Effect of Short Term Expressive Writing on Stress Reaction

Effect of Short Term Expressive Writing on Stress Reaction
Author(s): CHAI Ming-li, YU Hui-hui, LIU Yuan, LU Qian, PAN Fang, School of Medicine, Shandong University, Department of Psychology, University of Houston
Pages: 1128-1132
Year: 2014 Issue:  6
Journal: Chinese Journal of Clinical Psychology
Keyword:  StressExpressive writingCortisolPosttraumatic growthPsychological intervention;
Abstract: Objective: To examine the effect of short term expression writing on stress response in laboratory condition.Methods: 64 4th grade clinical medical students were randomly divided into intervention group and control group. Stress responses were induced by videoes doctor-patient conflicts. After that, state anxiety, negative emotion(such as anger, anxiety, depression and fear), salivary cortisol and posttraumatic growth were assessed. 15 minutes expressive writings included feeling and ideas, express emotion and search for resources and support about stress event was used as the intervention method in writing group for 3 times. The subjects of control group took uninvolved writing. Results: The conflict video induced obvious stress response of subjects, the levels of state anxiety, anger, anxiety, depression and fear scores after video show were significantly higher than that at the baseline in both groups(P<0.01). Both expressive and uninvolved writing significantly decreased the levels of state anxiety, anger, anxiety and fear(P<0.01), but had no effects on depression scores(P>0.05). Compared with control group, expressive writing group had lower levels of anxiety and anger(P<0.01; P<0.05). Expressive writing had no significant effect on salivary cortisol level and posttraumatic growth(P>0.05). Trait anxiety had positive correlation with state anxiety, anxiety, depression and fear(P<0.001) just after stress-induction, and had positive correlation with state anxiety and depression after intervention(P<0.001). Gender(female) had positive association with state anxiety, depression and fear after stress(P<0.001; P<0.005). Conclusion: Short term expressive writing significantly can decrease stress reactions effciently.
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The effect of expressive writing intervention for infertile couples: a randomized controlled trial.

Hum Reprod. 2017 Feb;32(2):391-402. doi: 10.1093/humrep/dew320. Epub 2016 Dec 21.

Frederiksen Y1, O’Toole MS2, Mehlsen MY2, Hauge B3, Elbaek HO4, Zachariae R2,5, Ingerslev HJ6,7.

Is expressive writing intervention (EWI) efficacious in reducing distress and improving pregnancy rates for couples going through ART treatment?

SUMMARY ANSWER:

Compared to controls, EWI statistically significantly reduced depressive symptoms but not anxiety and infertility-related distress.

WHAT IS KNOWN ALREADY:

ART treatment is considered stressful. So far, various psychological interventions have been tested for their potential in reducing infertility-related distress and the results are generally positive. It remains unclear whether EWI, a brief and potentially cost-effective intervention, could be advantageous.

STUDY DESIGN SIZE, DURATION:

Between November 2010 and July 2012, a total of 295 participants (163 women, 132 men) were randomly allocated to EWI or a neutral writing control group.

PARTICIPANTS/MATERIALS, SETTING, METHODS:

Participants were couples undergoing IVF/ICSI treatment. Single women and couples with Preimplantation Genetic Diagnosis or acute change of procedure from insemination to IVF, were excluded. EWI participants participated in three 20-min home-based writing exercises focusing on emotional disclosure in relation to infertility/fertility treatment (two sessions) and benefit finding (one session). Controls wrote non-emotionally in three 20-min sessions about their daily activities. The participants completed questionnaires at the beginning of treatment (t1), prior to the pregnancy test (t2), and 3 months later (t3). In total, 26.8% (79/295) were lost to follow-up. Mixed linear models were chosen to compare the two groups over time for psychological outcomes (depression, anxiety and infertility-related distress), and a Chi2 test was employed in order to examine group differences in pregnancy rates MAIN RESULTS AND THE ROLE OF CHANCE: One hundred and fifty-three participants received EWI (women = 83; men = 70) and 142 participants were allocated to the neutral writing control group (women = 83; men = 62). Both women and partners in the EWI group exhibited greater reductions in depressive symptoms compared with controls (P = 0.049; [CI 95%: -0.04; -0.01] Cohen’s d = 0.27). The effect of EWI on anxiety did not reach statistical significance. Overall infertility-related distress increased marginally for the partners in the EWI group compared to the partners in the control group (P = 0.06; Cohen’s d = 0.17). However, in relation to the personal subdomain, the increase was statistically significant (P = 0.01; Cohen’s d = 0.24). EWI had no statistically significant effect on pregnancy rates with 42/83 (50.6%) achieving pregnancy in the EWI group compared with 40/80 (49.4%) in the control group (RR = 0.99 [CI 95% = 0.725, 1.341]; P = 0.94).

LIMITATIONS, REASONS FOR CAUTION:

The results for depressive symptoms corresponded to a small effect size and the remaining results failed to reach statistical significance. This could be due to sample characteristics leading to a possible floor-effect, as we did not exclude participants with low levels of emotional distress at baseline. Furthermore, men showed increased infertility-related distress over time.

WIDER IMPLICATIONS OF THE FINDINGS:

EWI is a potentially cost-effective and easy to implement home-based intervention, and even small effects may be relevant. When faced with infertility, EWI could thus be a relevant tool for alleviating depressive symptoms by allowing the expression of feelings about infertility that may be perceived as socially unacceptable. However, the implications do not seem to be applicable for men, who presented with increased infertility-related distress over time.

https://www.ncbi.nlm.nih.gov/pubmed/28007790

Effects of Guided Written Disclosure Protocol on mood states and psychological symptoms among parents of off-therapy acute lymphoblastic leukemia children.

J Health Psychol. 2013 Jun;18(6):727-36. doi: 10.1177/1359105312462434. Epub 2012 Nov 23.

Martino ML1, Freda MF, Camera F.

This study assesses the effects of Guided Written Disclosure Protocol on psychological distress in mothers and fathers of off-therapy acute lymphoblastic leukemia children. An experimental group participated in the writing intervention with a control group subject only to test-taking standards. The Symptom Questionnaire and Profile of Mood States were administered at baseline, post-intervention, and follow-up. Guided Written Disclosure Protocol had significant effects on the progressive reduction of anxiety, depression, somatic symptoms, hostility, tension-anxiety, and fatigue-inertia within the experimental group. However, the control group distress levels tended to worsen over time. The mediating role of emotional processing was highlighted.

https://www.ncbi.nlm.nih.gov/pubmed/23180872

Health and writing: meaning-making processes in the narratives of parents of children with leukemia.

Qual Health Res. 2015 Mar;25(3):348-59. doi: 10.1177/1049732314551059. Epub 2014 Sep 22.

Freda MF1, Martino ML2.

There is literary evidence stating that expressive writing affects health outcomes. Nevertheless, the processes underlying its benefits remain unclear. In our previous article, we described the benefits of writing; in this article, we investigate the meaning-making processes underlying the traumatic experiences of parents of children with leukemia in off-therapy. We collected the writings of 23 parents and grouped them according to the parents’ psychological outcome (low/good/high) with respect to anxiety, as assessed during a follow-up. We qualitatively analyzed the texts written by parents with good psychological outcomes to highlight their main meaning-making processes, that is, how they put into words the shattering experience, reordered the events, connected their emotions and the events, reevaluated the event, and reconstructed the time process. We found that parents with low/high outcomes articulated these processes differently. Furthermore, we discussed the uses and functions of written narration for each group.

https://www.ncbi.nlm.nih.gov/pubmed/25246328

Betrayal trauma: relationship to physical health, psychological distress, and a written disclosure intervention.

J Trauma Dissociation. 2005;6(3):83-104.

Freyd JJ1, Klest B, Allard CB.

In the current study we sought, first, to distinguish associations with health arising from types of trauma as indicated by betrayal trauma theory (Freyd, 1996, 2001), and, second, to investigate the impact of disclosing a trauma history in survey form and/or writing essays about betrayal traumas. We recruited 99 community adults reporting at least 12 months of chronic medical illness or pain, 80 of whom completed all four sessions of this six-month longitudinal intervention study. Participants were randomly assigned to write about betrayal traumas or neutral events, and they were randomly assigned to complete an extensive trauma survey or a long personality inventory, producing four groups of participants. All 99 participants were assessed at their initial visit for trauma history using the Brief Betrayal Trauma Survey (BBTS) and physical and mental symptoms. The BBTS assesses exposure to both traumas high in betrayal (such as abuse by a close other) and traumas low in betrayal but high in life-threat (such as an automobile accident). Exposure to traumas with high betrayal was significantly correlated with number of physical illness, anxiety, dissociation, and depression symptoms. Amount of exposure to other types of traumas (low betrayal traumas) did not predict symptoms over and above exposure to betrayal trauma. While neither the survey manipulation nor the writing intervention led to main effects on change in symptoms over time, there were interactions between betrayal trauma history and condition such that participants with many betrayal traumas fared better in the control conditions while participants with fewer betrayal traumas had better outcomes if they were placed in the trauma writing and/or survey conditions. We discuss ongoing and future research aimed at evaluating the role of increased structure in writing assignments as beneficial for those with severe histories of betrayal trauma.

Psychological impact of writing about abuse or positive experiences.

Violence Vict. 2005 Dec;20(6):717-28.

Antal HM1, Range LM.

Writing often helps people deal with trauma. To see if writing about childhood physical or sexual abuse, or positive experiences, helps, psychology undergraduates wrote for 20 minutes on 4 days about their abuse, a positive experience, or a trivial topic. Among 102 who began and 85 who completed pre-, post-, and 4-week follow-up measures of depression, anxiety, and suicidal ideas, abuse writers were more likely to discontinue, and positive writers were more depressed and anxious. Compared to pretest, all completers were less depressed, anxious, and suicidal at follow-up, but nonsignificantly different in health visits. Completers who wrote about abuse rated the study as more valuable than did those who wrote about positive experiences. College students who wrote about childhood physical or sexual abuse benefited from any type of structured writing assignment (where they interacted with a researcher and got extra credit) in terms of reduced anxiety, depression, and suicidal ideas, but they found value in writing about their trauma more than writing about innocuous topics.

https://www.ncbi.nlm.nih.gov/pubmed/16468447

 

Does writing about the bereavement lessen grief following sudden, unintentional death?

Death Stud. 2000 Mar;24(2):115-34.

Range LM1, Kovac SH, Marion MS.

Writing about traumatic events produces improvement in an array of areas including physical and psychological functioning. To see if these improvements extended to improved bereavement recovery after the accidental or homicidal death of a loved one, 64 undergraduates (51 women, 13 men) began, and 44 completed, a writing project. At pretest, they completed measures of depression, anxiety, grief, impact, and non-routine health visits. Then, they were randomly assigned to write about either the bereavement experience (profound condition), or innocuous topics (trivial condition). They wrote for 15 minutes a day for four days, then completed the same measures a second time (posttest). Six weeks later, they were mailed the same measures again (follow-up). A 2 (CONDITION: Profound versus Trivial) x 3 (Time: Pre-, Post-, or Follow-up) MANOVA yielded a significant main effect for time, but no main effect for condition and no interaction. Follow-up ANOVAs indicated that, across conditions, from pretest to follow-up testing participants reported less anxiety and depression, less impact, greater grief recovery, but about the same health center visits. A 2 (CONDITION) x 4 (Writing Day) MANOVA and follow-up tests indicated that those in the profound condition reported less subjective distress from Day 1 to Day 3, compared to those in the trivial condition. Combined with Kovac and Range (1999), present results suggest that writing projects may be more beneficial to those experiencing the unique bereavement of suicidal death, rather than those experiencing the nonintentional death of a loved one by accident or homicide.

https://www.ncbi.nlm.nih.gov/pubmed/11010659