Expressive disclosure to improve well-being in patients with amyotrophic lateral sclerosis: a randomised, controlled trial.

Psychol Health. 2013;28(6):701-13. doi: 10.1080/08870446.2012.754891. Epub 2013 Jan 7.

Averill AJ1, Kasarskis EJ, Segerstrom SC.

Amyotrophic lateral sclerosis (ALS) is a terminal neurological disease associated with progressive paralysis, loss of communicative ability and functional decline. Expressive disclosure may help people with ALS, particularly those who are emotionally or socially inhibited, meet psychological challenges associated with the disease. People with ALS (N = 48) were randomised to expressive disclosure about their disease or no disclosure. Psychological well-being (affect, depression and quality of life) was assessed pre-intervention and also three and six months later. Results of multi-level models indicated that the group that disclosed thoughts and feelings about ALS had higher well-being than the control group at three months post-intervention, but not six months. Ambivalence over emotional expression (AEE) moderated three-month post-intervention well-being. Those low in AEE had higher well-being than those high in AEE regardless of condition. Those high in AEE, who disclosed, had increased well-being from pre-intervention, whereas controls had decreased well-being from pre-intervention. Expressive disclosure may be helpful for people with ALS, but only those who have difficulty expressing emotions. In addition, the intervention had only temporary effects; the dynamic challenges of ALS progression may mean that the effect of processing thoughts and feelings about the disease in one stage may not generalise to later stages.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4302768/

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Self-report and linguistic indicators of emotional expression in narratives as predictors of adjustment to cancer.

J Behav Med. 2006 Aug;29(4):335-45. Epub 2006 Jul 15.

Owen JE1, Giese-Davis J, Cordova M, Kronenwetter C, Golant M, Spiegel D.

Emotional expression and cognitive efforts to adapt to cancer have been linked to better psychological adjustment. However, little is known about the relationship between linguistic indicators of emotional and cognitive coping efforts and corresponding self-report measures of related constructs. In this study, we sought to evaluate the interrelationships between self-reports of emotional suppression and linguistic indicators of emotional and cognitive coping efforts in those living with cancer. Seventy-one individuals attending a community cancer support group completed measures of emotional suppression and mood disturbance and provided a written narrative describing their cancer experience. Self-reports of emotional suppression were associated with more rather than less distress. Although linguistic indicators of both emotional expression and cognitive processing were generally uncorrelated with self-report measures of emotional suppression and mood disturbance, a significant interaction was observed between emotional suppression and use of cognitive words on mood disturbance. Among those using higher levels of emotional suppression, increasing use of cognitive words was associated with greater levels of mood disturbance. These findings have implications for a) the therapeutic use of emotion in psychosocial interventions and b) the use of computer-assisted technologies to conduct content analysis.

https://www.ncbi.nlm.nih.gov/pubmed/16845583

Does Written Emotional Disclosure about Stress Improve College Students’ Academic Performance? Results from Three Randomized, Controlled Studies.

J Coll Stud Ret. 2010;12(4):407-428.

Radcliffe AM1, Stevenson JK, Lumley MA, D’Souza P, Kraft C.

Several early studies and subsequent reviews suggested that written emotional disclosure (WED)-writing repeatedly about personal stressful experiences-leads to improved academic performance of college students. Yet a critical review of available studies casts some doubt on this, so we conducted three randomized, controlled experiments of the effects of WED versus control writing on grade point average (GPA) of college students. In all three studies, WED writing was implemented effectively-it contained more negative emotion language and generated more negative mood than did control writing. In Study 1, WED did not influence GPA during either the writing semester or subsequent semester among 96 students with headaches. In Study 2, WED had no effect on GPA compared with either control writing or no writing conditions among 124 students with unresolved stress. In Study 3, WED did not influence GPA or retention among 68 academically at-risk ethnic minority students, although secondary analyses suggested some benefits of WED among students who wrote more than once, particularly men. These three studies challenge the belief that WED improves academic performance of college students, and research should examine subgroups of students who might benefit from WED.

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3082942/

Minority stressors and dual identities: an analysis of lesbians’ expressive writing journals.

J Lesbian Stud. 2008;12(4):501-17. doi: 10.1080/10894160802278663.

The purpose of the current study was to examine the content of the expressive writing journals of female sexual minorities. In addition, the relationship between the content of expressive writing journals and mood and perceived stress measured two months later was examined. Journal content was also examined as a function of demographic characteristics. Thirty-nine participants each wrote a total of six journal entries about significant stressful or traumatic events or recurring problems they have experienced as lesbians. Topics that participants wrote about were differentness, leading a double life, coming out, discrimination, rejection, fears of rejection and safety, self-acceptance, and same- and opposite-sex intimate experiences. Themes of feeling different, negative coming out experiences, and negative same-sex intimate experiences were associated with more psychological distress two months after the expressive writing exercise. Occupational level was associated with themes related to leading a double life and negative same-sex and coming out experiences. These results are considered in light of the unique minority stressors experienced by lesbians as well as the difficulties inherent in lesbians having ties to both lesbian and heterosexual cultures.

Expressive writing for high-risk drug dependent patients in a primary care clinic: a pilot study.

Harm Reduct J. 2006 Nov 19;3:34.

Baikie KA1, Wilhelm K, Johnson B, Boskovic M, Wedgwood L, Finch A, Huon G.

Previous research has shown that expressive writing is beneficial in terms of both physical and emotional health outcomes. This study aimed to investigate the effectiveness and acceptability of a brief expressive writing intervention for high-risk drug dependent patients in a primary care clinic, and to determine the relationship between linguistic features of writing and health outcomes.

METHODS:

Participants completed four 15-minute expressive writing tasks over a week, in which they described their thoughts and feelings about a recent stressful event. Self-report measures of physical (SF-12) and psychological health (DASS-21) were administered at baseline and at a two-week follow-up. Fifty-three participants were recruited and 14 (26%) completed all measures.

RESULTS:

No statistically significant benefits in physical or psychological health were found, although all outcomes changed in the direction of improvement. The intervention was well-received and was rated as beneficial by participants. The use of more positive emotion words in writing was associated with improvements in depression and stress, and flexibility in first person pronoun use was associated with improvements in anxiety. Increasing use of cognitive process words was associated with worsening depressive mood.

CONCLUSION:

Although no significant benefits in physical and psychological health were found, improvements in psychological wellbeing were associated with certain writing styles and expressive writing was deemed acceptable by high-risk drug dependent patients. Given the difficulties in implementing psychosocial interventions in this population, further research using a larger sample is warranted.

https://www.ncbi.nlm.nih.gov/pubmed/17112389

Written emotional expression and emotional well-being: the moderating role of fear of rejection.

Pers Soc Psychol Bull. 2005 Jun;31(6):818-30.

Langens TA1, Schüler J.

Empirical research shows that individuals high in fear of rejection typically report low levels of perceived social support and are more vulnerable to stressful experiences. At the same time, writing about stressful experiences in an emotional way seems to help people adapt to current stressors and not-yet-assimilated stressful experiences. Therefore, the authors suggest that written emotional expression may be a particularly effective strategy to manage negative emotions for individuals high in fear of rejection. Three studies were conducted to test these assumptions. Study 1 found that high fear of rejection is linked to a lack of perceived social support. Longitudinal Studies 2 and 3 supported our main hypothesis, demonstrating that written emotional expression is linked to lower levels of negative mood among individuals high (but not among individuals low) in fear of rejection.

https://www.ncbi.nlm.nih.gov/pubmed/15833908

Expressive writing and post-traumatic stress disorder: effects on trauma symptoms, mood states, and cortisol reactivity.

Br J Health Psychol. 2008 Feb;13(Pt 1):85-93. doi: 10.1348/135910707X250866.

Smyth JM1, Hockemeyer JR, Tulloch H.

This study investigates the boundary conditions (feasibility, safety, and efficacy) of an expressive writing intervention for individuals with post-traumatic stress disorder [PTSD].

DESIGN:

Randomized trial with baseline and 3-month follow-up measures of PTSD severity and symptoms, mood states, post-traumatic growth, and (post-only) cortisol reactivity to trauma-related stress.

METHODS:

Volunteers with a verified diagnosis of PTSD (N=25) were randomly assigned to an experimental group (writing about their traumatic experience) or control group (writing about time management).

RESULTS:

Expressive writing was acceptable to patients with PTSD and appeared safe to utilize. No changes in PTSD diagnosis or symptoms were observed, but significant improvements in mood and post-traumatic growth were observed in the expressive writing group. Finally, expressive writing greatly attenuated neuroendocrine (cortisol) responses to trauma-related memories.

CONCLUSIONS:

The present study provides insight into several boundary conditions of expressive writing. Writing did not decrease PTSD-related symptom severity. Although patients continue to exhibit the core features of PTSD, their capacity to regulate those responses appears improved following expressive writing. Dysphoric mood decreased after writing and when exposed to traumatic memories, participants’ physiological response is reduced and their recovery enhanced.

https://www.ncbi.nlm.nih.gov/pubmed/18230238