The Effect of COVID-Focused Expressive Writing on Symptoms of Depression, Anxiety, and Distress in College Students: A Randomized Controlled Trial

Objective: The coronavirus disease of 2019 (COVID-19) pandemic has been associated with increased levels of distress for college students. This study aimed to assess the efficacy of a COVID-focused expressive writing intervention in reducing symptoms of depression, anxiety, and distress. Methods: A total of 169 college students were assigned either to a COVID-focused expressive writing intervention or to a nonwriting control group. All participants completed a 1-month follow-up assessment, and all study procedures were completed online due to COVID-19 restrictions. Depression was measured with the Beck Depression Inventory-II, anxiety was measured with the Beck Anxiety Inventory, and distress was measured with a Likert-scale question that measured distress specifically related to the COVID-19 pandemic. Results: Results indicated that participants in the expressive writing group demonstrated a significant decrease (b = -1.35) in anxiety symptoms whereas participants in the control group did not. None of the participants in either group demonstrated a significant decrease in depression symptoms. Ratings of distress in the expressive writing group were significantly lower (d = -0.51) at the 1-month follow-up when compared to the control group. Discussion: COVID-focused expressive writing is a relatively brief and inexpensive intervention that has been associated with lower symptoms of anxiety and distress in college students. Theoretical implications are discussed. [ FROM AUTHOR] Copyright of Journal of Social & Clinical Psychology is the property of Guilford Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Testing a new form of expressive writing on wellbeing, physical health, and depression symptomatology

Writing has existed as a form of catharsis and healing for thousands of years but has only been tested experimentally within the last few decades. One of these writing interventions- expressive writing- has shown to have small but consistent effects across various physiological and psychological constructs. However, there have been recent criticisms of the expressive writing paradigm, with researchers questioning if the current prompts open-ended nature leads to confounds in discovering underlying processes of the expressive writing task. Additionally, researchers have criticized utilizing measures that promote a disease model paradigm. Therefore, the current study contributes to the literature on expressive writing by creating a new expressive writing prompt and empirically comparing it to the common expressive writing prompt through quantitative methods. One hundred and fifty-four respondents completed a three-day online survey about their current depressive symptoms, physical health, and wellbeing. Additionally, they completed either an expressive writing or positive expressive writing task for twenty minutes, followed by measures to examine psychological flow and broadened cognition. Results revealed lower depression scores immediately after the three-day positive expressive writing intervention, but not in the expressive writing as normal condition, as well as lowered physical health symptoms in the positive expressive writing condition over the course of treatment. Additionally, broadened cognition immediately after the expressive writing task predicted reduced depression scores in the positive expressive writing group, but not the expressive writing as normal group. However, the lack of long-term psychological gains led to recommendations for future research and working towards alternative methods of expressive writing and brief interventions during the COVID-19 pandemic. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Linguistic Predictors of Psychological Adjustment in Healthcare Workers during the COVID-19 Pandemic.

COVID-19 broke out in China in December 2019 and rapidly became a worldwide pandemic that demanded an extraordinary response from healthcare workers (HCWs). Studies conducted during the pandemic observed severe depression and PTSD in HCWs. Identifying early predictors of mental health disorders in this population is key to informing effective treatment and prevention. The aim of this study was to investigate the power of language-based variables to predict PTSD and depression symptoms in HCWs. One hundred thirty-five HCWs (mean age = 46.34; SD = 10.96) were randomly assigned to one of two writing conditions: expressive writing (EW n = 73) or neutral writing (NW n = 62) and completed three writing sessions. PTSD and depression symptoms were assessed both pre- and post-writing. LIWC was used to analyze linguistic markers of four trauma-related variables (cognitive elaboration, emotional elaboration, perceived threat to life, and self-immersed processing). Changes in PTSD and depression were regressed onto the linguistic markers in hierarchical multiple regression models. The EW group displayed greater changes on the psychological measures and in terms of narrative categories deployed than the NW group. Changes in PTSD symptoms were predicted by cognitive elaboration, emotional elaboration, and perceived threat to life; changes in depression symptoms were predicted by self-immersed processing and cognitive elaboration. Linguistic markers can facilitate the early identification of vulnerability to mental disorders in HCWs involved in public health emergencies. We discuss the clinical implications of these findings.

Effectiveness of online expressive writing in reducing psychological distress among the asymptomatic COVID-19 patients in Fangcang Hospitals: A quasi-experiment study.

Objective: This study aimed to assess the applicability and effectiveness of an online format of expressive writing (EW) in reducing psychological distress among the asymptomatic COVID-19 patients in Fangcang Hospitals with a quasi-experiment. Method: Altogether 244 patients were assigned to the EW group(n=122) and the control group(n=122). Besides the routine psychological intervention (broadcast relaxation training at a fixed time) in Fangcang hospitals, The EW group was engaged in 8-day theme-based adaption EW intervention, whereas the control group received no interventions. All the participants were tested with the Brief Profile of Mood States (BPOMS) and Inpatient Mental Health Preliminary Screening Scale(IMHPS) before and after the intervention. After the intervention, the writing quality and intervention satisfaction of the EW group were evaluated by a self-designed writing quality questionnaire and EW satisfaction questionnaire. Results: The results indicated that the EW significantly improved in the BPOMS test, whereas the control group showed no significant change. The IMHPS score in the control group was statistically deteriorated than that before intervention, whereas the EW group showed no significant change. The writing quality was highly correlated with the score change of BPMOS. The overall satisfaction of patients with EW was 81.13%. Conclusion: EW can reduce psychological distress among the asymptomatic COVID-19 patients in Fangcang Hospitals. The higher the quality of writing, the greater the improvement of mood states. As a new form of psychological intervention in Fangcang hospitals with high patient satisfaction, EW has a value of popularization and application.

E-counseling-based Expressive Writing Therapy Platform for Overcoming Student Mental Health Problems

The COVID-19 pandemic has significantly impacted increasing mental health problems in Indonesia. People were haunted by anxiety, fear, and mental stress resulting from isolation activities, as well as physical restrictions and conditions of uncertainty. Even data before the pandemic showed that mental health problems were a task that had not been entirely resolved, both in Indonesia nationally and internationally. According to data from the Ministry of Health of the Republic of Indonesia, in 2016, there were 1,800 data on suicides in one year. This is equivalent to a total of 5 people who commit suicide in one day. Even sadder, it is known that 47.7% of suicide victims are aged 10 to 39 years, namely teenagers and productive age, including university students. Therefore, this study aims to design an e-counseling-based expressive writing therapy platform for college students. The expressive writing therapy method was chosen because it has a positive effect on depressive symptoms. The final result of this research is a system design in the form of a UML diagram that describes the actors, process flows, and system components, and also the prototype of the system. © 2022 Institute of Advanced Engineering and Science (IAES).

A Brief Gratitude Writing Intervention Decreased Stress and Negative Affect During the COVID-19 Pandemic.

Exploring ways to mitigate the stress of the COVID-19 pandemic is important for long-term health. Expressive and gratitude-focused writing are effective methods to help individuals process traumatic or stressful events. Gratitude-focused writing may yield additional benefits because it helps individuals appraise events positively. We hypothesized that an online gratitude writing intervention would yield greater benefits than an expressive writing intervention or control group. Participants were randomized to one of three groups and completed assessments one-week and one-month post-intervention. The gratitude writing group maintained gratitude levels and decreased stress and negative affect at one-month post-intervention. The expressive writing group decreased in gratitude and showed no changes in stress or negative affect at one-month post-intervention. The control group decreased in gratitude and negative affect and showed no changes in stress at one-month post-intervention. Gratitude writing may be a better resource for dealing with stress and negative affect than traditional expressive writing methods under extremely stressful situations with uncertain trajectories.

Can an online expressive writing program support people with inflammatory bowel disease? A feasibility randomised controlled trial.

BACKGROUND: We explored feasibility, acceptability and preliminary efficacy of an online writing intervention (WriteforIBD) against an active control condition for distress in people with inflammatory bowel disease (IBD) at the time of the COVID-19 pandemic. METHODS: A feasibility RCT was conducted in 19 adults (89.5% female, aged 20-69 years) with IBD and mild-moderate distress. Participants allocated to the WriteForIBD group completed a 4-day 30-min writing program adapted for IBD. The active control group wrote about trivial topics provided by researchers. Feasibility was established based on the recruitment and retention while acceptability based on completion rates and a numeric rating scale. All participants completed measures of mental health and disease activity before and after the intervention (one week) and at follow-up three months after the study commencement. RESULTS: The retention rate in the study was high (100% WriteForIBD; 82% control). All participants attended every session. 84.2% of participants were satisfied with the intervention. All participants reported a significant improvement in IBD-Control immediately after the intervention; F (2, 33.7) = 7.641, p = .002. A significant interaction of group*time for resilience was noted, R2 = 0.19, p < .001, with the active control group reporting a significant decline in resilience from the first follow-up to three months while no significant change in resilience for the WriteForIBD group was recorded. CONCLUSIONS: Online expressive writing is potentially feasible and highly acceptable to people with IBD who report distress. Future large-scale trials should explore the intervention that is adapted from this feasibility study. REGISTRATION: ID: ACTRN12620000448943p.

Expressive writing during the COVID-19 pandemic: themes of mixed expressive writing

In order to curb the depression levels among youth during the coronavirus disease 2019 (COVID-19) outbreak, we examined the recurrent themes of mixed expressive writing among undergraduates during the pandemic. Previous quantitative studies had emphasized on the effectiveness of expressive writing in reducing depressive symptoms, however, less qualitative studies were conducted in evaluating the content within people’s writings. As the pandemic had caused major disruptions among people, we implemented mixed expressive writing in capturing both positive and negative experiences during the pandemic. Ten participants were recruited to perform mixed expressive writing twice per week, for four consecutive weeks. Thematic analysis was used in analyzing their writings and forming the emerged themes. Five themes were formed, which included ‘school’, ‘relationships’, ‘reflection’, ‘work’, and “random incidents’. Future research should examine the effectiveness of expressive writing in writing specific themes on improving its respective psychological constructs. © 2022, Intelektual Pustaka Media Utama. All rights reserved.

Think Positive, be Positive: Expressive Writing Changes Young People’s Emotional Reactions Towards the COVID-19 Pandemic

Combining the transactional model of stress and coping and expressive writing theory, this research studied whether writing on one’s personal experiences with the COVID-19 pandemic may improve young people’s emotional reactions to the situation. A standard expressive writing instruction was compared to a positive writing instruction (writing about the positive aspects) and a coping writing instruction (writing about previous experiences and how these are helpful to cope with the situation). The results showed that participants in the positive writing instruction experienced a significantly higher positive change in feelings in relation to the COVID-19 pandemic in comparison with participants in the other writing instructions. This relationship was not mediated by the relative contents of writing. The results can help in designing online social support interventions for coping with the COVID-19 pandemic and stressful events in general. Copyright © 2022 Mariën, Poels and Vandebosch.

A Short, Multimodal Activity Break Incorporated Into the Learning Context During the Covid-19 Pandemic: Effects of Physical Activity and Positive Expressive Writing on University Students' Mental Health-Results and Recommendations From a Pilot Study.

Physical inactivity, sedentary behavior and mental ill health, due to high levels of perceived stress or self-reported depressive symptoms, are highly prevalent among university students. There are concerns that these behaviors and mental symptoms have significantly increased during the current Covid-19 pandemic, partly because academic life has changed considerably from face-to-face communication to e-learning and studying at home. Self-regulation and physical activity are hard to maintain during pandemic lockdowns. Short activity breaks could be helpful to avoid physical inactivity and sustain mental health. The breaks should comprise short and easy-implementable physical activity exercises that can be integrated into the learning context. Moreover, cognitive interventions, such as writing about positive events and feelings might help as coping strategy for self-regulation during study breaks. This study investigated and compared the effects of a physical activity intervention and a cognitive intervention (positive expressive writing) on mental health among university students. Both interventions are particularly suitable for use at home. N = 20 university students, studying in Germany, were assigned to a physical activity group or a cognitive intervention group. The physical activity intervention consisted of a mix of physical exercises including endurance exercises, muscular strength, relaxation, and ballroom dance movements. The interventions were carried out guided, once a week, for 5-10 mins at the beginning of classes. The effects of group × time showed no significant interaction on self-reported perceived stress, mood, quality of life (QoL) assessed online and compared at the beginning of the term before the intervention (T0) and at the end of the term after the intervention (T3). However, the physical activity group reported a similar physical activity level per day over time, while the cognitive intervention group showed a decrease in physical activity from T0 to T3. Low-dose, short physical activity interventions as well as cognitive interventions consisting of positive expressive writing could buffer university students' perceived stress, mood, and QoL across the term. Moreover, both interventions seem to be promising in buffering the negative side effects of stress during the Covid-19 pandemic.

Feasibility, acceptability, and potential effectiveness of an online expressive writing intervention for COVID-19 resilience.

BACKGROUND & PURPOSE: The COVID-19 pandemic has negatively impacted mental health in the general population. In this trial, our objective was to assess whether a 6-week expressive writing intervention improves resilience in a sample from the general population in the midst of the COVID-19 pandemic. MATERIALS & METHODS: This 6-week trial was conducted online. Eligible participants (n=63) were a sample of adults who self-identified as having been significantly affected by the COVID-19 pandemic. PRIMARY OUTCOME: Connor-Davidson Resilience Scale (CD-RISC). SECONDARY OUTCOMES: Perceived Stress Scale - 10-Item (PSS-10); Center for Epidemiologic Studies Depression Scale - Revised (CESD-R); Post-Traumatic Growth Inventory (PTGI). RESULTS: Resilience measures (CD-RISC) increased from baseline (66.6 ± 14.9) to immediately post-intervention (73.0 ± 12.4; p=0.014; Cohen's d =0.31), and at a 1- month follow-up (72.9 ± 13.6; p=0.024; Cohen's d =0.28). Across the same timepoints, perceived stress scores (PSS-10) decreased from baseline (21.8 ± 6.6) to immediately post-intervention (18.3 ± 7.0; p=0.008; Cohen's d =0.41), and at the 1- month follow-up to (16.8 ± 6.7; p=0.0002; Cohen's d =0.56). Depression symptoms (CESD-R) decreased from baseline (23.3 ± 15.3) at 6 weeks (17.8 ± 15.4; p=0.058; Cohen's d =0.22), and 10 weeks (15.5 ± 12.7; p=0.004; Cohen's d =0.38). Posttraumatic growth (PTGI) increased from baseline (41.7 ± 23.4) at 6 weeks (55.8 ± 26.4; p=0.004; Cohen's d =0.44), and at the 1-month follow-up (55.9 ± 29.3; p=0.008; Cohen's d =0.49). CONCLUSION: An online expressive writing intervention was effective at improving resilience in the midst of the COVID-19 pandemic. NCT#: NCT04589104.

Written benefit finding for improving psychological health during the Covid-19 pandemic first wave lockdown.

Objectives. Written benefit finding is known to improve psychological and physical health in a range of patient groups. Here, we tested the efficacy of written benefit finding, delivered online during the Covid-19 pandemic lockdown, on mood and physical symptoms. We also investigated perseverative thinking as a moderator of these effects. Design. A quantitative longitudinal design was employed. Main Outcome Measures. Participants (n = 91) completed self-report measures of anxiety, depression, stress and physical symptoms at baseline, and two weeks after being randomised to complete three consecutive days of writing about the positive thoughts and feelings they experienced during the pandemic (written benefit finding) or to unemotively describe the events of the previous day (control). State anxiety was measured immediately before and after writing. Perseverative thinking was measured at baseline. Results. Anxiety and depression symptoms decreased between baseline and the two week follow-up, but did not differ significantly between the two conditions. Perseverative thinking was negatively associated with changes in symptoms of anxiety, depression and stress, but did not moderate any writing effects. There was a significant reduction in state anxiety in the written benefit finding condition. Conclusions. Written benefit finding may be a useful intervention for short-term improvements in wellbeing.

Benefits of Expressive Writing on Healthcare Workers' Psychological Adjustment During the COVID-19 Pandemic.

COVID-19 outbroke in Wuhan, China, in December 2019 and promptly became a pandemic worldwide, endangering health and life but also causing mild-to-severe psychological distress to lots of people, including healthcare workers (HCWs). Several studies have already showed a high prevalence of depression, anxiety, and post-traumatic symptoms in HCWs but less is known about the efficacy of psychological interventions for relieving their mental distress. The aims of this study were: (1) to evaluate the psychological adjustment of Italian HCWs during the COVID-19 pandemic; (2) to investigate the efficacy of an expressive writing (EW) intervention, based on Pennebaker's paradigmatic protocol, on their psychological adjustment; (3) to analyze if outcomes of EW vary in function of individual differences (age, gender, marital status, and baseline values of symptoms). Fifty-five HCWs were randomly assigned to one of two writing conditions: EW (n = 30) or neutral writing (NW; n = 25). Psychological adjustment (in terms of ptsd, depression and global psychopathology's symptoms, perceived social support, and resilience) was assessed before and after three writing sessions. Participants who received the EW intervention showed higher improvements in ptsd, depression, and global psychopathology symptoms. Improvements in EW group varied in function of age, gender, marital status, and baseline values: young, men, married participants and those who had higher baseline scores showed a higher reduction of psychological distress symptoms while women, single and those who had lower baseline value showed increased social support, and resilience. In conclusion, the EW intervention had positive effects which varied in function of individual differences on HCWs' psychological health.

The 4Ds of Dealing With Distress - Distract, Dilute, Develop, and Discover: An Ultra-Brief Intervention for Occupational and Academic Stress.

The Covid-19 crisis has clarified the demand for an ultra-brief single-session, online, theory-led, empirically supported, psychological intervention for managing stress and improving well-being, especially for people within organizational settings. We designed and delivered "4Ds for Dealing with Distress" during the crisis to address this need. 4Ds unifies a spectrum of familiar emotion regulation strategies, resilience exercises, and problem-solving approaches using perceptual control theory and distils them into a simple four-component rubric (Distract-Dilute-Develop-Discover). In essence, the aim is to reduce distress and restore wellbeing, both in the present moment through current actions (distract or dilute), and through expressing longer-term goal conflicts (e.g., through talking, writing, and drawing) to discover new perspectives that arise spontaneously after sufficient time and consideration. The intervention is user-led in that it draws on users' own idiosyncratic and pre-existing experiences, knowledge, skills and resources to help them apply an approach, or combination of approaches, that are proportionate and timed to the nature and context of the stress they are experiencing. In this article we review the empirical basis of the approach within experimental, social, biological and clinical psychology, illustrate the novel and time-efficient delivery format, describe its relevance to sports and exercise, summarise feedback from the recipients of the intervention to date, and describe the directions for future evaluation.

Effectiveness of Expressive Writing in the Reduction of Psychological Distress During the COVID-19 Pandemic: A Randomized Controlled Trial.

OBJECTIVE: Due to the wide impact of the COVID-19 pandemic on mental health, the need for scalable interventions that can effectively reduce psychological distress has been recognized. Expressive writing (EW) can be beneficial for different conditions, including depression, suicidal ideation, and coping with trauma. Therefore, we aim to assess the applicability and effectiveness of an online format of EW in the reduction of psychological distress in context of the COVID-19 pandemic. METHODS: In this parallel-group, randomized controlled trial, participants (n = 120) were randomly allocated to (1) the intervention group-who completed five EW sessions over the 2 week period-or (2) the control group-who received treatment as usual (TAU). Participants were assessed for primary and secondary outcome measures at baseline, post-treatment, and follow-up-1-month after the treatment. The primary outcome was severity of psychological distress assessed at post-treatment, operationalized as Depression Anxiety Stress Scale (DASS) summary score. Secondary outcomes were severity of depression, anxiety, and stress (DASS subscale scores), well-being (WHO-5), subjective perception of quality of life (SQOL), and subjective evaluation of difficulties coping with pandemic, which were also assessed at post-treatment. Per protocol, analysis was conducted with available cases only. RESULTS: A less favorable outcome was found in the intervention group on psychological distress, and symptoms of stress, after controlling for baseline scores. Increased stress was recorded in the treatment group, with no effect in the control group. There was no significant difference between the groups on depression, anxiety, well-being, and subjective quality of life. No group effect for any of the outcomes measures was recorded at follow-up. Additional analysis revealed moderation effects of age and gender with older and male participants scoring higher on distress measures. CONCLUSION: Engaging in EW during the pandemic was found to elevate stress; thus, when applied in the context of the COVID-19 pandemic, it may be harmful. Hence, EW or similar self-guided interventions should not be applied without prior evidence on their effects in the context of a pandemic and similar stressful and unpredictable circumstances. CLINICAL TRIAL REGISTRATION: This study is approved by the Institutional Ethics Committee (Protocol number #2020-20), and a trial has been registered at ISRCTN registry https://www.isrctn.com/ISRCTN17898730.

Expressive writing to combat distress associated with the COVID-19 pandemic in people with inflammatory bowel disease (WriteForIBD): A trial protocol.

OBJECTIVE: A large proportion of patients with inflammatory bowel disease (IBD) receive immunosuppressive medication, may be at higher risk of complications if they contract SARS-CoV-2 virus, and therefore report high levels of COVID-19-related distress. This trial will evaluate a brief, evidence-based, online, group-based expressive writing intervention to reduce COVID-19-related distress in people living with IBD at the time of pandemic. METHODS: A parallel double-blind randomised controlled trial will be conducted. Overall, up to 154 adult participants with IBD and mild-moderate distress will be recruited via patient organisations. Participants will be allocated to the expressive writing intervention or an active control group. All participants will complete questionnaires including measures of distress, quality of life, resilience, self-efficacy, social support and disease activity before and after the intervention (1 week) and at 3 months post-intervention. The expressive writing group will participate in the evidenced-based 4-day writing program adapted from Pennebaker and Beall, 1986. The active control group will write about untherapeutic topics provided by researchers. Statistical analysis will be carried out on an intention-to-treat basis and will involve linear mixed effects models. CONCLUSIONS: If successful, this simple intervention may bring personal and societal benefits, particularly because it is low cost, can be easily implemented online, ensuring social distancing, and be made widely available, during future disasters and to help with trauma-related distress in IBD. TRIAL REGISTRATION: The trial has been prospectively registered in the Australian New Zealand Trial Registry - ACTRN12620000448943p.

Linguistic Markers of the Emotion Elaboration Surrounding the Confinement Period in the Italian Epicenter of COVID-19 Outbreak.

The expressive writing method has rarely been proposed in contexts of large-scale upheavals that affect large populations. In this study this method was applied as an intervention and tool of investigation during the confinement period in the Lombardy region, the Italian Epicenter of COVID-19 outbreak. Sixty-four participants took part in an online expressive writing project, and a total of 167 writings were collected together with some self-report evaluations on emotions and physical sensations. A linguistic analysis through two different sets of computerized linguistic measures was conducted on the collected writings in order to study the linguistic markers of emotion regulation and elaboration. Results indicated that online expressive writing has helped respondents to get more in touch with the intense emotions that were experienced following the upheavals they witnessed. Writing even only once or twice helped, particularly those respondents who had at least one COVID-19 patient among close friends or relatives. Their writings showed an intense emotional involvement together with the ability to reflect and reorganize the personal meaning of the events and emotions experienced. This study shows that expressive writing can be used in the context of a psychological emergency, both as a powerful instrument to investigate and detect the complex psychodynamic processes underpinning the distress, and as a useful intervention to reduce the negative impact of traumatic events.