Using Human and Computer-Based Text Analysis of Clinical Notes to Understand Military Service Members’ Experiences with Therapeutic Writing

https://www.sciencedirect.com/science/article/pii/S0197455618301370

Linguistic Markers of Processing Trauma Experience in Women’s Written Narratives During Different Breast Cancer Phases: Implications for Clinical Interventions

Eur J Psychol. 2015 Nov; 11(4): 651–663.
Published online 2015 Nov 27. doi:  10.5964/ejop.v11i4.991
Research into the change processes underlying the benefits of expressive writing is still incomplete. To fill this gap, we investigated the linguistic markers of change in cognitive and emotional processing among women with breast cancer, highlighting the differences and peculiarities during different treatment phases. A total of 60 writings were collected from 20 women: 10 receiving chemotherapy and 10 receiving biological therapy. We performed a series of repeated measures ANOVA for the most meaningful LIWC linguistic categories, including positive/negative emotions and cognitive processes, to assess change over three sessions. Results demonstrated a significant increase in the positive emotions category for the entire group of women, with particular relevance for the biological therapy group of women, and a marginally significant (p = .07) greater use of words indicating cognitive processes for women receiving biological therapy. For the negative emotions category time was significant for the whole group of women, showing a peak of use in the second session of writing. Peculiar differences in the linguistic markers of processing trauma were observed between the two groups. Although the writing intervention is a support for both groups of women, it seems to be beneficial when there is a large time gap since the administration of chemotherapy and, thus, when the patient can revisit the experience. The relationship of the illness with life can be rearticulated, and the writing becomes a space for resignifying the traumatic cancer experience.

Linguistic Predictors of Mindfulness in Written Self-Disclosure Narratives.

J Lang Soc Psychol. 2009 Sep;28(3):281-296. Epub 2009 Jan 5.

Moore SD1, Brody LR1.

This study investigated whether relative changes in cognitive, emotion, temporal, and self-reference word frequencies in repeated narratives predicted improvements in mindfulness skills (i.e., nonjudgmental acceptance of present-moment experiences, observing and describing present stimuli, and acting with awareness) subsequent to narrative self-disclosure. Participants wrote repeated narratives of traumatic or daily events over 3 days. Mindfulness was assessed at baseline and 4 to 8 weeks posttask. Results indicated that relative increases in cognitive processing words (among traumatic events participants and women in both conditions) and present tense words (among all participants) significantly predicted increases in nonjudgmental acceptance, describing, or overall mindfulness. Increases in present tense words appeared to partially mediate the higher mindfulness outcomes of participants writing about daily events when compared with those writing about trauma. The findings suggest that linguistic changes in self-disclosure narratives are associated with improvements in specific mindfulness skills.

https://www.ncbi.nlm.nih.gov/pubmed/27134331

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4847735/

Linguistic Markers of Processing Trauma Experience in Women’s Written Narratives During Different Breast Cancer Phases: Implications for Clinical Interventions.

Eur J Psychol. 2015 Nov 27;11(4):651-63. doi: 10.5964/ejop.v11i4.991. eCollection 2015 Nov.

Martino ML1, Onorato R1, Freda MF1.

Research into the change processes underlying the benefits of expressive writing is still incomplete. To fill this gap, we investigated the linguistic markers of change in cognitive and emotional processing among women with breast cancer, highlighting the differences and peculiarities during different treatment phases. A total of 60 writings were collected from 20 women: 10 receiving chemotherapy and 10 receiving biological therapy. We performed a series of repeated measures ANOVA for the most meaningful LIWC linguistic categories, including positive/negative emotions and cognitive processes, to assess change over three sessions. Results demonstrated a significant increase in the positive emotions category for the entire group of women, with particular relevance for the biological therapy group of women, and a marginally significant (p = .07) greater use of words indicating cognitive processes for women receiving biological therapy. For the negative emotions category time was significant for the whole group of women, showing a peak of use in the second session of writing. Peculiar differences in the linguistic markers of processing trauma were observed between the two groups. Although the writing intervention is a support for both groups of women, it seems to be beneficial when there is a large time gap since the administration of chemotherapy and, thus, when the patient can revisit the experience. The relationship of the illness with life can be rearticulated, and the writing becomes a space for resignifying the traumatic cancer experience.

https://www.ncbi.nlm.nih.gov/pubmed/27247683

How do I love thee? Let me count the words: the social effects of expressive writing.

Psychol Sci. 2006 Aug;17(8):660-4.

Slatcher RB1, Pennebaker JW.

Writing about emotional experiences is associated with a host of positive outcomes. This study extended the expressive-writing paradigm to the realm of romantic relationships to examine the social effects of writing. For 3 consecutive days, one person from each of 86 dating couples either wrote about his or her deepest thoughts and feelings about the relationship or wrote about his or her daily activities. In the days before and after writing, instant messages were collected from the couples. Participants who wrote about their relationship were significantly more likely to still be dating their romantic partners 3 months later. Linguistic analyses of the instant messages revealed that participants and their partners used significantly more positive and negative emotion words in the days following the expressive-writing manipulation if the participants had written about their relationship than if they had written about their daily activities. Increases in positive emotion words partially mediated the relation between expressive writing and relationship stability.

https://www.ncbi.nlm.nih.gov/pubmed/16913946

Linguistic changes in expressive writing predict psychological outcomes in women with history of childhood sexual abuse and adult sexual dysfunction.

Psychol Trauma. 2015 Jan;7(1):50-7. doi: 10.1037/a0036462. Epub 2014 Aug 18.

Pulverman CS1, Lorenz TA2, Meston CM1.

An expressive writing treatment was recently reported to reduce depressive symptoms and improve sexual function and satisfaction in a sample of female survivors of childhood sexual abuse (Meston, Lorenz, & Stephenson, 2013). We conducted a linguistic analysis of this data to determine whether pre- to posttreatment changes in participants’ language use were associated with the improvements in sexuality and depression. Linguistic Inquiry and Word Count (LIWC), a program that counts the use of word categories within a text, was used to evaluate the impact of several word categories, previously associated with changes in mental health (Frattaroli, 2006), and shown to differ between childhood sexual abuse survivors and nonabused women (Lorenz & Meston, 2012), on treatment outcomes. A reduction in the use of the word “I” and an increase in positive emotion words were associated with decreased depression symptoms. A reduction in the use of “I” and negative emotion words were associated with improvement in sexual function and sexual satisfaction. The findings suggest that, because language may serve as an implicit measure of depression and sexual health, monitoring language changes during treatment may provide a reliable indicator of treatment response free of the biases of traditional self-report assessments.

https://www.ncbi.nlm.nih.gov/pubmed/25793593

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

 

Effects and linguistic analysis of written traumatic emotional disclosure in an eating-disordered population.

Perm J. 2013 Winter;17(1):16-20. doi: 10.7812/TPP/12-056.

Gamber AM1, Lane-Loney S, Levine MP.

In previous studies, writing about traumatic life events produced positive physical and psychological outcomes in various populations. Specific linguistic trends, such as increasing insight and cognitive words, have paralleled health benefits.

OBJECTIVE:

This study explored the effects of written traumatic emotional disclosure on eating disorder behavior and cognitions as well as linguistic dimensions of the disclosure writings completed by eating-disordered patients.

DESIGN:

Twenty-nine female patients, aged 16 to 39 years, from the Penn State Hershey Eating Disorders partial-hospitalization program participated. Twenty-five subjects completed a traumatic disclosure or control writing task, and 21 completed all writings and baseline and follow-up questionnaires to assess eating-disorder symptoms, emotional regulation strategies, self-efficacy, and motivation to change eating-disorder behaviors. The handwritten essays were transcribed into a word-processed document and analyzed on numerous dimensions using the Linguistic Inquiry and Word Count software.

RESULTS:

Individuals completing the disclosure writing did not differ from those in the control task group on any of the questionnaires at follow-up. However, the disclosure group did use more negative emotion, insight, cognitive, function, and filler words on all writing days along with decrease of tentative words. These changes in word use correlated with previous study findings.

CONCLUSIONS:

Whereas the expected linguistic trends were evident in the disclosure group writings, no correlating health benefits could be found between the disclosure and control groups. Eating-disordered populations, often alexithymic, may have difficulty engaging with the disclosure task and could potentially benefit from guidance in processing traumatic events and their affective states.

https://www.ncbi.nlm.nih.gov/pubmed/23596363

Are alexithymia and emotional characteristics of disclosure associated with blood pressure reactivity and psychological distress following written emotional disclosure?

https://www.ncbi.nlm.nih.gov/pubmed/17621414

Br J Health Psychol. 2008 Sep;13(Pt 3):495-512. Epub 2007 Jul 6.

O’Connor DB1, Ashley L.

This study had three aims: 1) to investigate whether cardiovascular responses to laboratory stress and levels of emotional distress were attenuated following written emotional disclosure; 2) to test, in addition to the potential main effects, whether levels of alexithymia moderated the impact of writing; and 3) to examine whether alexithymics who successfully disclosed emotion in their essays would experience positive effects following writing.

DESIGN AND METHODS:

Eighty-seven participants wrote about their most stressful life experience or about a non-stressful experience, for 15 minutes, over 3 consecutive days. Two weeks later, blood pressure (BP) responses to laboratory stress and levels of emotional distress were assessed. Emotional characteristics of the disclosure essays were analysed with the Linguistic Inquiry and Word Count programme and alexithymia was assessed at baseline using the Toronto Alexithymia Scale-20.

RESULTS:

Analyses found no evidence in support of the main effects of disclosure on cardiovascular responses to stress or on emotional distress. However, alexithymia was found to moderate the impact of writing such that non-alexithymic participants in the experimental condition reported significantly lower emotional distress 2 weeks later. In addition, alexithymic participants who disclosed a greater number of negative when compared with positive emotion words exhibited reduced systolic and diastolic responses to stress. Conversely, non-alexithymic participants who disclosed more positive and less negative emotion words displayed attenuated BP reactivity to stress.

CONCLUSIONS:

The results of this exploratory study are important as they highlighted, in the absence of main effects, the importance of examining potential moderators of the emotional writing process. These findings may have implications for the development of cardiovascular health interventions.

Expressive writing in women with advanced breast cancer.

Oncol Nurs Forum. 2007 Sep;34(5):1019-24.

Laccetti M1.

To explore the relationships between patterns of affective word use (words with positive or negative connotations) in expressive writing conducted over four consecutive days and quality of life (QOL) three months after the writing exercise in women with metastatic breast cancer.

DESIGN:

Descriptive, correlational.

SETTING:

Six clinical sites in New England.

SAMPLE:

68 women with metastatic breast cancer.

MAIN RESEARCH VARIABLES:

Patterns of positive and negative affective word use and QOL.

METHODS:

Usage patterns of affective words in expressive writing were identified through the Linguistic Inquiry and Word Count (LIWC). Relationships between patterns of affective word use and QOL were explored. QOL was measured at baseline and three months after the writing exercise by the Functional Assessment of Cancer Therapy-Breast. Correlations between patterns of word use and QOL were investigated using general linear regression.

FINDINGS:

A significant relationship was found between positive-affect word use and emotional well-being. Manual scoring of 10 expressive writing texts to validate LIWC data identified a significant difference between LIWC and manual counts for negative language. Contextual evaluation suggested marked ambivalence in how the women wrote about cancer.

CONCLUSIONS:

A positive relationship between affective language in disclosure and QOL was demonstrated, illustrating a cognitive process occurring in expressive writing.

IMPLICATIONS FOR NURSING:

The findings suggest that expressive writing is a positive, helpful intervention for patients with cancer attempting to reintegrate the experience in life. Nurses should gain deeper understanding of underlying cognitive processes of disclosure to identify the most effective manner in which to use such interventions.

 

https://www.ncbi.nlm.nih.gov/pubmed/17878130