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/