Lessons from writing sessions: a school-based randomized trial with adolescent orphans in Rwanda.

Eur J Psychotraumatol. 2014 Dec 22;5:24917. doi: 10.3402/ejpt.v5.24917. eCollection 2014.

Treatments for adolescents affected by long-term loss in low- and middle-income countries are lacking. As school-based interventions are cost-efficient and easy to disseminate, an evaluation of this treatment setting for adolescents is worthwhile.

OBJECTIVE:

Examining the effect of a school-based unstructured emotional writing intervention (sensu Pennebaker, group 1) about the loss of a parent to reduce adaptation problems to loss, compared to writing about a hobby (group 2), and non-writing (group 3).

METHOD:

We randomly assigned 14-18-year-old Rwandan orphans to one of the three conditions (n=23 per condition). Before and after the intervention, subjects completed the Prolonged Grief Questionnaire for Adolescents and the Mini International Neuropsychiatric Interview for Children and Adolescents, Part A, on depression as self-report measures of long-term effects of early parental loss.

RESULTS:

Repeated measures analyses of variance showed no differential effect for any of the three conditions but revealed a significant effect of time at posttest regarding grief severity. Reduction of grief symptoms was significantly higher in subjects with elevated grief. Depressive symptoms showed no significant change from pre- to posttest in the emotional writing condition, whereas they significantly decreased in the control condition.

CONCLUSIONS:

RESULTS imply that unstructured, brief emotional writing might not be indicated in adolescents affected by early parental loss who show severe and long-term distress; a more structured approach seems recommendable.

 

https://www.ncbi.nlm.nih.gov/pubmed/25537814

Languages of Grief: a model for understanding the expressions of the bereaved

Health Psychol Behav Med. 2014 Jan 1; 2(1): 132–143.
Published online 2014 Jan 22. doi:  10.1080/21642850.2013.879041

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

Writing projects: lessening undergraduates’ unique suicidal bereavement.

Suicide Life Threat Behav. 2000 Spring;30(1):50-60.

Kovac SH1, Range LM.

To assess if writing projects lessen undergraduates’ grief following a loved one’s suicide, 40 students whose loved one died by suicide in the past 2 years wrote on four occasions over 2 weeks about profound topics (e.g., events and emotions surrounding the death) or trivial topics (e.g., description of the previous meal). All participants completed pre- and posttest measures of grief and self-reported health visits, and 75% completed the same measures at 6-week mailed follow-up. As expected, individuals in the profound condition reported less grief associated with suicide at follow-up than those in the trivial condition. However, the trivial and profound groups were not significantly different in general grief or health visits. Writing about grief associated with the suicide of a loved one appeared to reduce suicidal grief associated with this event. However, this benefit did not extend to general grief or physical health.

https://www.ncbi.nlm.nih.gov/pubmed/10782718

Figures of grief: metaphors from a bereavement writing group.

Omega (Westport). 2007-2008;56(4):359-67.

Young E1.

In a community-based bereavement writing group, patterns of metaphor emerged and helped the group members identify and deal with particularly challenging aspects of death and grief, including taboo subjects such as abuse and suicide. The metaphors show how a bereavement writing group functioned to address the needs of people coping with different kinds of grief effectively and efficiently. Analysis of the specific metaphors suggests why figurative language enabled the group to bond quickly and strongly, delve into the complex emotions death elicits, and integrate experiences of loss and grief safely and productively. The patterns of metaphors the group produced in their writing about death and grief are discussed in terms of bereavement processes, and the topics the group used to elicit the figures of speech are presented for further refinement and use.

https://www.ncbi.nlm.nih.gov/pubmed/18435327

Results from a systematic writing program in grief process: part 2.

Patient Prefer Adherence. 2011 Jan 6;5:15-21. doi: 10.2147/PPA.S15155.

Furnes B1, Dysvik E.

This paper, the second of two, reports the results of a systematic writing program used as a tool in the grief process. The study was based on a specifically developed program, which has been described and discussed previously in Part 1.

METHODS:

The study had a qualitative research design, with a hermeneutic phenomenological approach. The research tool of the study, a writing program, was developed and implemented. A purposive sample was used, consisting of 13 bereaved adults.

RESULTS:

From an analysis of all of the texts written during the program, we drew four conclusions. Writing yields new thoughts and increases knowledge. Writing is stressful as well as a relief. Writing awakens and preserves memories. The value of writing is related to the forms, ways, and situations of writing.

CONCLUSION:

We have discussed handling grief with a unique process. Our findings reveal a great breadth and variation in the experiences associated with different writing forms, ways of writing, and writing situations. This implies that flexibility and individualization are important when implementing grief management programs like this. We believe that a structured writing program can be helpful in promoting thought activity and as a tool to gain increased coherence and understanding of the grief process. This writing program may be a valuable guide for program development and future research.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3034296/

A systematic writing program as a tool in the grief process: part 1.

Patient Prefer Adherence. 2010 Dec 6;4:425-31. doi: 10.2147/PPA.S14864.

Furnes B1, Dysvik E.

The basic aim of this paper is to suggest a flexible and individualized writing program as a tool for use during the grief process of bereaved adults.

METHODS:

An open, qualitative approach following distinct steps was taken to gain a broad perspective on the grief and writing processes, as a platform for the writing program.

RESULTS:

Following several systematic methodological steps, we arrived at suggestions for the initiation of a writing program and its structure and substance, with appropriate guidelines.

DISCUSSION:

We believe that open and expressive writing, including free writing and focused writing, may have beneficial effects on a person experiencing grief. These writing forms may be undertaken and systematized through a writing program, with participation in a grief writing group and with diary writing, to achieve optimal results.

CONCLUSION:

A structured writing program might be helpful in promoting thought activities and as a tool to increase the coherence and understanding of individuals in the grief process. Our suggested program may also be a valuable guide to future program development and research.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003609/

The efficacy of a brief internet-based self-help intervention for the bereaved.

Behav Res Ther. 2010 May;48(5):359-67. doi: 10.1016/j.brat.2009.12.009. Epub 2009 Dec 23

Research so far has shown little evidence that written disclosure facilitates recovery from bereavement. There are good reasons to assume that written disclosure may only benefit those bereaved who are at risk for developing problems or who are experiencing significant psychological problems as a result of their loss, and only when appropriate writing instructions are used. Drawing on previous work in the area of post-traumatic stress, a writing intervention was designed to test these assumptions. Bereaved individuals, who were still significantly distressed by their loss, were randomly assigned to the intervention condition (N = 460) or a waiting-list control condition (N = 297). Both groups filled in questionnaires online at baseline, and 3 and 6 months later. The intervention was administered via e-mail immediately after baseline measurement. Results showed that writing decreased feelings of emotional loneliness and increased positive mood, in part through its effect on rumination. However, writing did not affect grief or depressive symptoms. Contrary to expectations, effects did not depend on participants’ risk profile or baseline distress level. Implications of these findings are discussed.

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/