Does narrative writing instruction enhance the benefits of expressive writing?

Understanding how college students characterise and cope with chronic pain: a thematic analysis of expressive writing samples

College students who experience chronic pain are a frequently overlooked population. This research attempts to provide insight into the language that college students use to describe their experiences with chronic pain, challenges they face and coping strategies they use. Over the course of 4 consecutive days, participants responded to an expressive writing prompt asking them to reflect on their emotions and thoughts related to being a college student with chronic pain. Writing samples were then analysed to identify themes pertaining to words with a positive or negative emotional valence, terms used to characterise pain, metaphors used to describe pain, challenges faced, and positive and negative coping strategies used. Results showed that participants were more likely to use negatively valenced words than positively valenced words to describe their pain. Several common words and phrases were used to characterise pain, including metaphors. Finally, participants reported a number of challenges associated with their lived-experience of chronic pain, as well as positive and negative strategies used to cope with those challenges. These findings help to put into perspective the language used to understand, and attempt to cope with, the challenges faced by college students experiencing chronic pain. Research must continue to investigate the needs of this population so that they can be properly supported physically, emotionally, socially and academically.

The effects of culturally adapted expressive writing interventions on depressive and anxiety symptoms among Chinese American breast cancer survivors: A randomized controlled trial

BACKGROUND

Expressive writing interventions confer mental health benefits for non-Hispanic Whites. However, research is lacking in adapting this paradigm for minoritized groups. This study evaluated the impacts of two culturally adapted expressive writing interventions on depressive and anxiety symptoms and potential mediators (perceived stress and intrusive thoughts) among Chinese American breast cancer survivors (CABCS).

METHODS AND RESULTS

CABCS (N = 136) were randomly assigned to one of three conditions to write three weekly essays: enhanced self-regulation condition (ESR) to write about stress and coping (Week 1), deepest feelings (Week 2), and finding benefits (Week 3); self-regulation condition (SR) to write about deepest feelings (Week 1), stress and coping (Week 2), and finding benefits (Week 3); and control condition to write about facts relevant to their cancer experience (Weeks 1-3). Compared with the control condition, the ESR but not SR, reduced depressive and anxiety symptoms at all follow-up time points (1, 3, and 6-months) through reductions in perceived stress.

CONCLUSION

A cultural adaptation altering the order of expressive writing prompts resulted in the greatest benefit for CABCS' depressive and anxiety symptoms. Research testing both the content and ordering of components may be vital to advance cultural adaptation science and optimize intervention efficacy.

CLINICAL TRIAL REGISTRATION NUMBER

NCT02946619.

Randomized controlled trial assessing the efficacy of expressive writing in reducing anxiety in first-year college students: the role of linguistic features

OBJECTIVE

Meta-analyses assessing the efficacy of expressive writing (EW) interventions have produced mixed results. The current study aimed to assess the efficacy of an EW intervention in the reduction of anxiety symptoms in first-year college students. In an effort to understand more about moderating variables that influence EW outcomes, the current study also assessed the role of linguistic features in symptom reduction.

DESIGN AND MEASURES

Ninety participants were assigned to complete either an EW intervention or a non-emotional writing intervention. Participants completed 3 consecutive days of writing and two follow-up visits. Anxiety was measured at each study visit with the Beck Anxiety Inventory, and linguistic features were assessed with the LIWC software program.

RESULTS

Results indicated that all participants demonstrated significant decreases in anxiety over time. Participants in the EW group who demonstrated the greatest decreases in anxiety utilized more first-person singular pronouns and fewer affect words.

CONCLUSIONS

Results are explained in the context of two prominent theories regarding the therapeutic mechanisms of EW: cognitive processing theory and exposure theory. Exposure theory received more support than cognitive processing theory.

Music Performance Anxiety: Can Expressive Writing Intervention Help?

Performance is an essential part of music education; however, many music professionals and students suffer from music performance anxiety (MPA). The purpose of this study was to investigate whether a 10-min expressive writing intervention (EWI) can effectively reduce performance anxiety and improve overall performance outcomes in college-level piano students. Two groups of music students (16 piano major students and 19 group/secondary piano students) participated in the study. Piano major students performed a solo work from memory, while group/secondary piano students took a sight-reading exam of an eight-measure piano musical selection. All students performed twice, at baseline and post-EWI, with 2 or 3 days between performances. During the EWI phase, students were randomly divided into two groups: an expressive writing group and a control group. Students in the expressive writing group wrote down feelings and thoughts about their upcoming performances, while students in the control group wrote about a topic unrelated to performing. Each student's pulse was recorded immediately before performing, and each performance was videotaped. Three independent judges evaluated the recordings using a modified version of the Observational Scale for Piano Practicing (OSPP) by Gruson (1988). The results revealed that, by simply writing out their thoughts and feelings right before performing, students who had high MPA improved their performance quality significantly and reduced their MPA significantly. Our findings suggest that EWI may be a viable tool to alleviate music performance anxiety.

Trauma and Suicide Risk in College Students: Does Lack of Agency, Lack of Pathways, or Both Add to Further Risk?

The present study sought to examine trauma history and hope as predictors of suicide risk in a sample of 561 college students. Furthermore, authors aimed to understand whether the lack of hope agency and hope pathways contributed to further risk for suicide, above and beyond trauma history. Results suggested that trauma history and hope agency were significant and unique predictors of suicide risk among college students. More specifically, hope agency accounted for additional variance in the prediction model of suicide risk, beyond that accounted for by trauma history. Some implications of the present findings for social work practice are discussed.

Stress Reduction Through a Brief Writing Intervention With Women in Jail

OBJECTIVE

To assess the feasibility/acceptability of writing as a stress reduction strategy with incarcerated women.

METHODS

The authors implemented a writing intervention in which six women wrote on topics of their choosing for 20 minutes on 5 consecutive days. Feasibility was assessed with investigator field notes; daily post-writing evaluations assessed intervention acceptability. The study also assessed the continuation of writing at 1-month postintervention and acceptability of instruments for evaluation of future interventions.

RESULTS

Implementation barriers were minimal; participants voiced enthusiasm about the program and continued to write 3 to 4 days per week in the month postintervention. No problems were encountered in the completion of evaluation instruments.

CONCLUSION

Writing is a feasible, reproducible stress relief intervention for incarcerated women.

Impact of Narrative Expressive Writing on Heart Rate, Heart Rate Variability, and Blood Pressure After Marital Separation

OBJECTIVE

Divorce is a common stressor that is associated with increased risk for poor long-term physical and mental health. Using an experimental design, the current study examined the impact of expressive writing (EW) on average heart rate (HR), HR variability (HRV), and blood pressure (BP) 7.5 months later.

METHODS

Participants from a community sample of recently separated adults (N = 109) were assigned to one of three conditions: traditional EW, narrative EW, or a control writing condition, and were assessed three times for an average of 7.5 months. Each study visit included 27 minutes of physiological assessment; the primary outcomes at each assessment were mean-level HR, HRV, BP scores averaged across six different tasks.

RESULTS

Participants in the traditional EW condition did not significantly differ from control participants in their later HR, HRV, or BP. However, relative to control participants, those in the narrative EW condition had significantly lower HR (B = -3.41, 95% confidence interval = -5.76 to -1.06, p = .004) and higher HRV 7.5 months later (B = 0.41, 95% confidence interval = 0.16 to 0.74, p = .001). When comparing narrative EW participants to those in the traditional EW and control writing as a single group, these effects remained and were moderately sized, Cohen d values of -0.61 and 0.60, respectively, and durable across all task conditions when analyzed in independent models. The writing condition groups did not differ in their later BP.

CONCLUSIONS

Narrative EW decreased HR and increased HRV after marital separation but did not affect BP. We discuss the possible disconnect between psychology and physiology in response to EW, as well as possible future clinical applications after marital separation.

Writing content predicts benefit from written expressive disclosure: Evidence for repeated exposure and self-affirmation

Expressive disclosure regarding a stressful event improves psychological and physical health, yet predictors of these effects are not well established. The current study assessed exposure, narrative structure, affect word use, self-affirmation and discovery of meaning as predictors of anxiety, depressive and physical symptoms following expressive writing. Participants (N = 50) wrote on four occasions about a stressful event and completed self-report measures before writing and three months later. Essays were coded for stressor exposure (level of detail and whether participants remained on topic), narrative structure, self-affirmation and discovery of meaning. Linguistic Inquiry and Word Count software was used to quantify positive and negative affect word use. Controlling for baseline anxiety, more self-affirmation and detail about the event predicted lower anxiety symptoms, and more negative affect words (very high use) and more discovery of meaning predicted higher anxiety symptoms three months after writing. Findings highlight the importance of self-affirmation and exposure as predictors of benefit from expressive writing.

Testing the feasibility and acceptability of a chaplaincy intervention to improving treatment attitudes and self-efficacy of adolescents with cystic fibrosis: a pilot study

Religious factors are known to contribute to treatment adherence in different patient populations, and religious coping has been found to be particularly important to adolescents dealing with chronic diseases. Adherence to prescribed treatments slows disease progression and contributes to desirable outcomes in most patients, and, therefore, adherence-promoting interventions provided by chaplains could be beneficial to various patient populations. The current article describes a pilot study to test the feasibility of a theoretically and empirically based chaplain intervention to promote treatment adherence for adolescents with CF. Cognitive interviews were conducted 24 with adolescents with CF, and content analysis was used to identify themes, which informed revision of the intervention protocol. The authors thought that presenting the methods and results of this pilot study would be helpful for chaplains who want to conduct intervention research. The results indicated that the proposed intervention was acceptable and feasible to deliver in hard copy or an electronic platform.

Al-Anon family groups: newcomers and members

OBJECTIVE

Empirical knowledge is lacking about Al-Anon Family Groups (Al-Anon), the most widely used form of help by people concerned about another's drinking, partly because conducting research on 12-step groups is challenging. Our purpose was to describe a new method of obtaining survey data from 12-step group attendees and to examine influences on initial Al-Anon attendance and attendees' recent life contexts and functioning.

METHOD

Al-Anon's World Service Office sent a mailing to a random sample of groups, which subsequently yielded surveys from newcomers (n = 359) and stable members (n = 264).

RESULTS

Reasons for groups' nonparticipation included having infrequent newcomers and the study being seen as either contrary to the 12 Traditions or too uncomfortable for newcomers. Main concerns prompting initial Al-Anon attendance were problems with overall quality of life and with the Al-Anon trigger (a significant drinking individual), and being stressed and angry. Goals for Al-Anon attendance were related to the following concerns: better quality of life, fewer trigger-related problems, and less stress. Members reported better functioning in some of these domains (quality of life, relationship with the trigger) but did not differ from newcomers on physical and psychological health. Newcomers were more likely to have recently drunk alcohol and to have obtained treatment for their own substance misuse problems.

CONCLUSIONS

This method of collecting data from 12-step group attendees yielded valid data and also was seen by many in Al-Anon as consistent with the Traditions. Both newcomers and members had aimed to improve their overall quality of life and well-being through Al-Anon, and, indeed, members were more satisfied with their quality of life than were newcomers.

Exploring the process of writing about and sharing traumatic birth experiences online

OBJECTIVE

This study aimed to explore the experience of writing about a traumatic birth experience and sharing it online.

METHOD

Twelve women who had submitted their stories about traumatic birth experiences to the Birth Trauma Association for online publication were interviewed about their experiences. Women were interviewed shortly after writing but before posting and again 1 month after the story was posted online. All participants completed both interviews. These were transcribed and analysed using template analysis.

RESULTS

Women described varied reasons for writing and sharing their stories, including wanting to help themselves and others. The process of writing was described as emotional, however was generally seen as a positive thing. Aspects of writing that were identified as helpful included organizing their experiences into a narrative, and distancing themselves from the experience.

CONCLUSION

Writing and posting online about a traumatic birth is experienced positively by women. It may be a useful self-help intervention and is worthy of systematic evaluation. The mechanisms through which writing is reported to have impacted as described in the interviews link to the mechanisms of change in cognitive-behavioural approaches to post-traumatic symptoms. Statement of contribution What is already known on this subject? Some women develop post-traumatic stress disorder-like symptoms following birth. These can impact on both themselves and their family, yet these women may not seek professional help. Writing about a traumatic event may be a useful approach for reducing post-traumatic stress symptoms, but the impact of online sharing is unknown. What does this study add? This study demonstrates that women report benefits from writing about their birth experiences. Writing enabled organizing the experience into a narrative and distancing from the trauma, which was helpful. Sharing the story online was an emotional experience for participants, however was generally seen positively.

Visible ink: A flexible and individually tailored writing intervention for cancer patients

OBJECTIVES

Subjective reports on the effectiveness of and satisfaction with writing interventions in medical populations have indicated that they can have a profound impact on patients. Further, past research on these programs has demonstrated that they can lead to a number of different positive outcomes depending on the personal characteristics of the participating patients and the type of writing with which they are tasked. For this reason, a flexible and individually tailored writing intervention may be particularly effective for patients, molding its approach to their desires and backgrounds. This paper examines Visible Ink, a writing program for cancer patients at Memorial Sloan-Kettering Cancer Center (MSKCC) that follows this model.

METHODS

At Visible Ink's First Fall Writing Festival in November 2012, an optional survey was provided to all program participants in attendance, capturing both quantitative and qualitative information on patient experiences in the program. Twenty-nine surveys were completed.

RESULTS

The program appears to have a variety of positive effects, including fostering personal growth and providing a positive distraction. Respondents reported that they write in a number of different genres on topics both related and not related to their illnesses, which supports the flexible model of the program. All respondents indicated that they would recommend the program to others, and satisfaction with the program's general approach (i.e., individualized work with a writing coach) was unanimous. A few areas for potential improvement were also identified, most of which involved expanding the services and events offered by the program.

SIGNIFICANCE OF RESULTS

Despite the limitations of this survey (e.g., small sample size and low response rate), its results support the promise of the Visible Ink model and demonstrate participants' satisfaction with the program. Future research can more thoroughly examine Visible Ink's effectiveness, and additional resources could enable the program to expand.