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

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Effects of directed written disclosure on grief and distress symptoms among bereaved individuals.

Death Stud. 2010 Jul;34(6):475-99.

Lichtenthal WG1, Cruess DG2.

Bereavement-specific written disclosure trials have generally demonstrated null effects, but these studies have not directed the focus of writing. This randomized controlled trial compared directed writing that focused on either sense-making or benefit-finding, both associated with adjustment to loss, to traditional, non-directed emotional disclosure and a control condition. Bereaved undergraduates (n = 68) completed three 20-min writing sessions over 1 week. Intervention effects were found on prolonged grief disorder, depressive, and posttraumatic stress symptoms 3 months postintervention, and the benefit-finding condition appeared particularly efficacious. Physical health improved over time in all treatment groups. Findings suggested that directing written disclosure on topics associated with adjustment to bereavement may be useful for grieving individuals.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909885/

Cognitive-behavioural emotion writing tasks: a controlled trial of multiple processes.

J Behav Ther Exp Psychiatry. 2008 Dec;39(4):558-66. doi: 10.1016/j.jbtep.2007.11.008. Epub 2008 Feb 6.

Guastella AJ1, Dadds MR.

We report on a controlled trial of three structured writing paradigms that engage the writer with cognitive-behavioural emotion-processes: exposure, devaluation, and benefit-finding. University students (N=198) wrote once a week for three weeks about their most upsetting experience. The long-term effects of these structured writing procedures were compared to an unstructured emotion writing condition and control. Outcomes indicated that exposure writing sped the reduction of intrusive and avoidant symptoms, while benefit-finding writing increased reports of positive growth. Results suggest the use of these paradigms to study emotion-processing mechanisms and, potentially, in practice to enhance coping in process-specific ways.

https://www.ncbi.nlm.nih.gov/pubmed/18346712

Writing for Health: Rationale and Protocol for a Randomized Controlled Trial of Internet-Based Benefit-Finding Writing for Adults With Type 1 or Type 2 Diabetes.

JMIR Res Protoc. 2017 Mar 14;6(3):e42. doi: 10.2196/resprot.7151.

Crawford J1,2, Wilhelm K1,2,3, Robins L1,3, Proudfoot J2,4.

Diabetes mellitus is Australia’s fastest growing chronic disease, and has high comorbidity with depression. Both subthreshold depression and diabetes distress are common amongst people with type 1 or type 2 diabetes, and are associated with poorer diabetes self-care. A need exists for low-intensity self-help interventions for large numbers of people with diabetes and diabetes distress or subthreshold depression, as part of a stepped-care approach to meeting the psychological needs of people with diabetes. Benefit-finding writing is a very brief intervention that involves writing about any positive thoughts and feelings about a stressful experience, such as an illness. Benefit-finding writing has been associated with increases in positive affect and positive growth, and has demonstrated promising results in trials amongst other clinical populations. However, benefit-finding writing has not yet been examined in people with diabetes.

OBJECTIVE:

The aim of this randomized controlled trial (RCT) is to evaluate the efficacy of an Internet-based benefit-finding writing (iBFW) intervention for adults with type 1 or type 2 diabetes (compared to a control writing condition) for reducing diabetes distress and increasing benefit-finding in diabetes, and also improving a range of secondary outcomes.

METHODS:

A two-arm RCT will be conducted, using the online program Writing for Health. Adults with type 1 or type 2 diabetes living in Australia will be recruited using diabetes-related publications and websites, and through advertisements in diabetes services and general practitioners’ offices. Potential participants will be referred to the study-specific website for participant information and screening. All data will be collected online. Participants will be randomized to either iBFW about diabetes, or a control writing condition of writing about use-of-time. Both conditions involve three daily sessions (once per day for three consecutive days) of 15-minute online writing exercises. Outcome measures will be administered online at baseline, one-month, and three-month follow-ups.

RESULTS:

This trial is currently underway. The primary outcomes will be diabetes distress and benefit-finding in diabetes. Secondary outcomes will be depression, anxiety, diabetes self-care, perceived health, and health care utilization. We aim to recruit 104 participants. All stages of the study will be conducted online using the Writing for Health program. Group differences will be analyzed on an intention-to-treat basis using mixed models repeated measures. Linguistic analyses of the writing exercise scripts, and examinations of the immediate emotional responses to the writing exercises, will also be undertaken.

CONCLUSIONS:

This RCT will be the first study to examine iBFW for adults with type 1 or type 2 diabetes. If iBFW is found to be efficacious in reducing diabetes distress and improving diabetes self-care and other outcomes, iBFW may offer the potential to be a low-cost, easily accessible self-help intervention to improve the wellbeing of adults with diabetes.

TRIAL REGISTRATION:

Australia and New Zealand Clinical Trials Registry (ACTRN12615000241538).

https://www.ncbi.nlm.nih.gov/pubmed/28292741

 

Benefit finding and expressive writing in adults with lupus or rheumatoid arthritis

, , , &

Journal

Psychology & Health

Volume 21, 2006 – Issue 5

 

Pages 651-665

https://doi.org/10.1080/14768320500456996

 

An intriguing question within the expressive writing literature is whether writing interventions that focus on positive aspects of adverse experiences can produce health benefits, particularly among individuals with serious physical illness. Seventy-five adults with lupus or rheumatoid arthritis were randomly assigned to one of three 4-session writing interventions: benefit finding (BF), standard expressive writing (EW), or a control group. Follow-up questionnaires were completed one and three months later. At three months, fatigue was lower in the BF and EW groups than in the control group. BF appeared effective in reducing pain levels for participants with high trait anxiety, whereas EW appeared effective for participants with low trait anxiety. No significant group effects were found for psychological functioning or disability. Results are discussed with regard to the literature on BF and EW among medical patients.

http://www.tandfonline.com/doi/abs/10.1080/14768320500456996

 

 

A beginner’s guide to keeping a journal

http://nymag.com/scienceofus/2017/08/a-beginners-guide-to-keeping-a-journal.html