Writing therapy: a new tool for general practice?

Feasibility evaluation of psychosocial intervention for internally displaced youth in Kenya

BACKGROUND

There is limited evidence on the cultural appropriateness of first-stage psychosocial interventions for youth with mental health problems who experience conflict and disadvantage in low- and middle-income countries (LMIC).

AIMS

To evaluate the feasibility of such an intervention (Writing for Recovery - WfR) among youth with emerging emotional problems following internal displacement in Kenya.

METHOD

Fifty-four youth aged 14-17 years were randomly allocated to a six-session intervention or a waiting list control group. They completed measures of stressful life events; post-traumatic stress, depressive and anxiety symptoms; quality of life; and free text on their experience of the intervention.

RESULTS

Young participants reported high levels of trauma exposure and emotional problems. The intervention was perceived as flexible and culturally acceptable, with reported short-term impact. This was found to have promising post-intervention effect in reducing post-traumatic stress, but not depressive or anxiety symptoms; and in enhancing quality of life scores.

CONCLUSIONS

Similar psychosocial interventions that can be delivered by paraprofessionals are important for resource-constrained LMIC settings, but need to be integrated within a comprehensive scaled service model.

Expressive Writing as Brief Psychotherapy

AIM:

To analyse the effect of expressive writing in three selected cases.

METHODS:

Case studies presented from three psychiatric patients in a hospital-based outpatient clinic in Surabaya, Indonesia, between May 2017 and July 2018. Clinical changes have been observed and reported. Three patients were selected based on the possibility of whether they were able to or not to participate in similar cognitive therapy. These three cases were considered to represent a diagnosis for the psychotic and non-psychotic spectrum. The first case was a male with suicidal depression, the second was a woman with Suicidal Depression, and the third was schizophrenic woman elderly with auditory hallucinations. Expressive writing was formulated from literature studies and then implemented in these patients. Clinical changes were observed both associated with a reduction in symptoms as well as new symptoms. These non-directive measures allowed the author to observe the therapeutic effects and side effects of the intervention given.

RESULTS:

Three cases were analysed. Targets were determined by patients themselves without author’s intervention. Each patient underwent 10 sessions in minimum and 32 sessions in maximum, from once per week to once per two weeks, and was stopped after it was considered reaching or approaching the desired target, or if unwanted side effects appeared. Main changes were “father hunger” symptom decreased in the first patient, self-esteem increased in the second patient, and cope with auditory hallucination in the third patient. Few adverse events also have been recorded such as masturbation as an obsession ritual of the first patient, possibly provoked double-identity symptom in the second patient and mental fatigue in the elderly in the third patient.

CONCLUSION:

Over six months of implementation, expressive writing show desirable results, yet some side effects in patients still need to be aware of.

The emerging diabetes online community

BACKGROUND

Diabetes self-management is complex and demanding, and isolation and burnout are common experiences. The Internet provides opportunities for people with diabetes to connect with one another to address these challenges. The aims of this paper are to introduce readers to the platforms on which Diabetes Online Community (DOC) participants interact, to discuss reasons for and risks associated with diabetes-related online activity, and to review research related to the potential impact of DOC participation on diabetes outcomes.

METHODS

Research and online content related to diabetes online activity is reviewed, and DOC writing excerpts are used to illustrate key themes. Guidelines for meaningful participation in DOC activities for people with diabetes, families, health care providers, and industry are provided.

RESULTS

Common themes around DOC participation include peer support, advocacy, self-expression, seeking and sharing diabetes information, improving approaches to diabetes data management, and humor. Potential risks include access to misinformation and threats to individuals' privacy, though there are limited data on negative outcomes resulting from such activities. Likewise, few data are available regarding the impact of DOC involvement on glycemic outcomes, but initial research suggests a positive impact on emotional experiences, attitudes toward diabetes, and engagement in diabetes management behaviors.

CONCLUSION

The range of DOC participants, activities, and platforms is growing rapidly. The Internet provides opportunities to strengthen communication and support among individuals with diabetes, their families, health care providers, the health care industry, policy makers, and the general public. Research is needed to investigate the impact of DOC participation on self-management, quality of life, and glycemic control, and to design and evaluate strategies to maximize its positive impact.