Does Guided Written Disclosure Reduce Distress and Improve Psychological Functioning in Patients with Skin Diseases?

Background. Skin diseases (e.g., psoriasis and systemic sclerosis) are generally associated with negative psychosocial outcomes. Although different psychological interventions have been used to improve the quality of life of dermatological patients, the effects of the guided written disclosure (GWD) protocol have not been previously examined in these patients. Moreover, little attention has been paid to positive psychology constructs. Methods. This study investigates the effectiveness of GWD on positive and negative functioning in dermatological patients. Pre- and 1-month post-intervention measures included emotion regulation, sense of inner peace, skin-related symptoms and functioning, sense of coherence, and psychological distress. Results. A total of 196 consecutive outpatients were randomly assigned to GWD and active control groups, of whom 60 (30.6%) completed the study and 45 (GWD: n = 24; AC: n = 21) provided complete data. Our results did not show any significant difference between the experimental and control groups in the outcome variables, whereas non-completers reported higher levels of distress, unpleasant skin-related emotions, and lower cognitive reappraisal compared to completers. Conclusions. These findings show a poor compliance, and suggest that expressive writing is not well accepted by patients and is not effective in improving positive and negative psychological functioning in dermatological patients.

A Brief Gratitude Writing Intervention Decreased Stress and Negative Affect During the COVID-19 Pandemic

Exploring ways to mitigate the stress of the COVID-19 pandemic is important for long-term health. Expressive and gratitude-focused writing are effective methods to help individuals process traumatic or stressful events. Gratitude-focused writing may yield additional benefits because it helps individuals appraise events positively. We hypothesized that an online gratitude writing intervention would yield greater benefits than an expressive writing intervention or control group. Participants were randomized to one of three groups and completed assessments one-week and one-month post-intervention. The gratitude writing group maintained gratitude levels and decreased stress and negative affect at one-month post-intervention. The expressive writing group decreased in gratitude and showed no changes in stress or negative affect at one-month post-intervention. The control group decreased in gratitude and negative affect and showed no changes in stress at one-month post-intervention. Gratitude writing may be a better resource for dealing with stress and negative affect than traditional expressive writing methods under extremely stressful situations with uncertain trajectories.

In Dialogue: How Writing to the Dead and the Living Can Increase Self-Awareness in Those Bereaved by Addiction

This article examines how writing can increase the self-awareness of a socially isolated and often stigmatized population: those bereaved by addiction. Writing about a traumatic event has been shown to increase self-awareness which can improve health and regulate negative behaviors. Using narrative analysis on the writing of individuals bereaved by addiction, this study found that participants were able to increase their self-awareness through writing to the dead, the living and themselves. Participants’ writing also demonstrated their attempts to make sense and make meaning out of their loss which are both strong predictors of positive health outcomes. All participants in this study demonstrated increased self-awareness as well as sense-making and/or meaning-making which can lead to improvements in behavior regulation, psychological health and physical heath. This suggests that writing may be a uniquely beneficial therapeutic intervention for those experiencing disenfranchised grief as a result of bereavement by addiction.

Effects of expressive writing and use of cognitive words on meaning making and post-traumatic Growth

Expressive writing can enhance cognitive processing and improve stress regulation. Particularly, the use of cognitive words (i.e., insightful and causal words) in writing may be associated with the process of meaning making and promotion of post-traumatic growth (PTG). The aim of the present study was to determine how expressive writing and the use of causal and insightful cognitive words influenced meaning making and PTG during writing. In total, 52 traumatized university students were recruited and randomly assigned to one of two writing conditions involving either an expressive writing task or a neutral writing task. The results showed that participants who engaged in expressive (vs. neutral) writing showed higher scores on the presence of meaning and PTG in the post-writing, self-report questionnaires. Moreover, writing task (expressive or neutral) and frequency of causal and insightful cognitive words were both significant predictors of meaning, which in turn led to high levels of PTG. In conclusion, the use of causal and insightful words might be a fundamental cognitive process for developing meaning in writing, which is essential for our further understanding of meaning making and PTG.

How does meaning in life predict proactive coping? The self-regulatory mechanism on emotion and cognition

OBJECTIVE

This study examined the effectiveness of a photographic intervention method on meaning in life (MIL) and further investigated the self-regulatory mechanism responsible for the effect of MIL in the promotion of proactive coping.

METHOD

Participants were 145 Chinese adults (M_age  = 27.82; 71.3% female), who were randomly assigned into one of three conditions: An intervention (taking photos and writing expressively), a taking-photos-only control, or an assessment-only control. MIL, positive affect, future temporal focus, and proactive coping were measured before and after the intervention, with follow-up assessments conducted 1 week and 1 month later. Additionally, daily assessments were conducted during the intervention week.

RESULTS

MIL improved daily in the intervention condition, an effect that was also found post-intervention and at follow-up. Significant increases in positive affect, future temporal focus, and proactive coping were also observed after the intervention. Hierarchical linear modeling demonstrated that daily MIL positively predicted daily future temporal focus and positive affect. Furthermore, longitudinal mediation analysis confirmed that future temporal focus and positive affect mediated the relationship between MIL and proactive coping.

CONCLUSIONS

MIL's self-regulatory mechanism is reflected in both cognitive (future temporal focus) and emotional (positive affect) dimensions, which promotes proactive coping with future stressors.

Linguistic Markers of Processing Trauma Experience in Women's Written Narratives During Different Breast Cancer Phases: Implications for Clinical Interventions

Research into the change processes underlying the benefits of expressive writing is still incomplete. To fill this gap, we investigated the linguistic markers of change in cognitive and emotional processing among women with breast cancer, highlighting the differences and peculiarities during different treatment phases. A total of 60 writings were collected from 20 women: 10 receiving chemotherapy and 10 receiving biological therapy. We performed a series of repeated measures ANOVA for the most meaningful LIWC linguistic categories, including positive/negative emotions and cognitive processes, to assess change over three sessions. Results demonstrated a significant increase in the positive emotions category for the entire group of women, with particular relevance for the biological therapy group of women, and a marginally significant (p = .07) greater use of words indicating cognitive processes for women receiving biological therapy. For the negative emotions category time was significant for the whole group of women, showing a peak of use in the second session of writing. Peculiar differences in the linguistic markers of processing trauma were observed between the two groups. Although the writing intervention is a support for both groups of women, it seems to be beneficial when there is a large time gap since the administration of chemotherapy and, thus, when the patient can revisit the experience. The relationship of the illness with life can be rearticulated, and the writing becomes a space for resignifying the traumatic cancer experience.

Emotional Distress Following Childbirth: An Intervention to Buffer Depressive and PTSD Symptoms

Childbirth for some women is a negative experience associated with depressive and post-traumatic symptoms. The preventive actions focusing on helping mothers to cope with negative emotions experienced after childbirth are strongly recommended. It is also recommended both to intervene early and on all women to avoid the risk that these symptoms can worsen in the months after childbirth. The intervention described in the current study is focalized on the elaboration of post-partum negative thoughts and emotion through a writing task, with the purpose to help new mothers to reflect, understand, evaluate and, thus, reformulate the stressful situation with new beliefs and emotions. 176 women aged from 19 to 43 years (M = 31.55, SD = 4.58) were assessed for depression and PTSD in the prenatal phase (T1). In about 96 hours after childbirth they were randomly assigned to either "Making Sense condition" (MS: in which they wrote about the thoughts and emotions connected with delivery and childbirth) or "Control-Neutral condition" (NC: in which they wrote about the daily events in behavioural terms) and then reassessed for depression and PTSD (T2). A follow up was conducted 3 months later (T3) to verify depression and posttraumatic symptoms. The results showed that depressive symptoms decreased both at 96 hours and at 3 months as a result of making-sense task. Regarding the posttraumatic symptoms the positive effect emerged at three months and not at 96 hours after birth.

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

This meta-analysis evaluated the effects of the expressive writing intervention (EW; Pennebaker & Beall, 1986) among adolescents. Twenty-one independent studies that assessed the efficacy of expressive writing on youth samples aged 10-18 ears were collected and analyzed. Results indicated an overall mean g-effect size that was positive in direction but relatively small (0.127), as well as significant g-effect sizes ranging from 0.107 to 0.246 for the outcome domains of Emotional Distress, Problem Behavior, Social Adjustment, and School Participation. Few significant effects were found within specific outcome domains for putative moderator variables that included characteristics of the participants, intervention instructions, or research design. Studies involving adolescents with high levels of emotional problems at baseline reported larger effects on school performance. Studies that implemented a higher dosage intervention (i.e., greater number and, to some extent, greater spacing of sessions) reported larger effects on somatic complaints. Overall, the findings suggest that expressive writing tends to produce small yet significant improvements on adolescents' well-being. The findings highlight the importance of modifying the traditional expressive writing protocol to enhance its efficacy and reduce potential detrimental effects. At this stage of research the evidence on expressive writing as a viable intervention for adolescents is promising but not decisive.

Enhancing the benefits of written emotional disclosure through response training

Writing about a personal stressful event has been found to have psychological and physical health benefits, especially when physiological response increases during writing. Response training was developed to amplify appropriate physiological reactivity in imagery exposure. The present study examined whether response training enhances the benefits of written emotional disclosure. Participants were assigned to either a written emotional disclosure condition (n=113) or a neutral writing condition (n=133). Participants in each condition wrote for 20 minutes on 3 occasions and received response training (n=79), stimulus training (n=84) or no training (n=83). Heart rate and skin conductance were recorded throughout a 10-minute baseline, 20-minute writing, and a 10-minute recovery period. Self-reported emotion was assessed in each session. One month after completing the sessions, participants completed follow-up assessments of psychological and physical health outcomes. Emotional disclosure elicited greater physiological reactivity and self-reported emotion than neutral writing. Response training amplified physiological reactivity to emotional disclosure. Greater heart rate during emotional disclosure was associated with the greatest reductions in event-related distress, depression, and physical illness symptoms at follow-up, especially among response trained participants. Results support an exposure explanation of emotional disclosure effects and are the first to demonstrate that response training facilitates emotional processing and may be a beneficial adjunct to written emotional disclosure.

Expressive Writing Can Impede Emotional Recovery Following Marital Separation

Marital separation and divorce are common life events that increases risk for poor health outcomes, yet few intervention studies explore how to mitigate this increased risk. This study implemented an expressive writing (EW; see Pennebaker, 1997) intervention for adults who experienced a recent marital separation. Ninety participants (32 men) were randomly assigned to and completed one of three experimental writing tasks: traditional EW, a novel (narrative-based) type of EW or control writing. Up to nine months after this writing, participants judged to be actively engaged in a search for meaning concerning their separation reported significantly worse emotional outcomes when assigned to either EW condition relative to control writing. Within the control condition, those participants actively engaged in a search for meaning reported the lowest levels of separation-related disturbance. We discuss these results in terms of the factors that may limit and promote psychological recovery following marital separation.