Randomized controlled trial of expressive writing for psychological and physical health: the moderating role of emotional expressivity.
ABSTRACT: The current study assessed main effects and moderators (including emotional expressiveness, emotional processing, and ambivalence over emotional expression) of the effects of expressive writing in a sample of healthy adults. Young adult participants (N=116) were randomly assigned to write for 20 minutes on four occasions about deepest thoughts and feelings regarding their most stressful/traumatic event in the past five years (expressive writing) or about a control topic (control). Dependent variables were indicators of anxiety, depression, and physical symptoms. No significant effects of writing condition were evident on anxiety, depressive symptoms, or physical symptoms. Emotional expressiveness emerged as a significant moderator of anxiety outcomes, however. Within the expressive writing group, participants high in expressiveness evidenced a significant reduction in anxiety at three-month follow-up, and participants low in expressiveness showed a significant increase in anxiety. Expressiveness did not predict change in anxiety in the control group. These findings on anxiety are consistent with the matching hypothesis, which suggests that matching a person's naturally elected coping approach with an assigned intervention is beneficial. These findings also suggest that expressive writing about a stressful event may be contraindicated for individuals who do not typically express emotions.
Project description:It is widely reported that expressive writing can improve mental and physical health. However, to date, the neural correlates of expressive writing have not been reported. The current study examined the neural electrical correlates of expressive writing in a reappraisal approach. Three groups of participants were required to give a public speech. Before speaking, the reappraisal writing group was asked to write about the current stressful task in a reappraisal manner. The irrelevant writing group was asked to write about their weekly plan, and the non-writing group did not write anything. It was found that following the experimental writing manipulation, both reappraisal and irrelevant writing conditions decreased self-reported anxiety levels. But when re-exposed to the stressful situation, participants in the irrelevant writing group showed increased anxiety levels, while anxiety levels remained lower in the reappraisal group. During the experimental writing manipulation period, participants in the reappraisal group had lower frontal alpha asymmetry scores than those in the irrelevant writing group. However, following re-exposure to stress, participants in the reappraisal group showed higher frontal alpha asymmetry scores than those in the irrelevant writing group. Self-reported anxiety and frontal alpha asymmetry of the non-writing condition did not change significantly across these different stages. It is noteworthy that expressive writing in a reappraisal style seems not to be a fast-acting treatment but may instead take effect in the long run.
Project description:Pregnancy, birth and adjusting to a new baby is a potentially stressful time that can negatively affect the health of women. There is some evidence that expressive writing can have positive effects on psychological and physical health, particularly during stressful periods. The current study aimed to evaluate whether expressive writing would improve women's postpartum health. A randomized controlled trial was conducted with three conditions: expressive writing (n?=?188), a control writing task (n?=?213), or normal care (n?=?163). Measures of psychological health, physical health and quality of life were measured at baseline (6-12 weeks postpartum), 1 and 6 months later. Ratings of stress were taken before and after the expressive writing task. Intent-to-treat analyses showed no significant differences between women in the expressive writing, control writing and normal care groups on measures of physical health, anxiety, depression, mood or quality of life at 1 and 6 months. Uptake and adherence to the writing tasks was low. However, women in the expressive writing group rated their stress as significantly reduced after completing the task. Cost analysis suggest women who did expressive writing had the lowest costs in terms of healthcare service use and lowest cost per unit of improvement in quality of life. Results suggest expressive writing is not effective as a universal intervention for all women 6-12 weeks postpartum. Future research should examine expressive writing as a targeted intervention for women in high-risk groups, such as those with mild or moderate depression, and further examine cost-effectiveness.Clinical trial registration number ISRCTN58399513 www.isrctn.com.
Project description:BACKGROUND:A randomized experiment by Rini et al. (Health Psychol. 33(12):1541-1551, 2014) demonstrated that expressive helping, which involves three expressive writing sessions regarding hematopoietic stem cell transplant, followed by one writing session directed toward helping other stem cell transplant recipients, reduced psychological distress and bothersome physical symptoms among stem cell transplant recipients with elevated survivorship problems, relative to a neutral writing control condition. PURPOSE:The current study evaluated whether word use reflective of emotional expression, cognitive processing, and change in perspective mediates the effects of expressive helping. METHOD:The essays of 67 stem cell transplant recipients with high survivorship problems were analyzed with Linguistic Inquiry and Word Count. Multiple mediation modeling was used to test the hypothesized mechanisms of expressive helping on distress and bothersome physical symptoms. RESULTS:Relative to the control condition, expressive helping produced significant reductions in psychological distress and marginal reductions in physical symptom bother in the analyzed subset of participants from the parent study. Results indicated that positive emotion word use significantly mediated effects of expressive helping on reduced distress, but only for participants who used average (compared to above or below average) rates of negative emotion words. Cognitive processing and change in perspective did not significantly mediate benefits of expressive helping. CONCLUSIONS:Expressive helping carried its positive effects on distress through participants' higher expression of positive emotions when coupled with moderate rates of negative emotions. Findings highlight the benefit of expressing both positive and negative emotions in stressful situations.
Project description:Individuals with Parkinson's disease (PD) and their caregivers are at risk for emotional distress and hypercortisolism. Expressive writing is an effective complementary intervention to ameliorate the psychological and physiological effects of chronic illness. This pilot study aimed to evaluate feasibility and preliminary effectiveness of an expressive writing intervention for individuals with PD and their caregivers.Individuals with PD (N?=?27) and their caregivers (N?=?14) were randomly assigned to expressive (N?=?15 patients, eight caregivers) or neutral (N?=?12 patients, six caregivers) writing conditions. Cortisol awakening response (CAR), non-motor functioning, quality of life, and performance on tests of cognitive functioning were assessed at baseline, immediate post, 4-month, and 10-month post intervention.Attrition was a challenge as eight patients (29.62 %) and four caregivers (28.57 %) chose to discontinue before beginning the intervention or were lost to follow up prior to completing the intervention or the first follow up visit. Significant reduction in anxiety, marginally significant improvement in depression and caregiver burden, and significant improvements in performance on tests of learning and memory were observed, but these changes did not differ by writing condition. CAR significantly differed over time between patients and caregivers and writing conditions.Some evidence for the feasibility and effectiveness of writing to alleviate hypercortisolism was demonstrated in a small sample of PD patients; however, relatively high attrition rates and the lack of difference between expressive and neutral writing conditions on emotional and neurocognitive outcomes suggests expressive writing procedure modifications may be needed to obtain optimal results for this population.ClinicalTrials.gov, NCT02217735 , Study Start Date: August 30, 2011.
Project description:To test the effects of emotionally expressive writing in a randomized controlled trial of metastatic breast cancer patients and to determine whether effects of the intervention varied as a function of perceived social support or time since metastatic diagnosis.Women (N = 62) living with Stage IV breast cancer were randomly assigned to write about cancer-related emotions (EMO; n = 31) or the facts of their diagnosis and treatment (CTL; n = 31). Participants wrote at home for four 20-min sessions within a 3-week interval.Depressive symptoms, cancer-related intrusive thoughts, somatic symptoms, and sleep quality at 3 months postintervention.No significant main effects of experimental condition were observed. A significant condition x social support interaction emerged on intrusive thoughts; EMO writing was associated with reduced intrusive thoughts for women reporting low emotional support (eta2 = .15). Significant condition x time since metastatic diagnosis interactions were also observed for somatic symptoms and sleep disturbances. Relative to CTL, EMO participants who were more recently diagnosed had fewer somatic symptoms (eta2 = .10), whereas EMO participants with longer diagnosis duration exhibited increases in sleep disturbances (eta2 = .09).Although there was no main effect of expressive writing on health among the current metastatic breast cancer sample, expressive writing may be beneficial for a subset of metastatic patients (including women with low levels of emotional support or who have been recently diagnosed) and contraindicated for others (i.e., those who have been living with the diagnosis for years).
Project description:Coronary heart disease (CHD) is typically associated with many cardiovascular risk factors (e.g., elevated blood pressure), low health-related quality of life, depression, anxiety and psychological stress. Expressive writing (EW) has shown beneficial effects on such variables in both people from the community and in patients with a variety of chronic illnesses. However, no study to date has evaluated the physical and psychological effects of the expressive writing procedure on coronary patients referred to cardiac rehabilitation (CR).The clinical effectiveness of a 2-week disease-related expressive writing procedure (writing about one's deepest thoughts and feelings regarding the experience with heart disease) compared with the standard writing task (writing about one's deepest thoughts and feelings about the most traumatic or negative event experienced in the life), a neutral writing condition (writing about the facts regarding heart disease and its treatment) and an empty control condition will be evaluated in a randomized controlled clinical trial (RCT) with repeated follow-up measurements at 3, 6 and 12 months after discharge from CR. The primary outcome is health-related quality of life (SF-12). Secondary outcome measures are depression (BDI-II), anxiety (BAI) and post-traumatic growth (PTGI). Furthermore, the study will explore the moderating effects of coping styles, type D personality, perceived emotional support and participants' evaluative ratings of the writing interventions on the main experimental effects in order to identify sub-groups of patients showing different results.The WRITTEN-HEART study aims to explore and expand the frontiers of the expressive writing research enterprise by investigating the feasibility, safety and clinical efficacy of brief and cost-effective expressive writing interventions in patients with CHD referred to CR.ClinicalTrials.gov NCT01253486.
Project description:The brain's mapping of bodily responses during emotion contributes to emotional experiences, or feelings. Culture influences emotional expressiveness, that is, the magnitude of individuals' bodily responses during emotion. So, are cultural influences on behavioral expressiveness associated with differences in how individuals experience emotion? Chinese and American young adults reported how strongly admiration- and compassion-inducing stories made them feel, first in a private interview and then during functional magnetic resonance imaging (fMRI). As expected, Americans were more expressive in the interview. Although expressiveness did not predict stronger reported feelings or neural responses during fMRI, in both cultural groups more-expressive people showed tighter trial-by-trial correlations between their experienced strength of emotion and activations in visceral-somatosensory cortex, even after controlling for individuals' overall strength of reactions (neural and felt). Moreover, expressiveness mediated a previously described cultural effect in which activations in visceral-somatosensory cortex correlated with feeling strength among Americans but not among Chinese. Post hoc supplementary analyses revealed that more-expressive individuals reached peak activation of visceral-somatosensory cortex later in the emotion process and took longer to decide how strongly they felt. The results together suggest that differences in expressiveness correspond to differences in how somatosensory mechanisms contribute to constructing conscious feelings. By influencing expressiveness, culture may therefore influence how individuals know how strongly they feel, what conscious feelings are based on, or possibly what strong versus weak emotions "feel like." (PsycINFO Database Record
Project description:BACKGROUND:Expressive writing involves writing about stressful or traumatic experiences. Despite trials in people with advanced disease, no systematic review to date has critiqued the evidence on expressive writing in this population. To synthesise the evidence of the effects of expressive writing on pain, sleep, depression and anxiety in people with advanced disease. METHODS:A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, CENTRAL, PsycINFO and PubMed were searched from January 1986 to March 2018. Other sources included clinical data registers and conference proceedings. Studies were included if they were randomised controlled trials that assessed the impact of an intervention involving expressive writing for adults with advanced disease and/or studies involving linguistic analysis on the expressive writing output. Methodological quality was assessed using the Cochrane risk of bias tool and the Mixed Methods Appraisal Tool. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the level of evidence for the outcomes of interest. The protocol of this systematic review has been registered on PROSPERO (CRD42017058193). RESULTS:Six eligible studies with a total of 288 participants were identified, including four randomised controlled trials. All of the trials were in cancer and recruited predominantly women. None of the interventions were tailored to the population. Studies had methodological shortcomings and evidence was generally of low quality. Combined analysis of the four trials, involving 214 participants in total, showed no clear difference in the effect of expressive writing on sleep, anxiety or depression compared to an active control. Pain was not evaluated in the trials. In contrast, analysis of the four studies that included linguistic analysis alluded to linguistic mechanisms for potential effects. CONCLUSION:Although the trial results suggest there is no benefit in expressive writing for people with advanced disease, the current evidence is limited. There is a need for more rigorous trials. It would be of benefit first to undertake exploratory research in trial design including how best to measure impact and in tailoring of the intervention to address the specific needs of people with advanced disease. TRIAL REGISTRATION:The protocol of this systematic review has been registered on PROSPERO, which can be accessed here (registration number: CRD42017058193 ).
Project description:For people with HIV/AIDS (PWHA), partner loss has unique factors that complicate the grieving process and can lead to prolonged bereavement. Empirical evidence has demonstrated the benefits of emotional disclosure through therapeutic writing on physical symptoms, immune responses, and psychological distress. Therapeutic writing is based on the assumption that writing about one's deepest thoughts and feelings allows cognitive, behavioral, and kinesthetic processing of stressful life events and/or traumas. The present case study explores the benefits and challenges of using expressive writing, in addition to cognitive-behavioral therapy, to address partner loss and disenfranchised grief in the context of living with HIV. This article (a) reviews the literature on coping with loss and factors that can make PWHA more vulnerable to disenfranchised grief; (b) describes a former patient whose partner loss was complicated by lack of closure around the termination of his 6-year-long relationship, the death of that partner without the family informing him, and his anger surrounding his partner infecting him with HIV; and (c) discusses how the therapist created a comprehensive treatment plan using therapeutic writing to improve emotional processing. Results suggest that therapeutic writing assisted with symptom alleviation, improvement in psychological well-being, and increased overall quality of life. Although the loss of a partner is a common human experience, therapists need to be aware that PWHA may have additional or different care needs that can put them at risk of heightened or prolonged bereavement. Recommendations for using therapeutic writing are included. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Project description:To explore the effect of expressive writing of positive emotions on test anxiety among senior-high-school students.The Test Anxiety Scale (TAS) was used to assess the anxiety level of 200 senior-high-school students. Seventy-five students with high anxiety were recruited and divided randomly into experimental and control groups. Each day for 30 days, the experimental group engaged in 20 minutes of expressive writing of positive emotions, while the control group was asked to merely write down their daily events. A second test was given after the month-long experiment to analyze whether there had been a reduction in anxiety among the sample. Quantitative data was obtained from TAS scores. The NVivo10.0 software program was used to examine the frequency of particular word categories used in participants' writing manuscripts.Senior-high-school students indicated moderate to high test anxiety. There was a significant difference in post-test results (P < 0.001), with the experimental group scoring obviously lower than the control group. The interaction effect of group and gender in the post-test results was non-significant (P > 0.05). Students' writing manuscripts were mainly encoded on five code categories: cause, anxiety manifestation, positive emotion, insight and evaluation. There was a negative relation between positive emotion, insight codes and test anxiety. There were significant differences in the positive emotion, anxiety manifestation, and insight code categories between the first 10 days' manuscripts and the last 10 days' ones.Long-term expressive writing of positive emotions appears to help reduce test anxiety by using insight and positive emotion words for Chinese students. Efficient and effective intervention programs to ease test anxiety can be designed based on this study.