports of psychological adjustment (i.e., well-being, recent stress) over time; and (3) whether the valence of the autobiographical event nuanced the ways narrative identity and adjustment co-evolve.

METHODS

In a mini-longitudinal study conducted over three months, 300 adults aged 18-to-29-years (M age = 24.39 years; 60% women) provided autobiographical narratives about high-point and low-point (LP) life events at five time points, as well as repeated reports on well-being and recent stress.

RESULTS

Overall, coherence showed (1) the most consistency across time and valence than other narrative themes and (2) the most consistent associations with adjustment. In multilevel models, LP coherence and LP growth coincided with higher levels of adjustment.

CONCLUSIONS

Findings reinforce the ways narrative identity reflects dynamic processes of understanding the events of one's life, and the ways individual differences in framing and reasoning about life are important for psychological adjustment.

Interpersonal Decentering and Interpersonal Problems: Testing the Multi-Method Utility of Person-Situation Interactions in Thematic Apperception Tests

Mature interpersonal decentering is a form of social cognitive role-taking involving reflective thought about one's interpersonal relationships. Previous research examining main effects for persons, card situation content, story content, and person-card interactions found more mature decentering in stories about heterosexual romantic-pull Thematic Apperception Test (TAT) cards (HRC) as compared with stories about nonromantic cards (NRC). To see whether differences in means corresponded to differential criterion validity, this multi-method study examined Inventory of Interpersonal Problems circumplex (IIP-C) scores associated with young adults' decentering maturity and deficits, comparing correlations with IIP-C scores of decentering scores calculated from HRC versus NRC. Similarly, to test the effect of story content, IIP-C scores were correlated with decentering scores calculated from stories having romantic versus nonromantic story content. Using circumplex statistical tests, decentering deficits were associated with domineering/vindictive interpersonal problems, and mature decentering with nonassertive/exploitable problems. Men who reported more exploitable problems decentered more maturely across all situations. Women who decentered more maturely in response to HRC reported more socially avoidant problems, whereas those who decentered more maturely to NRC reported more exploitable problems. Results for romantic versus nonromantic story content were largely uninterpretable (did not meet circumplexity assumption). Findings might assist clinicians' card selection.

Benefits of Expressive Writing on Healthcare Workers' Psychological Adjustment During the COVID-19 Pandemic

COVID-19 outbroke in Wuhan, China, in December 2019 and promptly became a pandemic worldwide, endangering health and life but also causing mild-to-severe psychological distress to lots of people, including healthcare workers (HCWs). Several studies have already showed a high prevalence of depression, anxiety, and post-traumatic symptoms in HCWs but less is known about the efficacy of psychological interventions for relieving their mental distress. The aims of this study were: (1) to evaluate the psychological adjustment of Italian HCWs during the COVID-19 pandemic; (2) to investigate the efficacy of an expressive writing (EW) intervention, based on Pennebaker's paradigmatic protocol, on their psychological adjustment; (3) to analyze if outcomes of EW vary in function of individual differences (age, gender, marital status, and baseline values of symptoms). Fifty-five HCWs were randomly assigned to one of two writing conditions: EW (n = 30) or neutral writing (NW; n = 25). Psychological adjustment (in terms of ptsd, depression and global psychopathology's symptoms, perceived social support, and resilience) was assessed before and after three writing sessions. Participants who received the EW intervention showed higher improvements in ptsd, depression, and global psychopathology symptoms. Improvements in EW group varied in function of age, gender, marital status, and baseline values: young, men, married participants and those who had higher baseline scores showed a higher reduction of psychological distress symptoms while women, single and those who had lower baseline value showed increased social support, and resilience. In conclusion, the EW intervention had positive effects which varied in function of individual differences on HCWs' psychological health.

Peeling Back the Layers: How Expressive Writing about Heterosexist Events Benefits Sexual Minority Adults

Expressive writing exercises, in which participants self-reflect upon a difficult experience, are widely researched interventions. These exercises have been adapted to address a host of concerns, including trauma, mental distress, physical health, and minority stress. Although several theories exist about the mechanisms through which expressive writing yields psychological benefits, the direct perspectives of those who have completed expressive writing exercise has remained unexplored. This study used grounded theory methods to analyze sexual minority adults' interviews about their experience of engaging in various formats of expressive writing exercises about personal heterosexist events. Participants described both what they found helpful and frustrating about the writing process and reflected on how their perspectives shifted throughout the process. These findings contribute to the literature on how change occurs in expressive writing and provide guidance on how to assist sexual minority adults in healing from heterosexism in their lives.

Prior disclosure and emotional expression: Interactive effects on post-traumatic stress disorder symptoms

Background Previous research has revealed mixed findings with regard to the effects of disclosure on trauma recovery. More recently, studies on psychological trauma have found associations among religion, meaning, and health. This study investigated prior disclosure as a moderator for the association between religious emotional expression and adaptive trauma processing, as measured by post-traumatic stress disorder (PTSD) symptoms. Methods Using Pennebaker's written emotional expression paradigm, 105 participants were assigned to either a conventional trauma-writing condition or religious trauma-writing condition. PTSD symptoms were assessed at baseline and again at one-month post writing. Results A two-way interaction was found between prior disclosure and writing condition on PTSD symptoms at follow-up. For the religious trauma-writing condition only, there was a significant difference between low versus high disclosure participants in PTSD symptoms at follow-up, such that low prior disclosure participants registered fewer PTSD symptoms than high prior disclosure participants, while prior disclosure did not have such effect in the conventional trauma-writing condition.

LIMITATIONS

This two-way interaction may be further qualified by other important psychosocial variables, such as differences in personality, coping style, social support, or use of prayer as a form of disclosure, which were not assessed in this study. Conclusion Religious emotional expression may encourage adaptive trauma processing, especially for individuals with low prior disclosure. These findings encourage further investigation of the conditions under which disclosure and religion may be a beneficial factor in trauma adaptation and treatment.

Physical and Psychological Benefits of Written Emotional Expression

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.

How effective are expressive writing interventions for adolescents? A meta-analytic review

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.

Randomised controlled trial of expressive writing and quality of life in men and women treated for colon or rectal cancer

OBJECTIVE

This randomised trial tested (i) whether a home-based expressive writing (EW) intervention improves quality of life in patients with colorectal cancer (CRC) and (ii) whether the intervention is more beneficial for men or for people who feel constrained in disclosing cancer-related concerns and feelings.

DESIGN

Patients treated for CRC were randomised to an EW (n = 101) or control writing (CW; n = 92) group. Assessments were completed at 1 month pre- and post-intervention. Sex and perceived social constraints on disclosure were evaluated as moderators.

MAIN OUTCOME MEASURES

Primary outcomes were depressive symptoms, sleep problems and quality of life indicators.

RESULTS

Eighty-one per cent of participants completed all writing assignments. Consistent with hypotheses, relative to the CW group, participants in the EW group expressed more negative emotion in writing and rated their writings as more meaningful, personal and emotionally revealing. There were no significant main effects of EW or moderating effects of sex or social constraints on outcomes.

CONCLUSIONS

Although EW is feasible to use with persons who have CRC, it was not effective as a stand-alone psychotherapeutic intervention. Neither was it more effective for men nor for people who felt they could not freely disclose cancer-related concerns and feelings.

Expressive writing promotes self-reported physical, social and psychological health among Chinese undergraduates

The present study examines the efficacy of expressive writing among Chinese undergraduates. The sample comprised of 74 undergraduates enrolled in a 9-week intervention (35 in experimental class vs. 39 in control class). The writing exercises were well-embedded in an elective course for the two classes. The 46-item simplified Chinese Self-Rated Health Measurement Scale, which assesses psychological, physical and social health, was adopted to measure the outcome of this study. Baseline (second week) and post-test (ninth week) scores were obtained during the classes. After the intervention on the eighth week, the self-reported psychological, social and physical health of the experimental class improved. Psychological health obtained the maximum degree of improvement, followed by social and physical health. Furthermore, female participants gained more psychological improvement than males. These results demonstrated that the expressive writing approach could improve the physical, social and psychological health of Chinese undergraduates, and the method can be applied in university psychological consulting settings in Mainland China.

Expressive talking among caregivers of hematopoietic stem cell transplant survivors: acceptability and concurrent subjective, objective, and physiologic indicators of emotion

This study sought to examine the effects of an expressive talking intervention for 58 caregiving partners of hematopoietic stem cell transplant survivors, persons known to experience distress. Caregivers were randomly assigned to a three-session emotional expression (EE) or control condition. Subjective, objective, and physiologic indicators of emotion were assessed. Relative to controls, EE participants experienced more negative emotion, uttered more negative emotion words, and perceived the exercises as more helpful and meaningful. The trajectory of skin conductance and the use of cognitive mechanism words increased across EE sessions, suggesting sustained emotional engagement. Future research is warranted to determine the optimal dose and timing of EE for this population.