Online writing about positive life experiences reduces depression and perceived stress reactivity in socially inhibited individuals

Writing to Keep on Living: A Systematic Review and Meta-Analysis on Creative Writing Therapy for the Management of Depression and Suicidal Ideation

PURPOSE OF REVIEW

The purpose of this review and meta-analysis was to explore the effectiveness of creative writing therapies for the management of depression and suicidal ideation.

RECENT FINDINGS

Twenty one of the 31 reviewed studies showed that creative writing significantly improved depressive symptoms, while five studies suggested improvement in other symptoms. The results of meta-analyses showed that narrative writing significantly reduced depression compared to those in neutral writing or treatment as usual condition in both post intervention and follow-up. However, the number of studies exploring the effects of creative writing in suicidal ideation was too low to perform a meta-analysis. A structured and well-targeted intervention using creative writing could have beneficial results for the management of depressive symptoms. More studies are needed to explore the potential benefits of creative writing for reducing suicidal ideation.

Waiting for a digital therapist: three challenges on the path to psychotherapy delivered by artificial intelligence

Growing demand for broadly accessible mental health care, together with the rapid development of new technologies, trigger discussions about the feasibility of psychotherapeutic interventions based on interactions with Conversational Artificial Intelligence (CAI). Many authors argue that while currently available CAI can be a useful supplement for human-delivered psychotherapy, it is not yet capable of delivering fully fledged psychotherapy on its own. The goal of this paper is to investigate what are the most important obstacles on our way to developing CAI systems capable of delivering psychotherapy in the future. To this end, we formulate and discuss three challenges central to this quest. Firstly, we might not be able to develop effective AI-based psychotherapy unless we deepen our understanding of what makes human-delivered psychotherapy effective. Secondly, assuming that it requires building a therapeutic relationship, it is not clear whether psychotherapy can be delivered by non-human agents. Thirdly, conducting psychotherapy might be a problem too complicated for narrow AI, i.e., AI proficient in dealing with only relatively simple and well-delineated tasks. If this is the case, we should not expect CAI to be capable of delivering fully-fledged psychotherapy until the so-called "general" or "human-like" AI is developed. While we believe that all these challenges can ultimately be overcome, we think that being mindful of them is crucial to ensure well-balanced and steady progress on our path to AI-based psychotherapy.

Exploring the use of AI text-to-image generation to downregulate negative emotions in an expressive writing application

Conventional writing therapies are versatile, accessible and easy to facilitate online, but often require participants to self-disclose traumatic experiences. To make expressive writing therapies safer for online, unsupervised environments, we explored the use of text-to-image generation as a means to downregulate negative emotions during a fictional writing exercise. We developed a writing tool, StoryWriter, that uses Generative Adversarial Network models to generate artwork from users' narratives in real time. These images were intended to positively distract users from their negative emotions throughout the writing task. In this paper, we report the outcomes of two user studies: Study 1 (N = 388), which experimentally examined the efficacy of this application via negative versus neutral emotion induction and image generation versus no image generation control groups; and Study 2 (N = 54), which qualitatively examined open-ended feedback. Our results are heterogeneous: both studies suggested that StoryWriter somewhat contributed to improved emotion outcomes for participants with pre-existing negative emotions, but users' open-ended responses indicated that these outcomes may be adversely modulated by the generated images, which could undermine the therapeutic benefits of the writing task itself.

Shouldering the load yet again: Black women's experiences of stress during COVID-19

Black women in the United States experience considerable amounts of stress, which has been exacerbated by the COVID-19 pandemic. Prior studies have linked stress to adverse mental and physical outcomes for Black women and, moreover, shown that Black women are more susceptible to maladaptive coping, which compounds these risks. Research on the Superwoman Schema and Sojourner's Syndrome, for instance, shows how Black women are compelled to portray strength and resilience while suffering internally and experiencing poor health outcomes. These phenomena can be attributed to the historical expectations of Black women to be pillars of their families and sources of strength despite adversity and persistent institutional discrimination. During the COVID-19 pandemic, Black women's greater likelihood of holding “essential worker” roles has further increased their risk of both COVID-19 exposure and heightened stress. Additionally, the COVID-19 pandemic has aggravated long standing structural inequities and disparities between Black women and other racial/ethnic groups. Drawing on journal entries submitted by Black women participating in the Pandemic Journaling Project (PJP), a combined online journaling platform and interdisciplinary research study, this paper illuminates the voices of Black women during the COVID-19 pandemic. Seventy-two Black women created journal entries using the PJP platform. We analyze the stories, idioms, and feelings they recorded during a global pandemic. We identify three prominent domains of stress: work and school, caregiving, and social (dis)connectedness. In addition to exploring manifestations of stress across these domains, we, discuss some of the mental health implications of COVID-19 and explore the potential for regular journaling as a possible mode of stress management among Black women.

The promotion of functional expected teaching-related emotions through expressive writing

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.

User experience and acceptance of patients and healthy adults testing a personalized self-management app for depression: A non-randomized mixed-methods feasibility study

Objective

Previous studies have shown positive treatment outcomes of e-mental health applications targeting depression. However, few applications provide personalized features. The aim of the present study is to ask for the user experience and acceptance of patients with depression and healthy adults, who tested the self-management app Self-administered Psycho Therapy SystemS over a period of 5 days. The results serve as a source for evidence-based recommendations for developers and clinicians.

Methods

A total of 110 participants (41 patients and 69 healthy controls) tested the app Self-administered Psycho Therapy SystemS over a period of 5 days and completed evaluation sheets developed for the purpose of this study. Quantitative measures were asked with 5-point Likert-scaled items (range: −2 to + 2) for the perceived quality of the programme and its components, its practicality (both referred to as user experience) and its acceptance. Student’s t-tests and Pearson correlations were calculated for group comparisons and associations, respectively. Open text fields were analysed by applying a qualitative structuring content analysis.

Results

The perceived quality of the total programme was rated with M = 0.96 (SD = 0.82), the practicality was M = 0.84 (SD = 0.08) and the acceptance was M = 0.25 (SD = 1.04). Patients rated perceived quality of the total programme and acceptance higher than healthy adults, while there was no difference in practicality. Acceptance was associated with increased depression scores (r = 0.33, p = .01), higher scores of perceived quality of the total programme (r = 0.48, p< .001) and of practicality (r = 0.45, p < .001). Feedback of both groups regarding usability, therapeutic content and personalization revealed a strong wish for guidance and insights into mood progress, opportunities for choice of interventions and features of customization for individualized treatment.

Conclusions

Patients with depression accepted the app Self-administered Psycho Therapy SystemS more than healthy adults and gave higher ratings in quality. User experience of all users shows a need for features of guidance, choice and personalization that clinicians and developers of future apps should pay attention to.

Writing Technique Across Psychotherapies-From Traditional Expressive Writing to New Positive Psychology Interventions: A Narrative Review

Writing Therapy (WT) is defined as a process of investigation about personal thoughts and feelings using the act of writing as an instrument, with the aim of promoting self-healing and personal growth. WT has been integrated in specific psychotherapies with the aim of treating specific mental disorders (PTSD, depression, etc.). More recently, WT has been included in several Positive Interventions (PI) as a useful tool to promote psychological well-being. This narrative review was conducted by searching on scientific databases and analyzing essential studies, academic books and journal articles where writing therapy was applied. The aim of this review is to describe and summarize the use of WT across various psychotherapies, from the traditional applications as expressive writing, or guided autobiography, to the phenomenological-existential approach (Logotherapy) and, more recently, to the use of WT within Acceptance and Commitment Therapy (ACT). Finally, the novel applications of writing techniques from a positive psychology perspective will be analyzed. Accordingly, the applications of WT for promoting forgiveness, gratitude, wisdom and other positive dimensions will be illustrated. The results of this review show that WT yield therapeutic effects on symptoms and distress, but it also promotes psychological well-being. The use of writing can be a standalone treatment or it can be easily integrated as supplement in other therapeutic approaches. This review might help clinician and counsellors to apply the simple instrument of writing to promote insight, healing and well-being in clients, according to their specific clinical needs and therapeutic goals.

Processing of Positive Memories Technique among Clients Reporting Traumatic Experiences: A Case Series

Many current treatments for posttraumatic stress disorder (PTSD) emphasize processing and engaging with trauma memories as the key mechanism of therapeutic change. However, promising emerging research indicates links between PTSD symptoms and positive memories. Processing positive memories, to therapeutically impact health outcomes for trauma-exposed individuals, may have several benefits, including (a) increasing access to positive coping mechanisms via activating positive affect and thoughts; (b) addressing avoidance of positive affect and thoughts; and (c) honing skills that will aid in the eventual processing of trauma memories. The present article demonstrates the utility and effects of a novel Processing of Positive Memories Technique (PPMT) with three clients who reported a history of traumatic experiences. We outline the procedures of a 5-session PPMT, that incorporates symptom assessment, detailed imaginal experiencing of positive memories, and processing of associated positive values, affect, strengths, and thoughts. We utilize longitudinal assessment data to demonstrate the clinical benefits of PPMT, such as less PTSD severity, improved mood (e.g., less negative affect), and greater self-esteem. Finally, we discuss treatment considerations based on unique client factors and treatment modalities (i.e., in-person vs. video telehealth).

Written benefit finding for improving psychological health during the Covid-19 pandemic first wave lockdown

Objectives. Written benefit finding is known to improve psychological and physical health in a range of patient groups. Here, we tested the efficacy of written benefit finding, delivered online during the Covid-19 pandemic lockdown, on mood and physical symptoms. We also investigated perseverative thinking as a moderator of these effects. Design. A quantitative longitudinal design was employed. Main Outcome Measures. Participants (n = 91) completed self-report measures of anxiety, depression, stress and physical symptoms at baseline, and two weeks after being randomised to complete three consecutive days of writing about the positive thoughts and feelings they experienced during the pandemic (written benefit finding) or to unemotively describe the events of the previous day (control). State anxiety was measured immediately before and after writing. Perseverative thinking was measured at baseline. Results. Anxiety and depression symptoms decreased between baseline and the two week follow-up, but did not differ significantly between the two conditions. Perseverative thinking was negatively associated with changes in symptoms of anxiety, depression and stress, but did not moderate any writing effects. There was a significant reduction in state anxiety in the written benefit finding condition. Conclusions. Written benefit finding may be a useful intervention for short-term improvements in wellbeing.

Positive memory intervention techniques: a scoping review

The scoping review examines and summarises the available knowledge base on intervention techniques focused on positive memories. An iterative series of PsycInfo and Medline searches was conducted up to April 2021 following PRISMA-ScR guidelines. Thirty-nine studies, spanning 12 intervention techniques, were selected and described including: (1) theoretical basis; (2) type of study, sample, and measures; (3) intervention protocol; and (4) results of empirical studies if applicable. Results indicated that most techniques have only been tested in one-two studies with modest sample sizes and, when follow-ups are conducted, they are typically short. Results indicate that working with positive memories has the greatest impact on improving positive affect and reducing depressive symptoms, and that these effects are often temporary. This review serves as a quick reference guide to help professionals' access to descriptions and information on empirical evidence of positive memory techniques, improving their therapeutic arsenal to enhance well-being and therapeutic outcomes in their patients.