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

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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