A pilot study on the effects and feasibility of compassion-focused expressive writing in Day Hospice patients.

Palliat Support Care. 2012 Jun;10(2):115-22. doi: 10.1017/S1478951512000181.

Imrie S1, Troop NA1.

Research has found that writing about stress can confer physical and psychological health benefits on participants and that adopting a self-compassionate stance may have additional benefits. This pilot study evaluated a self-compassionate expressive writing intervention in a Day Hospice setting.


Thirteen patients with life-limiting illnesses wrote on two occasions about recent stressful experiences. Half also received a self-compassion instruction for their writing. Outcome measures were taken at baseline and one week after the second writing session, and text analysis was used to identify changes in the types of words used, reflecting changes in psychological processes.


Patients given the self-compassion instruction increased in their self-soothing and self-esteem in contrast to patients in the stress-only condition. Happiness broadly increased in both groups although reported levels of stress generally increased in patients given the self-compassion instruction but decreased in patients in the stress-only condition. Those given the self-compassion instruction also increased in their use of causal reasoning words across the two writing sessions compared with those in the stress-only condition.


Expressive writing appears to be beneficial in patients at a hospice and was viewed as valuable by participants. The inclusion of a self-compassion instruction may have additional benefits and a discussion of the feasibility of implementing expressive writing sessions in a Day Hospice is offered.



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The purpose of the present study was twofold: The first objective of this study was to investigate the relationships between self-compassion, self-esteem, body esteem, and body comparison; the second objective was to test the effectiveness of an expressive writing intervention for fostering self-compassion and positive body esteem. Part 1 of this study included a diverse sample of 299 graduate and undergraduate students (98 Male, 201 Female) from a large southwestern university. Results indicated that higher levels of self-compassion, self-esteem, and body esteem are positively correlated, and all negatively correlated with frequency of body comparison. Additionally, results suggest that self-esteem may account for the correlations between self-compassion and body esteem, and self-compassion and body comparison, indicating body esteem and body comparison may be subsumed under the broader definition of self-esteem. This finding warrants an exploration of body attitudes that relate to self-compassion. A new concept – body compassion – is introduced, which would incorporate dimensions of self- compassion into one’s perception of body. Women reported lower body esteem and a higher frequency of body comparison than men did. Women reported higher levels of common humanity as well. Further, age and education level differences, indicated that younger participants and those earlier in their college career experienced lower levels of self-compassion and self-esteem, and a higher frequency of body comparisons than older cohorts. Of those 299 participants, 28 completed part 2 of the study and were randomly assigned to either a Best Possible Self (BPS) writing topic condition or a control writing topic. Measures were administered after three days of writing and at 6-10 weeks later. Self-compassion, body esteem, and body comparison were not improved through this method of writing. However, self-esteem was found to have increased significantly after writing, suggesting that writing about one’s Best Possible Self may be an effective means of increasing self-esteem. Limitations of the study and directions for future research are discussed.

Writing Can Heal: Effects of Self-Compassion Writing Among Hong Kong Chinese College Students


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Asian American Journal of Psychology © 2016 American Psychological Association 2016, Vol. 7, No. 1, 74–82 1948-1985/16/$12.00 http://dx.doi.org/10.1037/aap0000041

Self-compassion has been repeatedly shown to be associated with mental and physical well-being. Recent studies showed that self-compassion writing can promote mental well-being, but this has not been examined among Chinese populations. The present study examined the effectiveness of self-compassion writing among Chinese students. One hundred and twelve university students were recruited and randomly assigned into 1 of the following 2 writing conditions: self-compassion writing and control writing. Participants were asked to write according to the instruction for 3 times in a week and report their levels of positive and negative affect immediately after writing. Self-reported depressive symptoms and physical symptoms, as well as self-compassion (i.e., self-kindness, common humanity, and mindfulness) and emotion regulation capacities (i.e., attention, clarity, and repair) were assessed at baseline and 2 follow-ups (1-month, 3-month). Results showed the self-compassion writing group reported more negative affect across the 3 days of writing than the control group. No significant group differences were found in depressive symptoms, self-compassion components, or emotion regulation capacities, but the self-compassion writing group reported a significant drop in physical symptoms at the 1- and 3-month follow-up whereas the control writing group reported no significant change in physical symptoms across time. The findings suggested that self-compassion writing may benefit physical health, but further studies should be conducted to examine its underlying mechanism.

Self-Compassion and the Expressive Writing Paradigm: A Study of Therapeutic Effectiveness for Chronic Pain


Chronic pain represents a wide-spread and costly problem that is often not treated effectively with traditional biomedical approaches (Turk et al., 2011). The literature emphasizes the importance of using psychological interventions that encourage self-management of pain. This study tested the effectiveness of two brief, online writing interventions that can be used by chronic pain patients in a wide-spread and cost-effective way (Kerns et al., 2001). Writing interventions have been found to produce beneficial psychological and physical outcomes for those with pain (e.g., Frattaroli, 2006,). This study added to the literature by using positive variations of the expressive writing paradigm that focused on self-compassion and self-efficacy, and testing the moderator variable of pain catastrophizing. Ninety-three participants with chronic pain were recruited from chronic pain forums and completed the writing intervention. Participants were randomized to either self-compassion or self-efficacy writing and wrote for 20 minutes once a week for three consecutive weeks. Participants completed baseline and post-intervention measures of pain severity, illness intrusiveness, pain acceptance, pain catastrophizing, depression symptoms, life satisfaction, self-compassion, and chronic pain self-efficacy. Results indicate that participants in both writing conditions reported significantly less pain, less depression, and greater self-compassion after the writing. Moreover, participants reported feeling more positive after each writing session. One significant difference emerged between the two types of writing: participants in the self-compassion condition reported less intrusive pain, whereas those in the self-efficacy condition reported more intrusive pain after the writing. In conclusion, although both types of writing have beneficial effects on psychological and physical health for those with chronic pain, the self-compassion writing may be even more favorable than the self-efficacy writing.

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The benefits of mindfulness-enhanced expressive writing among depression-vulnerable individuals

Baum, Emily Sylvain



An impressive body of research indicates expressive writing (Pennebaker & Beall, 1986) produces physiological and psychological benefits. One study found that expressive writing decreases depressive symptoms among formerly depressed college students (Gortner, Rude, & Pennebaker, 2006). Gortner et al. (2006) argue that expressive writing may produce changes by reducing negative evaluations of emotional experiences and self-judgment, often associated with depression, through instructions encouraging participants to delve into their “deepest thoughts and feelings.” In other words, the standard writing instructions appear to send an implicit message that individuals be accepting and non-judgmental towards emotions and cognitions. The mindfulness literature suggests that making this message explicit may improve the preventative power of expressive writing in depression-vulnerable populations (Baer, 2003; Kingston, Dooley, Bates, Lawlor, & Malone, 2007; Teasdale et al., 2000; Toneatto & Nguyen, 2007). Therefore, the specific goal of the present study was to examine the effects of a mindfulness-enhanced expressive writing intervention among depression-prone individuals. Depression-vulnerable participants (e.g., dysphoric or formerly depressed) were randomly assigned to one of three groups. Although writing instructions varied for each group, all participants wrote for 20 minutes across a three-day period. The mindfulness condition received writing instructions that encouraged participants to be non-judgmental, accepting, and self-compassionate as they wrote about distressing events. Participants in the traditional writing condition received standard writing instructions, which consisted of writing about their deepest thoughts and feelings related to an emotional incident. Finally, students in the control condition were instructed to write about what they did the previous day. Results showed marginally significant decreases in depressive symptoms among participants in the mindfulness group compared to the control condition. In addition, results indicated that low suppressive depression-vulnerable individuals in the mindfulness condition marginally improved their cognitive processing biases compared to their counterparts in the traditional and control groups. Results failed to support hypotheses that predicted improvements on self-compassion, rumination, and mindfulness skills. Further, self-compassion was not found to mediate the effects of treatment on depressive symptoms and rumination. Obviously more research needs to be conducted, however preliminary results suggest that brief mindfulness interventions may be beneficial for a depression-vulnerable population.