Disclosure of traumas and immune function: Health implications for psychotherapy

Moving toward affective immunology: Legacy and future directions

The term "affective immunology" has recently been used to denote a field focused on the interplay between affective processes (including mood states, specific emotions, and regulatory processes) and various aspects of immune function. The overarching goals of this commentary are a) to provide historical underpinnings of this field with a focus on the profound impact of the work of Janice Kiecolt-Glaser, who is further honored in this special issue, b) to review important off-shoots of her legacy work in this domain, and c) to highlight important future directions for the field. Kiecolt-Glaser's work laid much of the foundation for affective immunology, with groundbreaking research related to depression, hostility and dyadic interactions, loneliness, and other affective patterns, often in the context of holistic models, novel experimental designs, and interventions. Her former mentees (and many of their mentees) have carried on her legacy in these domains, in ways that continue to advance appreciation of how affective processes relate to immune function. There are numerous remaining questions for the field to pursue, including better understanding of the role of emotion regulation, emotional reactivity and recovery, restorative processes, affective variability, and developmental and dynamic social processes. Such work will require greater use of longitudinal and within-person approaches and/or examination of processes in daily life, as well as models that account for interactive and reciprocal processes and which integrate behavior, social context, sociocultural factors, individual differences, and other aspects of health. As more work in these domains continues, building on Kiecolt-Glaser's rich legacy, we move toward the emergence of affective immunology as an important subfield in the domain of psychoneuroimmunology, one which will offer more nuanced understanding of the role of affective processes in immune health.

Investigating cognitive and motivational proximal outcomes in a randomized clinical trial of writing about the future self to reduce drinking

BACKGROUND

Drinking identity (the extent to which one links the self with drinking alcohol) is a unique risk factor for college students' hazardous drinking that is not directly targeted by existing interventions. We conducted a study that aimed to decrease drinking identity among college students with hazardous drinking. We adapted a writing task about the future self and tested whether three writing sessions could decrease drinking identity and change drinking. We also investigated whether two additional factors (writing perspective and inclusion of participants' social networks) would enhance task impact. The present study evaluated whether posited proximal cognitive and motivational outcomes (drinking identity, self-efficacy, readiness to change, and drinking intentions) changed immediately after each writing session.

METHOD

The study is a randomized clinical trial in which hypotheses and analyses were pre-registered. Participants were 328 college students who met hazardous drinking criteria. The study had a 2 (narrative writing topic: low-risk drinker vs. reduced smartphone use) × 2 (writing perspective: first-person vs. non-first-person) × 2 (social network instruction: instructed to include vs. not) factorial design. Proximal outcomes were drinking identity, self-efficacy, readiness to change, and drinking intentions. The clinical outcome was alcohol consumption. Participants completed three laboratory sessions at weekly intervals that included the writing task and pre- and post-task assessments.

RESULTS

Results were largely null, except that readiness to reduce drinking was higher in the low-risk drinker condition and increased over the lab sessions. Time effects indicated that reductions in drinking identity, drinking intentions, and alcohol consumption, and increases in self-efficacy were observed but did not change above and beyond control conditions.

CONCLUSIONS

Findings indicate the need to strengthen the writing task and select a more appropriate control task to target proposed proximal outcomes. Future studies might try personalizing the task, evaluating its efficacy with individuals motivated to change their drinking, and using a control task that does not involve imagining a future self.

Interdisciplinary approach to identify language markers for post-traumatic stress disorder using machine learning and deep learning

Post-traumatic stress disorder (PTSD) lacks clear biomarkers in clinical practice. Language as a potential diagnostic biomarker for PTSD is investigated in this study. We analyze an original cohort of 148 individuals exposed to the November 13, 2015, terrorist attacks in Paris. The interviews, conducted 5-11 months after the event, include individuals from similar socioeconomic backgrounds exposed to the same incident, responding to identical questions and using uniform PTSD measures. Using this dataset to collect nuanced insights that might be clinically relevant, we propose a three-step interdisciplinary methodology that integrates expertise from psychiatry, linguistics, and the Natural Language Processing (NLP) community to examine the relationship between language and PTSD. The first step assesses a clinical psychiatrist's ability to diagnose PTSD using interview transcription alone. The second step uses statistical analysis and machine learning models to create language features based on psycholinguistic hypotheses and evaluate their predictive strength. The third step is the application of a hypothesis-free deep learning approach to the classification of PTSD in our cohort. Results show that the clinical psychiatrist achieved a diagnosis of PTSD with an AUC of 0.72. This is comparable to a gold standard questionnaire (Area Under Curve (AUC) ≈ 0.80). The machine learning model achieved a diagnostic AUC of 0.69. The deep learning approach achieved an AUC of 0.64. An examination of model error informs our discussion. Importantly, the study controls for confounding factors, establishes associations between language and DSM-5 subsymptoms, and integrates automated methods with qualitative analysis. This study provides a direct and methodologically robust description of the relationship between PTSD and language. Our work lays the groundwork for advancing early and accurate diagnosis and using linguistic markers to assess the effectiveness of pharmacological treatments and psychotherapies.

Letter Writing as a Clinical Tool in Grief Psychotherapy

The benefits of expressive writing have been explored since at least the 1980s. The effect of expressive bereavement-related writing has been studied primarily in college students, yielding inconclusive results. Nonetheless, recent effective, integrated psychotherapy protocols, targeting complicated and prolonged grief, include writing assignments, typically in the form of letters. The present paper explores how and why letter writing might be effective and meaningful as a therapeutic tool in the context of grief psychotherapy. It describes how working with letters, addressed to the deceased, might help facilitate self-disclosure, promote exposure to what is avoided, confront unfinished business, encourage continuing bonds, and help achieve a coherent narrative around experiences with the loss. As a therapeutic tool, letter writing has the potential to be helpful to many bereaved people, as it is a simple, effective, and meaningful way to access and work with relevant clinical material in the context of psychotherapy.

Writing about the future self to shift drinking identity: An experimental investigation

College student drinking is prevalent and costly to public and personal health, leading to calls to identify and target novel mechanisms of behavior change. We aimed to manipulate drinking identity (a cognitive risk factor for hazardous drinking) via three sessions of narrative writing about a future self. We tested whether writing could shift drinking identity and would be accompanied by changes in alcohol consumption and problems. Participants were college students meeting hazardous drinking criteria (N = 328; Mage = 20.15; 59% women, 40% men, 1% gender-diverse; 60% white; 23% Asian; 12% multiple races; 2% other racial groups; 8% identified as Hispanic/Latino/a/x). The study had a 2 [narrative writing topic: low-risk drinker vs. reduced smartphone use] × 2 [writing perspective: first person vs. non-first-person] × 2 [social network instruction: instructed to include vs. not] factorial design. Outcomes were drinking identity, drinking refusal self-efficacy, alcohol consumption, alcohol-related problems, and craving. Participants completed three writing sessions and online follow-up assessments at 2, 4, and 12 weeks. The study is a registered clinical trial; hypotheses and analyses were preregistered (https://osf.io/vy2ep/). Contrary to predictions, narrative writing about a future self as a low-risk drinker did not significantly impact outcomes. Null results extended to expected interactions with writing perspective and social network instructions. The narrative writing task did not shift drinking or alcohol-related outcomes. Future experimental work may benefit from greater flexibility in conceptualizing a future self, recruiting individuals interested in behavior change, and more sensitive measures of drinking identity.

Exploring self-esteem during expressive writing about trauma predicts decreased depression in people with HIV

Self-esteem is often negatively impacted by trauma. Low self-esteem has been related to significantly worse depression in people with HIV (PWH). This study explores whether the expression of words related to self-esteem during a 4-session augmented trauma writing intervention predicted post-traumatic stress, depressive symptoms, and health outcomes 6-months later. Ninety-five PWH completed four 30-minute augmented trauma writing sessions in the intervention arm of a randomized controlled trial. One augmented session was devoted to self-esteem. Two individuals coded trauma essays for number of self-esteem words. CD4+ and viral load data were collected, and the Davidson PTSD Scale and the Hamilton Depression Rating Scale were administered at baseline, one-, and six-month follow-up. Greater total self-esteem words were related to lower depressive symptoms at 6-months, controlling for depressive symptoms at study entry, age, race, and education (t(80) = -2.235, ß = -0.239, SE = 0.283, p < 0.05, 95% CI [-1.195, -.069). Total self-esteem words were not predictive of PTSD, viral load, or CD4+ at 6-months. Exploring self-esteem when writing about and processing a traumatic event could be an important mechanism for decreasing depressive symptoms among PWH. Research is needed to test augmented expressive writing interventions that support efforts to bolster self-esteem in PWH.

Chasing elusive expressive writing effects: emotion-acceptance instructions and writer engagement improve outcomes

Introduction

Pennebaker's expressive writing (EW) paradigm in which participants are encouraged to explore their "deepest thoughts and feelings" about a difficult experience in several short writing sessions has yielded impressive mental health outcomes and holds great promise as a cost-effective intervention. Yet results have been difficult to replicate and it is unclear what conditions are necessary for observing the effect. Our aim was to discover reasons for the variability in EW outcomes. We explored the impact of augmenting writing instructions to encourage acceptance of emotional experience, which we thought would encourage engagement with writing; and we examined essay length, an index of writer engagement, as a possible moderator of writing outcomes.

Methods

We compared traditional expressive writing (tEW), conducted according to Pennebaker's paradigm in which participants write about a self-chosen emotional experience for 15 min at a time on each of three closely spaced days, with an acceptance-enhanced version (AEEW), identical except that it supplemented traditional instructions with encouragement of an accepting approach to emotional experience, and with a control condition which asked participants to write about their use of time on particular days. Self-reported depression was the outcome measure.

Results

Essay length (a proxy for writer engagement) moderated effects of writing at posttest 2 weeks later: Condition differences were found only for participants who wrote longer essays: For these participants the AEEW condition outperformed both control and tEW; and tEW did not differ significantly from control.

Conclusion

Findings suggest that degree of engagement in the writing process may partially explain the puzzle of variable outcomes in the EW literature. Results also provide practical guidance: those who are motivated to engage deeply in the writing process are most likely to benefit; and encouraging writers to accept and to openly explore emotional experience is expected to enhance benefits.

Grounding co-writing: An analysis of the theoretical basis of a new approach in mental health care

This contribution aims to highlight the theoretical and epistemological premises of the co-writing experience, a practice where a clinician and a patient are mutually engaged in jointly or collaboratively writing a narrative related to the patient's experience. Unlike a typical set of therapeutic techniques, co-writing is based on sharing perspectives and meanings about the experience of crisis, recovery, and the therapeutic process. The paper identifies and briefly describes four non-clinical epistemological paradigms on which it is grounded: ethnography, values-based practice, narrative care, and phenomenology. Although they differ in several ways, at the same time, they seem to share some common features that the paper investigates and comments. For clinicians, nurses, researchers and Mental Health Service managers, attention to the users and to the improvement of their active roles represents not only a strategy for the empowerment of results, but also the access door to a different perspective which relies on a renewed conceptualization of the mental disease nature that may lead to overcoming the epistemic asymmetry between the 'expert' and the 'other' in favor of intersubjective dialogue.

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.

Facilitating connection to enhance college student well-being: Evaluation of an experiential group program

This randomized controlled trial examined the impact of The Connection Project, an experiential, relationship-focused intervention designed to improve school belongingness and decrease symptoms of depression and loneliness among new college students. Participants were 438 first-year and transfer students (232 treatment, 206 waitlist-control) at a medium-sized, 4years, predominantly White public university in the Southeastern United States. At postintervention, the treatment group reported significant relative increases in school belonging and significant relative reductions in levels of loneliness and depressive symptoms in comparison to waitlist-controls. Program effects were stronger for students from marginalized racial or ethnic backgrounds, students from lower socioeconomic status households, and transfer students. Results are interpreted as suggesting the utility of experiential, peer-support prevention programming to promote college students' well-being, particularly college students who hold identities that are traditionally disadvantaged in this context.

Reflect on emotional events from an observer's perspective: a meta-analysis of experimental studies

Self-distancing has been proposed as an emotion regulation strategy to reduce the duration and intensity of emotions. This meta-analysis synthesised 48 studies and 102 effect sizes examining the effects of self-distancing on emotion regulation. The results showed an overall significant, small effect of self-distancing in attenuating emotional responses (Hedges' g = -0.26, 95%CI: [-0.36, -0.15]). Moderator analyses highlighted the efficacy of one intervention feature: approach. Stronger effect was associated with the visual and verbal approach to process emotional events, in comparison to the visual only approach and the pronouns approach. The effectiveness of self-distancing was consistent across other intervention features (context, stimuli, time, emotional outcome) and individual characteristics (emotional vulnerability, age, culture). These findings suggest that self-distancing is effective in emotion regulation when people externalise and articulate thoughts through writing and talking. Practical implications were discussed in relation to the design of interventions to enhance emotional well-being.

Caring for Carers (C4C): Results from a feasibility randomised controlled trial of positive written disclosure for older adult carers of people with psychosis

Background

Older adult carers of people who experience psychosis are at increased risk of developing physical and mental health problems due to the compounding factors of supporting their care-recipient and the health changes associated with ageing. Effective interventions exist but can be difficult to access and maintain prolonged engagement. Self-directed writing therapies, frequently referred to as Written Emotional Disclosure (WED), might be a suitable alternative intervention to improve the wellbeing of carers.

Methods

This study aimed to determine the feasibility (recruitment, retention and primary outcome completion) and acceptability of a specific WED intervention known as Positive Written Disclosure (PWD). Informal carers of people with psychosis were randomised to PWD, neutral writing or no writing. Quantitative outcomes including positive and negative affect, carer wellbeing, quality of life, depression, anxiety, stress, self-efficacy, leisure time satisfaction as well as health care utilisation were collected at baseline, 1-, 3-, and 6-month assessments. Qualitative feedback was also collected via questionnaire and semi-structured interviews from those randomised to either writing group.

Results

We successfully met our progression criteria, recruiting to target and within timeframes whilst attaining 97% retention and 84% primary outcome data completed at 6 months. Carers randomised to the positive writing group described the intervention as enabling them to have a more positive attitude and focus on activities for themselves. Both writing groups described their tasks as providing distraction from caring responsibilities. However, some carers found the narrow positive emotion focus challenging.

Conclusions

PWD is a feasible and acceptable intervention for older adult carers of people with psychosis within a community setting. Further refinement of the writing protocol to include choice in type of emotion disclosed in addition to screening for some level of need may be required in future trials to reduce floor/ceiling effects of outcomes which may explain the lack of change observed.

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

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, η_p² = 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, η_p² = 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).

Validación cognitiva de un protocolo instruccional de reexperimentación emocional en adultos víctimas de violencia política en Colombia

La reexperimentación emocional (re) permite dar sentido a hechos traumáticos o estresantes mediante un proceso dirigido por instrucciones verbales o escritas, y por ello puede generar beneficios en el bienestar psicológico y la salud física autoinformada. El objetivo del presente estudio fue evaluar la comprensión de tres tipos de instrucciones experimentales (re tradicional, re con claves de aceptación y compromiso, y re psicosocial) y una instrucción para el grupo control (re trivial), mediante técnicas de validación cognitiva (pruebas centradas en el significado y verbalización de pensamiento) en personas expuestas a hechos de violencia política en Colombia. Para ello, se desarrolló un estudio de tipo cualitativo con corte instrumental, en el que se entrevistó a 42 colombianos víctimas de violencia política, en su mayoría mujeres, elegidos con un muestro por conveniencia. Las entrevistas fueron transcritas y codificadas mediante un análisis categorial mixto que tomó como referente procedimientos del Movimiento de Aspectos Cognitivos de la Metodología de Encuestas. Como resultado, los participantes comprendieron de manera diferencial las instrucciones dadas en cada protocolo, enfocándose en aspectos como el contexto sociopolítico en el caso del protocolo psicosocial, y en respuestas asociadas a la aceptación en el protocolo con claves de aceptación y compromiso. Se identificaron dificultades en la comprensión de algunas secciones de los protocolos, las cuales fueron ajustadas. Finalmente, se enfatiza la importancia de implementar técnicas de validación cognitiva para verificar la comprensión de instrucciones, protocolos o instrumentos, dado que el desempeño de los participantes y la calidad de las medidas de las intervenciones pueden verse afectados por la comprensión e interpretación de las instrucciones propuestas.

Gender differences in the physiological effects of emotional regulation

Previous research has established that emotional regulation impacts our health; emotional expression is associated with a host of psychological and physiological benefits whereas emotional suppression has negative health consequences. Given that emotional-display rules restrict the range of emotion that men feel comfortable expressing, we hypothesized that gender might moderate the health outcomes associated with emotional regulation strategies. In a laboratory experiment, we instructed participants to either suppress or express their feelings in an interview with a researcher about a film they had watched. These participants provided saliva samples at four different points during the procedure for the later determination of cortisol. A Mixed Model ANOVA revealed that participant gender moderated the effect of emotional regulation strategy on cortisol. Contrary to the health consequences typically associated with emotional regulation strategies, men benefited more from emotional suppression than they did from emotional expression. These findings have important implications for future research and clinical work.

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.

Toward Linguistic Recognition of Generalized Anxiety Disorder

Background

Generalized anxiety disorder (GAD) refers to extreme, uncontrollable, and persistent worry and anxiety. The disorder is known to affect the social functioning and well-being of millions of people, but despite its prevalence and burden to society, it has proven difficult to identify unique behavioral markers. Interestingly, the worrying behavior observed in GAD is argued to stem from a verbal linguistic process. Therefore, the aim of the present study was to investigate if GAD can be predicted from the language people use to put their anxious worries into words. Given the importance of avoidance sensitivity (a higher likelihood to respond anxiously to novel or unexpected triggers) in GAD, this study also explored if prediction accuracy increases when individual differences in behavioral avoidance and approach sensitivity are taken into account.

Method

An expressive writing exercise was used to explore whether GAD can be predicted from linguistic characteristics of written narratives. Specifically, 144 undergraduate student participants were asked to recall an anxious experience during their university life, and describe this experience in written form. Clinically validated behavioral measures for GAD and self-reported sensitivity in behavioral avoidance/inhibition (BIS) and behavioral approach (BAS), were collected. A set of classification experiments was performed to evaluate GAD predictability based on linguistic features, BIS/BAS scores, and a concatenation of the two.

Results

The classification results show that GAD can, indeed, be successfully predicted from anxiety-focused written narratives. Prediction accuracy increased when differences in BIS and BAS were included, which suggests that, under those conditions, negatively valenced emotion words and words relating to social processes could be sufficient for recognition of GAD.

Conclusions

Undergraduate students with a high GAD score can be identified based on their written recollection of an anxious experience during university life. This insight is an important first step toward development of text-based digital health applications and technologies aimed at remote screening for GAD. Future work should investigate the extent to which these results uniquely apply to university campus populations or generalize to other demographics.

Effects of Priming Discriminated Experiences on Emotion Recognition Among Asian Americans

This study explored the priming effects of discriminated experiences on emotion recognition accuracy of Asian Americans. We hypothesized that when Asian Americans were reminded of discriminated experiences due to their race, they would detect subtle negative emotional expressions on White faces more accurately than would Asian Americans who were primed with a neutral topic. This priming effect was not expected to emerge in detecting negative facial expressions on Asian faces. To test this hypothesis, 108 participants were randomly assigned to one of two conditions: write about their experiences with racial discrimination (experimental) or write about a neutral topic (control). Then, they were given an emotion recognition test consisting of White and Asian faces. The current study found a significant interaction effect of priming condition by target race. When Asian Americans were reminded of discriminated experiences, they displayed heightened sensitivity to negative emotional expressions on White faces, but not to the negative expressions on Asian faces. The implications of these findings were discussed.

Does Social Pension Expansion Relieve Depression and Decrease Medical Costs? Evidence From the Rural Elderly in China

Objectives: This study was designed to explore the effect of the New Rural Pension Scheme on depressive symptoms or medical costs induced by depression.

Methods: We used the Logit, OLS and 2SLS models to explore the impact of the pension on depression and medical costs. We also adopt the method of quantile regression and discontinuity regression to verify the causal relationship between the New Rural Pension Scheme and depression or medical costs induced by depression of the rural elderly.

Results: We have found that the New Rural Pension Scheme decreases depressive symptoms of elderly in rural China (OR = 0.90), and the medical costs induced by depressive symptoms by 4.6%. Regression discontinuity results showed that pension significantly reduced the depressive symptoms (depression) and the medical expenditure caused by depressive symptoms (depression) by using parametric and non-parametric methods, and performing a placebo test. The mediating effect results showed that pension may improve mental health by increasing confidence about the future.

Conclusion: We demonstrate that the pension significantly decreased both mental health problems and the medical expenses due to depressive symptoms and depression of elderly in rural China. Therefore, our results suggest that the Chinese government should perfect the New Rural Pension Scheme to eliminate barriers to mental health resources, especially for the rural elderly.

Pilot Randomized Trial of an Expressive Writing Intervention to Reduce Sexual HIV-Transmission Risk and Substance Use Among Emerging Adult Gay and Bisexual Men

This pilot randomized controlled trial evaluated the feasibility, acceptability, and preliminary efficacy of expressive writing to reduce HIV-related sexual risk taking and symptoms of drug dependence among emerging adult gay and bisexual men (EAGBM) through linguistic mechanisms involving use of words associated with cognitive processing (e.g., think, cause), positive emotion (e.g., love, nice), and negative emotion (e.g., hurt, shame). Between 2014 and 2015, EAGBM (n = 78; aged 18-29) completed a baseline survey and were randomized to complete three 15-min expressive writing or equivalent control-group writing sessions and follow-up assessments 2 months post-baseline. EAGBM in the expressive writing condition utilized significantly more positive emotion, negative emotion, and cognitive processing words. Path model results indicated the intervention condition resulted in significant reductions in symptoms of drug dependence and frequency of condomless anal sex (CAS) through paths mediated by positive emotion words, and significant increases in CAS through a path mediated by negative emotion words.

RANDOMIZED EVALUATION OF AN INTERVENTION TO ENHANCE A SENSE OF BELONGINGNESS AMONG ENTERING COLLEGE STUDENTS

This study examined an intervention designed to improve sense of belongingness for new students at a medium-sized, four-year, public university in the Eastern United States. A randomized controlled trial was used to assess the impact of The Connection Project, a novel, 9-session intervention in a sample of 128 first-year students (77 treatment, 48 waitlist control). Given the onset of COVID-19, students received a hybrid in-person/online intervention. At post-intervention, the intervention group reported a significantly higher sense of school belongingness, after accounting for baseline levels, than control group students. Post-hoc analyses of moderation by demographic variables indicate that the intervention functioned similarly for students from a variety of backgrounds in this sample. These results are interpreted as suggesting the potential value of this intervention to promote a sense of community and connection among new students in college, whether delivered in-person or online.

Caring for the Animal Caregiver-Occupational Health, Human-Animal Bond and Compassion Fatigue

Laboratory Animal Professionals experience many positive and rewarding interactions when caring for and working with research animals. However, these professionals also may experience conflicting feelings and exhaustion when the work is stressful due to factors such as limited resources, making end of life decisions, dealing with conflicting priorities, and negotiating animal care priorities with colleagues. These stresses may be further complicated by each individual's self-understanding and emotional investment in the human-animal bond. The term used for this type of complex emotional conflict and exhaustion is Compassion Fatigue. Compassion Fatigue in the Laboratory Animal Science setting is a combination of physical, emotional and psychological depletion associated with working with and caring for animals and their well-being in a research environment. The University of Washington has developed a Compassion in Science Program called Dare2Care which emphasizes self-care and helps Laboratory Animal Professionals identify stress factors and work toward a personal solution to relieve stress. The first step in developing a resiliency program is to assess the current culture and needs of the organization. At an institutional level we identified that we needed increased communication concerning study endpoints, as well as identified individuals with whom affected personnel can talk about personal concerns. We also implemented community events to reflect on the positive aspects of this field of work. We improved the physical work environment, and provided outlets established for personnel to express feelings via written word or artistically. Lastly, we started working with our Center for One Health to encompass a holisitic approach to the occupational health of our animal caregivers. One health is the relationship and interplay between people, animals and the environment and we needed to include emotional well-being in our assessment of the health of our personnel. A question was added to our occupational health screening form to include additional health or workplace concerns (e.g., Compassion Fatigue) not covered by the questionnaire, and we added a component of Compassion Fatigue awareness in our training program. Here we review the importance of identifying Compassion Fatigue in the animal research setting, focus on developing a compassion resiliency culture and provide tools and coping strategies to validate and strengthen the human-animal bond with research animals and to sustain the care that is necessary for both people and research animals.

Sexual Victimization Disclosure: A Cluster Analysis Approach to Understanding Victimization Experiences in Disclosers and Non-Disclosers

Research has used cluster analysis to identify clusters, or groups, of sexual victimization survivors who share similar assault experiences. However, researchers have not investigated whether disclosure status is a key component of the survivors' experience. The current study identified two clusters among 174 disclosing and non-disclosing sexual victimization survivors. Cluster One (n = 74) included an incapacitated assault by a lesser-known perpetrator and disclosure of the event. Cluster Two (n = 100) included a verbally instigated assault by a well-known perpetrator and nondisclosure of the event. Follow up independent t-tests revealed that women in Cluster One had significantly higher depression and posttraumatic stress disorder (PTSD) symptoms than women in Cluster Two. Results support prior research identifying clusters of victimization based on assault characteristics and suggest that disclosure status is a key variable in the recovery process. Specific implications for clinicians, policy makers, and the community are discussed.

A Social Psychological Toolbox for Clinical Psychology

Abstract. Translational science involves the fruitful interplay between basic research paradigms and related fields of application. One promising candidate for such synergy is the relationship between social and clinical psychology. Although the relation is principally bi-directional, such that either discipline can take the role of the basic and the applied science, we take the perspective of transfer from basic social and cognitive social psychology to applications in the clinical realm. Starting from a historical sketch of some of the earliest topics in the interface of both disciplines, we first come to conclude that truly integrative co-theorizing is conspicuously missing. Then, however, we recognize the strong potential for productive collaboration at the pragmatic level of an adaptive research toolbox containing approved methods and compact theoretical tools that carry over between disciplines. We outline the notion of a generic, provisional toolbox as distinguished from a fixed repertoire of established standard procedures. We provide examples of two subsets of tools, methods and logical principles required proper diagnostic reasoning, and theoretically founded influence tools that can enrich the repertoire of therapeutic interventions. Rather than propagating a normatively prescriptive toolbox, we interpret translational science as a pluralistic endeavor, such that different clinicians complete their personalized toolboxes in manifold ways.

Environmental Considerations for Effective Telehealth Encounters: A Narrative Review and Implications for Best Practice

Background: Due to the reduction in-person visits, the COVID-19 pandemic has led to expansions in the use of telehealth technology to provide patient care, yet clinicians lack evidence-based guidance on how to most effectively use video communication to enhance patient experience and outcomes. Methods: A narrative review was conducted to describe environmental factors derived from research in social psychology and human-computer interaction (HCI) that may guide effective video-based clinician-patient telehealth communication. Results: Factors such as nonverbal cues, spatial proximity, professionalism cues, and ambient features play an important role in patient experience. We present a visual typology of telehealth backgrounds to inform clinical practice and guide future research. Discussion: A growing body of empirical evidence indicates that environmental cues may play an essential role in establishing psychological safety, improving patient experience, and supporting clinical efficacy in these virtual experiences. Conclusion: The expanded use of telehealth visits suggests the need for further research on the relative effects of these environmental factors on patient experience and outcomes.

The Fort McMurray Mommy Baby Study: A Protocol to Reduce Maternal Stress Due to the 2016 Fort McMurray Wood Buffalo, Alberta, Canada Wildfire

Introduction: Data show that maternal stress triggered by exposure to a natural disaster before, during or just after pregnancy is associated with adverse pregnancy and newborn outcomes. In this paper, the first aim is to describe our efforts to test a simple, low-cost intervention to large numbers of women following a major natural disaster. The second aim is to outline the challenges faced and lessons learned during the execution of this natural disaster study. Methods: The setting was the May 2016 Fort McMurray Wood Buffalo wildfire in northern Alberta, Canada. Women who were pregnant or preconception at the time of the disaster were invited to participate via social media. This prospective cohort study included a randomized controlled trial to test the effectiveness of an expressive writing intervention on the levels of prenatal maternal stress and maternal, birth, and early childhood outcomes. At recruitment and at multiple timepoints postpartum, a battery of questionnaires was administered to evaluate objective and subjective stress exposure to the fire as well as maternal mental health, resilience and its contributing factors as well as infant developmental milestones. Qualitative content analysis of the expressive writing was conducted. Discussion: There is an increasing need to develop effective, wide-spread, rapid, and low-cost interventions to reduce prenatal maternal stress, increase resilience, and improve pregnancy outcomes following a natural disaster. Though analysis of data is ongoing, we highlight the strengths of this study which include strong community participation, rapid recruitment of eligible participants, low-cost intervention and data acquisition, and successful testing of the intervention. We acknowledge the challenges we encountered including the high rate of participant disqualifications or losses due to incomplete collection of online data; evacuation, dispersal, and inconsistent return to homes; and the high levels of stress accumulated post-disaster which led to inability to complete the study. Despite potential challenges, there remains a need for such research amid natural disasters.

Fatigue influence on inhibitory control: Cardiovascular and performance findings elucidate the role of restraint intensity

Various papers have detailed an analysis of behavioral restraint that provides suggestions regarding fatigue influence on inhibitory control. A well-known limited resource model by Baumeister suggests that fatigue should directly impair it. By contrast, the behavioral restraint analysis suggests-first-that fatigue might affect control indirectly by impacting the intensity of restraint. Second, fatigue should impair control consistently only when it leads people to withhold restraint effort. We evaluated these suggestions in an experiment that presented participants a task designed to induce low- or high- mental fatigue and then challenged them to maintain a neutral facial expression while watching a more- or less emotionally evocative film clip. As expected, cardiovascular assessments during the facial restraint period revealed interactional response patterns indicative of opposing fatigue influence on restraint intensity under low- as compared to high-evocativeness conditions. Also as expected, fatigue combined with evocativeness to produce a three versus one pattern of inhibitory control operationalized in terms of the duration of non-neutral facial displays. Control failure increased with evocativeness only when fatigue was high and increased with fatigue only when evocativeness was high. Findings support the restraint analysis suggestions, extend results from previous research, and bear out the promise of the restraint analysis for advancing understanding of inhibitory control.

The Connection Project: Changing the peer environment to improve outcomes for marginalized adolescents

This study evaluated a school-based intervention to enhance adolescent peer relationships and improve functional outcomes, building upon Ed Zigler's seminal contribution in recognizing the potential of academic contexts to enhance social and emotional development. Adolescents (N = 610) primarily from economically or racially/ethnically marginalized groups were assessed preintervention, postintervention, and at 4-month follow-up in a randomized controlled trial. At program completion, intervention participants reported significantly increased quality of peer relationships; by 4-month follow-up, this increased quality was also observable by peers outside of the program, and program participants also displayed higher levels of academic engagement and lower levels of depressive symptoms. These latter effects appear to have potentially been mediated via participants' increased use of social support. The potential of the Connection Project intervention specifically, and of broader efforts to activate adolescent peer relationships as potent sources of social support and growth more generally within the secondary school context, is discussed.

Feasibility and pilot study of a brief self-compassion intervention addressing body image distress in breast cancer survivors

BACKGROUND

The majority of breast cancer survivors (BCSs) experience body image concerns following treatment. Body Image distress (BID) is associated with psychological distress and diminished quality of life. A web-based self-compassion focused writing activity (My Changed Body - MyCB) reduces BID in BCSs, yet limited research exists on participant characteristics associated with such intervention adherence. Self-compassion-based meditations are also efficacious in reducing BID in non-BCS populations. This parallel, double-blind pilot randomised controlled trial aimed to assess the feasibility and acceptability of MyCB, with and without an additional meditation component, on BID and related psychological outcomes in BCSs. The trial was registered with the Australian and New Zealand Clinical Trials Registry (#ACTRN12619001693112).

METHODS

BCSs were randomly allocated to MyCB (n = 39), MyCB + Meditation (MyCB + M) (n = 17) or an expressive writing (EW) active control arm (n = 23). The primary outcome was BID. Secondary outcomes were body appreciation, affect (positive and negative), psychological distress (depression, anxiety and stress) and self-compassion (state and trait). Assessments were completed online at baseline, post-intervention and 1-month.

RESULTS

Adherence to the MyCB writing (45%) and meditation (50%) was modest, and acceptability was high for both MyCB and MyCB + M. Intent to treat linear mixed model analyses indicated: Post-intervention - state self-compassion and positive affect increased for MyCB compared to EW; 1-month: BID scores decreased across all conditions; trait self-compassion increased and anxiety decreased for MyCB + M compared to MyCB and EW.

CONCLUSION

These findings provide preliminary evidence for the efficacy and potential clinical use of the MyCB brief web-based self-compassion intervention alone and with the addition of meditation, to increase self-compassion and psychological wellbeing in BCSs.

Lessons in Stories: Why Narrative Medicine Has a Role in Pediatric Palliative Care Training

Narrative medicine is introduced and explored as a potential tool for developing competency in medical training, including reduction of burnout, sustaining empathy, and allowing for reflective practice. Developing cultural humility, communication skills, ethics, community building, and advocacy are also reviewed as domains that may be bolstered by training in narrative. Applications specific to pediatric palliative care are suggested, along with avenues for further research.

Psychological Bases of Symptom Reporting: Perceptual and Emotional Aspects of Chemical Sensitivity

The reporting of physical symptoms is influenced to a large degree by psychological processes. Individuals are more likely to notice subtle sensations in environments lacking in stimulation than those demanding external attention. The beliefs or schemas that people hold dictate where and how they attend to their bodies as well. These normal perceptual processes help explain why people are of ten poor at accurately detecting internal physiological activity. Several individual differences are also related to the symptom reporting process. Females are more likely to base their symptom reports on external situational cues than are males. In addition, individuals with chronic anxiety those high in Negative Affectivity (NA) report more symptoms than those low in NA. Finally, individuals who have had traumatic experiences, either in childhood or within 16 months prior to a major symptom reporting episode, tend to be high symptom reporters. Several recommendations are made to help researchers and clinicians distinguish between psychological or perceptual factors with presumed biological effects. One implication of this work is that MCS and allied syndromes should be viewed as both a mental and a physical health problem.

The Event-Specific Benefits of Writing About a Difficult Life Experience

Previous research demonstrates that writing about life's difficult moments benefits the writer cognitively and emotionally. However, it is unclear whether the benefits of writing are specific to the event written about or whether the benefits are global. This study was designed to address this issue. Participants were 120 undergraduate students who had experienced at least two difficult life events. Participants were randomly assigned into experimental and control groups. Experimental participants wrote about one of these difficult events and control participants wrote about an interesting life event of their choosing. Experimental participants reported their positive and negative emotions as well as their cognitive avoidance and intrusion concerning the event written about and another event not written about. Control participants reported their emotions and cognitions concerning two difficult life events. All participants also reported their general distress. These assessments were done immediately after writing and one week later. The results indicated that experimental participants were emotionally stronger, less upset, and less cognitively avoidant about the particular difficult life event they wrote about compared to an event they did not write about. Similar comparisons between ratings of a written-about and a not-written-about event were not significant for passion, fear, and cognitive intrusion. There was evidence for a possible indirect effect of writing on general distress through changes in event-specific cognitions and emotions. Discussion of these results focuses on how writing may specifically help change a writer's feelings and thoughts about a particular situation.

Mapping gender transition sentiment patterns via social media data: toward decreasing transgender mental health disparities

Objective

Transgender people face substantial mental health disparities, and this population’s emotional well-being can be particularly volatile during gender transition. Understanding gender transition sentiment patterns can positively impact transgender people by enabling them to anticipate, and put support in place for, particularly difficult time periods. Yet, tracking sentiment over time throughout gender transition is challenging using traditional research methods. This study’s objective was to use social media data to understand average gender transition sentiment patterns.

Materials and Methods

Computational sentiment analysis and statistics were used to analyze 41 066 posts from 240 Tumblr transition blogs (online spaces where transgender people document gender transitions) to understand sentiment patterns over time and quantify relationships between transgender identity disclosures, sentiment, and social support.

Results

Findings suggest that sentiment increases over time on average throughout gender transition, particularly when people receive supportive responses to transgender identity disclosures. However, after disclosures to family members, people experienced temporary increased negative sentiment, followed by increased positive sentiment in the long term. After transgender identity disclosures on Facebook, an important means of mass disclosure, those with supportive networks experienced increased positive sentiment.

Conclusions

With foreknowledge of sentiment patterns likely to occur during gender transition, transgender people and their mental healthcare professionals can prepare with proper support in place throughout the gender transition process. Social media are a novel data source for understanding transgender people’s sentiment patterns, which can help reduce mental health disparities for this marginalized population during a particularly difficult time.

Why Do Women Talk About It? Reasons for Disclosure of Sexual Victimization and Associated Symptomology

Many sexual victimization survivors disclose their experience; however, there is limited research investigating why women disclose this experience and how reasons relate to psychopathology. The current online study aims to further understand the experiences of 142 female survivors (aged 18-29 years) by identifying their reason for disclosure and investigating how reasons relate to self-reported depression and post-traumatic stress disorder (PTSD) symptomology. Qualitative analyses identified two reasons: intentional and elicited disclosures. Hierarchical linear regressions revealed that elicited disclosures were associated with higher PTSD symptomology than intentional disclosures above and beyond relevant covariates, suggesting that disclosure reason is an important factor in the recovery process.

Separation, self‐disclosure, and social evaluation anxiety as facets of trait social anxiety

In the current article, we propose an expansion of the trait anxiety concept to include interpersonal or social facets of trait anxiety involving separation from significant others and disclosing aspects of the self to others, as a supplement to the existing focus on social evaluation anxiety. Participants in three studies completed a modified version of the Endler Multidimensional Anxiety Scales that included a measure of trait social evaluation anxiety, as well as new measures of trait separation anxiety and trait self‐disclosure anxiety (i.e., three measures of trait social anxiety). Results showed that the social evaluation, separation, and self‐disclosure trait anxiety scales have strong psychometric properties and that they represent distinct but related components of trait anxiety. With respect to validity, the facets of trait social anxiety were predictive of related variables including self‐concealment, anxiety sensitivity, and trait worry. The theoretical and practical implications of a multifaceted approach to trait social anxiety are discussed in terms of an expanded multidimensional interaction model of anxiety. Copyright © 2002 John Wiley & Sons, Ltd.

Real-Time Psychophysiological and Writing Correlates of Expressive Writing

Concealing memories and emotions associated with a traumatic event seems to have negative effects on health. Re-enacting those events through writing is an opportunity to disclose such memories and emotions, and especially for emotion regulation. To study this, 57 university students were randomly assigned to one of two groups. They either completed an expressive writing or a neutral writing task. Real-time writing and psychophysiological data were recorded throughout the experiment to examine writing dynamics associated with emotion regulation and its psychophysiological correlates (electrodermal activity and electrocardiography measures). The results showed that the expressive group (EG) paused for longer than the control group (CG) denoting a positive and medium effect size ( η p 2 = .10 ) . Furthermore, during and after writing, the EG showed a higher low frequency/high frequency ratio than the CG, evidencing a positive and large effect size ( η p 2 = .22 ) . These real-time findings are interpreted as signs of emotion regulation happening during writing.

Linguistic Markers of the Emotion Elaboration Surrounding the Confinement Period in the Italian Epicenter of COVID-19 Outbreak

The expressive writing method has rarely been proposed in contexts of large-scale upheavals that affect large populations. In this study this method was applied as an intervention and tool of investigation during the confinement period in the Lombardy region, the Italian Epicenter of COVID-19 outbreak. Sixty-four participants took part in an online expressive writing project, and a total of 167 writings were collected together with some self-report evaluations on emotions and physical sensations. A linguistic analysis through two different sets of computerized linguistic measures was conducted on the collected writings in order to study the linguistic markers of emotion regulation and elaboration. Results indicated that online expressive writing has helped respondents to get more in touch with the intense emotions that were experienced following the upheavals they witnessed. Writing even only once or twice helped, particularly those respondents who had at least one COVID-19 patient among close friends or relatives. Their writings showed an intense emotional involvement together with the ability to reflect and reorganize the personal meaning of the events and emotions experienced. This study shows that expressive writing can be used in the context of a psychological emergency, both as a powerful instrument to investigate and detect the complex psychodynamic processes underpinning the distress, and as a useful intervention to reduce the negative impact of traumatic events.

Characterizing the choice to disclose nonsuicidal self-injury

OBJECTIVE

Despite nonsuicidal self-injury (NSSI) being a prevalent and problematic behavior, only approximately half of those who engage in NSSI disclose their behavior. Yet, limited research has explored the choice to disclose. This study sought to identify if NSSI characteristics, emotional distress, and perceived interpersonal obstacles discriminated between NSSI disclosure status. Exploratory aims also investigated reasons for one's disclosure decision and disclosure contextual factors.

METHOD

Participants included 977 undergraduate students (83% female) with a lifetime history of NSSI.

RESULTS

Greater NSSI intrapersonal functions, suicide risk, and significant other support, and lower depression symptoms were associated with NSSI disclosure. Exploratory results highlight perceptions of one's NSSI severity and desire to receive support in disclosure choice; intrapersonal functions and peer support were associated with the timing of disclosure.

CONCLUSIONS

Findings underscore the potential importance of individual attitudes toward NSSI, in addition to traditionally measured risk factors, as potential drivers in NSSI disclosure.

Can high quality listening predict lower speakers' prejudiced attitudes?

Theorizing from humanistic and motivational literatures suggests attitude change may occur because high quality listening facilitates the insight needed to explore and integrate potentially threatening information relevant to the self. By extension, self-insight may enable attitude change as a result of conversations about prejudice. We tested whether high quality listening would predict attitudes related to speakers' prejudices and whether self-insight would mediate this effect. Study 1 (preregistered) examined scripted conversations characterized by high, regular, and poor listening quality. In Study 2, we manipulated high versus regular listening quality in the laboratory as speakers talked about their prejudiced attitudes. Finally, Study 3 (preregistered) used a more robust measure of prejudiced attitudes to test whether perceived social acceptance could be an alternative explanation to Study 2 findings. Across these studies, the exploratory (pilot study and Study 2) and confirmatory (Studies 1 & 3) findings were in line with expectations that high, versus regular and poor, quality listening facilitated lower prejudiced attitudes because it increased self-insight. A meta-analysis of the studies (N = 952) showed that the average effect sizes for high quality listening (vs. comparison conditions) on self-insight, openness to change and prejudiced attitudes were, ds = 1.19, 0.46, 0.32 95%CIs [0.73, 1.51], [0.29, 0.63] [0.12, 0.53], respectively. These results suggest that when having conversations about prejudice, high-quality listening modestly shapes prejudice following conversations about it, and underscore the importance of self-insight and openness to change in this process.

Guilt and expressive writing for reducing alcohol use in college students: Study protocol for a randomized control trial

The current proposed study aims to evaluate expressive writing as a novel intervention for reducing problematic drinking among college students. College students are at increased risk for alcohol misuse compared to other adults, and the development of efficacious intervention approaches is an urgent priority. The vast majority of individually focused brief interventions targeting college drinking have focused on personalized feedback approaches and recent innovations have largely been limited to refinements of this paradigm, which require large-scale assessment and intricate programming for implementation. The present research proposes expressive writing as a novel alternative, which has been used extensively in other domains but not as an alcohol intervention strategy. We propose a theoretically-based approach that incorporates expression of the self-conscious emotion of guilt and the written analogue of change talk as proposed mechanisms of intervention efficacy. We will also examine individual differences in guilt-proneness as a moderator of intervention efficacy. Heavy drinking college students (N = 600) will be randomly assigned to one of six expressive writing conditions based on a 2 (alcohol vs. distress) × 2 (guilt vs. no guilt) + 1 (control writing) + 1 (personalized feedback) design. Participation in the study involves completion of a screening assessment, a baseline assessment, three in-lab intervention sessions, post-intervention assessments, and follow-up assessments one-month, three-months, six months, and twelve-months later. If effective, this novel intervention approach would not require any pre-assessment or programming of personalized feedback, and would serve as a more easily disseminable alternative to existing approaches.