ArticleLiterature Review

Written emotional expression: Effect sizes, outcome types, and moderating variables

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Abstract

A research synthesis was conducted to examine the relationship between a written emotional expression task and subsequent health. This writing task was found to lead to significantly improved health outcomes in healthy participants. Health was enhanced in 4 outcome types--reported physical health, psychological well-being, physiological functioning, and general functioning--but health behaviors were not influenced. Writing also increased immediate (pre- to postwriting) distress, which was unrelated to health outcomes. The relation between written emotional expression and health was moderated by a number of variables, including the use of college students as participants, gender, duration of the manipulation, publication status of the study, and specific writing content instructions.

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... Meta-analyses and systematic reviews of expressive writing in healthy, clinical, and mixed populations revealed inconsistent and mixed findings. For instance, the first meta-analysis of expressive writing on a healthy college student population [9] established that expressive writing has a moderate effect size on psychological and physical health (d = 0.47). ...
... e present overview's null finding on expressive writing's general effectiveness contrasts with earlier meta-analyses with healthy [9] and mixed populations [8] who found an overall effect for EWI. For example, Zachariae and O'Toole [2] found no evidence for the general effects of EWI on any of the psychological or physical health outcomes in cancer patients and survivors. ...
... [23] Only Tim [24] discovered evidence for expressive writing's general effectiveness in breast cancer patients, consistent with some earlier meta-analyses conducted on healthy and mixed populations. [8,9] Similarly, several of the moderating effects identified in this overview are consistent with Fratarroli's [8] findings from a Overall conclusion large meta-analysis (n = 146) and several subsequent primary studies, including our 2 min single-session expressive writing study with traumatized undergraduates. [25] To contextualize this finding, it is essential to note that ...
Article
Objectives Numerous primary studies and systematic reviews, both with and without meta-analyses, examined the effects of expressive writing intervention (EWI), yielding mixed and inconsistent findings. The purpose of this review was to assess the effects of EWI on health outcomes in cancer patients using systematic reviews with or without meta-analyses. Materials and Methods Google Scholar, Google, and Yahoo search engines and the Cochrane databases of systematic reviews published between 1986 and October 2019 were used to conduct the searches. Five studies met all of the criteria for inclusion. According to the AMSTAR tool, 80% of the included studies achieved a moderate level of methodological quality, while the remaining 20% achieved a low level of methodological quality. Results There were no consistent or robust findings regarding expressive writing effects, with some studies (40%, n = 2) indicating that expressive writing has no general effectiveness. In comparison, others (40%, n = 2) indicated that expressive writing affects only physical health outcomes, and only one study (20%, n = 1) indicated that expressive writing has a general effect. In addition, several studies (40%, n = 2) discovered a moderating effect. Conclusion In summary, the findings of this narrative overview indicate that there are mixed or inconsistent findings and several moderators regarding expressive writing effects in the cancer population, implying that substantial clinical heterogeneity and deviation from Pennebaker and Beal’s, 1986, initial experiment, as well as some moderating variables, may account for this finding. Thus, future primary and review studies should employ a more rigorous methodology and greater homogeneity, notably similar to that of Pennebaker and Beal’s original study in 1986, to replicate their initial findings.
... Die Durchführung dieser expressiven Schreibprogramme hat verschiedenste Vorteile. Dazu gehören: Vorteile für die physiologische Gesundheit von Personen, meistens gemessen in weniger notwendigen Arztbesuchen nach der Teilnahme (Lowe, 2006;Baikie & Wilhelm, 2005;Cameron & Nicholls, 1998;Greenberg, Wortman & Stone, 1996;Richards, Beal, Seagal & Pennebaker, 2000;Pennebaker, Colder & Sharp, 1990), und Langzeitverbesserung der psychologischen Gesundheit (Pennebaker & Smyth, 2016;Pennebaker & Chung, 2007;Gortner, Rude & Pennerbaker, 2006;Lepore & Smyth, 2002;Smyth, 1998;Lepore, 1997). Andere Ergebnisse weisen darauf hin, dass z.B. kürzlich gekündigte Arbeitnehmer schneller eine Neuanstellung gefunden haben (Smyth, 1998;Spera, Buhrfreind & Pennebaker, 1994). ...
... Dazu gehören: Vorteile für die physiologische Gesundheit von Personen, meistens gemessen in weniger notwendigen Arztbesuchen nach der Teilnahme (Lowe, 2006;Baikie & Wilhelm, 2005;Cameron & Nicholls, 1998;Greenberg, Wortman & Stone, 1996;Richards, Beal, Seagal & Pennebaker, 2000;Pennebaker, Colder & Sharp, 1990), und Langzeitverbesserung der psychologischen Gesundheit (Pennebaker & Smyth, 2016;Pennebaker & Chung, 2007;Gortner, Rude & Pennerbaker, 2006;Lepore & Smyth, 2002;Smyth, 1998;Lepore, 1997). Andere Ergebnisse weisen darauf hin, dass z.B. kürzlich gekündigte Arbeitnehmer schneller eine Neuanstellung gefunden haben (Smyth, 1998;Spera, Buhrfreind & Pennebaker, 1994). Es konnten nach Teilnahme an expressiven Schreibprogrammen auch höhere Notendurchschnitte unter Studenten nachgewiesen werden (Morisano et al., 2010). ...
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Die persönliche Zielsetzung stellt das Individuum vor eine Vielzahl an Herausforderungen. Wir wissen, dass wiederholte Fehlschläge zur erlernten Hilflosigkeit eines Menschen führen können. Gleichzeitig wissen wir aber auch, dass hoch gesteckte Ziele besonders motivierend wirken können. Expressives Schreiben kann dem Individuum dabei helfen, ein Gleichgewicht zwischen einem hohen Anspruch bei der Zielsetzung und gleichzeitig realistischen Zielen zu finden. Verschiedenste Heldenepen aus den unterschiedlichsten Kulturen der ganzen Welt, veranschaulichen uns seit Urzeiten, wie Individuen die höchsten Ziele verfolgen und über ihre eigenen Grenzen hinauswachsen. Der Konsum fiktiver Werke der Literatur und die Aktivität des Schreibens sind nicht bloße Möglichkeiten für ein Individuum, seine Zeit zu vertreiben, sondern stehen auf verschiedene Weisen in positivem Zusammenhang mit der menschlichen Natur. Dazu gehören gesundheitliche, motivationale und emotionale Vorteile. Diese Erkenntnisse können wir uns durch die praktische Anwendung im Rahmen von angeleiteten expressiven Schreibprogrammen zur persönlichen Zielsetzung zunutze machen. Das Schreibprogramm "Persönliche Heldenreise" soll genau das tun, indem es die Teilnehmer anhand verschiedener Fragestellungen durch ein Narrativ der Heldenreise führt, im Rahmen dessen die Teilnehmer das Streben und Erreichen ihrer persönlichen Ziele verschriftlichen. Dieser Artikel fasst den wissenschaftlich-theoretischen Hintergrund des angeleiteten expressivem Schreibprogramms "Persönliche Heldenreise" zusammen.
... However research on the effects of writing on emotion regulation is sparse-to the best of the authors' knowledge only one published study was found, investigating the efficacy of a journal-writing group based on Dialectical Behavior Therapy, on emotion regulation in adolescents with mood or anxiety disorder [20]. Therapeutic use of writing has been studied in the form of expressive writing [18], and written exposure therapy [21], amongst others. Benefits of therapeutic writing have been demonstrated in physical health, emotional wellbeing [18], rumination, decreased nonsuicidal self-injury and Post Traumatic Stress Disorder (PTSD) symptoms [21]. ...
... Therapeutic use of writing has been studied in the form of expressive writing [18], and written exposure therapy [21], amongst others. Benefits of therapeutic writing have been demonstrated in physical health, emotional wellbeing [18], rumination, decreased nonsuicidal self-injury and Post Traumatic Stress Disorder (PTSD) symptoms [21]. ...
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Difficulties in emotion regulation underlie many psychiatric disorders, are associated with poor socio-occupational functioning and poor outcomes in treatment; hence from a core focus in psychotherapy. Although writing tasks are part of many psychotherapy interventions, evidence is sparse regarding the effects of writing on emotion regulation. This case report presents the use of therapeutic writing for emotion regulation, as an adjunct to psychotherapy. The client had a long history of emotionally unstable personality disorder, and persisting clinical risk and socio-occupational dysfunction despite several previous stints of psychotherapy. In addition to thrice-weekly in-person sessions, structured daily writing tasks were designed for her, with suitable probes and questions postulated to help with specific aspects of emotion regulation. Following four weeks of intervention (30 writing sessions and 17 in-person sessions), improvements in emotion regulation were noted [Difficulties in Emotion Regulation Scale scores 128 (pre) and 93 (post); reappraisal sub scale of Emotion Regulation Questionnaire 11 (pre) and 23 (post)]. The benefits and putative processes involved in such a writing intervention as experienced by this client are discussed. Despite limitations to generalizability from case report findings, therapeutic writing shows promise as an adjunct to psychotherapy in addressing emotion regulation. Therapeutic writing may have potential advantages in providing a way to internalize the skills, enhancing clients’ agency and clinical outcomes, reducing burden on healthcare systems; and bears further research as a stand-alone intervention.
... The hypothesis of this research-that the efficacy of EW is associated with the dosage-is based on a prior research by Smyth [42], who conducted a meta-analysis and examined three different "doses" of EW. The meta-analysis found that the number of EW sessions (ranging from 1 to 5) and the length of each EW session (from 15 to 30 min) were unrelated to the efficacy of EW. ...
... However, the current study found a null main effect, which suggests that increasing the dosage does not appear to improve the efficacy of EW in BC patients undergoing chemotherapy. We found that the studies included in the meta-analysis by Smyth [42] were all focused on healthy participants rather cancer patients. Our results suggest that increasing the dosage of EW failed to show any main effects among BC patients undergoing chemotherapy. ...
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PurposeThis study aims to evaluate the effects of prolonged expressive writing on health outcomes in breast cancer patients undergoing chemotherapy to help understand how the dosage of an expressive writing intervention might moderate its effects.MethodsA total of 112 breast cancer patients undergoing chemotherapy were randomly allocated to the expressive writing group (n = 56) or the prolonged expressive writing group (n = 56). The expressive writing group received the standard expressive writing intervention based on Pennebaker’s prompt to write for at least 20 min over four consecutive days (4 sessions). The prolonged expressive writing group used a modified prompt: write for at least 20 min 3 times a week over a 4-week period (12 sessions); patients could choose whether to write on consecutive days or not. All participants were required to write about their stressor-related upsetting or traumatic feelings about breast cancer. Outcomes were assessed and compared at baseline, as well as 1 month, 3 months, and 6 months postintervention.ResultsThere was no significant difference in the patients’ quality of life, or physical and psychological wellbeing between the expressive writing group and the prolonged expressive writing group at any time point (all p > .05). The quality of life of breast cancer patients significantly decreased in the two groups over time (F = 40.64, p < .001).Conclusion Our findings suggest that the writing dosage does not moderate the effects of expressive writing on breast cancer patients undergoing chemotherapy.Trial registrationChiCTR1800016278
... Language is intricately linked to scientific literacy, science learning, and science teaching, because language provides a generic medium for interpreting experiences and communicating ideas (Norris and Phillips, 2003;Carlsen, 2007;Halliday and Matthiessen, 2007). In particular, personal writing was found to be effective for learning (Smyth, 1998;Bangert-Drowns et al., 2004). Consequently, science education researchers used writing assignments to facilitate development of conceptual understanding, critical thinking, and reflective thinking, among others, and for assessment. ...
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Introduction Science educators use writing assignments to assess competencies and facilitate learning processes such as conceptual understanding or reflective thinking. Writing assignments are typically scored with holistic, summative coding rubrics. This, however, is not very responsive to the more fine-grained features of text composition and represented knowledge in texts, which might be more relevant for adaptive guidance and writing-to-learn interventions. In this study we examine potentials of machine learning (ML) in combination with natural language processing (NLP) to provide means for analytic, formative assessment of written reflections in science teacher education. Methods ML and NLP are used to filter higher-level reasoning sentences in physics and non-physics teachers’ written reflections on a standardized teaching vignette. We particularly probe to what extent a previously trained ML model can facilitate the filtering, and to what extent further fine-tuning of the previously trained ML model can enhance performance. The filtered sentences are then clustered with ML and NLP to identify themes and represented knowledge in the teachers’ written reflections. Results Results indicate that ML and NLP can be used to filter higher-level reasoning elements in physics and non-physics preservice teachers’ written reflections. Furthermore, the applied clustering approach yields specific topics in the written reflections that indicate quality differences in physics and non-physics preservice teachers’ texts. Discussion Overall, we argue that ML and NLP can enhance writing analytics in science education. For example, previously trained ML models can be utilized in further research to filter higher-level reasoning sentences, and thus provide science education researchers efficient mean to answer derived research questions.
... In a meta-analysis of 39 randomized controlled trials, Reinhold et al. [10] found that expressive writing exerted only limited effects in reducing depressive symptoms, and sometimes exacerbated results in unpredictable ways. In unsupervised settings, expressive writing can occasionally increase psychological distress [11,12], even to the point of causing patients to discontinue their treatment [13,14]. These conflicting findings indicate that, despite the efficacy and convenience of expressive writing for emotion regulation, care should be taken when deploying this approach in self-directed practices. ...
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Conventional writing therapies are versatile, accessible and easy to facilitate online, but often require participants to self-disclose traumatic experiences. To make expressive writing therapies safer for online, unsupervised environments, we explored the use of text-to-image generation as a means to downregulate negative emotions during a fictional writing exercise. We developed a writing tool, StoryWriter, that uses Generative Adversarial Network models to generate artwork from users’ narratives in real time. These images were intended to positively distract users from their negative emotions throughout the writing task. In this paper, we report the outcomes of two user studies: Study 1 ( N = 388), which experimentally examined the efficacy of this application via negative versus neutral emotion induction and image generation versus no image generation control groups; and Study 2 ( N = 54), which qualitatively examined open-ended feedback. Our results are heterogeneous: both studies suggested that StoryWriter somewhat contributed to improved emotion outcomes for participants with pre-existing negative emotions, but users’ open-ended responses indicated that these outcomes may be adversely modulated by the generated images, which could undermine the therapeutic benefits of the writing task itself.
... An alternative approach could be to formulate an individual-level photo method intervention, such as integrating photo methods with expressive writing to create a self-directed intervention. Expressive writing interventions have been found to be effective in general populations [47]; however, in cancer populations, documented effects are small or null [48,49]. Supplementing expressive writing exercises with accompanying photographs could bolster the effects on well-being among cancer survivors and reduce obstacles to attending in-person photo method group sessions. ...
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PurposePhoto methods such as photo-elicitation and photovoice have traditionally been implemented as knowledge-generation techniques; however, they have also been conceptualized as tools for community impact and as interventions in and of themselves. We performed a scoping review to document how photo methods have been used in studies of cancer, to describe participant populations, and to identify opportunities for future directions for the use of photo methods in cancer.Methods An a priori search strategy was implemented across health-related databases with the following inclusion criteria: (1) study participants were diagnosed with cancer and/or were caregivers of those with cancer; (2) study participants were asked to take and/or respond to photographs as part of the study protocol; (3) articles were published in peer-reviewed journals; (4) articles were written in English.ResultsEighty non-duplicative articles were identified; of these, 30 articles describing 24 individual studies were included for review. All but one (95.8%) of the studies utilized photovoice solely as a knowledge-generation technique without participant outcome measurement or analysis. Across all included studies, participants were largely women with breast cancer; other demographic and cancer-related variables (e.g., race and cancer stage) were not consistently reported. Caregivers were included in 37.5% of studies.Conclusion Photo methods are most frequently used in order to capture qualitative data in cancer populations; however, there are missed opportunities in their lack of use for intervention and systemic change. In addition, inconsistent reporting of demographics and cancer characteristics limits our ability to synthesize these data across studies.
... They found that writing about trauma results in immediate increased negative mood, but long term positive emotional enhancement (Pennebaker & Beall, 1986; Pennebaker, Kiecolt-Glaser, & Glaser, 1988; Donnelly & Murray, 1991). Also, researchers found that when individuals disclose their thoughts and feelings about a traumatic life event through writing, it is beneficial to their health (Greenberg & Stone, 1992;King, 2001;Pennebaker, Kiecolt-Glaser, & Glaser, 1988;Pennebaker, 1997Pennebaker, , 2000Smyth, 1998) and may enhance positive selfperception, resulting in a stronger self-concept (King, 2001;Pennebaker & Keough, 1999). ...
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It is well known that writing about traumatic life events has both physical and psychological long term benefits. James Pennebaker and his colleagues (Pennebaker, Mayne, & Francis, 1997; Pennebaker & Seagal, 1999) suggested that both negative and positive disclosure writing instructions could be useful in understanding positive life events, not only the negative life events. The purpose of this study is to experimentally investigate the order in which participants write about their positive or negative perspectives of life events through an expressive writing paradigm and manipulate the order of instructions that includes negative-only expression, negative to positive expression, positive negative expression, and neutral writing expression. It is hypothesized that writing about negative events then positive events could allow for a greater increase in positive affect, in contrast to writing about strictly negative events or strictly positive events. Once individuals have written about a negative topic then a positive topic, it could help make individuals gain an understanding about a negative event and view positive events with great meaning, without allowing for rumination and negative mood. Undergraduate students were instructed to complete a writing task for fifteen minutes for two days. Follow up evaluations were administered two weeks after the second writing task, asking participants to rate their meaning in life, their health and wellbeing, and positive and negative effectiveness (PANAS). This experiment could determine that the order in which participants write could change the writing paradigm from the completely separating life experiences into strictly negative expression and strictly positive expression. In conclusion, results showed that writing about negative and positive events created further benefits of writing allowing individuals to put negative events in perspective while focusing on the presence of positive life events.
... Expressive writing-a technique that involves writing about a stressful or traumatic event 15-20 minutes for three to five days-has been linked with improved health, physiological benefits, and increases in psychological well-being (Pennebaker & Beall, 1986;Smyth, 1998). ...
Article
The stories we tell can shape our lives and our experiences. Unfortunately, many African American adolescents are often subjected to stereotypes and one-sided deficit narratives that can become self-fulfilling prophecies undermining their achievement, aspirations, and well-being. However, the college admission process offers an intervention opportunity to help these students tell a different story—their story. In this paper, the author presents an analysis of the threats and opportunities inherent in the college-admission process and a literature review on topics aligned to three pillars—beliefs, belonging, and becoming. The paper concludes with the application plan for an intervention that leverages the college admission essay and essay-writing process to reframe beliefs and shape positive personal narratives. Inspired by research from narrative psychology, social psychology, and positive psychology, OurStory challenges dominant deficit narratives and aims to improve academic outcomes, college matriculation rates, and adolescent flourishing and well-being.
... Electronic health diaries are also used in research contexts where they offer more timely or even real-time reporting of health-related indicators and can thus meaningfully complement medical records or retrospective questionnaires [1]. In addition, free-text entries of diary studies can offer a window into a person's emotions [3][4][5][6] and daily-life contexts. ...
Article
Background: Electronic health diaries hold promise in complementing standardized surveys in prospective health studies but are fraught with numerous methodological challenges. Objective: The study aimed to investigate participant characteristics and other factors associated with response to an electronic health diary campaign in persons with multiple sclerosis, identify recurrent topics in free-text diary entries, and assess the added value of structured diary entries with regard to current symptoms and medication intake when compared with survey-collected information. Methods: Data were collected by the Swiss Multiple Sclerosis Registry during a nested electronic health diary campaign and during a regular semiannual Swiss Multiple Sclerosis Registry follow-up survey serving as comparator. The characteristics of campaign participants were descriptively compared with those of nonparticipants. Diary content was analyzed using the Linguistic Inquiry and Word Count 2015 software (Pennebaker Conglomerates, Inc) and descriptive keyword analyses. The similarities between structured diary data and follow-up survey data on health-related quality of life, symptoms, and medication intake were examined using the Jaccard index. Results: Campaign participants (n=134; diary entries: n=815) were more often women, were not working full time, did not have a higher education degree, had a more advanced gait impairment, and were on average 5 years older (median age 52.5, IQR 43.25-59.75 years) than eligible nonparticipants (median age 47, IQR 38-55 years; n=524). Diary free-text entries (n=632; participants: n=100) most often contained references to the following standard Linguistic Inquiry and Word Count word categories: negative emotion (193/632, 30.5%), body parts or body functioning (191/632, 30.2%), health (94/632, 14.9%), or work (67/632, 10.6%). Analogously, the most frequently mentioned keywords (diary entries: n=526; participants: n=93) were "good," "day," and "work." Similarities between diary data and follow-up survey data, collected 14 months apart (median), were high for health-related quality of life and stable for slow-changing symptoms such as fatigue or gait disorder. Similarities were also comparatively high for drugs requiring a regular application, including interferon beta-1a (Avonex) and glatiramer acetate (Copaxone), and for modern oral therapies such as fingolimod (Gilenya) and teriflunomide (Aubagio). Conclusions: Diary campaign participation seemed dependent on time availability and symptom burden and was enhanced by reminder emails. Electronic health diaries are a meaningful complement to regular structured surveys and can provide more detailed information regarding medication use and symptoms. However, they should ideally be embedded into promotional activities or tied to concrete research study tasks to enhance regular and long-term participation.
... Interest in WBIs has been widespread, with at least 16 meta-analyses in this field, comprising hundreds of empirical studies. Although some metaanalyses failed to prove the efficacy of WBIs (Reinhold et al., 2018), several other meta-analyses (Smyth, 1998;Frattaroli, 2006) showed its efficacy in improving general psychological health. The disparity in the meta-analysis results can be explained by several factors, such as the number of studies included, the criteria for study selection (e.g., effects on specific populations), and the variables of interest (e.g., effects on either physical or psychological wellbeing). ...
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Background There are a plethora of studies on expressive writing and positive writing interventions, but few have addressed the combination of both paradigms. Additionally, research on the role of ambivalence toward change in the context of writing-based interventions is lacking. Ambivalence toward change is a natural movement of approaching and avoiding change that may occur in various situations. In psychotherapy, its resolution is associated with successful outcomes.AimThis study tested the efficacy of a combination of expressive and positive writing paradigms in an internet-based intervention to improve university students’ mental health. Additionally, focusing participants on a current, unresolved problem allowed us to explore the possible role of ambivalence toward change as a mediator of the intervention’s results.Methods We recruited 172 participants who were randomly divided into experimental (n = 85) and control (n = 87) groups. The intervention consisted of the identification of a current problem and four writing tasks on consecutive days. Assessment was conducted at baseline and posttest in both groups and at follow-up in the experimental group. Participants in the experimental condition were also assessed after each task. Measures of anxiety, depression, rumination, ambivalence toward change, distress, and wellbeing (optimism, affect, and satisfaction with life) were collected.ResultsMultivariate analysis of variance (MANOVA) showed that participants in the experimental group had a significant decrease from baseline to posttest in ambivalence toward change and rumination when compared with the control group. These results were maintained at follow-up. No differences were found in the remaining measures. Within the experimental group, ambivalence toward change, rumination, and distress significantly decreased throughout the intervention and the exploratory mediation analysis indicated that ambivalence toward change partially mediated the improvements in rumination and distress.DiscussionConsidering different perspectives about a current problem and using a combination of expressive and positive writing fostered the reduction of ambivalence toward change and rumination. Ambivalence toward change reduction after the second writing task may have created optimal conditions for the subsequent decrease in rumination and distress. Future studies should replicate this finding and dismantle the components that are more adequate in changing these variables.
... This is supported by evidence from traditional sports that highlights the positive effects of social support (e.g., Hayward et al., 2017; Kristiansen & Roberts, 2010) as well communication (e.g., Freeman & Wuhn, 2019) on coping. By contrast, stress management strategies such as debriefing (e.g., McArdle et al., 2010) and journaling (e.g., Smyth, 1998) have not been reported in previous qualitative research on esports to date. While these strategies are usually introduced by sport psychologists and/or performance coaches, these professional roles are not yet present in all esports teams. ...
Thesis
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Driven by the need to inform evidence-based intervention strategies for performance and health promotion in esports, this thesis aimed to provide a starting point for future research on esports and, in particular, psychophysiological stress in esports. To this end, this work began by addressing why and how sport and exercise psychology could research esports. Following this, a systematic review of the literature on stress in non-competitive and competitive esports was performed. The results indicated that playing esports in competitive settings–in contrast to non-competitive settings–seems to be related to psychophysiological stress responses, and also highlighted a number of theoretical and methodological limitations with research in this area. To build on this initial understanding of stress in esports, a qualitative study was conducted that explored the subjective experiences of professional players. Here, a variety of stressors, perceived stress responses, and coping strategies were identified. To complete the work, a different perspective and approach was taken, using an online questionnaire to investigate perceived performance factors and stress management strategies utilized by sport psychologists and performance coaches in esports. Overall, this work provided a number of implications for future research and applied practice that are addressed in this thesis.
... Future research should explore how expressive writing interventions need to be adapted to reduce potential harmful effects, identify potential additional therapeutic supports and how to best recruit participants in challenging and unpredictable times. In Frattaroli's [24] meta-analysis and the previous review by Smyth [53], there was indication that weekly interventions produced a larger effect size compared with sessions run across consecutive days. However, these Note: Satterthwaite estimates for degrees of freedom. ...
Article
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.
... However, long, and short-term incensed stressors e.g., as trauma also led to several negative outcomes. A coping reaction to these negative outcomes, an individual express feelings and emotions about traumatic event as emotional disclosure which is preferred process for physical as well as psychological health (Smyth, 1998;Pennebaker et al, 2001;Pennebaker et al., 2007). In contrast, not giving intra-disclosure to emotions for long period of time then escalate mental health problems in individual. ...
Thesis
Abstract This study was aimed. The study consisted of 291 pregnant women, age range 18-40 (M=26.56) from first to third trimester, from two different cities of Punjab. The study consisted of two phases as first phase was scale development and second phase consisted of collecting data. For collecting data informed consent, demographic data form, the EMBU-C (Egna Minnen av Barndoms Uppfostran; (one's memories of upbringing) (Muris et al., 2003), Multidimensional Scale of Perceived Social Support (Zimet et al., 2012), The Emotional Disclosure Scale (ESDS) (Seadatee Shamir et al., 2014) and indigenous Perinatal Anxiety Scale, were employed in this study as measures of required variables. The results revealed that overprotective parenting, rejective parenting are positively associated with perinatal anxiety in pregnant women. Emotional warmth parenting and emotional disclosure negatively associated with perinatal anxiety. Further spousal support was founded to have strong significant positive relationship with emotional disclosurse. In addition, overprotective parenting and emotional self- disclosure were predicters of perinatal anxiety in pregnant women. Further, mediation analysis revealed that emotional disclosure partially mediates the relationship between overprotective parenting and perinatal anxiety in pregnant women. Key words: Perinatal anxiety, Maternal Parenting, Spousal Support, Emotional Disclosure, Perinatal Health, Maternal Health Predictors, Pregnancy, Underdeveloped Countries
... In the case of a particular user who is under a lot of stress, he or she may choose to relax for a few hours or do anything monotonous. As a result of the system's improved emotional awareness of the user, the system provides new means of engagement in response [23]. When the user is under extreme stress, the system may instruct him or her to work in safe mode. ...
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When it comes to our everyday life, emotions have a critical role to play. It goes without saying that it is critical in the context of mobile-computer interaction. In social and mobile communication, it is vital to understand the influence of emotions on the way people interact with one another and with the material they access. This study tried to investigate the relationship between the expressive state of mind and the efficacy of the human-mobile interaction while accessing a variety of different sorts of material over the course of learning. In addition, the difficulty of the feeling of many individuals is taken into account in this research. Human hardness is an important factor in determining a person’s personality characteristics, and the material that they can access will alter depending on how they engage with a mobile device. It analyzes the link between the human-mobile interaction and the person’s mental toughness to provide excellent suggestion material in the appropriate manner. In this study, an explicit feedback selection method is used to gather information on the emotional state of the mind of the participants. It has also been shown that the emotional state of a person’s mind influences the human-mobile connection, with persons with varying levels of hardness accessing a variety of various sorts of material. It is hoped that this research will assist content producers in identifying engaging material that will encourage mobile users to promote good content by studying their personality features.
... On the other hand, it can produce an immediate increase in the negative affects perceived rather than an immediate relief in emotional tension and the health benefits obtained are not related to the amount of emotions or negative anguish expressed or reported after the writing session (8). ...
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Background and aim of the work: Expressive Writing (EW) is a useful tool for taking care of the person globally, and literature shows that self-care and self-awareness improve the coping skills of health professionals, positively increasing personal and professional satisfaction and reducing the negative aspects related to the profession, such as burnout. The objective of the research is to analyze the writings produced by healthcare professionals belonging to palliative care in a previous quantitative study to identify any changes between two sessions. Methods: It is a longitudinal qualitative research with an interpretative phenomenological methodology of analysis of documents written by professionals. The study included 50 expressive writings: 25 at Time 0 (T0) and 25 at Time 1 (T1). The analysis sample is composed of 25 professionals. All participants completed an Expressive Writing protocol homogeneous in procedure, mandate, and timing. Results: The study revealed a variation in contents from T0 to T1 highlighting both professional and intimate growth of the professionals. The practitioner appears more aware of working together to achieve a goal. Writing evolve as more spontaneous. Attention is focused on the relationship with the patient as an engine of personal and professional growth. The satisfaction is linked to the management of a complex case in its entirety. Conclusions: The investigated instrument resulted in a beneficial change in the healthcare professionals involved. Writing helps to find strategies to take care of the other, improves communication, favors the sharing of experience with the other, increasing the awareness of limitations and strengths.
... writing gratitude or forgiveness letters). Smyth (1998) reviewed 13 case-controlled writing therapy studies that showed the positive influence of writing techniques on psychological well-being. The benefits produced in writing activity (self regulation, clarifying life goals, gaining insight, finding meaning, getting a different point of view) can be described under the rubric of psychological and emotional well-being. ...
Article
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Writing Therapy (WT) is defined as a process of investigation about personal thoughts and feelings using the act of writing as an instrument, with the aim of promoting self-healing and personal growth. WT has been integrated in specific psychotherapies with the aim of treating specific mental disorders (PTSD, depression, etc.). More recently, WT has been included in several Positive Interventions (PI) as a useful tool to promote psychological well-being. This narrative review was conducted by searching on scientific databases and analyzing essential studies, academic books and journal articles where writing therapy was applied. The aim of this review is to describe and summarize the use of WT across various psychotherapies, from the traditional applications as expressive writing, or guided autobiography, to the phenomenological-existential approach (Logotherapy) and, more recently, to the use of WT within Acceptance and Commitment Therapy (ACT). Finally, the novel applications of writing techniques from a positive psychology perspective will be analyzed. Accordingly, the applications of WT for promoting forgiveness, gratitude, wisdom and other positive dimensions will be illustrated. The results of this review show that WT yield therapeutic effects on symptoms and distress, but it also promotes psychological well-being. The use of writing can be a standalone treatment or it can be easily integrated as supplement in other therapeutic approaches. This review might help clinician and counsellors to apply the simple instrument of writing to promote insight, healing and well-being in clients, according to their specific clinical needs and therapeutic goals.
... The effects of expressive writing on mental and emotional well-being are equally compelling. Research has demonstrated a reduction in self-reported depression (Smyth et al., 2011, Kacewicz et al., 2007, improved life satisfaction and subjective well-being (King, 2001;Pennebaker & Chung, 2012;Schutte et al., 2012), enhanced creativity (Pennebaker & Chung, 2012), reduced traumatic distress (Smyth, 1998), increased meaning (Schutte et al., 2012), decreased autonomic arousal, and increased emotional self-regulation (Davidson et al., 2002). ...
Article
Interactive Journaling is a structured writing process that motivates and guides individuals toward positive change and greater well-being in target life areas. This paper maps the properties of Interactive Journaling to core properties and criteria of positive interventions – activities within the field of positive psychology that are empirically validated and strive to promote well-being. These properties include underpinnings in the evidence-based paradigm of expressive writing, an emphasis on participant agency and person-activity fit, and other evidence-based norms within the practice of Interactive Journaling. Based on this alignment, Interactive Journaling can be considered a positive intervention. Existing positive interventions may also be enhanced when integrated into the Interactive Journaling framework. Researchers are invited to examine Interactive Journaling more closely using validated well-being measures and new populations.
... Meta-analyses and scienti c reviews show that emotionally expressive writing improves physical and psychological outcomes in healthy and medically-ill populations (21)(22)(23). Some but not all studies of expressive writing in people diagnosed with cancer show similar bene ts (24-26); inconsistent ndings may be due to methodological shortcomings (e.g., small sample sizes) and the need to consider moderators of effects of expressive writing in this population (27)(28)(29). ...
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Background: During, shortly after, and sometimes for years after hematopoietic stem cell transplant, a large proportion of hematological cancer patients undergoing transplant report significant physical and psychological symptoms and reduced health-related quality of life. To address these survivorship problems, we developed a low-burden, brief psychological intervention called expressive helping that includes two theory- and evidence-based components designed to work together synergistically: emotionally expressive writing and peer support writing. Building on evidence from a prior randomized control trial showing reductions in physical symptoms and distress in long-term transplant survivors with persistent survivorship problems, the Writing for Insight, Strength, and Ease (WISE) trial will evaluate the efficacy of expressive helping when used during transplant and in the early post-transplant period, when symptoms peak and when intervention could prevent development of persistent symptoms. Methods: WISE is a multi-site, two-arm randomized controlled efficacy trial. Adult hematological cancer patients scheduled for a hematopoietic stem cell transplant will complete baseline measures and then, after hospitalization but prior to transplant, they will be randomized to complete either expressive helping or a time and attention “neutral writing” task. Both expressive helping and neutral writing involve four brief writing sessions, beginning immediately after randomization and ending approximately four weeks after hospital discharge. Measures of symptom burden (primary outcome), distress, health-related quality of life, and fatigue (secondary outcomes) will be administered in seven assessments coinciding with medically relevant time points from baseline and to a year post-intervention. Discussion: The steady and continuing increase in use of stem cell transplantation has created growing need for efficacious, accessible interventions to reduce the short- and long-term negative physical and psychosocial effects of this challenging but potentially life-saving treatment. Expressive helping is a psychological intervention that was designed to fill this gap. It has been shown to be efficacious in long-term transplant survivors, but could have even greater impact if it is capable of reducing symptoms during and soon after transplant. The WISE study will evaluate these benefits in a rigorous randomized controlled trial. Trial registration: Clinicaltrial.gov: NCT03800758. Expressive Helping for Stem Cell Transplant Patients, registered January 11, 2019. https://www.clinicaltrials.gov/ct2/show/NCT03800758?term=expressive+helping&draw=2&rank=2
... 2 The typical expressive writing protocol includes four twenty-minute writing sessions, with participants randomly assigned to write about either (a) a neutral topic (control condition), (b) their thoughts, (c) their emotions, or (d) their thoughts and emotions related to a specific experience (Pennebaker, 1994). Meta-analytic evidence indicates that writing involving both emotions and thoughts is the most effective in generating beneficial outcomes (Smyth, 1998). Accordingly, we focus on the emotions and thoughts condition and refer to this as "traditional expressive writing." 3 To ensure confidentiality, participants were assigned a numeric code for study materials. ...
Article
Decades of research have demonstrated that experiencing workplace unfairness can result in profound negative consequences for employees. Integrating conservation of resources theory with meaning-finding perspectives, we argue that engaging in meaning-finding in the aftermath of unfairness can foster state resilience and promote positive outcomes. To promote meaning-finding, we develop and test a new expressive writing intervention (i.e. a guided writing technique that facilitates the processing of negative experiences). Results indicate that the meaning-finding expressive writing intervention is associated with higher resilience than traditional expressive writing. Moreover, resilience mediates the relationship between meaning-finding (vs. traditional) expressive writing and willingness to reconcile, positive relationships with others, and life satisfaction. Theoretically, our findings highlight that engaging in meaning-finding can transform aversive experiences into opportunities to foster resilience and positive outcomes. Practically, meaning-finding expressive writing provides an effective, simple, and cost-effective tool that can be used by employees and counseling programs to promote recovery.
... This article explores the enhancement of empathy through creative writing, as creative writing also functions as a form of treatment for various social and emotional problems (Harber and Pennebaker, 1992;Smyth, 1998). More specifically, the enhancement of empathy, which is part of a wider set of social learning skills, is achieved through the research / intervention program "Creative Writing and Social Learning Skills", which includes creative writing activities, based on literary texts from Balkan countries and countries of Eastern and Southeastern Europe. ...
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Education is not only about the transferring of knowledge, but also about the cultivation of strong social and emotional skills, which are necessary for the strengthening of the social competence of students, their positive self-perception, and their success in school. Empathy, which refers to the ability to recognize another person’s emotional state is one of the basic skills of the 21st century, which helps all students grow up to become active and critically aware citizens. The research/intervention program "Creative Writing and Social Learning Skills", implemented by students of the 5th and 6th grade of elementary schools in Thessaloniki, Greece, explore the enhancement of empathy, through the use of creative writing as an educational tool. Activities used were based on literary texts from Balkan countries and countries of Eastern and Southeastern Europe. The research sample consisted of 573 students, who were divided into the Intervention Group, that implemented the program, and the Control Group, that attended its regular curriculum. The analysis of the level of skills in children, and especially the level of empathy, which is of concern to us in the present study, was carried out using a structured improvised questionnaire, the alpha Cronbach coefficients where of range at very high levels. Study results showed that the Intervention Group exhibited statistically greater improvement in the assessment of empathy compared to the Control Group.
... Many variations of the Pennebaker procedure have been developed since. 4 The majority of these research projects and therapeutic set-ups work with short writing tasks that are restrictive and highly standardized, hence the term "programmed writing" (L'Abate 2004;Smyth 1998). The many attempts to systematically prove the effect of therapeutic writing and the preoccupation for quantitative outcomes are likely to go hand in hand with an effort to prove to the effectiveness of art to funding agencies or to more broadly promote its usefulness for society (Swinnen 2016(Swinnen , p. 1379Williamson and Wright 2018). ...
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This chapter investigates how-to books on creative “life writing” for therapy, transformative learning, and personal development, in short, therapeutic writing. This subgenre of writing advice is situated in two different domains with psychology and pedagogy on the one hand, and life writing and creative writing on the other hand. After a brief overview of the history of therapeutic writing, we focus on Jessica Kingsley Publishers (JKP), a leading international niche publisher in the field of neurological and cognitive differences. JKP offers a combination of popular-science books, memoirs, and self-help publications, as well as a series of how-to books on writing for therapy or personal development. By this specific grouping of genres and formats, JKP turns its readers into writers and also guides the process of writing by setting out standards for narratives about neurological illness and disability, both in content and form. Combining both textual and contextual analysis, we examine the advice oeuvres of three JKP authors, Gillie Bolton, Kate Thompson, and Celia Hunt, to see how they relate to the therapeutic and self-help ethos as well as to more literary forms of creative writing, and how they negotiate the ideas of becoming a writer through craft, therapy, and self-expression.
... 14 Disclosive writing about possible selves has been found to improve emotional adjustment through learning about oneself, restructuring one's priorities, and gaining better insight into one's motives. [51][52][53][54] In addition, emotional well-being and optimism can be increased through a program asking a person to visualize a life consistent with his/her ideal self. 55 Therefore, the likelihood-of-realization score seems to be linked to subjective wellbeing and optimism through the concept of "best possible self. ...
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Objective: Enhancing subjective well-being is an effective way to improve mental health. This study aimed to validate a virtual realitybased interactive feedback program as an intervention tool for promoting subjective well-being. Methods: Thirty-six males participated in this program, consisting of three tasks constructed based on the theories of positive psychology: 'Experience-based problem recognition task', 'Future self-based success story expression task', and 'Strength expression task'. Participants rated visual analog scores associated with each of the tasks' contents. The concurrent validity of task scores was evaluated by correlations with the psychological scale scores. Results: The total task score was positively correlated with scores of Mental Health Continuum-Short Form (MHC-SF) emotional wellbeing and psychological well-being, Rosenberg's Self-Esteem Scale, Dispositional Hope Scale agency dimension and pathways dimension, and Life Orientation Test Revised, but not with MHC-SF social well-being scores. After controlling for the effects of the other task scores, the task scores had linear relationships with certain psychological assessments. Conclusion: Since the task scores are closely related to indicators of well-being, self-esteem, hope, and optimism, the program contents are well associated with certain aspects of subjective well-being and thus may be available for training that improves subjective well-being through interactive feedback.
... Yet, some difficulties stemming from the nature of writing make it difficult for learners to take pleasure from writing activity and to establish it as a skill for lifelong use (Yaman, 2010). Research studies have exhibited that writing is a complex internal process and that it causes individuals to relax emotionally (Kloss and Lisman, 2002;Smyth, 1998;Sloan et al., 2009). On examining the components of writingwhich is an internal and complex process -we find that long term active memory, cognitive processes, and motivation come into prominence (Sharples, 1998); and those components make the writing process individual and cause the emergence of self-efficacy perception. ...
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In addition to being a vehicle of communicating individuals’ feelings and thoughts, writing as an action is also a domain of skill reflecting individuals’ emotional states. The act of writing becomes meaningful to learners when it is considered as an instrument of expressing learners’ thoughts, feelings and personal experiences, and of com-municating, and when used in this way (Hidi and Boscolo, 2006). Yet, some difficulties stemming from the nature of writing make it difficult for learners to take pleasure from writing activity and to establish it as a skill for lifelong use (Yaman, 2010). Research studies have exhibited that writing is a complex internal process and that it causes individuals to relax emotionally (Kloss and Lisman, 2002; Smyth, 1998; Sloan et al., 2009). On examining the components of writing – which is an internal and complex process - we find that long term active memory, cogni-tive processes, and motivation come into prominence (Sharples, 1998); and those components make the writing process individual and cause the emergence of self-efficacy perception. Unless methods for raising the motivation are available to perform a writing activity, it is impossible for writing individuals to make considerable progress and development (Ackerman, 2006). Hidi and Boscolo (2006) list the factors influencing the motivation to write as such: (1) having a desire to write, (2) having sufficient knowledge of the topic, (3) an uncomplicated topic for writing, (4) giving instant feedback for the writing, and (5) being able make constant efforts during writing Moti-vation is a broad concept containing wishes, desires, needs, impulses and interests (Cuceloglu, 2004). It is a factor which has become an important element in learning the native language and a foreign language (Vaezi, 2008) for the last thirty years, which represents one of the most attractive and most complicated variables used in explaining the individual differences in language learning (MacIntyre et al., 2001), and which is necessary for successful language acquisition (Dornyei, 2001a). Through years, students’ performances dramatically decreased despite the curricula’s expectations of the students, and several studies were conducted in relation to the issue so as to raise learners’ in-class study motivations (Ackerman, 2006). The actualisation of the writing activity depends on stu-dents’ interest in the activity, their willingness and needs. On reviewing the relevant literature, it was found that motivation for reading, which was a skill directly related with writing, was addressed by researchers and that the scale for reading motivation was developed (Wigfield and Guthrie, 1995). Research has shown that students with high motivation to read devote time to reading and that they transform reading into a habit (Gambrell, 2011). Various scales on writing anxiety were developed so as to determine the anxiexties about writing in the native language (Petzel and Wenzel, 1993) and an in foreign language (Cheng, 2004). Besides, a self-efficacy scale for writing was developed (Sengül, 2013) in relation to writing in the native language No measurement tools proved to be valid and reliable were encountered in Turkey to determine secondary school students’ levels of motivation for writing in the native language. This study aims at developing a valid and reliable scale so as to determine secondary school students’ levels of motivation to write in their native language.This research was conducted with 493 students attending the primary education schools in Istanbul. Since the selection of the participants was made on the basis of willingness, the method of purposive sampling was employed. 55.2% (272) of the participants were male while 44.8% (221) of them were female. 24.9% (123) of the students were the fifth graders whereas 31.8% (157) were the sixth graders, 23.9% (118) were the seventh graders, and 19.3% (95) were the eighth graders. Prior to the scale development work, literature was reviewed, and the scales used in similar studies were examined. In addition to that, students were asked to write a composition about writing activities in Turkish classes. Thus, a content analysis was performed for the students’ compositions and the research studies found in literature. Special care was taken to include as many trial items as possible in order to uncover the writing motivation present in primary school students; and consequently, a pool of 60 items was formed. The items were then analysed by 5 experts (measurement and evaluation experts, experts on teaching Turkish, and Turkish teachers) who had been doing their post-doctorate research. Following the modifications based on expert opinions, a form of 53 items was prepared. The construct validity was analysed for the validity study of the writing motivation scale (WMS). In order to prove the construct validity, factor analysis was performed for the data so as to find whether the scale was one dimensional or multidimensional, and if it was multidimensional, to see on what dimensions the items cluste-red. Confirmatory factor analysis was done in order to evaluate the extent to which the factors composed of a number of variables fitted the real data. So as to find whether or not the items were valid, item analysis was performed. The corrected item-total correlations were examined in relation to the evidence for the reliability of the scale, internal consistency coefficient, and item analysis. And for the analyses of the data obtained from the validity and reliability studies of the scale, the SPSS 20.0 and LISREL 8.54 programmes were used.This research aimed to develop a tool of measurement in order to determine secondary school students’ motivation for writing. The scale was composed of 4 sub-scales; namely, self-efficacy, affective state, social acceptance, and physical state. It was found in consequence of literature review that the research studies performed in relation to writing motivation focussed on such issues as purpose in writing, the need felt for writing, the value attached to writing, interest in writing (Hidi and Boscolo, 2007), belief in self-efficacy, target tendencies, interests, and results obtained (Troia et al., 2012). Besides, by taking families and writing experiences in the school setting into consideration among the factors influencing learners’ writing motivation, Nolen (2007) lay emphasis on social contexts. The first dimension in this current research was “self-efficacy”. Bandura (1986: 361) defines the concept of self-efficacy as “individu-als’ judgement of themselves in relation to the capacity to organise and successfully perform the activities neces-sary for displaying a certain level of performance”. In writing skills, a directly proportional relation exists between high motivation and self-efficacy, moreover, high motivation also paves the way for the increase of the author’s perception of self-efficacy (Bruning and Horn 2000; Pajares, 2003). The second dimension mentioned in this study was “social acceptance”. Walker and Symons (1997) consider the leading theories on human motivation as a whole and summarise the general properties of the theories in five main points. According to one of those five points, when people are approved / accepted by others, their motivation reaches the maximum level. Another dimension in this study was the “physical state”. In addition to their influence in visual-motor skills and in assuring the hand-eye coordination in the writing process, physical factors are also important in affecting the cognitive and the social development. Puberty was the period on which this research was focussed. In this period, the development of the muscles enabling writing is at a more advanced level than the one in the primary school period and it comes very close to that of mature people’s. The number of studies addressing this dimension of writing is very small in Turkey. The research studies conducted by Temur (2011), Temur et al. (2012) - which deals with such physical factors as holding the pencil, the position of the paper, the posture in sitting, and applying pressure on the paper- are remarkable in this respect. The final dimension dealt with in this research was the dimension of “affective state”. Students’ emotional status in the writing process is also important in the development of the writing skill. “Individuals’ affective side involves emotions, preferences, sensations, beliefs, expectations, attitudes, apprecia-tion, values, morals, ethics, etc. Learning the affective properties is important for individuals. This can be consi-dered from two perspectives: First, teaching purely affective properties, and second, the instrumental use of the learnt affective properties in teaching or learning the cognitive and the psychomotor behaviours. For instance, if an individual has negative attitudes towards mathematics, it becomes difficult for one to teach that person mathe-matics” (Tekindal, 2009: 1). In consequence, it may be said that the self-efficacy dimension as well as the affective state which contains interests and the concepts of value, and the social dimension have similarities to the dimen-sions addressed in other research studies. On the other hand, the dimension of physical state was not encountered in other research studies. This is an important dimension in that it is not included in other research studies.
... In particular, women with low alexithymia scores reported a greater use of words expressing affectivity and sadness from the first to the last writing session. The result regarding the increment of sadness words seems to be coherent with previous studies highlighting the importance of expressing negative emotions during the writing process (Smyth, 1998). The capacity to describe the more ambivalent feelings involved in an ART experience can be considered as a meas- [page 128] [Research in Psychotherapy: Psychopathology, Process and Outcome 2020; 23:452] ure of increment in awareness. ...
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Expressive writing techniques are methods focusing on written emotional expression that require people to write about traumatic or difficult experiences, with the objective of promoting an elaboration of these events. The general aim of the study is to investigate the influence of alexithymia, a deficit in emotional regulation processes, on the effects of an expressive writing intervention, analyzing the writing protocols through the use of the Linguistic Inquiry and Word Count (LIWIC) and Referential Process (RP) linguistic measures via IDAAP software. Thirty-five women undergoing an assisted reproductive treatment participated in the study and filled out a sociodemographic questionnaire, the 20-item Toronto Alexithymia Scale. They also underwent three session of writing, following a request that they write about their emotions regarding their current situation. The women enrolled were divided into two groups: low alexithymia and high alexithymia, comprising individuals with a TAS-20 total score lower or higher than the mean, respectively. Analyses within the groups during the three writing sessions revealed that the women with low alexithymia reported a greater number of words expressing affectivity, sadness and future perspective, whereas no significances in the high alexithymia group emerged. Moreover, when analysing differences between the groups, high-alexithymia women reported lower scores in RP indexes and fewer words expressing sadness, future perspectives and we verbal. In conclusion, these preliminary findings may confirm the hypothesis that alexithymia affects the effectiveness of expressive writing through a difficulty in becoming involved in the writing process and a lack of symbolizing processes.
... Studies offer evidence of EW decreasing post-traumatic stress disorder (PTSD) related to pregnancy [44] and having long-term health benefits that include improved mood/affect and feelings of greater psychological well-being [45]. A meta-analysis of EW studies found a significant overall benefit (d ¼ 0.47, p < 0.0001) in objective or self-reported health areas such as physical health, psychological well-being, and physiological and general functioning [46]. ...
Article
The worst disaster of natural origin in recent Canadian history occurred in May 2016 in the northern Alberta community of Fort McMurray Wood Buffalo (FMWB). Among the 88,000 people abruptly evacuated amidst a raging wildfire were approximately 1850 pregnant or pre-conception women. Based on the Allostatic Load and Preterm Birth Conceptual Framework (Olson et al., 2015) [1], a simple, cost-effective expressive writing intervention following Pennebaker's work (Pennebaker and Beall, 1986; Pennebaker et al., 2007) [2,3] was implemented in a primary study to help mitigate the negative effects of stress on a sample of these women and their unborn children. Journal writing served as an intervention in the primary study while the contents of the journal entries became the data analyzed in this qualitative study. This study utilized both inductive and deductive thematic analysis of journal entries completed by 54 women over four consecutive days (15 min/day). Deductive analysis followed a coding structure that was generated from two resilience scales. Themes that emerged during inductive analysis were also coded. The main themes that emerged described the women's challenging experiences: fears for themselves and their offspring, fire-related and past trauma, and relationship changes. Resilience characteristics and practices also emerged from the writings and mirrored those found in the literature: (a) post-traumatic growth, (b) adaptability, (c) emotional/social connectedness, (d) composure, and (e) reasoning. This paper highlights the challenging experiences of pregnant women exposed to a disaster and the resilience they demonstrated in the face of the tragedy.
Article
This study aims to figure out the relationship between writing competence and grammatical knowledge. Recently, the importance of practical English competence has been emphasized more and more, and we can see a movement towards the improvement of English writing skills. Compared to other language skills, writing has not been given much attention by instructors because giving writing instructions is not easy, and the assessment of writing is also not a simple process. Therefore, learners have not had many opportunities for practicing their writing skills. When it comes to writing, learners need to generate ideas, organize their thoughts, choose the proper vocabulary, and complete the writing assignment with coherence. In addition, there are many aspects of writing such as spelling, mechanics, organization and content. Learners are required to master various characteristics of writing to complete their essay. Among those factors, learners have difficulty in applying grammatical rules, leading to a lack of motivation for writing. Therefore, the objective of this study is to highlight the relationship between writing competence and grammatical knowledge through correlation analysis. For the study, 108 students who took a writing course at university were asked to take a grammar test, and they completed ten writing activities over the course of one semester. An analysis of correlation was conducted using SPSS 21 Version and further discussion was introduced.
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Imagine that you are a product manager at a software company. When users disclose some information to your product, they can use all the great features you and your team have integrated into the software. Utilizing these features is essential for the success of your product: it makes users satisfied and encourages others to use the software as well. Furthermore, the user and usage data can be used to improve the product and help implementing new features over time. However, since your product collects users’ data, you are worried about privacy-related issues. What causes users’ privacy concerns, and what are the potential consequences of those concerns? The APCO ( A ntecedents → P rivacy C oncerns → O utcomes) and enhanced APCO models provide a summary of the current scientific findings related to these questions and present them in a conceptual model. The APCO framework will help practitioners and scholars to bring different privacy-related aspects of a product to their attention and suggests how these aspects can interrelate. Throughout this chapter, we will consider a use case scenario of a fitness tracker application and discuss how APCO applies to this scenario.
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There are diverse streams of empirical research attempting to study complex privacy behaviors in different scenarios. In this chapter, we connect those streams and present them under three themes: (1) individuals’ uncertainty about their own preferences as well as their uncertainty about the consequences of information disclosure; (2) the context-dependence of individuals’ concern, or lack thereof, about privacy; (3) the degree to which privacy concerns are malleable and prone to manipulations by commercial and government entities. Building on these themes, we discuss the role of public policy in the protection of privacy in the information age.
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This chapter examines privacy as a multilevel concept. While current conceptualizations of privacy tend to focus on the individual level, technological advancements are making group privacy increasingly important to understand. This chapter offers a typology of both groups and group privacy to establish a framework for conceptualizing how privacy operates beyond the individual level. The chapter describes several contemporary practices that influence the privacy of multiple actors and considers the dynamics of multi-stakeholder privacy decision-making. Potential tensions that exist between the rights and preferences of individual group members or between individuals and the group as a whole are also examined. Finally, recommendations for tools and other mechanisms to support collaborative privacy management and group privacy protection are provided.
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This chapter introduces the book Modern Socio-Technical Perspectives on Privacy . The book informs academic researchers and industry professionals about the socio-technical privacy challenges related to modern networked technologies. This chapter provides a working definition of privacy, describes the envisioned audiences of this book, and summarizes the key aspects covered in each chapter. The chapter concludes with an invitation to join our community of privacy researchers and practitioners at modern-privacy.org .
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We interviewed a panel of 13 applied researchers to understand why applied and academic privacy researchers do not collaborate more often. While many agree about the benefits of collaboration, they simply do not collaborate due to real and perceived barriers, such as timelines, goal differences, and data-sharing difficulties. We synthesize the findings and provide actionable recommendations to help bridge the gap between academic and applied research.
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Modern information systems require their users to make a myriad of privacy decisions, but users are often neither motivated nor capable of managing this deluge of decisions. This chapter covers the concept of tailoring the privacy of an information system to each individual user. It discusses practical problems that may arise when collecting data to determine a user’s privacy preferences, techniques to model these preferences, and a number of adaptation strategies that can be used to tailor the system’s privacy practices, settings, or interfaces to the user’s modeled preferences. Throughout the chapter, we provide recommendations on how to develop user-tailored privacy solutions, depending on the requirements and characteristics of the system and its users.
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As many technologies have become available around the world and users increasingly share personal information online with people and organizations from different countries and cultures, there is an urgent need to investigate the cross-cultural differences in users’ privacy attitudes and behaviors in the use of these technologies. Such investigation is important to understand how users in different cultures manage their information privacy differently and to inform the privacy design for technologies that are used globally. This chapter covers major cross-cultural differences that have been reported in privacy research. Specifically, it briefly reviews the concept of culture, discusses the cross-cultural differences in privacy management, and recommends design implications on privacy design in the international context.
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Η Binkley και οι συνεργάτες της στο μοντέλο που παρουσίασαν για τις δεξιότητες του 21ου αιώνα, τις οποίες πολλοί ταυτίζουν με τις κοινωνικές δεξιότητες, αναφέρουν ότι στους τρόπους σκέψης ανήκουν η συγκλίνουσα/αποκλίνουσα σκέψη, η καινοτομία/δημιουργικότητα και η μεταγνώση. Το ερευνητικό/παρεμβατικό πρόγραμμα «Δημιουργική Γραφή και Δεξιότητες Κοινωνικής Μάθησης» του τμήματος Βαλκανικών, Σλαβικών και Ανατολικών Σπουδών του Πανεπιστημίου Μακεδονίας, διάρκειας πέντε μηνών περίπου, διερευνά την ενίσχυση των παραπάνω δεξιοτήτων, οι οποίες αποτελούν μέρος ενός ευρύτερου συνόλου κοινωνικών δεξιοτήτων που σχετίζονται με τη μάθηση, έχοντας ως εκπαιδευτικό εργαλείο τη δημιουργική γραφή και αφόρμηση λογοτεχνικά κείμενα των βαλκανικών χωρών. Το δείγμα της έρευνας αποτέλεσαν 573 μαθητές της Ε΄ και ΣΤ΄ τάξης των δημοτικών σχολείων του νομού Θεσσαλονίκης, οι οποίοι χωρίστηκαν στην Ομάδα Παρέμβασης, που υλοποίησε το πρόγραμμα και στην Ομάδα Ελέγχου, που παρακολούθησε το κανονικό της πρόγραμμα. Η διερεύνηση του επιπέδου των δεξιοτήτων κοινωνικής μάθησης των παιδιών έγινε με τη χρήση ενός δομημένου αυτοσχέδιου ερωτηματολογίου, του οποίου οι συντελεστές αξιοπιστίας alpha Cronbach κυμαίνονται σε πολύ υψηλά επίπεδα. Η ανάλυση των αποτελεσμάτων κατέδειξε ότι η Ομάδα Παρέμβασης σημείωσε στατιστικά σημαντική μεγαλύτερη βελτίωση στην αξιολόγηση των παραπάνω δεξιοτήτων σε σχέση με την Ομάδα Ελέγχου και με εξισωμένα τα δημογραφικά και άλλα στοιχεία των μαθητών.
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Purpose Innovative firms leverage big data analytics (BDA) benefits in optimising value creation, particularly in business-to-business (B2B) contexts. Examples of this are found in new product success and product innovation performance. However, knowledge of how innovative firms and their corporate customers generate insights from big data, develop new products and gain higher-quality service from intra- and inter organisations' resources is limited. This knowledge manifests in the form of opportunities available in BDA and through the adoption of the co-creation approach to generate value in the form of new product innovation. BDA reflects an excellent means of enhancing a firm's customer agility, but how this is possible remains largely unknown. Design/methodology/approach In this research, the authors hypothesise that new product success is a function of a firm's customer agility and product innovation performance moderated by environmental turbulences. In turn, the firm's customer agility is enhanced by the effect of big data aggregation and analytical tools. These hypotheses have been confirmed by a survey in an emerging market. Findings The authors use structural equation modelling to test the authors’ hypotheses. The main contribution of this research is the conceptualisation and test of an integrative framework identifying the links among a firm's customer agility, new product success and BDA capabilities. Practical implications The study established that BDA tools – the effective use of data aggregation tools and the effective use of data analysis tools – shape customer agility in achieving new product success. This study contributes to one’s understanding of the relevance of BDA in B2B value creation contexts. Originality/value The study findings show that BDA shapes a firm's customer agility in achieving new product success.
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Stereotypical thoughts are directly linked with discrimination and prejudice and hence to be avoided. However, previous studies have failed to establish methods to reduce stereotypical thoughts, nor investigate how they influence affective states. In this report, we used an expressive writing which influences restructuring cognitions as well as affective states and examined how stereotypes about older adults and affective states were influenced by intentional expression or suppression of stereotypical thoughts. Participants were randomly assigned to groups of intentional expression, intentional suppression of stereotypical thoughts, or the control condition. In each group, the participants first performed an expressive writing task concerning the behavior of an older person. The intentional expression group emphasized aging stereotypes, the suppression group was asked to avoid describing stereotypes about older individuals; then participants performed a stereotype rating task in which they reported their impressions of another individual after reading sentences concerning one person. Their own emotional states were reported before and after the expressive writing task and after evaluating the impressions. Results revealed no differences in ratings of aging stereotypes across the three groups of manipulated stereotypical thoughts. However, a reduction in negative affect was found in all conditions. These findings suggest that we could not identify a strategy for reducing negative aging stereotypes but we found a strategy for improving negative affect.
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The study examined how social constraints on discussion of a traumatic experience can interfere with cognitive processing of and recovery from loss. Bereaved mothers were interviewed at 3 weeks (T1), 3 months (T2), and 18 months (T3) after their infants' death. Intrusive thoughts at T1, conceptualized as a marker of cognitive processing, were negatively associated with talking about infant's death at T2 and T3 among socially constrained mothers. The reverse associations were found among unconstrained mothers. Controlling for initial level of distress, there was a positive relation between T1 intrusive thoughts and depressive symptoms over time among socially constrained mothers. However, higher levels of T1 intrusive thoughts were associated with a decrease in T3 depressive symptoms among mothers with unconstrained social relationships.
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This article introduces the construct of self-concealment, the active concealment from others of personal information that one perceives as negative or distressing. A Self-Concealment Scale (SCS) was developed and was included in a questionnaire battery completed by 306 subjects. The SCS had excellent psychometric properties. Self-concealment was conceptually and empirically distinguished from self-disclosure. Self-concealment significantly correlated with self-report measures of anxiety, depression, and bodily symptoms and accounted for a significant incremental percentage of the variance in physical and psychological symptoms even after controlling for occurrence of trauma, trauma distress, disclosure of the trauma, social support, social network, and self-disclosure. The implications of these findings are discussed and directions for further research are briefly outlined.
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This paper is based on Pierre Janet's dissociation theory and his concept of the non-realization of a traumatic event. A model of treatment that integrates Janet's dissociation-integration theory with contemporary trauma-based models of therapy is delineated. The nature of traumatic memories is described, and a stage-oriented model for their treatment in patients with multiple personality disorder (MPD) is presented. Ideally a discrete phase in the overall treatment of MPD, this phase can itself be subdivided into the following stages: (1) preparation; (2) synthesis; and (3) realization/integration. Although a number of treatment recommendations are offered, the emphasis here is more on clarifying concepts than on the description of techniques. Multiple Personality Disorder (MPD) usually results from severe and repeated traumatization in childhood (Putnam, Guroff, Silberman, Barban, & Post, 1986; Ross, Norton, & Wozney, 1989; Schultz, Braun, & Kluft, 1989). The core pathogenic problem, i.e., the presence and disrupted impact of dissociated traumatic memories, is often independent of the form or complications of the MPD. Experienced therapists concur that this disorder cannot be completely resolved until these traumatic memories have been successfully processed. Modern clinicians working with MPD have developed effective treatment strategies to achieve this (e.g.. Fine, 1991; Putnam, 1989,1992; Ross, 1989; Steele & Colrain, 1990), but in our opinion the conceptual language in which these strategies are couched is inadequate. In two related papers, some of the authors drew attention to the uncritical use of the term "abreaction," and they argued in favor of the concept of dissociation over repression in describing and explaining the origins and maintenance of traumatic memories (Van der Hart, & Brown, 1992; Van der Hart, Steele, & Brown, manuscript in preparation). Recently,
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Introduces the binomial effect size display, which displays the change in success rate (e.g., survival and improvement rates) attributable to a new treatment procedure. An example of the use of this method is presented. (11 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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The purpose of this study was to compare vocal and written expression of feeling about interpersonal traumatic and trivial events in 20-min sessions over a 4-day period. Similar emotional processing was produced by vocal and written expression of feeling about traumatic events. The painfulness of the topic decreased steadily over the 4 days. At the end, both groups felt better about their topics and themselves and also reported positive cognitive changes. A content analysis of the sessions suggested greater overt expression of emotion and related changes in the vocal condition. Finally, there was an upsurge in negative emotion after each session of either vocal or written expression. These results suggest that previous findings that psychotherapy ameliorated this negative mood upsurge could not be attributed to the vocal character of psychotherapy.
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Results of 375 controlled evaluations of psychotherapy and counseling were coded and integrated statistically. The findings provide convincing evidence of the efficacy of psychotherapy. On the average, the typical therapy client is better off than 75% of untreated individuals. Few important differences in effectiveness could be established among many quite different types of psychotherapy. More generally, virtually no difference in effectiveness was observed between the class of all behavioral therapies (e.g., systematic desensitization and behavior modification) and the nonbehavioral therapies (e.g., Rogerian, psychodynamic, rational-emotive, and transactional analysis). (PsycINFO Database Record (c) 2006 APA, all rights reserved).
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In this reappraisal of the work of Pierre Janet at the centenary of the publication of L'automatisme psychologique, the authors review his investigations into the mental processes that transform traumatic experiences into psychopathology. Janet was the first to systematically study dissociation as the crucial psychological process with which the organism reacts to overwhelming experiences and show that traumatic memories may be expressed as sensory perceptions, affect states, and behavioral reenactments. Janet provided a broad framework that unifies into a larger perspective the various approaches to psychological functioning which have developed along independent lines in this century. Today his integrated approach may help clarify the interrelationships among such diverse topics as memory processes, state-dependent learning, dissociative reactions, and posttraumatic psychopathology.
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A meta-analysis of the efficacy of remediation with drinking/driving offenders included 215 independent evaluations identified through a comprehensive literature search. Study characteristics, including dimensions of methodological quality were coded using scales and protocols developed by expert panels. Better methodological quality (as indicated by group equivalence) was associated with smaller effect size and less variation in effect size. Among studies with adequate methods (as determined empirically through examination of effect size variation with quality), the average effect of remediation on drinking/driving recidivism was an 8-9% reduction over no remediation. A similar effect size was found for alcohol involved crashes. However, licensing actions tended to be associated with reduction in occurrence of non-alcohol events (e.g. non-alcohol crashes). Exploratory regression analysis and confirmatory within study analysis suggested that combinations of modalities--in particular those including education, psychotherapy/counseling and follow-up contact/probation--were more effective than other evaluated modes for reducing drinking/driving recidivism. Treatment effects are probably underestimated in the literature due to overemphasis on education as a treatment for all offenders and drinking/driving recidivism as the most frequent measure of outcome. Limitations of the primary literature and future research needs are discussed.
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Conventional reviews of research on the efficacy of psychological, educational, and behavioral treatments often find considerable variation in outcome among studies and, as a consequence, fail to reach firm conclusions about the overall effectiveness of the interventions in question. In contrast meta-analytic reviews show a strong, dramatic pattern of positive overall effects that cannot readily be explained as artifacts of meta-analytic technique or generalized placebo effects. Moreover, the effects are not so small that they can be dismissed as lacking practical or clinical significance. Although meta-analysis has limitations, there are good reasons to believe that its results are more credible than those of conventional reviews and to conclude that well-developed psychological, educational, and behavioral treatment is generally efficacious.
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The words people use in disclosing a trauma were hypothesized to predict improvements in mental and physical health in 2 studies. The first study reanalyzed data from 6 previous experiments in which language variables served as predictors of health. Results from 177 participants in previous writing studies showed that increased use of words associated with insightful and causal thinking was linked to improved physical but not mental health. Higher use of positive relative to negative emotion words was also associated with better health. An empirical measure that was derived from these data correlated with subsequent distress ratings. The second study tested these models on interview transcripts of 30 men who had lost their partners to AIDS. Cognitive change and empirical models predicted postbereavement distress at 1 year. Implications of using computer-based text analyses in the study of narratives are discussed.
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Ever since people's responses to overwhelming experiences have been systematically explored, researchers have noted that a trauma is stored in somatic memory and expressed as changes in the biological stress response. Intense emotions at the time of the trauma initiate the long-term conditional responses to reminders of the event, which are associated both with chronic alterations in the physiological stress response and with the amnesias and hypermnesias characteristic of posttraumatic stress disorder (PTSD). Continued physiological hyperarousal and altered stress hormone secretion affect the ongoing evaluation of sensory stimuli as well. Although memory is ordinarily an active and constructive process, in PTSD failure of declarative memory may lead to organization of the trauma on a somatosensory level (as visual images or physical sensations) that is relatively impervious to change. The inability of people with PTSD to integrate traumatic experiences and their tendency, instead, to continuously relieve the past are mirrored physiologically and hormonally in the misinterpretation of innocuous stimuli as potential threats. Animal research suggests that intense emotional memories are processed outside of the hippocampally mediated memory system and are difficult to extinguish. Cortical activity can inhibit the expression of these subcortically based emotional memories. The effectiveness of this inhibition depends, in part, on physiological arousal and neurohormonal activity. These formulations have implications for both the psychotherapy and the pharmacotherapy of PTSD.
Chapter
This chapter explores the nature of confession and inhibition. Conversely, not confiding significant experiences is associated with increased disease rates, ruminations, and other difficulties. This pattern of findings has helped in developing a useful theory of active inhibition that shares many of the assumptions of learning theory, psychodynamic models, and more recent cognitive perspectives. The chapter examines the nature of confession per se. The chapter focuses on the physiological and psychological effects of confronting or actively avoiding past traumatic experiences. Based on a number of laboratory and field studies, it is clear that requiring people to write or talk about traumas is associated with both immediate and long-term health benefits. The chapter presents a formal theory of active inhibition. The links among the theory and Freud, animal learning, and cognitive perspectives are discussed in the chapter. The chapter describes the reexamination of catharsis, the development and breakdown of the self, and the role of psychosomatics in social psychology.
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In an effort to understand emotional change, brief psychotherapy was compared with written expression about stressful life events as well as with a control condition of writing about trivial events using college students. The written expression condition was quite effective in temporarily arousing negative affect but not in changing feelings about the traumatic events. Some self-generated cognitive changes did occur. In contrast, psychotherapy aroused less negative affect but showed much more cognitive reappraisal and a dramatic shift to positive affect, as well as in a basic change in attitude about the stressful event. The study supports a model of therapeutic change stressing emotional expression followed by cognitive reappraisal rather than a model of simple affective discharge.
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This study examined the relationships of problem-focused coping and emotion-focused coping, on the one hand, and psychopathology profile (SCL-90 subscales) after participation in a war, on the other. The sample consisted of 139 Israeli soldiers who participated in the 1982 Lebanon War and were followed up 3 yr after their participation in combat. Statistical analyses revealed that a pervasive use of emotion-focused coping was generally found to be related with the presence of psychiatric symptoms. In addition, it was found that a high level of problem-focused coping moderated the detrimental effects of emotion-focused coping on mental health. Results were discussed in terms of Lazarus and Folkman's theory of stress and coping.
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This article describes what should typically be included in the introduction, method, results, and discussion sections of a meta-analytic review. Method sections include information on literature searches, criteria for inclusion of studies, and a listing of the characteristics recorded for each study. Results sections include information describing the distribution of obtained effect sizes, central tendencies, variability, tests of significance, confidence intervals, tests for heterogeneity, and contrasts (univariate or multivariate). The interpretation of meta-analytic results is often facilitated by the inclusion of the binomial effect size display procedure, the coefficient of robustness, file drawer analysis, and, where overall results are not significant, the counternull value of the obtained effect size and power analysis. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
Provides a theoretical, empirical, and clinical rationale for the application of writing as a therapeutic tool in clinical populations. Five projects are discussed that use programmed writing workbooks with undergraduates on a variety of clinically relevant topics and with outpatient clients. Topics of the research projects include a comparison of the usefulness of 3 depression workbooks, programmed writing with the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) content scales and programs, and programmed writing as a treatment for anxiety. There is growing support for the fact that writing can be used as an adjunct to traditionally verbal psychotherapeutic practices or as a tertiary prevention. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
ABSTRACT For 21 consecutive days, 186 male and female college students recalled the most stressful event of the day, recorded how the event was appraised, and indicated the coping methods they employed as well as their perceived effectiveness and the sequence in which they were used. Gender differences in seven coping strategies were examined in terms of frequency of use, extent of use, relative use, and the frequency with which each method was used first in the coping sequence. The gender differences that emerged were consistent with a socialization hypothesis that predicts more problem-focused coping in men and more use of support seeking and emotion-focused coping in women. Both men and women rated problem-focused coping responses as more generally effective than seeking social support, and the latter as more effective than emotion-focused coping responses. Additionally, we explored the roles of stressor type and of threat, challenge, and control appraisals in the observed gender differences.
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Results from a series of studies are summarized in support of a general theory of inhibition and psychosomatics. According to this view, to inhibit thoughts, feelings, or behaviors is associated with physiological work. In the short term, inhibition results in increased autonomic nervous system activity. Over time, inhibition serves as a cumulative stressor that increases the probability of psychosomatic disease. Actively avoiding thoughts and feelings surrounding a trauma and/or not discussing a trauma is a particularly insidous form of inhibition. The results from recent surveys and experiments indicate: (a) childhood traumatic experiences, particularly those never discussed, are highly correlated with current health problems; (b) recent traumas that are not discussed are linked with increased health problems and ruminations about the traumas; (c) requiring individuals to confront earlier traumas in writing improves health and immune system functioning; (d) actively talking about upsetting experiences is associated with immediate reductions in selected autonomic activity. Implications of these findings for our understanding of disclosure, trauma, and disease are discussed.
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Longitudinal data from 290 firefighters who had completed questionnaires 4, 11, and 29 months after exposure to a natural disaster were used to examine the role of intrusive and distressing memories in the etiology of posttraumatic stress disorder. At 42 months, all those who were at risk of having developed a psychiatric disorder (N = 113) and a randomly selected comparison group (N = 34) who had never developed symptoms were interviewed using the Diagnostic Interview Schedule. The intrusion subscale score of the Impact of Events Scale accounted solely for the etiological link between the disaster and posttraumatic disorders. Avoidance had no direct relationship with the onset of symptoms and appeared to be a defensive strategy to contain the distress generated by the re-experiencing of the disaster, indicating the importance of separating these phenomena from disorder mood and arousal in posttraumatic stress disorder. An information processing model was validated using three different data sets, which suggests its robustness. Using cross-lagged panel correlations, a bidirectional relationship was demonstrated between disorder and intrusive recollections, suggesting that the intensity of recurring memories of a traumatic experience is as indicative of a disturbance of mood and arousal as the exposure to the trauma.
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The authors use six case vignettes to illustrate underrecognized complications occurring during flooding therapy for posttraumatic stress disorder (PTSD), including exacerbation of depression, relapse of alcoholism, and precipitation of panic disorder. A common denominator to the majority of these cases appears to be the mobilization of negative posttrauma appraisal, accompanied by shame, guilt, and anger. The authors suggest that flooding may not be helpful for these negative emotions in the manner that it is for anxiety. Suggestions for preventing and treating complications of flooding therapy for PTSD include employing more cognitive forms of therapy in cases at risk; supporting abstinence from alcohol and other substances; providing adjunctive pharmacologic treatment as indicated, e.g., tricyclics for depression or panic; and providing long-term follow-up.
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The effect of psychosocial intervention on time of survival of 86 patients with metastatic breast cancer was studied prospectively. The 1 year intervention consisted of weekly supportive group therapy with self-hypnosis for pain. Both the treatment (n = 50) and control groups (n = 36) had routine oncological care. At 10 year follow-up, only 3 of the patients were alive, and death records were obtained for the other 83. Survival from time of randomisation and onset of intervention was a mean 36.6 (SD 37.6) months in the intervention group compared with 18.9 (10.8) months in the control group, a significant difference. Survival plots indicated that divergence in survival began at 20 months after entry, or 8 months after intervention ended.
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The opioid peptide hypothesis of repression (1) predicts that repressive coping is associated with increased functional endorphin levels in the brain, which can result in decreased immunocompetence and hyperglycemia. In a random sample of 312 patients seen at a Yale Medical School outpatient clinic, significant main effects of coping style were found for monocyte and eosinophile counts, serum glucose levels, and self-reports of medication allergies. Specifically, repressive and defensive high-anxious patients demonstrated significantly decreased monocyte counts. In addition, repressive coping was associated with elevated eosinophile counts, serum glucose levels, and self-reported reactions to medications. This behavioral, immunologic, and endocrine profile is consistent with the opioid peptide hypothesis, which provides an integrative framework for relating the attenuated emotional experience of pain and distress characteristic of repressive coping with reduced resistance to infectious and neoplastic disease.
Article
This study examined the longitudinal course, over a 25-month period, of posttraumatic morbidity in a group of 469 firefighters exposed to a bushfire disaster. The patterns of posttraumatic morbidity were defined by the General Health Questionnaire. Contrary to expectation, an acute pattern of morbidity was less common than the delayed-onset or chronic forms. Predisaster variables were found to be as important in the onset and course of the disorder as were the firefighters' losses or extent of exposure to the disaster. These data suggest that exposure to an extreme trauma is necessary but not sufficient to explain the onset and pattern of posttraumatic morbidity.
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Eighteen children with bronchial asthma (ages 7.5 to 12) and 18 control children were exposed to a pleasant comic film and a stress-inducing achievement task. Facial expressions of emotion and heart rate (HR) were recorded, and pre- and posttest forced expiratory volume at 1 sec (FEV1) were assessed. The asthmatic children showed significantly fewer expressions of emotion than the control subjects in the stress-inducing but not in the joy-inducing situation. Their FEV1 decreased significantly under both experimental conditions, whereas no significant changes were found in the control group. The asthmatic children's mean HR was significantly higher under both experimental conditions than during the preceding pauses. In the control group, no significant changes in mean HR were found from the pause to the stressful situation; during the comic film, mean HR was significantly lower than during the preceding pause. No significant correlations were found for either group between number of emotions expressed, pre- to posttest changes in FEV1, and changes in mean HR.
Article
A casual review of the research literature on coping strategies suggests that strategies involving avoidant tactics are effective in reducing pain, stress, and anxiety in some cases, whereas nonavoidant strategies (called here attention), appear to be more effective in others. This article reports the results of a series of meta-analyses to ascertain whether there are systematic patterns in the empirical literature that describe when attention strategies are more or less effective than avoidant strategies. In particular, we consider the role of different kinds of attentional sets and also the role of time--whether some kinds of strategies work best in the early phases of the stress experience, and others are more efficacious in later phases of the stress experience. Results of an overall analysis of studies providing tests of attention versus avoidance indicated little evidence for one strategy's superiority. However, supplementary analyses, motivated by theoretical reasons, suggest there are boundary conditions that define the relative efficacy of a specific strategy. Overall, avoidance was associated with more positive adaptation in the short-run. However, attention was superior to avoidance if the former involved a focus on sensory schemata rather than emotional processing. If attention involved an emotional interpretational set or no explicit set, then it was associated with more negative outcomes than avoidance. In terms of long-term outcomes, avoidance indicates better outcomes initially, but with time, attention was associated with more positive outcomes. A final set of analyses found that both attention and avoidance facilitate adaptation as compared with no instruction controls. The meta-analyses suggest the important role of interpretational set and whether one looks at the immediate or at the long-term effects of coping. Limitations of the analyses and directions for future research are discussed.
Article
We tested the assumption that the act of inhibiting ongoing behavior requires physiological work. In a guilty knowledge test (GKT) paradigm, subjects were induced to attempt to deceive the experimenter on two separate occasions while electrodermal activity was measured. For 20 of the 30 subjects, overt behaviors (changes in eye movement and facial expression) were recorded during the second GKT. Results indicated that the incidence of behaviors decreased during their deceptive responses. This behavioral inhibition coincided with increases in skin conductance level. In addition to suggesting nonverbal correlates of deception, the results indicate that long-term behavioral inhibition may be a factor in psychosomatic disease.
Article
A working definition of the concept of emotional processing is presented, with the aim of integrating a set of clinical and experimental observations. If successful, the concept may help to unify such apparently unrelated events as obsessions, the return of fear, abnormal grief reactions, nightmares, treatment failures, and so on.Factors that may facilitate or impede emotional processing are presented, and some circumstances that may give rise to initial difficulties in processing are mentioned. A number of theoretical problems are posed, and some methodological innovations offered.
Article
Meta-analytic methods were used to synthesize the results of published randomized, controlled-outcome studies of psychosocial interventions with adult cancer patients. Forty-five studies reporting 62 treatment-control comparisons were identified. Samples were predominantly White, female, and from the United States. Beneficial effect size ds were .24 for emotional adjustment measures, .19 for functional adjustment measures, .26 for measures of treatment- and disease-related symptoms, and .28 for compound and global measures. The effect size of .17 found for medical measures was not statistically significant for the few reporting studies. Effect sizes for treatment-control comparisons did not significantly differ among several categories of treatment: behavioral interventions, nonbehavioral counseling and therapy, informational and educational methods, organized social support provided by other patients, and other nonhospice interventions.
Article
Previous research has shown that emotional disclosure of traumatic or stressful events is associated with facilitating insight into the experience, improving mood, and modulating some aspects of the immune system. The current study examined how cognitive changes and experiential involvement during an emotional disclosure induction protocol relate to immune functioning, as measured by IgG antibody titres to the Epstein-Barr virus viral capsid antigen (EBV-VCA). Seventy-six college undergraduates were randomly assigned to either a disclosure induction or an assessment-only control condition. Experimental subjects met with an experimenter for three weekly 20-min individual sessions during which time they were asked to discuss a stressful or traumatic topic which they had previously discussed only minimally with others. Blood was drawn a week prior to the first session and at one week following the third session. Subjects completed the Impact of Event Scale (IES) after session 1 and at followup, and the extent of experiential involvement in disclosure during each session was assessed by means of the Experiencing Scale. Mood was assessed before and after each disclosure using the Nowlis Mood Adjective Checklist. Although the disclosure induction did not directly affect EBV-VCA antibody titres, individual differences in subjects' ability to involve themselves in the disclosure process and abandon their avoidance of the stressful tropic during the course of the 3-wk period were predictive of antibody decrements. These associations were more pronounced for individuals who disclosed older and more troublesome events.
Article
When individuals are asked to write or talk about personally upsetting experiences, significant improvements in physical health are found. Analyses of subjects' writing about traumas indicate that those whose health improves most tend to use a higher proportion of negative emotion words than positive emotion words. Independent of verbal emotion expression, the increasing use of insight, causal, and associated cognitive words over several days of writing is linked to health improvement. That is, the construction of a coherent story together with the expression of negative emotions work together in therapeutic writing. Evidence of these processes are also seen in specific links between word production and immediate autonomic nervous system activity. Implications for therapy and for considering the mind and body as fluid, dynamic systems are discussed.
Article
This article applies recent developments in cognitive-social theory to health-protective behavior, articulating a Cognitive-Social Health Information Processing (C-SHIP) model. This model of the genesis and maintenance of health-protective behavior focuses on the individual's encodings and construals, expectancies, affects, goals and values, self-regulatory competencies, and their interactions with each other and the health-relevant information in the course of cognitive-affective processing. In processing health information, individuals are assumed to differ in both the accessibility of these mental representations and the organization of relationships among them. In this article, the model is applied to analyze and integrate the often-confusing findings on breast self-examination in cancer screening. Implications are considered for assessments and interventions to enhance adherence to complex, long-term, health-protective regimens, tailored to the needs and characteristics of the individual.
Article
Psychotherapy meta-analyses commonly combine results from controlled experiments that use random and nonrandom assignment without examining whether the 2 methods give the same answer. Results from this article call this practice into question. With the use of outcome studies of marital and family therapy, 64 experiments using random assignment yielded consistently higher mean post-test effects and less variable posttest effects than 36 studies using nonrandom assignment. This difference was reduced by about half by taking into account various covariates, especially pretest effect size levels and various characteristics of control groups. The importance of this finding depends on (a) whether one is discussing meta-analysis or primary experiments, (b) how precise an answer is desired, and (c) whether some adjustment to the data from studies using nonrandom assignment is possible. It is concluded that studies using nonrandom assignment may produce acceptable approximations to results from randomized experiments under some circumstances but that reliance on results from randomized experiments as the gold standard is still well founded.
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