Emotional disclosure through writing or speaking modulates latent Epstein-Barr virus antibody titers

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.

CAREGIVER Randomized Trial of Two Mindfulness Methods to Improve the Burden and Distress of Caring for Persons with Cirrhosis

BACKGROUND

Patient caregivers experience burden and distress that negatively impacts health-related quality of life (HRQOL). Mindfulness may alleviate caregiver burden but randomized trials of mindfulness activities on caregiver burden and distress are lacking.

METHODS

Caregivers for patients with advanced liver disease were recruited from the Universities of Michigan and Pennsylvania (12/2019-12/2021) and followed for 8 weeks. Participants were randomized 1:1:1 to: written emotional disclosure for 4 weeks, resilience training for 4 weeks, or control (no active intervention). All completed assessments at baseline, week 4 and 8. The primary outcome was change in the Zarit Caregiver Burden Index-12 (ZBI) at week 8. Secondary outcomes included changes at week 4 and 8 in the ZBI, distress thermometer (DT), HRQOL visual analog scale (VAS), and caregiver captivity index (CCI).

RESULTS

Eighty seven caregivers were enrolled, 59(72%) completed the study. In unadjusted analyses at week 4, the burden measured by ZBI was not significantly different between arms, increasing by 0.6 ± 5.7 and 2.5 ± 5.2 points, for the written emotional disclosure and resilience training study arms, respectively, and by 2.9 ± 6.1 points in the control arm. At week 8, the non-significant ZBI change was - 1.0 ± 8.9, 2.8 ± 6.1, and 1.5 ± 7.4 for written emotional disclosure, resilience training, at week 8, respectively. The DT and VAS worsened in all arms, however, it worsened the least in the written emotional disclosure arm. In analyses adjusted for differences in baseline characteristics, the ZBI declined by - 4.21 ± 2.03(p = 0.04) in the emotional disclosure arm at week 4. This decrease was attenuated week 8, - 1.13 ± 2.6(p = 0.67). There were no significant differences in secondary outcomes save for resilience training reducing the CCI at week 4 by 1.36 ± 0.67(p = 0.04).

CONCLUSION

Written emotional disclosure may reduce caregiver burden in the short term among caregivers for patients with cirrhosis.

REGISTRATION

NCT04205396.

Effect of Psycho-Educational Intervention to Reduce Anxiety and Depression at Postintervention and Follow-Up in Women with Breast Cancer: A Systematic Review and Meta-Analysis

OBJECTIVES

To examine the effectiveness of the psycho-educational intervention in reducing anxiety and depressive symptoms for women with breast cancer in post- and follow-up status.

DATA SOURCES

A systematic search of 16 electronic databases to identify all randomized controlled trial studies that examine the effects of psycho-education on anxiety and depression among women with breast cancer. The standardized mean differences (SMDs) between groups in depression and anxiety levels for postintervention and follow-up were computed for each study.

CONCLUSION

Evidence suggests that psycho-educational intervention effectively relieves anxiety and depressive symptoms among women with breast cancer postintervention and follow-up.

IMPLICATIONS FOR PRACTICE

A significant effect of the psycho-education intervention was found to reduce anxiety and depressive symptoms in women with breast cancer. Such service was recommended in nursing practice.

Women's disclosure of college sexual assault: Greek-life status does not influence disclosure

Objective: Due to high prevalence rates of sexual assault among college-aged women and the benefits of disclosure (e.g., emotional well-being), it remains important to consider barriers to disclosure. The current paper aimed to examine if barriers to disclosure may be more salient to sorority women. Participants: We examined differences in rates of hypothetical willingness to formally disclose (N = 693) and actual formal/informal disclosure (N = 584) as well as mental health as a function of Greek-life status among college women. Method: Two separate online surveys were administered (October, 2016; January, 2017), respectively. Results: Findings suggest no significant differences in rates of hypothetical or actual formal/informal disclosure as a function of Greek-life status; however, Greek-life members reported lower mental health. Conclusion: Findings from the current studies suggest that institutional factors (e.g., campus climate) may serve as a barrier to disclosure. Limitations and future directions in this important area are discussed.

The Health Benefits of Autobiographical Writing: An Interdisciplinary Perspective

A large body of experimental evidence in the empirical sciences shows that writing about life experiences can be beneficial for mental and physical health. While empirical data regarding the health benefits of writing interventions have been collected in numerous studies in psychology and biomedicine, this literature has remained almost entirely disconnected from scholarship in the humanities and cognitive neuropsychology. In this paper, I review the literature from psychological and biomedical writing interventions, connect these findings to views from philosophy, cognitive neuropsychology and narratology and argue that examining established regularities in how narratives are structured can shed further light on the psychological processes engaged during writing interventions. In particular, I argue that the narratological concept of conflict can be applied to resolve patterns of seemingly conflicting empirical findings in psychological studies. More generally, I propose that an interdisciplinary perspective can provide a broader theoretical basis for understanding the psychological processes underlying the health benefits of autobiographical writing and provide directions for future research in psychology and biomedicine.

How Do Emotions during Goal Pursuit in Weight Change over Time? Retrospective Computational Text Analysis of Goal Setting and Striving Conversations with a Coach during a Mobile Weight Loss Program

During behavioral weight management, individuals reflect on their progress and barriers through goal pursuit (goal setting and goal striving). Emotions during goal pursuit are largely unknown, and previous investigations of emotions in weight management have primarily relied on self-report. In this retrospective study, we used a well-validated computational text analysis approach to explore how emotion words changed over time during goal setting and striving conversations with a coach in a mobile weight loss program. Linear mixed models examined changes in emotion words each month from baseline to program end and compared emotion words between individuals who set an overall concrete goal for the program (concrete goal setters) and those who set an overall abstract goal (abstract goal setters). Contrary to findings using self-report, positive emotion words were stable and negative emotion words significantly increased over time. There was a marginal trend towards greater negative emotion word use being associated with greater weight loss. Concrete goal setters used more positive words than abstract goal setters, with no differences in negative emotion words and weight loss. Implications include the possibility that individuals may need increasing support over time for negative emotions expressed during goal setting and striving, and concrete goals could boost positive emotion. Future research should investigate these possibilities.

Behavioral Medicine Methods in Treatment of Somatic Conditions

Background

The aim of this article is to present a short review of noninvasive, nonpharmacological treatment methods used in somatic illnesses that fall under the umbrella of approach called behavioral medicine.

Methods

The narrative review method was applied in the study. Science paper databases, including PubMed, had been used to retrieve papers on therapeutic methods used in clinical setting that meet the broad criteria of behavioral medicine definition as stated in the Charter of International Behavioral Medicine Society

Results

Main groups of methods, disorders in which they are being employed and their effectiveness, have been identified.

Conclusions

Behavioral medicine is grouping treatment methods and interventions that hold large potential for clinical setting. Two groups of methods can be distinguished by the scrutiny and level of evidence gathered in their effectiveness assessment; for biofeedback, guided imagery, and hypnosis techniques, comprehensive evidence reports in the framework of U.S. Evidence Synthesis Program exist. Meditation techniques, disclosure therapies, and relaxation methods are less well assessed. Broader employment of behavioral medicine therapies in clinical setting is possible after addressing two major problems in the field, which are deficiencies in quality evidence of effectiveness for many of the methods and their insufficiencies in underlying therapeutic mechanism knowledge.

The efficacy of written exposure therapy versus imaginal exposure delivered online for posttraumatic stress disorder: Design of a randomized controlled trial in Veterans

Adapting evidence-based treatments for online delivery has potential to significantly increase the reach of effective care to Veterans with posttraumatic stress disorder (PTSD). This paper describes the rationale for and methods of a randomized controlled trial comparing the efficacy and efficiency of written exposure therapy versus imaginal exposure for PTSD delivered in a novel online and variable length format. Participants will be 300 Veterans seeking treatment for clinically significant symptoms of PTSD. Participants will be randomly assigned to either written exposure or imaginal exposure via verbal recounting and will complete between 4 and 8 online therapy sessions facilitated by trained peer support specialists. Treatment is terminated before session 8 if the PTSD symptom improvement criterion is met. Assessments will be conducted at baseline, post-treatment, and at 3-month follow-up. The primary hypotheses are that written exposure therapy will be noninferior to imaginal exposure with respect to treatment efficacy and efficiency. Secondary hypotheses relate to identifying and comparing potential mediators of PTSD treatment outcome, including trauma-related cognitions and emotion regulation.

The Effect of Expressive Writing on Symptoms of Depression in College Students: Randomized Controlled Trial

Introduction: The first year of college can be particularly difficult for students, as they typically face a number of emotional, developmental, social, and financial challenges. Expressive writing (EW) is a writing intervention that requires participants to write about their thoughts and feelings related to a particular event over several days.

Methods: Participants in this study included 90 first-year undergraduate students. Participants were assigned to the EW condition (writing about their thoughts and feelings related to their transition to college) or a control condition (writing about any object or event of their choosing). Participants completed 3 consecutive days of writing, and then completed two follow-up visits that occurred one month and six months post-intervention. Participants were divided into two groups based on their initial depression scores (one group with minimal symptoms, and a second group with mild/moderate/severe symptoms).

Results: Among participants in the mild/moderate/severe group, those in the EW condition demonstrated significant decreases in depression symptoms over the six-month study period, while participants in the control condition did not. Among this same subset of participants, those in the EW condition also demonstrated significantly fewer physician visits due to physical illness when compared to the control group. Changes in depression and physical illness visits were not found for participants with minimal symptoms of depression.

Discussion: EW is a low-cost procedure that has been empirically demonstrated to alleviate symptoms of depression six months post-intervention. However, this finding only held for participants who were initially categorized in the group of participants with mild/moderate/severe symptoms of depression (as opposed to those participants initially categorized with minimal symptoms of depression). Clinical implications and future directions are discussed.

Past, present or future? Word tense and affect in autobiographical narratives of women with HIV in relation to health indicators

This study examined how the expression of positive and negative affect words and word tense in autobiographical narratives of 98 HIV+ women, predominantly African American, predicted undetectable HIV viral load (UDVL), CD4+ cells/mm3 counts and antiretroviral therapy medication (ART) adherence assessed concurrently (T1) and at 3 to 9-month follow-up (T2). Logistic regressions revealed that higher past tense words predicted worse odds of UDVL, CD4+ cells/mm3 above 350 at T1, and worse odds of 95% ART adherence at T2. However, using both high past tense words and high positive affect words predicted better odds of CD4+ cells/mm3 > 350 at T2. Higher future tense words predicted better odds of CD4+ cells/mm3 > 350 at T1. Additionally, using both high present tense words and negative affect words predicted better odds of UDVL at T1. These findings provide preliminary evidence that the quality of affect expression significantly interacts with temporal context to relate to the health of women with HIV.

Emotional and physical health benefits of expressive writing

Writing about traumatic, stressful or emotional events has been found to result in improvements in both physical and psychological health, in non-clinical and clinical populations. In the expressive writing paradigm, participants are asked to write about such events for 15–20 minutes on 3–5 occasions. Those who do so generally have significantly better physical and psychological outcomes compared with those who write about neutral topics. Here we present an overview of the expressive writing paradigm, outline populations for which it has been found to be beneficial and discuss possible mechanisms underlying the observed health benefits. In addition, we suggest how expressive writing can be used as a therapeutic tool for survivors of trauma and in psychiatric settings.

Verbal Emotional Disclosure of Traumatic Experiences in Adolescents: The Role of Social Risk Factors

It is well-known that traumatic events and adverse life situations are very important in both physical and psychological health. Prevalence studies suggested that adolescents experience at least one potentially traumatic event before reaching age 18. The paradigm of research centered on expressive writing has evidenced the beneficial effects that the emotional disclosure of previous traumas produces on physical health and psychological adjustment. The aims of the study are threefold: determining the prevalence of adverse or traumatic events; examining the extent to which psychopathological symptoms developed in those exposed to traumatic events; and exploring an verbal emotional disclosure (VED) paradigm in which variations on time spent talking about traumatic experiences to others resulted in a reduction of the psychological impact of trauma in a sample of Spanish adolescents. 422 volunteer adolescents participated, 226 boys and 192 girls, from 10 to 19 years old, all of them living in Tenerife. The mean age was 14.8 years (SD = 1.83). All of them completed the instruments used to assess the psychological impact of traumatic experiences and VED. The main results indicated that 77% of the participants had suffered a traumatic situation. The participants who have been exposed to traumatic events scored significantly higher in measures of post-traumatic stress, disorder, intrusive thoughts, avoidance behaviors, anxiety and depression, compared to those without trauma. Furthermore, results show a decrease in symptomatology scores as a function of time spent disclosing emotional experiences to others, particularly when disclosure occurred several times. In conclusion, stressful events or traumatic experiences and their concomitant emotional effects are highly prevalent in adolescents, and repeated VED to others appears to ameliorate their impact. VED shows greater therapeutic benefits when adolescents narrate the experience on several occasions and in an extensive way.

An Expressive Writing Intervention to Cope with Lesbian-Related Stress: The Moderating Effects of Openness about Sexual Orientation

Over the past two decades, expressive writing interventions have been used successfully to reduce distress and improve well-being for those dealing with traumatic events, stressors, and illnesses. The purpose of this study was to investigate an expressive writing intervention for lesbian-related stressors. As expected, writing about traumatic events related to sexual orientation reduced self-reported confusion and perceived stress over a 2-month period for those lesbians who were less open about their sexual orientation. Interestingly, writing about such traumatic experiences was associated with increases in confusion and perceived stress for those who were more open about their sexual orientation. Applying this paradigm to assist individuals in coping with stressors related to their sexual orientation represents an important addition to the expressive writing literature. Furthermore, it offers a promising, cost-effective method to assist closeted lesbians in coping with stressors related to their sexual orientation.

Writing about the Perceived Benefits of Traumatic Events: Implications for Physical Health

Research by Pennebaker and his colleagues supports the healing power of writing about traumatic events. This study explored the importance of writing about the perceived benefits of traumatic events as a factor in this process. The study included 118 participants who were randomly assigned to write about one of four topics in a 2 (writing about perceived benefits vs. not writing about perceived benefits)× 2 (writing about trauma vs. not writing about trauma) factorial design. Participants also completed questionnaire measures of subjective well-being and released health center information for the year. Participants who wrote only about trauma or perceived benefits showed significantly fewer health center visits for illness 3 months after writing. In addition, 5 months after writing, the trauma-only and perceived-benefits-only groups maintained a difference from the control group. These results suggest that writing about perceived benefits from traumatic events may provide a less upsetting but effective way to benefit from writing.

The Health Benefits of Writing about Life Goals

In a variation on Pennebaker’s writing paradigm, a sample of 81 undergraduates wrote about one of four topics for 20 minutes each day for 4 consecutive days. Participants were randomly assigned to write about their most traumatic life event, their best possible future self, both of these topics, or a nonemotional control topic. Mood was measured before and after writing and health center data for illness were obtained with participant consent. Three weeks later, measures of subjective well-being were obtained. Writing about life goals was significantly less upsetting than writing about trauma and was associated with a significant increase in subjective well-being. Five months after writing, a significant interaction emerged such that writing about trauma, one’s best possible self, or both were associated with decreased illness compared with controls. Results indicate that writing about self-regulatory topics can be associated with the same health benefits as writing about trauma.

Does Self-Affirmation, Cognitive Processing, or Discovery of Meaning Explain Cancer-Related Health Benefits of Expressive Writing?

Although expressive writing has positive effects on health, little is known about the underlying psychological mechanisms for these effects. The present study assessed self-affirmation, cognitive processing, and discovery of meaning as potential mediators of the effects of expressive writing on physical health in early-stage breast cancer survivors. A content analysis of the essays showed that self-affirmation writing was associated with fewer physical symptoms at a 3-month follow-up assessment, with self-affirmation writing fully mediating the effects of the emotional expression and benefit-finding writing conditions on reduced physical symptoms. Cognitive processing and discovery of meaning writing were not associated with any physical health outcomes. Consistent with evidence showing that self-affirmation plays an important role in buffering stress, the present study provides the first evidence for self-affirmation as a viable mechanism underlying the health benefits of expressive writing.

Predicting Pain and Adjustment in Rheumatoid Arthritis

The role of disclosure and emotional processing of stressful life events has not been studied in chronically ill populations. We attempted to predict the pain, physical dysfunction, and affective disturbance of 82 patients with rheumatoid arthritis (RA) from their life stress and from various measures of emotional processing: disclosure to others and thought frequency about stressful events, positive and negative emotional expression, ambivalence about emotional expression and secrecy. After controlling for demographics (gender, race, education, disability status), disease measures (duration of diagnosis, objective disease activity), and life stress, we found that pain was related to an increased expression of negative emotion; physical dysfunction was related to an increased frequency of thinking about stressful events; and affective disturbance was related to both increased ambivalence about emotional expression and increased thought frequency. We conclude that RA pain and adjustment are better predicted by emotional processing of stressful life events—including disclosure to others and emotional expression—than by the experience of stressful events, per se.

Keeping Emotional Memories Secret

The present study investigated two predictions derived from inhibition theory. It was hypothesized that emotional secrecy has a negative impact on (1) physical and (2) subjective well-being. Also, the study examined whether the relation holds when controlling for negative affectivity (NA), a variable that can be assumed to mediate the relation between emotional secrecy and physical and subjective well-being. Consistent with the hypothesis, emotional secrecy negatively affected physical health. This finding was not explained by NA, which contributed independently to physical health. Contrary to the prediction, emotional secrecy affected life satisfaction but indirectly through the mediating influence of physical health. The implications of these results for future research on emotional secrecy and physical and subjective well-being are discussed.

Writing About Emotional Experiences as a Therapeutic Process

For the past decade, an increasing number of studies have demonstrated that when individuals write about emotional experiences, significant physical and mental health improvements follow The basic paradigm and findings are summarized along with some boundary conditions Although a reduction in inhibition may contribute to the disclosure phenomenon changes in basic cognitive and linguistic processes during writing predict better health Implications for theory and treatment are discussed

Examining the Theory and Clinical Utility of Writing About Emotional Experiences

Pennebaker s (this issue) intervention for writing about emotional experiences shows promise as a module for inclusion in therapeutic packages There are conceptual, methodological and practical issues to be considered, however These issues are discussed, and parallels are drawn from the literatures on the mood-regulatory function of dreams and on the effects of social support on health Although there is evidence that writing about emotional experiences has beneficial effects on health, it is premature to recommend writing intervention as a treatment component for specific problems What is needed at this point is systematic research to evaluate its clinical utility

The Process of Reporting and Receiving Support Following Exposure to Intimate Partner Violence During Childhood

While a significant body of research suggests that exposure to intimate partner violence (IPV) during childhood has severe and long-lasting consequences, little is known about how children cope with witnessing IPV, including who they tell about the violence, whether they receive support after disclosing, and the association between childhood disclosure and adulthood mental health. The current study examines these issues in 703 Swedish young adults who endorsed witnessing IPV during childhood. In this sample, 57% reported that they had ever confided in someone about the witnessed violence. The primary reason given for not disclosing was the belief that no one could do anything about it, which was endorsed by 41% of the young adults who kept the violence concealed. Individuals who disclosed the violence were most likely to tell a friend and least likely to use an anonymous hotline. Young adults with higher levels of depression were less likely to have disclosed IPV during their childhood. Individuals' use of formal reporting outlets was endorsed infrequently, with only 5.2% recalling that they had personally reported the violence or someone else had reported it on their behalf. If such reports were filed, it was most likely to the police. These formal reports typically resulted in participants feeling that the problem continued anyway or that they were believed, but no changes were made. Given the infrequent use of formal reporting services, results suggest that for this sample, reporting outlets for IPV exposure may be underutilized and may not be perceived as beneficial.

The effect of expressive writing intervention on psychological and physical health outcomes in cancer patients--a systematic review and meta-analysis

OBJECTIVE

This study aimed to evaluate the effectiveness of expressive writing intervention (EWI) for improving psychological and physical health in cancer patients and survivors.

METHODS

We searched databases and existing reviews for randomized controlled studies published between 1986 and 2014 that evaluated the effects of EWI on psychological and physical health outcomes. We computed and combined effect sizes and examined the role of methodological characteristics.

RESULTS

From 223 unique citations, we identified 16 independent randomized controlled trials published from 1999 to 2014, examining the effect of EWI on a range of psychological and physical health outcomes. No statistically significant effects were found for any of the individual or combined psychological (Hedges's g: 0.04; 95% CI, -0.06 to 0.14; p = 0.42), physical (0.08; 95% CI, -0.05 to 0.20; p = 0.22), or quality-of-life outcomes (0.09; 95% CI, -0.05 to 0.24; p = 0.22). The results were unaffected by differences in study characteristics, for example, type of control condition, study setting, cancer type, and overall study quality ratings. Results from a subset of studies indicated a possible moderating effect of social constraints, suggesting that participants experiencing low levels of emotional support may be more likely to benefit from EWI.

CONCLUSIONS

Our results do not support the general effectiveness of EWI in cancer patients and survivors. However, given the practical and inexpensive intervention, it is possible that even small effects in subgroups of patients could be clinically relevant, and future studies are recommended to test the effects of potential moderators, including pre-intervention distress levels and context-dependent factors such as emotional support.

Effect of written emotional disclosure on secondary hyperalgesia in women with trauma history

OBJECTIVE

This study investigated the effects of written emotional disclosure on a model of chronic pain in healthy women with and without trauma history.

METHOD

Participants were prescreened for their trauma history (N = 78) and randomized to a disclosure or a control writing condition. Pain testing occurred either 1 day or 1 month after disclosure. Capsaicin was applied to the forearm to evoke spontaneous burning pain at the application site and mechanical secondary hyperalgesia in the surrounding untreated skin.

RESULTS

As hypothesized, the effect of disclosure on the area and intensity of secondary hyperalgesia depended on trauma history and time of testing (F(1,69) ≥ 7.37, p = .008). Disclosure increased secondary hyperalgesia in participants with trauma history compared with those without trauma when testing occurred 1 day after writing (F(1,69) ≥ 5.27, p ≤ .025), whereas the opposite pattern was observed 1 month later (F(1,69) ≥ 4.88, p ≤ .031). Of the participants with trauma history in the disclosure condition, secondary hyperalgesia was reduced at 1 month compared with 1 day after writing (p = .001). Moreover, greater use of positive emotional words predicted reduced secondary hyperalgesia at 1 month (β = -0.71, p = .022). In contrast, disclosure had no effect on spontaneous pain.

CONCLUSIONS

Disclosure modulates secondary hyperalgesia observed in women with trauma history, producing a short-term enhancement and a long-term reduction. This suggests that disclosure has a long-term protective effect that reduces sensitization of pain, which may explain the therapeutic effects of disclosure in patients with chronic pain.

A more global approach to musculoskeletal pain: expressive writing as an effective adjunct to physiotherapy

The aim of this study was to investigate the effects of written emotional disclosure as an adjunct to physiotherapy. Forty outpatients with musculoskeletal pain were treated with Mézières physiotherapy for 10 sessions. Half of the subjects also wrote about difficult life experiences immediately after four of these sessions. Data analysis showed that although both the writing and non-writing groups displayed lower pain scores after physiotherapy, the difference was stronger in the writing group. Pain scores continued to decrease six months after physiotherapy in the writing group alone. The postural evaluation revealed a greater improvement in the writing group than in the non-writing group, while the TAS-20 and SCL-90 scores decreased in the writing group alone. These results indicate that written emotional disclosure is an effective adjunct to physiotherapy insofar as it promotes further health improvements at both the physical and psychological levels.

Effects of expressive writing on sexual dysfunction, depression, and PTSD in women with a history of childhood sexual abuse: results from a randomized clinical trial

INTRODUCTION

Women with a history of childhood sexual abuse (CSA) have high rates of depression, posttraumatic stress disorder, and sexual problems in adulthood.

AIM

We tested an expressive writing-based intervention for its effects on psychopathology, sexual function, satisfaction, and distress in women who have a history of CSA.

METHODS

Seventy women with CSA histories completed five 30-minute sessions of expressive writing, either with a trauma focus or a sexual schema focus.

MAIN OUTCOME MEASURES

Validated self-report measures of psychopathology and sexual function were conducted at posttreatment: 2 weeks, 1 month, and 6 months.

RESULTS

Women in both writing interventions exhibited improved symptoms of depression and posttraumatic stress disorder (PTSD). Women who were instructed to write about the impact of the abuse on their sexual schema were significantly more likely to recover from sexual dysfunction.

CONCLUSIONS

Expressive writing may improve depressive and PTSD symptoms in women with CSA histories. Sexual schema-focused expressive writing in particular appears to improve sexual problems, especially for depressed women with CSA histories. Both treatments are accessible, cost-effective, and acceptable to patients.

God give me strength: exploring prayer as self-disclosure

The current project was designed to examine the contention that written prayers about difficult life events function as self-disclosure to God and are structurally and effectively the same as other forms of written self-disclosure, at least in the short term. Over four writing sessions, 155 participants either wrote about mundane experiences (the control group) or wrote narratives about traumatic or stressful life events that were targeted at no one, targeted at a person of their choice, or construed as prayers to God. The results indicate that written prayers are lexically similar to the other two types of written narratives and distinct from the control group. Furthermore, the immediate effects of trauma writing on mood and physical well-being were similar as well. These findings have potentially important implications for understanding the relationship between personal prayer and a variety of health outcomes.

Ressourcentagebuch: Verbesserung der Emotionsregulation und der Ressourcenrealisierung durch therapeutisches Schreiben im Anschluss an eine Psychotherapie

Theoretischer Hintergrund: Defizite in Emotionsregulation und Ressourcenrealisierung können auch nach Behandlung und Remission der psychischen Störung bestehen bleiben und langfristig Rückfälle verursachen. Fragestellung: Können mittels einer vierwöchigen Schreibintervention in Form eines Ressourcentagebuchs Stimmung, Emotionsregulation und Ressourcenrealisierung bei Patienten nach stationärer Psychotherapie verbessert werden? Methode: 41 Patienten wurden randomisiert entweder der Interventionsgruppe (N = 21) oder der unbehandelten Kontrollgruppe (N = 20) zugeteilt. Die Ergebnisvariablen wurden im Abstand von fünf Wochen erhoben. Ergebnisse: Die Interventionsgruppe zeigte gegenüber der Kontrollgruppe einen signifikanten Anstieg der positiven Stimmung, sowie der Emotionsregulationsstrategie Neubewertung. Unterschiede in der Ressourcenrealisierung zeigten sich nicht zwischen den Gruppen. Schlussfolgerungen: Die Ergebnisse dieser Pilotstudie geben erste Hinweise auf eine Verbesserung der Stimmung und der Emotionsregulation durch das Schreiben eines Ressourcentagebuchs.

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.

Expressive writing and positive writing for participants with mood disorders: an online randomized controlled trial

INTRODUCTION

Expressive writing--writing about traumatic, stressful or emotional events--often leads to improvements in physical and psychological health in non-clinical and clinical populations. Recent studies have shown that positive writing may also be beneficial. Research has not yet investigated whether either expressive writing or positive writing offers benefits for people with mood disorders.

METHOD

Participants were recruited online and were randomly allocated to expressive writing, positive writing or control writing. The following questionnaires were completed online: Centre for Epidemiological Studies-Depression Scale (CES-D), Depression Anxiety Stress Scales (DASS), Pennebaker Inventory of Limbic Languidness (PILL), overall health questions, Temperament and Personality Questionnaire (TPQ) and COPE Inventory (COPE). Participants then wrote for 20 min on 4 occasions, and then completed follow-up questionnaires.

RESULTS

Linear mixed models with custom contrasts were conducted to assess differences between groups and over time. All 3 groups showed significant improvements over time on mental health and some physical health outcomes. There were no significant differences between groups and no significant group by time interactions. These results were not moderated by demographic factors, personality subtypes or coping styles.

CONCLUSION

The expressive writing, positive writing and time management control writing groups all reported significantly fewer mental and physical symptoms for at least 4 months post-writing. When expressive and positive writing groups were combined, the resulting `emotional writing group' showed significantly lower scores on the DASS stress subscale than the control writing group at all time-points. Potential reasons are discussed and areas of further study identified.

Emotional inhibition: a discourse analysis of disclosure

Evidence generated within the emotional disclosure paradigm (EDP) suggests that talking or writing about emotional experiences produces health benefits, but recent meta-analyses have questioned its efficacy. Studies within the EDP typically rely upon a unidimensional and relatively unsophisticated notion of emotional inhibition, and tend to use quantitative forms of content analysis to identify associations between percentages of word types and positive or negative health outcomes. In this article, we use a case study to show how a qualitative discourse analysis has the potential to identify more of the complexity linking the disclosure practices and styles that may be associated with emotional inhibition. This may illuminate the apparent lack of evidence for efficacy of the EDP by enabling more comprehensive theorisations of the variations within it.

What I never wanted to tell you: therapeutic letter writing in cultural context

Therapeutic letter writing has been viewed by psychologists as a powerful form of creative writing in health care settings. I explore the cultural contexts that have aided its popularization to shed fresh light on debates about its psychological function and efficacy. I draw on the sociologist Frank Furedi's analysis of 'therapy culture' to argue that contemporary ideologies of the vulnerable self have stimulated this practice, particularly in the form of letters written not-to-be-sent. I conclude by considering models of developmental letter writing that attempt to challenge these ideologies, including narrative therapists' provocative method of corresponding with clients.

Is disclosure therapeutic for children following exposure to traumatic violence?

Trauma theory suggests that to recover from exposure to traumatic events, such as exposure to violence, therapeutic interventions should include opportunities to disclose and to process the fearful and stressful events. Yet little is known about the circumstances that foster disclosure of such information in therapeutic environments by children and related mental health outcomes for those children. In this study, the process of disclosure was examined among children ages 6 to 12 years (N = 121) in a community-based intervention program for children exposed to intimate partner violence (IPV). Therapists documented children's spontaneous disclosure in their group. Mothers and children completed demographic and standardized attitudinal and mental health questionnaires. Fifty-two percent of children spontaneously disclosed during therapy. Child ethnicity, harm to the child, internalizing behavioral adjustment problems, and engagement in therapy predicted disclosure. Disclosure within the group was associated with gains for individual children in internalizing behavioral adjustment problems and improvement in attitudes and beliefs concerning the acceptability of violence.

The effects of different methods of emotional disclosure: differentiating post-traumatic growth from stress symptoms

Research on emotional disclosure should test the effects of different disclosure methods and whether symptoms are affected differently than post-traumatic growth. We randomized 214 participants with unresolved stressful experiences to four disclosure conditions (written, private spoken, talking to a passive listener, talking to an active facilitator) or two control conditions. All groups had one 30-minute session. After 6 weeks, disclosure groups reported more post-traumatic growth than controls, and disclosure conditions were similar in this effect. All groups decreased in stress symptoms (intrusions, avoidance, psychological and physical symptoms), but disclosure did not differ from control. We conclude that 30 minutes of disclosure leads to post-traumatic growth but not necessarily symptom reduction, and various disclosure methods have similar effects. Research on the effects of disclosure should focus on the benefits of growth as well as symptom reduction.

How benefits of expressive writing vary as a function of writing instructions, ethnicity and ambivalence over emotional expression

Written emotional disclosure has been reported to confer a variety of benefits on physical and psychological well-being. However, variable findings suggest that outcomes may vary systematically as a function of specific parameters of the experimental design. This study aims to investigate the unique and combined effects of disclosure instructions focusing on emotional expression and instructions facilitating cognitive reappraisal and to examine how ambivalence over emotional expression and ethnicity moderate the effects of these writing instructions. Seventy-one Asian and 59 Caucasian undergraduates (N = 130) with at least minimal physical or depressive symptoms were randomly assigned to one of the four writing conditions: emotional disclosure (ED), cognitive reappraisal (COG), the combination of ED and COG, or a control condition. Self-reported physical symptoms, positive affect (PA) and negative affect were assessed at baseline and three follow-ups spanning 4 months. Mixed linear models revealed that COG writing reduced physical symptoms, ED buffered a decrease in PA over time, and the combination of ED and COG (i.e. self-regulation; SR) was most effective. Asians and highly ambivalent participants benefited most from expressive writing. Findings contribute to the development of a SR moderator model and carry implications for designing expressive disclosure studies, particularly for ethnic minorities.