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Expressive Writing and Wound Healing in Older Adults: A Randomized Controlled Trial
Abstract
Objective
To investigate whether expressive writing could speed wound reepithelialization in healthy, older adults.Methods
In this randomized controlled trial, 49 healthy older adults aged 64 to 97 years were assigned to write for 20 minutes a day either about upsetting life events (Expressive Writing) or about daily activities (Time Management) for 3 consecutive days. Two weeks postwriting, 4-mm punch biopsy wounds were created on the inner, upper arm. Wounds were photographed routinely for 21 days to monitor wound reepithelialization. Perceived stress, depressive symptoms, health-related behaviors, number of doctor visits, and lipopolysaccharide-stimulated proinflammatory cytokine production were also measured throughout the study.ResultsParticipants in the Expressive Writing group had a greater proportion of fully reepithelialized wounds at Day 11 postbiopsy compared with the Time Management group, with 76.2% versus 42.1% healed, χ(2)(1, n = 40) = 4.83, p = .028. Ordinal logistic regression showed more sleep in the week before wounding also predicted faster healing wounds. There were no significant group differences in changes to perceived stress, depressive symptoms, health-related behaviors, lipopolysaccharide-induced proinflammatory cytokine production, or number of doctor visits over the study period.Conclusions
This study extends previous research by showing that expressive writing can improve wound healing in older adults and women. Future research is needed to better understand the underlying cognitive, psychosocial, and biological mechanisms contributing to improved wound healing from these simple, yet effective, writing exercises.Trial RegistrationAustralian New Zealand Clinical Trials Registry (trial number 343095).
... found that participants who performed expressive writing prior to receiving a 4 mm punch biopsy had significantly smaller wounds after 14 days, as measured by a high-resolution ultrasound, than whose who performed control writing. Similarly, Koschwanez and colleagues [7] found that a significantly greater proportion of participants who performed expressive writing prior to a punch biopsy were rated as having healed wounds on day 11, as assessed from photographs, compared to those who performed control writing. However, Koschwanez et al. [7] found no significant differences between expressive and control writing in pro-inflammatory cytokine production in peripheral blood, further emphasising the need for more research into the effects of writing on cellular processes at the wound site. ...
... Similarly, Koschwanez and colleagues [7] found that a significantly greater proportion of participants who performed expressive writing prior to a punch biopsy were rated as having healed wounds on day 11, as assessed from photographs, compared to those who performed control writing. However, Koschwanez et al. [7] found no significant differences between expressive and control writing in pro-inflammatory cytokine production in peripheral blood, further emphasising the need for more research into the effects of writing on cellular processes at the wound site. ...
... A power analysis was conducted to calculate the number of participants required to find a difference between groups in reepithelialisation (assessed from photographs) [8]. Based on a medium effect size (Cramers V of 0.35) from a previous study [7], power of 0.80. and alpha of 0.05, 128 participants were required. ...
Objective
To investigate the effects of expressive writing and its timing (pre or post wounding) on re-epithelialisation and leucocyte subsets within healing tissue. We previously showed expressive writing pre-wounding improved re-epithelialisation. Here we investigate cellular processes in the wound.
Methods
In a 2(writing content) x 2(writing timing) randomized trial, 122 participants were randomized to perform either expressive or control writing, before or after a 4 mm punch biopsy wound. On day 14 post-wounding, participants had a 5 mm punch biopsy of the initial wound. Seven of 16 primary registered outcomes were analysed, including re-epithelialisation from two photographs of the 4 mm biopsy (previously reported). This paper reports immunohistochemistry analysis of five primary outcomes - Langerhans cells, immune cell activation (HLA and CD3+), and macrophages (CD68 and MPO) - in the 5 mm biopsies in a random sample of 96 participants.
Results
Participants who performed either writing task pre-wounding had greater Langerhans cell infiltration, than those who wrote post-wounding (F(1,85) = 7.86, p = .006, ηp² = 0.08). Those who performed expressive writing also had greater Langerhans cell infiltration than those who performed control writing (F(1,85) = 4.00, p = .049, ηp² = 0.04). There were no significant group or interaction effects on immune cell activation or macrophages. Healed wounds on day 10 had lower levels of macrophages (z = −1.96, p = .050), and CD3+ cells (z = −1.99, p = .046) than non-healed wounds.
Conclusion
Langerhans cells in the healing skin are affected by the timing and topic of writing. More research is needed to further explore timing and corroborate these results.
Clinical Trials Registration
Registered at https://www.anzctr.org.au/ (Trial ID: ACTRN12614000971639).
... This category could be considered the most diverse due to the different ways wounds were created (punch biopsy, tape stripping, blister, and laser ablation). Within this category, two studies looked at the effects of relaxation (Gouin, Kiecolt-Glaser, Malarkey, & Glaser, 2008;Robinson, Jarrett, & Broadbent, 2015), one looked at social support (Robles, 2007), two looked at expressive writing (Koschwanez et al., 2013;Weinman, Ebrecht, Scott, Walburn, & Dyson, 2008), and one study investigated placebo effects (Vits et al., 2015). ...
... There were no differences in skin barrier recovery between those that did or did not receive support, but it is questionable whether the intervention helped to buffer stress in this study. Two randomized trials investigated the benefits of expressive writing on punch biopsy wound healing (Koschwanez et al., 2013;Weinman et al., 2008). Both of these studies used the same intervention protocol and implemented the intervention 2 weeks prior to the 4-mm punch biopsy wound on the upper inner arm. ...
... Three studies implemented the intervention prior to wounding. Two of these studies investigated expressive writing (Koschwanez et al., 2013;Weinman et al., 2008), and both had significant effects on healing of a punch biopsy wound. One study used empathetic patient centred care (Pereira et al., 2016) prior to surgery and found that this brief intervention had a significant effect on healing. ...
Purpose:
Psychological stress has been shown to delay wound healing. Several trials have investigated whether psychological interventions can improve wound healing, but to date, this evidence base has not been systematically synthesized. The objective was to conduct a systematic review of randomized controlled trials in humans investigating whether psychological interventions can enhance wound healing.
Methods:
A systematic review was performed using PsychINFO, CINAHL, Web of Science, and MEDLINE. The searches included all papers published in English up until September 2016. The reference lists of relevant papers were screened manually to identify further review articles or relevant studies. Nineteen studies met inclusion criteria and were included in the review.
Results:
Fifteen of nineteen studies were of high methodological quality. Six studies were conducted with acute experimentally created wounds, five studies with surgical patients, two studies with burn wounds, two studies with fracture wounds, and four studies were conducted with ulcer wounds. Post-intervention standardized mean differences (SMD) between groups across all intervention types ranged from 0.13 to 3.21, favouring improved healing, particularly for surgical patients and for relaxation interventions. However, there was some evidence for publication bias suggesting negative studies may not have been reported. Due to the heterogeneity of wound types, population types, and intervention types, it is difficult to pool effect sizes across studies.
Conclusions:
Current evidence suggests that psychological interventions may aid wound healing. Although promising, more research is needed to assess the efficacy of each intervention on different wound types. Statement of contribution What is already known on this subject? Psychological stress negatively affects wound healing. A number of studies have investigated whether psychological interventions can improve healing. However, no systematic reviews have been conducted. What does this study add? Synthesis and review of 19 trials conducted on psychological interventions and wound healing. Most evidence supports improved healing, particularly for surgical wounds and relaxation interventions. More research is needed on different intervention types with clinical wounds and into mechanisms of action.
... It is thought that writing about stressful or traumatic events and upsetting emotions can help a person process the event, which in turn can decrease stress and rumination (Pennebaker, 1997). Expressive writing has been shown to have beneficial effects on the healing of punch biopsy wounds compared to writing factually about a neutral topic (Weinman et al., 2008;Koschwanez et al., 2013). Consistent with these studies, a systematic review showed that emotional disclosure has significant effects on immune parameters (Frattaroli, 2006). ...
... An important consideration in the translation of this laboratorybased research to clinical populations is the timing of intervention delivery. The previous two studies on emotional disclosure and wound healing both administered the intervention two weeks prior to wounding with instructions to write over the following three consecutive days (Weinman et al., 2008;Koschwanez et al., 2013). However, administering a writing intervention prior to surgery may be impractical in some situations, such as when emergency surgery is performed, when the date of surgery is scheduled at late notice or surgery is postponed. ...
... The aim of this study was to compare the effectiveness of an expressive writing intervention performed either pre or post wounding on the healing of punch biopsy wounds. Previous research found that expressive writing performed prior to wounding significantly improved healing assessed ten to twelve days after the biopsy, and 90% of all wounds were healed by day 14 (Koschwanez et al., 2013). Therefore, the primary endpoint for this study was whether wounds were healed or not at ten days postbiopsy. ...
Objective:
Recent studies have shown that written emotional disclosure (expressive writing) performed in the two weeks prior to wounding improves healing of punch biopsy wounds. In many clinical settings, it would be more practical for patients to perform this intervention after wounding. The aim of this study was to investigate whether expressive writing could speed the healing of punch biopsy wounds if writing was performed after wounds were made.
Methods:
One hundred and twenty-two healthy participants aged between 18 and 55 years were randomly allocated to one of four groups in a 2 (intervention) by 2 (timing) design. Participants performed either expressive writing or neutral writing, either before or after receiving a 4mm punch biopsy wound. Wounds were photographed on day 10 (primary endpoint) and day 14 after the biopsy to measure epithelisation. Participants also completed questionnaires on stress and affect two weeks prior to the biopsy, on the day of biopsy and two weeks after biopsy.
Results:
There was a significant difference in healing at day 10 between groups, χ(2)(3, N = 97) = 8.84, p = .032. A significantly greater proportion of participants who performed expressive writing before the biopsy had fully reepithelialised wounds on day 10 compared to participants who performed neutral writing either before or after wounding, with no other significant differences between groups. Amongst people who wrote expressively after wounding, those who finished writing over the first 6 days were significantly more likely to be healed at 14 days than those who finished writing later. There were significant differences in positive and negative affect over the healing period between the pre and post expressive writing groups.
Conclusions:
Expressive writing can improve healing if it is performed prior to wounding. Performing expressive writing after wounding may be able to improve healing depending on the timing of writing and wound assessment. Expressive writing causes worsening affect followed by a subsequent improvement in affect and it is important to consider this in the timing of intervention delivery. Further research with patient groups is required to determine the clinical relevance of these findings.
... Much of this research has been performed with healthy university students but also with nonstudent populations including medical patients. Initial studies suggest that writing expressively about upsetting life events, as compared with writing about how you spend your time, can improve healing of experimentally induced punch biopsy wounds in the inner upper arm of healthy adults (Koschwanez et al., 2013;Weinman, Ebrecht, Scott, Walburn, & Dyson, 2008). Weinman and colleagues (2008) randomized 36 males with a mean age of 22 years to either an experimental group (asked to write about a traumatic and upsetting experience) or to a control group (asked to write about time management-i.e., to write objectively about what they had done the previous day, that day, and their plans for the next week). ...
... Approximately 2 weeks prior to surgery (at least 10 days), patients completed a preoperative (baseline) questionnaire, and were randomly assigned to either write factually about how they spent their time (daily activities writing; control) or to write emotionally about important life events (expressive writing; intervention) group. This timeframe was chosen to be similar to the two previous studies on expressive writing and wound healing (Koschwanez et al., 2013;Weinman et al., 2008). Patients were asked to write for 20 min a day, for 3 consecutive days at home, on the assigned topic. ...
... Patients were asked to write for 20 min a day, for 3 consecutive days at home, on the assigned topic. These instructions were very similar to the instructions used in the previous studies on expressive writing and wound healing (Koschwanez et al., 2013;Weinman et al., 2008), and other studies on expressive writing (Frattaroli, 2006). Pennebaker recommends writing for at least 3 days (Pennebaker, 2000) and a meta-analysis showed that writing for 3 or more days was associated with better outcomes than writing for less than 3 days (Frattaroli, 2006). ...
Written emotional disclosure (expressive writing) has been shown to reduce stress and speed the healing of punch-biopsy wounds in laboratory studies. However, no research has investigated whether expressive writing can improve wound healing in surgical patients. We investigated whether a pre-operative expressive writing intervention could improve surgical wound healing. A randomized controlled trial was conducted with 76 patients undergoing elective laparoscopic bariatric surgery. Patients were randomized either to write about their thoughts and feelings about distressing events (expressive writing) or to write objectively about how they spent their time (time management), for 20 minutes on 3 consecutive days, beginning two weeks before surgery. In both groups, 24 hour wound fluid was analysed for pro-inflammatory cytokines, and hydroxyproline was collected in ePTFE tubes at the wound site over 14 days. Contrary to our hypothesis, patients who wrote about time management had significantly more hydroxyproline at their wound sites than did expressive writing patients (t(34) = −2.433, p = .020; 95% CI −4.611 to −0.413) and higher TNF-alpha (t(29) = −2.423, p = .022, 95% CI −0.424 to −0.036). Many patients in the expressive writing group wrote about pre-surgical anxiety while those in the time-management group wrote about plans for preparing for surgery. These results may differ to laboratory studies due to patients’ high pre-operative anxiety about their surgery, a situation in which time management may be better than expressive writing for managing stress.
... Several studies have shown that the method can be advantageous for patient groups and healthy populations with a variety of cultural backgrounds. 9,[15][16][17][18][19] Expressive writing has been shown to reduce the frequency of physicians' visits, and have beneficial effects on somatic factors, such as wound healing, 20 blood pressure, 15 lung and immune functions, as well as reducing symptoms, like pain. 16,[19][20][21] Expressive writing has been demonstrated to contribute to improved physical quality of life in cancer patients. ...
... 9,[15][16][17][18][19] Expressive writing has been shown to reduce the frequency of physicians' visits, and have beneficial effects on somatic factors, such as wound healing, 20 blood pressure, 15 lung and immune functions, as well as reducing symptoms, like pain. 16,[19][20][21] Expressive writing has been demonstrated to contribute to improved physical quality of life in cancer patients. 22 Studies involving expressive writing among women with breast cancer have tended to rely on self-report instruments with results ranging from no significant effects on health outcomes to short-and longer-term health outcomes across largely randomized and/or controlled studies. ...
... This study contributes a thoughtful analysis of what it is like to take part in expressive writing and therefore has important implications for clinical practice and future research. Findings augment a substantial body of international research supporting expressive writing as a low-cost self-help tool for cancer patients in general, 20,23 and for breast cancer patients in particular, [8][9][10][11][12][13][14]42 provided that one takes into account moderating factors described in the discussion. Our findings show that expressive writing is a strong evidence-based intervention, not only from the perspective of measurable outcomes but also from the patients' own perspectives: the method was feasibly implemented as home-writing for breast cancer patients within weeks and up to 18 months after primary and reconstructive surgery, at times during which participants were on medical leave. ...
Background:
Expressive writing has been shown to improve quality of life, fatigue, and posttraumatic stress among breast cancer patients across cultures. Understanding how and why the method may be beneficial to patients can increase awareness of the psychosocial impact of breast cancer and enhance interventional work within this population. Qualitative research on experiential aspects of interventions may inform the theoretical understanding and generate hypotheses for future studies.
Aim:
The aim of the study was to explore and describe the experience and feasibility of expressive writing among women with breast cancer following mastectomy and immediate or delayed reconstructive surgery.
Methods:
Seven participants enrolled to undertake 4 episodes of expressive writing at home, with semistructured interviews conducted afterward and analyzed using experiential thematic analysis.
Results:
Three themes emerged through analysis: writing as process, writing as therapeutic, and writing as a means to help others.
Conclusions:
Findings illuminate experiential variations in expressive writing and how storytelling encourages a release of cognitive and emotional strains, surrendering these to reside in the text. The method was said to process feelings and capture experiences tied to a new and overwhelming illness situation, as impressions became expressions through writing. Expressive writing, therefore, is a valuable tool for healthcare providers to introduce into the plan of care for patients with breast cancer and potentially other cancer patient groups.
Implications for practice:
This study augments existing evidence to support the appropriateness of expressive writing as an intervention after a breast cancer diagnosis. Further studies should evaluate its feasibility at different time points in survivorship.
... This could lead to multidisciplinary integration between psychological therapy, relaxation techniques, and osteopathic therapy. 12,13 With reference to the neurocognitive approach, Koschwanez et al 14 have emphasized the role of expressive writing (a form of therapy that uses writing to facilitate the communication of the posttraumatic emotional state) in increasing the rapidity of reepithelization, without any changes to perceived stress, depressive symptoms, health-related behaviors, lipopolysaccharide-induced proinflammatory cytokine production, or the number of medical visits over the study period. 14 In this study, the authors have assumed that psyche may be involved in the wound healing process in a way that has not been fully explained from a psychological and biological point of view. ...
... 12,13 With reference to the neurocognitive approach, Koschwanez et al 14 have emphasized the role of expressive writing (a form of therapy that uses writing to facilitate the communication of the posttraumatic emotional state) in increasing the rapidity of reepithelization, without any changes to perceived stress, depressive symptoms, health-related behaviors, lipopolysaccharide-induced proinflammatory cytokine production, or the number of medical visits over the study period. 14 In this study, the authors have assumed that psyche may be involved in the wound healing process in a way that has not been fully explained from a psychological and biological point of view. 14 Hypnosis has been proven to accelerate the process of wound healing after surgery. ...
... 14 In this study, the authors have assumed that psyche may be involved in the wound healing process in a way that has not been fully explained from a psychological and biological point of view. 14 Hypnosis has been proven to accelerate the process of wound healing after surgery. 15 Hypnosis has also been shown to be useful in the management of wounds originating from burns, as well as for painful symptoms. ...
The purpose of this article is to carry out a narrative review regarding the approach to scars through complementary and alternative medicine focusing on osteopathy, naturopathy, and other minor methods and traditional rehabilitative medicines, such as physiotherapy and manual therapies. We analyzed the existing literature regarding the possible influences of techniques relaxing the diaphragm - both manual and psychophysical relaxing techniques - and the consequent local response to events leading to scar tissue healing. The objective of the study is to become a useful instrument of knowledge for those manual therapists and professionals who deal with patients affected by discontinuity of the skin surface due to trauma or surgery. This article also intends to stimulate research in order to find and propose new methods of scar treatment, taking into consideration the information gained so far from other complementary and alternative disciplines.
... In 29 studies (38.7%), healthy volunteers were included as the study population [34,. Other samples included patients or vulnerable adults, e.g., patients with various types of cancer [63][64][65][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82], patients with HIV infection [35,[83][84][85][86][87], patients with rheumatoid arthritis [26,[88][89][90], older adults [91][92][93][94], patients with asthma/allergies [95][96][97], widows/women who had lost a close relative to cancer [98,99], patients with ulcerative colitis [100,101], women with depression after bypass surgery [102], patients with late-life insomnia [103], women suffering from infertility [104], veterans [105], and patients who had undergone surgery [106]. The mean age of the participants varied between 18.5 and 78.8 years. ...
... Therefore, the effects of psychological interventions might be less prominent at a cellular level, but it seems to be mainly expressed in response to chemical challenges. Particularly for the in vivo challenges, we found exploratory that the effectiveness of a psychological intervention in allergic participants by exposing them to skin tests yielded highest effect sizes [91][92][93]. These findings are presumably due to the fact that skin tests provide a rather sensitive immune function parameter in allergic patients. ...
Background:
There is consistent evidence showing an interplay between psychological processes and immune function in health and disease processes.
Objectives:
The present systematic review and meta-analysis aims to provide a concise overview of the effectiveness of stress-reducing psychological interventions on the activation of immune responses in both healthy subjects and patients.
Methods:
Included are 3 types of challenges: in vivo, in vitro, and psychophysiological. Such challenges are designed to mimic naturally occurring immune-related threats.
Results:
A systematic literature search was conducted using PubMed, EMBASE, and PsychInfo, resulting in 75 eligible studies. The risk of bias was assessed with the Cochrane risk-of-bias tool. Across all studies, a small-to-medium effect size was found for the effects of psychological interventions on optimization of the immune function (g = 0.33; 95% CI 0.22-0.43). While the largest effects were found for in vivo immune-related challenges (g = 0.61; 95% CI 0.34-0.88; especially on studies that incorporated skin tests and wound healing), studies incorporating psychophysiological challenges and in vitro immune-related stimulations similarly suggest more optimal immune responses among those receiving stress-reducing interventions (g = 0.28; 95% CI 0.15-0.42).
Conclusion:
These findings showed substantial heterogeneity depending on the type of challenge, the study populations, and the intervention types. These data demonstrate support for the effectiveness of stress-reducing psychological interventions in improving immunity in studies that tested immune function by means of incorporating an in vivo,in vitro, or psychophysiological challenge. Future research should more consistently incorporate challenges into the study design to gather more insights in the mechanisms underlying the optimized immune function following a psychological intervention. This is also relevant for clinical practice, as psychological interventions can possibly supplement, or at least partially replace, current drug treatments in various somatic conditions to reduce side effects.
... Generally, the studies were of relatively low scientific quality. The interventions were characterized by very small sample sizes [36,55] and were often too simplified [45]. The participants were largely women [38,40,46,51], were well educated [43,55] and had voluntarily signed up for the studies, e.g. by responding to advertisement flyers. ...
... The interventions were characterized by very small sample sizes [36,55] and were often too simplified [45]. The participants were largely women [38,40,46,51], were well educated [43,55] and had voluntarily signed up for the studies, e.g. by responding to advertisement flyers. Thus, the samples were often not representative of the general elderly population. ...
Background:
The aim of the present study was to conduct a systematic review to identify documented mental health promotion interventions developed and tested among population-based older adults.
Methods:
A systematic review based on PRISMA guidelines. The literature was searched in PsycINFO and PubMed between June and September 2016. The Effective Public Health Practice Project tool was used to assess the quality of the included study.
Results:
In total 53 randomized controlled trial studies qualified for the systematic review. Across studies, three types of common conceptual themes emerged for interventions, including: 1) individual characteristics; 2) content and structure of the interventions; and 3) implementation of the interventions.
Conclusions:
No specific interventions could be recommended on the aforementioned basis. We conclude that a number of factors are of central importance for an intervention to have the desired effect. If these factors are considered, mental health can be successfully promoted among older adults.
... Domains of bias judged by the Cochrane Collaborations's tool for assessing risk of bias (Higgins & Green, 2011) were not significantly associated with studies' effect sizes, suggesting that study quality did not have any impact on study outcomes. Two studies with unrealistically large effect sizes of g fu1 = À1.5 (Koschwanez et al., 2013) and g fu1 = À2.1 (Epstein, Sloan, & Marx, 2005) were identified. The former seems to be caused by a typo in the article, as the reported summary statistics are inconsistent with the results of the significance tests. ...
... The former seems to be caused by a typo in the article, as the reported summary statistics are inconsistent with the results of the significance tests. Thus, the study of Koschwanez et al. (2013) was excluded from further analyses. The statistics reported by Epstein et al. (2005) appear valid and were thus included in the main analyses. ...
This meta-analysis addresses the question of whether expressive writing shows an effect on reducing depressive symptoms. It focuses on samples of physically healthy adults with varying degrees of stress but without posttraumatic stress disorder. A total of 39 randomized controlled trials with 64 intervention-control group comparisons were obtained through keyword search in databases and backward search. Expressive writing did not yield significant long-term effects on depressive symptoms. However, effects were larger when the number of sessions was higher and when the writing topic was more specific. The results of this meta-analysis did not support the effectiveness of brief, self-directed expressive writing as an intervention that decreases depressive symptoms in physically healthy adults with varying degrees of psychological stress. Future research should examine whether longer, more directed writing interventions with additional therapeutic support would lead to different results.
... One of the most intriguing questions regarding EW is how this brief psychological intervention results in physical health benefits. For example, two studies have reported that EW led to improved wound healing, but not improvements in perceived stress (Koschwanez et al., 2013;Weinman, Ebrecht, Scott, Walburn, & Dyson, 2008). Thus, if wound-healing effects of EW are not operating via reductions in stress (Koschwanez et al., 2017), at least stress as captured by self-report measures, then one of the key challenges is to understand how these psychological processes interact with physiological processes (Lutgendorf & Ullrich, 2002). ...
and Keywords Expressive writing (EW) was developed in the 1980s by Pennebaker and colleagues, who defined it as "writing focusing on traumatic, stressful or emotional events, and the feelings inspired by these." There have been developments in terms of process, covering a range of instructions, target groups, and writing conditions and, more recently, benefit-finding writing (BFW) about benefits derived from stress or traumatic situations. EW has now been trialed across a broad range of situations, involving mental and physical health domains. Results from meta-analyses find small but significant improvements more related to physical health than mental health parameters. It is thought to be best suited to people with mild-to-moderate psychological distress who are addressing stress-related conditions and situations. The chapter describes common forms of EW and explores the place of BFW. Some mechanisms for expressive writing are discussed, but these are still speculative.
... A escrita reflexiva traz benefícios à saúde, tanto física quanto mental, como apontam Baines (2022), Koschwanez et al. (2013) e Wurtz et al. (2022). Alt et al. (2022) destacam que a capacidade de reflexão é uma habilidade acadêmica e profissional importante para a aprendizagem ao longo da vida e para o pleno funcionamento pessoal em ambientes complexos e diversos, enquanto Epp (2008) apresenta evidências de que um nível significativo de reflexividade pode ser encontrado em diários reflexivos de estudantes de graduação, o que incentiva a adoção dessa ferramenta na educação superior. ...
RESUMO Objetivo: Explorar as contribuições de diários reflexivos para a aprendizagem e seu valor como instrumento de avaliação para a educação superior. Escopo: O artigo descreve a experiência de uso de diários reflexivos em um programa de formação integrada de um curso de graduação em Administração de Empresas. Trechos de diários produzidos por estudantes ilustram as dimensões reflexivas e demonstram o potencial do instrumento para avaliação formativa e diagnóstica. Originalidade: Aborda uma ferramenta não convencional no campo de ensino, aprendizagem e avaliação educacional em Administração. Relevância: Oferece subsídios a professores que desejem utilizar diários reflexivos como forma de contribuir para a aprendizagem e/ou avaliação educacional. Palavras-chave: Diário reflexivo, avaliação formativa, avaliação diagnóstica, educação superior, ensino de Administração. ABSTRACT Purpose: To explore the contributions of reflective journals to learning and their value as an assessment tool in higher education. Scope: The article describes the experience of using reflective journals in an integrated training program of an undergraduate business management course. Excerpts from journals kept by students illustrate reflective dimensions and demonstrate the tool's potential for formative and diagnostic assessment. Originality: It discusses an unconventional tool in the field of management teaching, learning and educational evaluation. Relevance: It provides a base for instructors who wish to use reflective journals as a way of contributing to learning and/or educational evaluation.
... For example, Baikie et al. [25] highlighted how expressive writing can be used for therapeutic reasons that have positive impact on physical and psychological health. Similarly, Koschwanez et al. [26] found that journaling could improve wound healing in older adults and women. ...
Over the years, there has been a global increase in the use of technology to deliver interventions for health and wellness, such as improving peoples mental health and resilience. An example of such technology is the Q-Life app which aims to improve peoples resilience to stress and adverse life events through various coping mechanisms, including journaling. Using a combination of sentiment and thematic analysis, this paper presents the results of analyzing 6023 journal entries from 755 users. We uncover both positive and negative factors that are associated with resilience. First, we apply two lexicon-based and eight machine learning (ML) techniques to classify journal entries into positive or negative sentiment polarity, and then compare the performance of these classifiers to determine the best performing classifier overall. Our results show that Support Vector Machine (SVM) is the best classifier overall, outperforming other ML classifiers and lexicon-based classifiers with a high F1-score of 89.7%. Second, we conduct thematic analysis of negative and positive journal entries to identify themes representing factors associated with resilience either negatively or positively, and to determine various coping mechanisms. Our findings reveal 14 negative themes such as stress, worry, loneliness, lack of motivation, sickness, relationship issues, as well as depression and anxiety. Also, 13 positive themes emerged including self-efficacy, gratitude, socialization, progression, relaxation, and physical activity. Seven (7) coping mechanisms are also identified including time management, quality sleep, and mindfulness. Finally, we reflect on our findings and suggest technological interventions that address the negative factors to promote resilience.
... Individuals with Alzheimer's disease and related dementias (hereafter referred to as 'dementia')-almost two-thirds of long-stay nursing home residents [11] are particularly affected by sleep disturbance [12,13]. Poor sleep quality in this population is associated with increases in self-reported fatigue, difficulties with activities of daily living (ADLs), depression, fall risk, and, together with decreases in memory, mobility, morbidity, and even rates of survival [3,[14][15][16][17]. ...
Background
Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency.
Methods
This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability.
Discussion
This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia.
Trial registration
NCT04533815, ClinicalTrials.gov, August 20, 2020.
... En suma, la promoción de la escritura de eventos traumáticos como técnica terapéutica parece prematura, por lo menos como técnica única, ya que dicha práctica no ha sido suficientemente justificada por los resultados empíricos (Koschwanez et al. 2013). Los resultados del presente estudio, junto con los de investigaciones anteriores, sugieren que, en el mejor de los casos, su uso debe limitarse a servir como un complemento a otros tratamientos apoyados empíricamente (Sloan, Sawyer, Lowmaster, Wernick, y Marx, 2015). ...
The beneficial effects on the health of the re-experimentation of traumatic experiences are well-established. The effectiveness of using reexperimentation seems to be affected by certain conditions. Among personal variables that have been shown to influence the recovery of such experiences it has highlighted the optimism and alexithymia. The aim of this study was to evaluate the effects on mental health of an intervention based on re-experimentation. The sample consisted in a total of 60 participants, of which 40 carried out a process of emotional re-experimentation through three sessions of expressive writing. The rest formed the control group. All participants were evaluated before and after the emotional disclosure in positive and negative affect, anxiety, depression, intrusive thoughts and cognitive avoidance. Furthermore, the level of optimism and alexithymia were controlled. The results showed the effectiveness of expressive writing on the positive and negative affect and on depression. Among the covariables, only optimism affected significantly to effect emotional variables. The contextual and personal conditions that can be ameliorated the clinical use of emotional disclosure were discussed.
... Hypothesis 3: Based on research that demonstrated that self-compassion is negatively correlated with mental illness (MacBeth & Gumley, 2012) and that self-compassion interventions can protect against mental illness (Trompetter et al., 2017;Waite et al., 2015), and reduce mental health symptoms like depression and anxiety (Arch et al., 2014;Neff & Germer, 2013), we hypothesized that participants who completed the self-compassion writing intervention in the current study would show a greater improvement in depression at the posttest and 1-month follow-up than participants in the control group. Hypothesis 4: Based on the original expressive writing study by Pennebaker and Beall (1986), subsequent expressive writing studies (Koschwanez et al., 2013;Petrie et al., 2004;Sloan & Marx, 2004), and Wong and Mak's (2016) self-compassion writing study that showed that writing interventions are effective at improving physical symptoms, we hypothesized that participants in the treatment group would show a greater decrease in physical symptoms at the posttest and 1-month follow-up than the control group. Hypothesis 5: Based on the previous self-compassion writing research that showed positive affect significantly improved for participants who wrote with self-compassion (Helm, 2016;Imrie & Troop, 2012;Ziemer, 2014) and positive writing research that resulted in immediate increases in positive affect after each wave's intervention (Burton & Kiing, 2007), we hypothesized that individuals in the treatment group in the current study would show a greater increase in positive affect than the control group after each wave's writing intervention. ...
Purpose
Studies have found that writing with self-compassion about a stressful event helps promote mental health in college students and nonclinical populations. Using a randomized controlled trial, this study investigated whether a self-compassion writing intervention would lead to increases in self-compassion and proactive coping and reductions in mental health symptoms in a sample of individuals with mental illness.
Method
Individuals with mental disorders were recruited and randomly assigned to a treatment condition in which participants wrote with self-compassion or a control condition where participants wrote about how they spent their time. Outcome measures were administered at pretest, after the 3-day intervention, and 1 month later.
Results
Both the treatment and control groups showed significant improvements in self-compassion, proactive coping, mental health, and physical health.
Discussion
Overall, the results suggest both self-compassion writing and writing about how one spends one’s time may be beneficial for individuals with mental illness.
... Individuals with Alzheimer's disease and related dementias (hereafter referred to as 'dementia')-almost two-thirds of long-stay nursing home residents (11) -are particularly affected by sleep disturbance (12,13). Poor sleep quality in this population is associated with increases in self-reported fatigue, di culties with activities of daily living (ADLs), depression, fall risk, and, together with decreases in memory, mobility, morbidity, and even rates of survival (3,(14)(15)(16)(17). ...
Background
Disturbed sleep places older adults at higher risk for frailty, morbidity, and even mortality. Yet, nursing home routines frequently disturb residents’ sleep through use of noise, light, or efforts to reduce incontinence. Nursing home residents with Alzheimer’s disease and or related dementias—almost two-thirds of long-stay nursing home residents—are likely to be particularly affected by sleep disturbance. Addressing these issues, this study protocol implements an evidence-based intervention to improve sleep: a nursing home frontline staff huddling program known as LOCK. The LOCK program is derived from evidence supporting strengths-based learning, systematic observation, relationship-based teamwork, and efficiency.
Methods
This study protocol outlines a NIH Stage III, real-world hybrid efficacy-effectiveness pragmatic trial of the LOCK sleep intervention. Over two phases, in a total of 27 non-VA nursing homes from 3 corporations, the study will (1) refine the LOCK program to focus on sleep for residents with dementia, (2) test the impact of the LOCK sleep intervention for nursing home residents with dementia, and (3) evaluate the intervention’s sustainability. Phase 1 (1 year; n = 3 nursing homes; 1 per corporation) will refine the intervention and train-the-trainer protocol and pilot-tests all study methods. Phase 2 (4 years; n = 24 nursing homes; 8 per corporation) will use the refined intervention to conduct a wedge-design randomized, controlled, clinical trial. Phase 2 results will measure the LOCK sleep intervention’s impact on sleep (primary outcome) and on psychotropic medication use, pain and analgesic medication use, and activities of daily living decline (secondary outcomes). Findings will point to inter-facility variation in the program’s implementation and sustainability.
Discussion
This is the first study to our knowledge that applies a dementia sleep intervention to systematically address known barriers to nursing home quality improvement efforts. This innovative study has future potential to address clinical issues beyond sleep (safety, infection control) and expand to other settings (assisted living, inpatient mental health). The study’s strong team, careful consideration of design challenges, and resulting rigorous, pragmatic approach will ensure success of this promising intervention for nursing home residents with dementia.
Trial registration
NCT04533815, ClinicalTrials.gov, August 20, 2020.
... There is substantial evidence that stress can impair wound healing (19) and that psychological interventions can improve the healing of both experimental and clinical wounds (20). Interventions include expressive writing (21), relaxation (22), social support (23), and mindfulness-based stress reduction (24). EE has been proposed to reduce stress and therefore could be a further intervention to improve wound healing. ...
Objective
Environmental enrichment (EE) can reduce stress, alter immunity, and speed wound healing in animals. However, it is not known whether these effects translate to humans. This study aimed to investigate whether sensory EE could improve wound healing after a stressor in humans.
Methods
A total of 105 participants underwent a tape-stripping procedure and were then stressed using a laboratory stress paradigm. After this, they were randomized to interact for 30 minutes with one of two possible sensory EE interventions (music as auditory enrichment or a Paro robot as multisensory enrichment) or to a control condition. Skin barrier recovery was measured using transepidermal water loss at baseline, after the stressor, and after the intervention. Stress was measured using self-report, heart rate, blood pressure, and salivary stress-related biological measures. Enjoyment during the intervention was measured by self-report as a possible mediator.
Results
The Paro condition had significantly improved skin barrier recovery (mean [M] = 44%, standard error [SE] = 1.92) compared with the control condition (M = 37% SE = 2.01, F (2,88) = 3.25, p = .043), both with and without controlling for covariates. The music condition did not significantly differ from the other conditions (M = 42%, SE = 1.95, p values > .05). Both objective and subjective stress measures did not significantly differ between conditions. Mediational analysis showed that enjoyment levels during the intervention period significantly mediated the relationship between condition and skin barrier recovery ( z = 2.00, p = .046).
Conclusions
Paro, or other companion robots, may be an effective form of enrichment to improve skin barrier recovery in humans after a laboratory stressor, and this effect may be due to enjoyment. Further research with patient groups is required to investigate whether Paro can help heal clinical wounds.
Trial Registration: ACTRN12618000953235, registered at https://anzctr.org.au.
... To date, only limited evidence suggests coping by emotional approach could yield impact on immune markers in older adults. In an experimental writing study, older adults were assigned either to induced EP and EE through writing about upsetting events or to a "time-management" control writing condition (Koschwanez et al., 2013). Written expressive disclosure significantly accelerated wound healing after punch biopsy compared to control writing (but had no effect on depressive symptoms). ...
Emotional approach coping involves active attempts at emotional expression and processing in response to stressful circumstances. This study tested whether dispositional emotional approach coping processes predict changes in physical and mental health in community-dwelling older adults, particularly within the context of higher perceived stress. To test this, older adults (N = 150) completed assessments of emotional expression and emotional processing at study entry. They also completed measures of perceived stress, depressive symptoms, and ill-health (a composite of subjective and objective physical health indicators, which included blood draw for collection of biomarkers), every 6 months over 4.5 years. Emotional processing and emotional expression were not related significantly to ill-health at study entry. However, emotional processing (but not emotional expression) significantly predicted changes in ill-health. At higher levels of emotional processing, ill-health remained low and stable; at lower levels of emotional processing, ill-health increased over time. However, when perceived stress was high, higher emotional processing and emotional expression were related to lower depressive symptoms at study entry, but higher emotional processing was associated with increasing depressive symptoms over time. Emotional approach coping processes evidence prospective relations with health outcomes, which are partially conditioned by stress perceptions. Emotional processing appears to have a protective impact against declining physical health. Predictive relationships for depressive symptoms are more complex. Older adults with chronically high perceived stress might benefit from interventions that target emotion-regulating coping processes. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... EW has previously been shown to improve mental health, including depression, [36][37][38] postpartum depression, [39][40][41][42] and posttraumatic stress disorder in ICU settings, 43,44 as well as to increase resiliency in caregivers of chronically ill people. [45][46][47] Additionally, EW can improve physical health in a variety of other health conditions, including asthma and rheumatoid arthritis, 48,49 hypertension, 50 wound healing, 51,52 and HIV. 53 In previous studies of health care practitioners, EW has been shown to promote resiliency, enhance empathy, and decrease burnout. ...
Introduction:
Expressive writing, the process of self-expression through writing, appears to have beneficial effects. Our hospital's narrative medicine group developed an expressive writing tool, the Three-Minute Mental Makeover (3MMM).
Objective:
To evaluate the effectiveness of the 3MMM to reduce stress and optimize communication between health care practitioners and their patients/families.
Methods:
Patients and families were recruited from a Chicago-area children's hospital from December 2016 through July 2017, from the neonatal intensive care unit, pediatric intensive care unit, inpatient pediatric unit, and outpatient pediatric clinics. Health care practitioners included a pediatric cardiologist, pediatric residents, child development specialists, and pediatric nurses. Practitioner and patient family participants completed prestudy and poststudy surveys to assess perceived stress and communication levels. Using a standardized script, practitioners led the 3MMM activity, writing concurrently with patients/families. Participants then shared their responses. Presurvey and postsurvey data were compared using nonparametric tests.
Results:
Eight practitioners led 96 patient/family members in 3MMM activities and study surveys. At baseline, all patients, family members, and practitioners reported experiencing 1 or more symptoms of stress. After participating in the 3MMM, patients/family members and practitioners reported reduced stress compared with baseline (p < 0.001). A significant improvement in communication was reported by practitioners (p < 0.001). Eighty-eight percent of patients/families reported that the 3MMM activity was helpful, even though only 35% had used writing or journaling in the past.
Conclusion:
The 3MMM is a short writing exercise that reduces stress for practitioners, patients, and families. Future studies may help determine long-term effects of the 3MMM.
... The general outcomes from these studies have been that a broad range of stressors can raise cortisol, reduce the activity of pro-inflammatory cytokines and therefore delay healing (Godbout and Glaser, 2006). As well, relationships have been established between perceived stress, self-reported general health and healing rate (Ebrecht et al., 2004) and interestingly, a positive association between healing rate and writing about distressing events, probably mediated by sleep ( Koschwanez et al., 2013). The role of exercise on healing is likely to be multi-factorial including mediating psychological stress and improving perfusion of tissues ( Emery et al., 2005). ...
This chapter, Stress Pain and Recovery: neuro-immune-endocrine interactions and clinical practice, was published in 2017 book titled Psychologically-informed Physiotherapy: embedding psychosocial perspectives within clinical management
... In particular, the emergence of the emotional semantic fields that permeated their stories suggests (Koschwanez et al., 2013;Ochsner & Gross, 2005) the spontaneous activation, through writing, of a therapeutic emotional component which served to heal. ...
The use of Classical Greek myth as a narrative and metaphorical tool can contribute to the construction of a professional teaching identity. Adopting a biographical narrative approach, the present study sought to assess this contribution in a group of teacher and researcher trainees undertaking a postgraduate university course. The construction of personal narratives used for collective interpretation by the participants that generated them was analysed and interpreted in relation to the development of teacher professionalism. Our findings show the effective activation of metacognitive processes in order to rethink teacher professionalism from a narrative point of view. Using the structure and content of Classical myths as a scaffold, participants established valuable reflections on crucial aspects of teaching, identifying personal achievements and conquests as well as fears and insecurities. The structures latent in myth provided an effective framework with which to project and identify at least three hermeneutical themes—symbolism, function and structure—that form constituent elements of professional identity and are not only intertwined but are also constituted within a community of practice. Thus, Greek myths continue to offer an interesting cognitive and emotional scaffold that contributes to teacher professionalism, facilitating the formulation of a reflective, collaborative and personal meaning of identity which brings together personal teaching experiences and knowledge and is necessarily shared with the surrounding community of practice.
... Weinman et al and Koschwanez et al examined whether preoperative expressive writing could result in better wound healing. 16,17 The authors suggest that disclosure of traumatic experiences can result in lower stress levels and thereby influence the immune system. In both studies patients were asked to write about a traumatic experience preoperatively for 20 minutes. ...
Background
Poor wound healing and scar formation remain a critical problem in daily surgical practice. Generally, most attention is paid to intra- and postoperative interventions to improve wound healing after surgery, while preoperative interventions remain explored unsatisfactorily.
Objective
In this systematic review, the available literature on the beneficial effects of preoperative interventions on wound healing and scar formation has been summarized and compared.
Methods
A comprehensive and systematic search has been conducted in MEDLINE, Pubmed, Embase, Web of science and Cochrane, supplemented by reference and citation tracking. All preoperative interventions and all clinically relevant outcome parameters have been considered for inclusion, due to expected limited availability of literature.
Results
A total of 13 studies were included, which were all randomized trials. No cohort studies or retrospective studies have been identified. All studies described different preoperative interventions and outcome parameters and could hence not be pooled and compared. Eight studies showed significantly better wound healing after a preoperative intervention. The individual studies have been summarized in this review.
Conclusion
This systemic review shows that preoperative interventions can be beneficial in improving wound healing and scar formation. In selected cases, wound healing was found to benefit from a higher preoperative body temperature, topical vitamin E application and low patient stress levels.
... En suma, la promoción de la escritura de eventos traumáticos como técnica terapéutica parece prematura, por lo menos como técnica única, ya que dicha práctica no ha sido suficientemente justificada por los resultados empíricos (Koschwanez et al. 2013). Los resultados del presente estudio, junto con los de investigaciones anteriores, sugieren que, en el mejor de los casos, su uso debe limitarse a servir como un complemento a otros tratamientos apoyados empíricamente (Sloan, Sawyer, Lowmaster, Wernick, y Marx, 2015). ...
Los efectos beneficiosos sobre la salud de la reexperimentación emocional mediante la utilización de la escritura expresiva de vivencias traumáticas están bien establecidos. La efectividad de la utilización de la reexperimentación parece verse afectada por ciertas condiciones. Entre las variables personales que han mostrado tener influencia sobre la recuperación de tales vivencias se ha destacado el optimismo y la alexitimia. El objetivo del presente trabajo fue evaluar los efectos de una intervención basada en la reexperimentación emocional sobre la salud mental. Se aplicó un diseño experimental intergrupo pre y posttratamiento. La muestra estuvo compuesta por un total de 60 participantes, de los que 40 llevaron a cabo un procedimiento de reexperimentación emocional mediante tres sesiones de escritura expresiva. El resto formaron el grupo control y escribieron sobre situaciones triviales. Todos fueron evaluados antes y después de la reexperimentación emocional en afecto positivo y negativo, ansiedad, depresión, pensamientos intrusivos y evitación cognitiva. Además, se controló el nivel de optimismo y la alexitimia. Los resultados mostraron la eficacia de la escritura expresiva sobre el afecto positivo y negativo y el nivel de depresión. Entre las covariables, únicamente el optimismo produjo un efecto significativo sobre las variables más emocionales. Se discuten las condiciones contextuales y personales que pueden favorecer el uso clínico de la reexperimentación emocional.
... An a priori power analysis determined 68 participants were required to achieve a power of 80% with α = 0.05, given a moderate effect size of d = 0.7. This effect size was chosen on the basis of two recent studies showing that the healing of punch biopsy wounds could be improved by psychological interventions with effect sizes of d = 0.82 and d = 0.77, respectively [17,14]. Furthermore, a review on the effects of open-labelled placebos versus no treatment showed a pooled effect size d = 0.88 [10]. ...
Background
Open-label placebos are a novel treatment option, in which participants take placebos with full knowledge that they do not contain active medicine. Open-label placebo treatments have been shown to result in patient-reported symptom improvements, but they have not been tested on objectively measurable physiological outcomes such as wound healing.
Purpose
The current study aimed to determine whether open-label placebos improved wound healing in punch biopsy wounds compared with no treatment.
Methods
In a randomized controlled trial, 70 participants (mean age 27.6 ± 10.1, 58 female) were provided with information about the beneficial effects of placebos and given a 4 mm punch biopsy wound. Participants were then randomized to either an open-label placebo intervention (two placebo tablets twice a day for 10 days) or a no-treatment control group. Wounds were photographed at 7 days and 10 days to determine reepithelialization of the wound surface.
Results
No significant differences were observed between the open-label placebo and control conditions in the percentage of wound area healed or for the number of participants with fully reepithelialized wounds at 7 days (placebo 7/32 wounds healed, control 10/33 wounds healed, (χ²[1, N = 65] = 0.60, p = .440, φ = 0.10) and 10 days after wounding (placebo 17/32, control 25/33 wounds healed (χ²[1, N = 65] = 3.64, p = .056, φ = 0.24).
Conclusions
Open-label placebo treatment does not improve the healing rate of wounds. Open-label placebos may be beneficial for subjective patient-reported outcomes but do not influence wound healing.
Australian New Zealand Clinical Trials Registration
ACTRN12616000411448.
... Participants were not specifically selected for elevated stress levels to ensure comparability with previous studies investigating the effects of psychological interventions on wound healing in healthy participants (e.g. Koschwanez et al. 2013;Robinson et al. 2015Robinson et al. , 2016Weinman et al. 2008). In addition, MBSR has been found to reduce stress in healthy populations not selected for elevated stress levels (Khoury et al. 2015). ...
Psychological factors have been shown to influence the process of wound healing. This study examined the effect of Mindfulness-Based Stress Reduction (MBSR) on the speed of wound healing. The local production of pro-inflammatory cytokines and growth factors was studied as potential underlying mechanism. Forty-nine adults were randomly allocated to a waiting-list control group (n = 26) or an 8-week MBSR group (n = 23). Pre- and post-intervention/waiting period assessment for both groups consisted of questionnaires. Standardized skin wounds were induced on the forearm using a suction blister method. Primary outcomes were skin permeability and reduction in wound size monitored once a day at day 3, 4, 5, 6, 7, and 10 after injury. Secondary outcomes were cytokines and growth factors and were measured in wound exudates obtained at 3, 6, and 22 h after wounding. Although there was no overall condition effect on skin permeability or wound size, post hoc analyses indicated that larger increases in mindfulness were related to greater reductions in skin permeability 3 and 4 days after wound induction. In addition, MBSR was associated with lower levels of interleukin (IL)-8 and placental growth factor in the wound fluid 22 h after wound induction. These outcomes suggest that increasing mindfulness by MBSR might have beneficial effects on early stages of wound healing.
Trial Registration NTR3652, http://www.trialregister.nl
... Don't worry about spelling, sentence structure, or grammar" (Pennebaker, 1997, p. 162). An array of positive outcomes have been associated with expressive writing, including improved wound healing time in older adults (Koschwanez et al., 2013) and decreased depressive rumination (Cooper, 2012). One study found that males benefited more than females from expressive writing interventions (Manier & Olivares, 2005). ...
Objectives: This paper describes the program evaluation of a group intervention combining reminiscence with literary creative writing instruction.
Method: This ten-week, one-hour group was completed seven times in an outpatient geriatric mental health clinic. Each session introduced a different reminiscence theme and creative writing practice. Feasibility and acceptability were assessed through group monitoring and qualitative feedback. Effectiveness was assessed with pre- and post-test depression screening (PHQ-9) and qualitative feedback.
Results: A total of 34 veterans participated in the groups, with a mean group size of 4.86 (SD = 0.69). Participants were 85% male (n = 29) and 15% female (n = 5) with a mean age of 70.89 (SD = 8.30). To increase accessibility, several adaptations were made. There were statistically significant reductions in PHQ-9 depression scores (p = 0.005). Veterans reported qualitative improvements including increased motivation and self-expression.
Conclusions: This intervention was feasible and acceptable to the veterans being served. Randomized controlled research is needed to better understand efficacy.
Clinical Implications: Clinicians may consider ways to augment or adapt reminiscence interventions to meet the needs of their patient population. Clinicians may find it useful to integrate creative writing instruction into reminiscence interventions.
... However, innovative use of technology can address this gap. A few studies have reported some success through the use of pre-operative psychological interventions such as relaxation with guided imagery (Broadbent et al. 2012) and expressive writing (Koschwanez et al. 2013). Moreover, there is an ongoing trial at the University of Toronto which is utilizing virtual reality headsets to immerse patients in a virtual peri-operative environment and monitoring for effect on anxiety (Haves 2016). ...
Psychological distress may hinder recovery following surgery. Studies examining the relationship between psychological distress and religiosity in the acute post-operative setting are lacking. The present study investigated this relationship, evaluated protocol design, and explored coping mechanisms. Psychological distress of surgical inpatients was assessed using the Hospital Anxiety and Depression Scale (HADS) and Rotterdam Symptom Checklist (RSCL). Religiosity was assessed using the Santa Clara Strength of Religious Faith Questionnaire. Correlations were obtained using Minitab software. Qualitative analysis identified coping mechanisms. Of eligible inpatients, 13/54 were recruited. No significant correlation was found between religiosity and psychological distress. The RSCL had a strong correlation with HADS (R = 0.82, p = 0.001). Assessment of distress was >2 min faster using RSCL compared to HADS. Relationships with pets, friends or family, and God emerged as the most common coping mechanism. Given study limitations, no conclusion was drawn regarding the relationship between religiosity and psychological distress. Weaknesses in study protocol were identified, and recommendations were outlined to facilitate the definitive study. This includes use of RSCL instead of HADS. Further study is warranted to explore how to strengthen relationships for inpatients.
... Even when legal and political battles to obtain access to services are not involved, the uncertainty and moral ambiguity associated with the lack of a diagnosis and explanation can leave sufferers in a state of 'embodied doubt' and permanent narrative 'chaos' (Frank, 1995;Nettleton, 2006). While it is commonsense -within a dualist framework -to suppose that a lack of narrative coherence may have implications for mental health, recent conceptualizations of the immune system suggest that the achievement of narrative coherence may be directly relevant to immune function and thus to physical health as well (Booth & Davison, 2003;Koschwanez et al., 2013;Pennebaker, Kiecolt-Glaser, & Glaser, 1988;Petrie, Fontanilla, Thomas, Booth, & Pennebaker, 2004). The implication of this is that there is a feedback loop between the psychosocial suffering associated with delegitimation (or what I called the second-order phenomenon) and the genesis of somatic symptoms (the first-order phenomenon). ...
This article describes an emergent reconfiguration of the problem of somatization in contemporary research and practice around ‘medically unexplained symptoms’ among UK-based primary care researchers with a special interest in these conditions. Based on an analysis of clinical research literature and on participant observation in the early stages of a clinical research project, the article explores recent accounts of the role of medicine and doctors in the co-production of somatization, and contemporary efforts to address this iatrogenic dimension by developing and testing clinically effective explanations. In this reconfigured discursive space, the problem of explanation is recast not in terms of the need for a representational, objective truth on the basis of which treatment of one kind or another should follow, but rather in terms of a pragmatic wager whose truth lies in the quality of its clinical effects. In this sense, these explanatory strategies can be characterized as a form of ‘speculative pragmatism’ and may be said to instantiate a form of ‘creative accountability’. The concluding section of the article contrasts this form of pragmatism with the ‘cash-value’ pragmatism implicit in explanatory strategies evident among participants of self-help groups for contested illnesses, particularly in the US. This contrast highlights the constraints that different healthcare systems – or policy environments, broadly conceived – impose on citizens’ ability to re-imagine themselves in ways that might facilitate their potential for growth, transformation and self-care.
... Expressive writing is based on the assumption that writing one's feelings gradually eases negative feelings or emotional trauma. These types of intervention have not exclusively been developed in the field of gerontology but as a more general approach to be used in many different types of target populations, for instance, people with traumatic experiences (Smyth & Helm, 2003) or chronic conditions (Broderick, Stone, Smyth, & Kaell, 2004;McGuire, Greenberg, & Gevirtz, 2005;Smith et al., 2015;Smyth, Stone, Hurewitz, & Kaell, 1999), including many nonclinical populations, for instance, student populations (Gortner, Rude, & Pennebaker, 2006;Park, Ramirez, & Beilock, 2014;Yang, Tang, Duan, & Zhang, 2015), and more recently to older adults (Klapow et al., 2001;Koschwanez et al., 2013). ...
Objectives: The aim of the current study was to analyze whether biographical writing interventions have an impact on depression and QoL compared to daily diary writing. We also wanted to investigate differential effects between structured and unstructured interventions.
Method: In two Northern regions of Germany, 119 older adults aged 64–90 were randomly assigned to three different types of narrative writing interventions: written structured and unstructured biographical disclosure as well as daily diary writing. Depression (PHQ-9), QoL (SF-12, EUROHIS) and trauma-related symptoms (PCL-C) were obtained pre- and post-interventions as well as at three-month follow-up.
Results: Follow-up measures were obtained from 85 participants (29% loss to follow-up; mean age = 73.88; 68.2% female). Results of repeated measurement analysis demonstrated a significant effect on depression with the daily diary writing group showing lower depressive symptoms than structured biographical writing. We did not find a significant impact on QoL. Post-hoc analyses showed that posttraumatic symptoms lead to increases in depressive symptoms.
Conclusion: In a non-clinical sample of community-dwelling older adults, biographical writing interventions were not favorable to daily diary writing concerning the outcomes of the study. This might be related to the association of traumtic reminiscences of former children of World War II and outcome measures.
... Emotional expression Disclosing one's thoughts and feelings about a stressful experience is posited to facilitate positive adjustment. Numerous experiments demonstrate that expressive writing [2] produces significant physical and psychological health benefits in healthy and clinical populations [2][3][4][5][6][7][8]. However, substantial variability exists in the benefits derived from expressive writing (see [3] for meta-analysis), and the evidence for the beneficial effects of expressive writing among cancer populations has been mixed [9][10][11][12][13][14][15][16]. ...
BackgroundA randomized experiment by Rini et al. (Health Psychol. 33(12):1541–1551, 2014) demonstrated that expressive helping, which involves three expressive writing sessions regarding hematopoietic stem cell transplant, followed by one writing session directed toward helping other stem cell transplant recipients, reduced psychological distress and bothersome physical symptoms among stem cell transplant recipients with elevated survivorship problems, relative to a neutral writing control condition. PurposeThe current study evaluated whether word use reflective of emotional expression, cognitive processing, and change in perspective mediates the effects of expressive helping. Method
The essays of 67 stem cell transplant recipients with high survivorship problems were analyzed with Linguistic Inquiry and Word Count. Multiple mediation modeling was used to test the hypothesized mechanisms of expressive helping on distress and bothersome physical symptoms. ResultsRelative to the control condition, expressive helping produced significant reductions in psychological distress and marginal reductions in physical symptom bother in the analyzed subset of participants from the parent study. Results indicated that positive emotion word use significantly mediated effects of expressive helping on reduced distress, but only for participants who used average (compared to above or below average) rates of negative emotion words. Cognitive processing and change in perspective did not significantly mediate benefits of expressive helping. Conclusions
Expressive helping carried its positive effects on distress through participants’ higher expression of positive emotions when coupled with moderate rates of negative emotions. Findings highlight the benefit of expressing both positive and negative emotions in stressful situations.
... interestingly, a positive association between healing rate and writing about distressing events, probably mediated by sleep (Koschwanez et al., 2013). The role of exercise on healing is likely to be multi-factorial including mediating psychological stress and improving perfusion of tissues (Emery et al., 2005). ...
... Promising outcomes have been demonstrated for a number of interventions aimed at improving healing through stress-reduction techniques, including expressive writing [28,29] , anger expression [30] and resilience-building [31] . Yet, even when supported by evidence from well-designed randomised controlled trials, these and similar approaches remain effectively relegated to the status of 'alternative' and 'complementary' [32] , and are largely omitted from best practice recommendations. ...
Throughout history, the ways wounds have been understood and managed in relation to the patient’s body has altered in line with social trends of the times. Today, the need to find efficient and effective ways to address the growing burden of chronic wounds has fuelled unprecedented advances in scientific knowledge of tissue repair and an exponential growth in new technologies designed to speed up this process. Despite calls to “assess and treat the whole person and not the hole in the person”, the ongoing reductionist approach of Western medicine to treating symptoms, rather than their cause, means that ‘quality’ wound practice remains heavily oriented towards local wound interventions. The relationship between patients’ emotions, wound occurrence and wound healing is by no means a new concept[. In recent times, however, as knowledge of this complex interplay is funnelled through the rigid parameters of evidence-based practice (EBP), not only does the requirement to produce rigorous scientific data influence how clinicians approach the topic, it also alters the way historical wound research is interpreted.
... En suma, la promoción de la escritura de eventos traumáticos como técnica terapéutica parece prematura, por lo menos como técnica única, ya que dicha práctica no ha sido suficientemente justificada por los resultados empíricos (Koschwanez et al. 2013). Los resultados del presente estudio, junto con los de investigaciones anteriores, sugieren que, en el mejor de los casos, su uso debe limitarse a servir como un complemento a otros tratamientos apoyados empíricamente (Sloan, Sawyer, Lowmaster, Wernick, y Marx, 2015). ...
The beneficial effects on the health of the re-experimentation of traumatic experiences are well-established. The effectiveness of using reexperimentation seems to be affected by certain conditions. Among personal variables that have been shown to influence the recovery of such experiences it has highlighted the optimism and alexithymia. The aim of this study was to evaluate the effects on mental health of an intervention based on re-experimentation. The sample consisted in a total of 60 participants, of which 40 carried out a process of emotional re-experimentation through three sessions of expressive writing. The rest formed the control group. All participants were evaluated before and after the emotional disclosure in positive and negative affect, anxiety, depression, intrusive thoughts and cognitive avoidance. Furthermore, the level of optimism and alexithymia were controlled. The results showed the effectiveness of expressive writing on the positive and negative affect and on depression. Among the covariables, only optimism affected significantly to effect emotional variables. The contextual and personal conditions that can be ameliorated the clinical use of emotional disclosure were discussed.
... Furthermore, studies have shown that stress reduction interventions can reduce stress and improve wound healing. Expressive writing (writing about traumatic events) 2 weeks before 4-mm punch biopsy wounds were made to the upper arm increased the speed of healing in both young and old healthy adults (2,3). In addition, relaxation and stress management programs have been shown to improve wound healing in surgical patients. ...
... Similarly, medical students who were randomly assigned to write about traumatic events had higher antibody levels following a Hepatitis B vaccination compared to control participants (Petrie et al., 1995). Wound healing is also enhanced in older adults engaging in expressive writing compared to control participants (Koschwanez et al., 2013). ...
Stress has been consistently associated with negative health outcomes, including increased rates of heart disease, slower wound healing, and compromised immune function. Interventions designed to improve peoples' ability to cope with stress can improve health outcomes. Such interventions include relaxation training, emotional expression, benefit finding, and cognitive-behavioral stress management and mindfulness-based stress reduction programs. Coping interventions have the potential to improve health outcomes for patients undergoing a stressful illness experience.
... Studier har vist at ekspressiv skriving er nyttig, både for kliniske utvalg, og friske populasjonsgrupper med forskjellig kulturell bakgrunn (Frisina, Borod og Lepore 2004;Harris 2006;Pennebaker 1997;Pennebaker og Chung 2011). Skrivingen kan ha gunstig innvirkning på somatiske forhold som sårhelbredelse (Koschwanez, Kerse, Darragh et al. 2013), lungefunksjon, blodtrykk og immunfunksjon, samt egenoppfattelse av smerter, sykdomssituasjon og helse (Frattaroli 2006;Lepore og Smith 2002;Smyth 1998). Det er usikkert hvilke virksomme mekanismer som utløser terapeutisk effekt. ...
p>Expressive writing as a self-help tool one year after the breast cancer diagnosis – results from a Norwegian pilot study
The article presents findings from a pilot study on expressive writing, a therapeutic method undescribed in a Norwegian scientific context. Objective: 1. Gain qualitative data on breast cancer women’s experiences with expressive writing. 2. Evaluate the intervention’s feasibility, based on participants’ experiences of the instruction, procedure, and circumstances for writing. Method & design: The study has an exploratory descriptive design. Data collection was achieved through in-depth interviews, followed by experiential thematic analysis of transcripts. Results: Two women enrolled, participating in writing/interviews. Analysis revealed three themes: "The experience of the writing process", "Writing as working through and work to clear the mind", "Strength and vulnerability in relation to others". Conclusion: Findings reveal that expressive writing was experienced as achievable for two breast cancer women, one year after diagnosis. Writing provided an opportunity to work through, and sort out, feelings and thoughts connected to participants’ lives and illness experiences. The instruction was evaluated as easy to understand and inspiring. The women became absorbed in electronic writing in their own homes. They both recommended expressive writing for other women with breast cancer, especially in the period after initial diagnosis.</p
... Furthermore, studies have shown that stress reduction interventions can reduce stress and improve wound healing. Expressive writing (writing about traumatic events) 2 weeks before 4-mm punch biopsy wounds were made to the upper arm increased the speed of healing in both young and old healthy adults (2,3). In addition, relaxation and stress management programs have been shown to improve wound healing in surgical patients. ...
Psychological interventions administered before wounding can reduce stress and improve healing. However, in many cases, it would be more practical for interventions to be delivered after wounding. This preliminary study investigated whether a brief relaxation intervention could improve healing when administered either before or after skin damage produced by tape stripping in comparison to a control group.
One hundred twenty-one healthy adults were randomized into one of three groups: a) relaxation prestripping group, b) relaxation poststripping group, or c) no relaxation. Participants completed measures of stress, fatigue, relaxation, and pain. Relaxation consisted of listening to 20 minutes of guided relaxation, whereas the control condition was quiet reading for 20 minutes. Skin barrier function was measured using transepidermal water loss at baseline, immediately after tape stripping and 25 minutes later.
Relaxation either before or after tape stripping improved skin barrier recovery compared with the control group (F(2,92) = 3.58, p = .032, partial η = 0.074). Participants who took part in the relaxation intervention were significantly more relaxed and reported greater reductions in pain than the control group did 25 minutes after tape stripping. Perceived stress over the last month was not significantly related to healing.
This study showed that a relaxation intervention had a beneficial effect on skin barrier recovery regardless of whether the intervention was administered before or after wounding. Future research needs to replicate these findings in other wound types and in clinical settings, and investigate the biological mechanisms involved.
This experimental study examined the effects of expressive writing (EW) and its differential effects by gender on acculturative stress and depressive symptoms among first-generation Korean immigrant older adults residing in areas without well-established Korean communities in the United States. A pretest–posttest control group design was used to assess a total of 25 participants at baseline, right after the final writing, and at one-month follow-up. Fifteen randomized experimental participants wrote about their stressful or traumatic experiences related to their immigration and acculturation, whereas 10 in the control group wrote about their daily routines for 15 to 20 minutes per day for three consecutive days. Mixed analyses of variance showed that participants in both writing conditions reported more acculturative stress and depressive symptoms right after the final writing. A two-way multivariate analysis of variance showed that the experimental group and female participants reported significantly fewer depressive symptoms at one-month follow-up relative to the control group and male participants; however, the same significant effect was not observed in acculturative stress. No significant interaction effect between writing conditions and gender was found on either of the outcome variables. EW can be a culturally sensitive and feasible short-term intervention for depressive symptoms among Korean immigrant older adults residing in areas lacking ethnic resources and services.
The collapse of the Champlain Towers South (CTS), a condominium in Miami, Florida, left a diverse group of survivors and healthcare clinicians tasked with finding ways of coping with the disaster. Within seconds, the CTS collapse became a global tragedy due to the coastal neighborhood's rich international mix of residents. Although this tragedy impacted communities across globe, a large population of Hispanic victims lived in CTS that were deeply affected. Culturally adaptive interventions and holistic healthcare for Hispanic individuals are highly relevant because Hispanic Americans represent one of the fastest growing demographic groups in the United States. To reach, engage, and address the needs of Hispanic victims, this article provides an overview of psychosocial factors that influence Hispanic victims with trauma and discusses holistic psychotherapeutic approaches in nursing care that can be applied to improve victims’ well-being. Culture is an important consideration in health; therefore, this article highlights and operationalizes culturally tailored holistic nursing care that draws from the physical, mental, emotional, and spiritual dimensions of health and well-being that can be used in clinical settings with Hispanic clients who have experienced trauma.
For over three decades, research in health and clinical psychology has consistently indicated that expressive writing, or writing about emotionally challenging experiences, can lead to measurable health benefits. This entry brings into conversation the empirical literature on expressive writing paradigms and the interdisciplinary work of the health humanities.
Although expressive writing has proved to be beneficial on physical, mental, and social health of individuals, it has been restrained to lab-based experimental studies. In the real world, individuals may naturally engage with expressive writing when dealing with difficult times, especially when facing a tough health journey. Health blogging may serve as an easy-to-access method for self-therapy, if spontaneous expressive writing occurs. However, many posts may not be expressive enough to provide the therapeutic power. In this study, we build a Gaussian naive Bayes model to detect expressive writing in an online health community, CaringBridge. Because we lack full text data as training data, we use a method to learn model parameters from meta-analysis of the literature. The classifier reaches reasonable accuracy on the test set annotated by the authors. We also explore factors that may influence users' spontaneous expressive writing. We find gender, health condition, author type, and privacy settings can affect individuals' spontaneous expressive writing. Finally, we reflect on our methodology and results and provide design implications for online health communities.
It is described the project and actuation of a room for writing inside of Alessandria’s Hospital. The idea was organized from know out matured by doctors and nurses who have participated in training curses in narrative medicine in these years. The realization was asked by the head of the Neurology Department and his assistant where is located. The writing room is thinking on the base of typology of the emerging needs of their patients. In a simple and practical way it is detailed the instruction of this rooms model with the purpose to make writing, in this contest, an effective behavioral resource in the adaptation to illness. In the base of the first results, the strategies are suggested to make initiated practical effectively.
The relationship between stress and skin health has been documented since ancient times. This chapter provides an overview of the biological pathways believed to play a role in the relationship between psychosocial stress and the physical appearance of skin. It summarizes the clinically important relationships and emphasizes areas of significant academic, clinical, and commercial impact. The molecular factors that comprise the central (systemic) and cutaneous (peripheral) stress axes provide important background for the clinical effects of stress on skin health. Psychosocial stress affects skin health through complex interactions with neuroendocrine, immune, and microbial networks. The understanding of the classic hypothalamic‐pituitary‐adrenal stress axis has expanded to include its cutaneous analog, considering a likely bidirectional relationship between the systemic and local stress response. Emerging studies of the skin microbiome highlight the importance of commensal bacteria and demonstrate microbial activation of the stress axis.
Background and purpose
Trauma is highly prevalent, with estimates that up to 90% of the U.S. population have been exposed to a traumatic event. The adverse health consequences of trauma exposure are diverse and often long-lasting. While expressive writing has been shown to improve emotional and physical health in numerous populations, the feasibility and potential effectiveness of a novel expressive writing program provided in a clinical setting to improve resilience is unknown. Our objective was to determine the feasibility and potential effectiveness of a 6-week expressive writing course provided in a clinical setting to improve resilience in individuals with a history of trauma.
Materials and methods
This prospective, observational trial of a 6-week expressive writing intervention (Transform Your Life: Write to Heal) was conducted in an academic outpatient integrative clinic. Eligible participants were a self-referred sample of 39 English-speaking adults who identified as having had a trauma, or significant emotional/physical upheaval, within the past year. Main outcome measures included: Feasibility: Enrollment, Retention in Program and Trial, Adherence. Acceptability: Adverse Events; Participant Ratings. Primary Psychological Outcome: Connor-Davidson Resilience Scale (CD-RISC). Secondary Psychological Outcomes: Perceived Stress Scale – 10 item (PSS-10); Center for Epidemiologic Studies Depression Scale (CES-D); Rumination Response Scale (RRS).
Results
All measures of feasibility including those related to enrollment, retention, and adherence support feasibility. All measures of acceptability including adverse events and participant ratings support the intervention as being safe, well-received and personally valuable. Resilience scores increased from baseline (64.3 ± 14.40) to post-intervention (74.2 ± 13.15), t(37) = 4.61, p < 0.0005; Cohen's d = 0.75. In addition, across the same period, Perceived Stress scores decreased close to a standard deviation (20.5 ± 7.43 to 14.3 ± 6.64), t(37) = −4.71, p < 0.0005, Cohen's d = 0.76; depression symptoms decreased (from 19.0 ± 13.48 to 12.7 ± 11.68), t(37) = −3.21, p = 0.003, Cohen's d = 0.52; and rumination scores decreased from 48.5 ± 12.56 to 39.8 ± 10.07), t(37) = −5.03, p < 0.0005, Cohen's d = 0.82. Effect sizes ranged from medium to large.
Conclusion
The Transform Your Life: Write to Heal program is feasible to offer in a clinical setting, was well-received by participants, and demonstrated preliminary findings of effectiveness. Our study suggests that this novel 6-week writing intervention including expressive, transactional, poetic, affirmative, legacy, and mindful writing prompts increases resilience, and decreases depressive symptoms, perceived stress, and rumination in an outpatient sample of those reporting trauma in the past year. The program appears suitable to be evaluated in a larger randomized controlled trial.
https://link.springer.com/chapter/10.1007/15695_2018_134 Wound healing is a complex process formed of various overlapping stages, namely, clot formation, inflammation, proliferation, and remodeling, which depend on the systemic health and a competent immune system. Negative cognitive processes such as pain and stress can induce the stress response, which delays wound healing by deteriorating health and modulating the immune function through the activation of the hypothalamus-pituitary-adrenal and sympathetic-adrenal-medullary axes. Hence, it seems that practices capable of mitigating stress or pain might accelerate wound healing. This chapter reviews the effects of relaxation and meditation, music therapy, expressive writing, hypnosis, and placebo on physiological health and wound recovery.
Objective:
Writing emotionally about upsetting life events (expressive writing) has been shown to speed healing of punch-biopsy wounds compared to writing objectively about daily activities. We aimed to investigate whether a presurgical expressive writing intervention could improve surgical wound healing.
Method:
Seventy-six patients undergoing elective laparoscopic bariatric surgery were randomized either to write emotionally about traumatic life events (expressive writing) or to write objectively about how they spent their time (daily activities writing) for 20 min a day for 3 consecutive days beginning 2 weeks prior to surgery. A wound drain was inserted into a laparoscopic port site and wound fluid analyzed for proinflammatory cytokines collected over 24 hr postoperatively. Expanded polytetrafluoroethylene tubes were inserted into separate laparoscopic port sites during surgery and removed after 14 days. Tubes were analyzed for hydroxyproline deposition (the primary outcome), a major component of collagen and marker of healing. Fifty-four patients completed the study.
Results:
Patients who wrote about daily activities had significantly more hydroxyproline than did expressive writing patients, t(34) = -2.43, p = .020, 95% confidence interval [-4.61, -0.41], and higher tumor necrosis factor-alpha, t(29) = -2.42, p = .022, 95% confidence interval [-0.42, -0.04]. Perceived stress significantly reduced in both groups after surgery.
Conclusions:
Expressive writing prior to bariatric surgery was not effective at increasing hydroxyproline at the wound site 14 days after surgery. However, writing about daily activities did predict such an increase. Future research needs to replicate these findings and investigate generalizability to other surgical groups. (PsycINFO Database Record
Objective:
Social support is known to reduce the negative effects of stress on health, but there is mixed evidence for the effects of social support on wound healing. This study aimed to investigate whether undergoing a task designed to promote social closeness with a fellow participant and being paired with that person during a tape-stripping procedure could reduce stress and improve skin barrier recovery compared to going through tape stripping alone.
Method:
Seventy-two healthy adults were randomized to either a social closeness condition where participants completed a relationship-building task and tape stripping in pairs or a control condition where they completed tape stripping alone. Skin barrier recovery was measured using transepidermal water loss. Salivary cortisol and alpha-amylase were collected at four time points as markers of the endocrine and autonomic stress response.
Results:
Social closeness had a beneficial effect on skin barrier recovery compared to the control condition, t(54) = 2.86, p = .006, r = .36. Social closeness significantly reduced self-reported stress. The effects of the intervention on skin barrier recovery were moderated by self-reported stress reduction (p = .035). There were no significant differences in cortisol between groups, but alpha-amylase increased significantly more from baseline to after tape stripping in the control group compared to the intervention group.
Conclusions:
This is the first study to show that social closeness with a person going through a similar unfamiliar procedure can positively influence wound healing. Future research needs to replicate these findings in other wound types and in clinical settings. (PsycINFO Database Record
Der Verhaltensmedizin liegt ein biopsychosoziales Modell von Gesundheit und Krankheit zugrunde, bei dem das Individuum in einem ständigen Austausch mit psychischen, sozialen und biologischen Ressourcen und Risikofaktoren steht. In diesem Kapitel werden verschiedene Messmethoden zur Erfassung psychischer, sozialer und biologischer Komponenten des vorgestellten Funktionsmodells präsentiert. Zur Erfassung psychischer Variablen werden Interviews, Fragebogen, Tagebücher und die Problem- und Verhaltensanalyse vorgestellt. Zur Erfassung sozialer Variablen werden ebenfalls verschiedene Fragebogen und moderne technische Messverfahren (u. a. Video- und Stimmanalysen) behandelt. Die Methoden zur Messung biologischer Informationen sind so verschieden wie die zugrunde liegenden biologische Systeme selbst (Nervensystem, endokrines System, Immunsystem, Genetik). Dabei wird besonders auf direkte oder indirekte Messungen der Aktivität verschiedener biologischer Systeme als auch auf deren Reaktion auf verschiedene Reize eingegangen (z. B. psychologische Stresstests). Spezifische Verhaltensmessungen (z. B. zur Messung von Adhärenz oder Essverhalten) runden das Kapitel ab.
The development of a self-report measure of subjectively assessed social support, the Multidimensional Scale of Perceived Social Support (MSPSS), is described. Subjects included 136 female and 139 male university undergraduates. Three subscales, each addressing a different source of support, were identified and found to have strong factorial validity: (a) Family, (b) Friends, and (c) Significant Other. In addition, the research demonstrated that the MSPSS has good internal and test-retest reliability as well as moderate construct validity. As predicted, high levels of perceived social support were associated with low levels of depression and anxiety symptomatology as measured by the Hopkins Symptom Checklist. Gender differences with respect to the MSPSS are also presented. The value of the MSPSS as a research instrument is discussed, along with implications for future research.
This study investigated whether emotional expression of traumatic experiences influenced the immune response to a hepatitis B vaccination program. Forty medical students who tested negative for hepatitis B antibodies were randomly assigned to write about personal traumatic events or control topics during 4 consecutive daily sessions. The day after completion of the writing, participants were given their first hepatitis B vaccination, with booster injections at 1 and 4 months after the writing. Blood was collected before each vaccination and at a 6-month follow-up. Compared with the control group, participants in the emotional expression group showed significantly higher antibody levels against hepatitis B at the 4 and 6-month follow-up periods. Other immune changes evident immediately after writing were significantly lower numbers of circulating
T helper lymphocytes and basophils in the treatment group. The finding that a writing intervention influences immune response provides further support for a link between emotional disclosure and health. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
There is a culturally-held belief that good narratives are associated with good mental or physical health. Scores of studies have demonstrated that writing about emotional upheavals can have salutary health effects. Despite the writing-health relationship, there is scant evidence that expressive writing samples that are judged to be good narratives are themselves linked to health change. Across multiple studies, linguistic features of essays have been empirically linked to health changes. For example, use of positive emotions, increasing use of causal and other cognitive words, and shifts in pronoun use are correlated with fewer physician visits. These language markers, however, are not strongly related to the quality of narrative. Whereas most research has been conducted with English-speaking samples, new analytic methods suggest that many of the language findings can be exported to other languages and cultures. Implications for our understanding narrative, language, and culture within the context of new language analytic methods are discussed.
Psychological stress has been shown to impair wound healing, but experimental research in surgical patients is lacking. This study investigated whether a brief psychological intervention could reduce stress and improve wound healing in surgical patients. This randomised controlled trial was conducted at a surgical centre. Inclusion criteria were English-speaking patients over 18 years booked to undergo elective laparoscopic cholecystectomy; exclusion criteria were cancellation of surgery, medical complications, and refusal of consent. Seventy five patients were randomised and 15 patients were excluded; 60 patients completed the study (15 male, 45 female). Participants were randomised to receive standard care or standard care plus a 45-min psychological intervention that included relaxation and guided imagery with take-home relaxation CDs for listening to for 3 days before and 7 days after surgery. In both groups ePTFE tubes were inserted during surgery and removed at 7 days after surgery and analysed for hydroxyproline as a measure of collagen deposition and wound healing. Change in perceived stress from before surgery to 7-day follow-up was assessed using questionnaires. Intervention group patients showed a reduction in perceived stress compared with the control group, controlling for age. Patients in the intervention group had higher hydroxyproline deposition in the wound than did control group patients (difference in means 0.35, 95% CI 0.66-0.03; t(43)=2.23, p=0.03). Changes in perceived stress were not associated with hydroxyproline deposition. A brief relaxation intervention prior to surgery can reduce stress and improve the wound healing response in surgical patients. The intervention may have particular clinical application for those at risk of poor healing following surgery.
The college years represent an important developmental period in the lives of young women, who report health-related difficulties such as sleep disturbance and body/eating concerns. This study explored whether expressive writing (EW) can decrease health-relevant complaints among college women. College females (n = 111) were randomised into an EW condition (writing about body concerns) or a control writing condition and completed three 15-min writing sessions. Results indicate that participants in the EW condition reported less sleep difficulty and less body-focused upward social comparison at 8-week follow-up, relative to control participants. For individuals who reported higher perceived stress at baseline, the EW condition resulted in less eating disturbance and less social comparison, relative to the control condition. The effect of EW on eating disturbance for those who were high in stress was partially mediated by the change in upward social comparisons focused on one's body. These findings suggest that EW about body image and appearance concerns may positively influence the trajectory of risk for, or resilience against, future complications as a result of sleep difficulty, eating disturbance and body dissatisfaction.
Moist wound care has been established as standard therapy for chronic wounds with impaired healing. Healing in acute wounds, in particular in minor superficial acute wounds - which indeed are much more numerous than chronic wounds - is often taken for granted because it is assumed that in those wounds normal phases of wound healing should run per se without any problems. But minor wounds such as small cuts, scraps or abrasions also need proper care to prevent complications, in particular infections. Local wound care with minor wounds consists of thorough cleansing with potable tap water or normal saline followed by the application of an appropriate dressing corresponding to the principles of moist wound treatment. In the treatment of smaller superficial wounds, it appears advisable to limit the choice of dressing to just a few products that fulfil the principles of moist wound management and are easy to use. Hydroactive colloid gels combining the attributes of hydrocolloids and hydrogels thus being appropriate for dry and exuding wounds appear especially suitable for this purpose - although there is still a lack of data from systematic studies on the effectiveness of these preparations.
Experimental evidence suggests that the healing of diabetic foot ulcers is affected by psychosocial factors such as distress. We examined this proposal in a prospective study, in which we considered the role of psychological distress and coping style in the healing of diabetic foot ulcers over a 24 week period. We also explored the role of salivary cortisol and matrix metalloproteinases (MMPs) as potential mechanisms.
For this prospective observational study we recruited 93 (68 men; mean age 60 years) patients with neuropathic or neuroischaemic diabetic foot ulcers from specialist podiatry clinics in secondary care. Clinical and demographic determinants of healing, psychological distress, coping, salivary cortisol and both MMP2 and MMP9 were assessed at baseline. Ulcers were assessed at baseline and at 6, 12 and 24 weeks post-baseline. The primary outcome was ulcer status at 24 weeks, i.e. healed vs not healed.
After controlling for clinical and demographic determinants of healing, ulcer healing at 24 weeks was predicted by confrontation coping, but not by depression or anxiety. Patients with unhealed ulcers exhibited greater confrontation coping (model including depression: OR 0.809, 95% CI 0.704-0.929, p = 0.003; model including anxiety: OR 0.810, 95% CI 0.704-0.930, p = 0.003). However, change in ulcer size over the observation period was associated with depression only (p = 0.04, d = 0.31). Healed ulcers by 24 weeks were also associated with lower evening cortisol, higher precursor MMP2 and a greater cortisol awakening response.
Confrontation coping and depression predict ulcer healing. Our preliminary enquiry into biological mechanisms suggests that cortisol and precursor MMP2 may underlie these relationships.
Can psychotherapy reduce the incidence of health problems? A general model of psychosomatics assumes that inhibiting or holding back one's thoughts, feelings, and behaviors is associated with long-term stress and disease. Actively confronting upsetting experiences--through writing or talk- ing-is hypothesized to reduce the negative effects of inhibition. Fifty healthy undergraduates were assigned to write about either traumatic experiences or superficial topics for 4 consecutive days. Two measures of cellular immune-system function and health center visits suggested that confronting traumatic experiences was physically beneficial. The implications for psychotherapy as a preventive treatment for health problems are discussed. There is little doubt that psychotherapy reduces subjective distress and yields positive behavioral outcomes. In recent years, a small group of researchers has sought to learn whether psychotherapy can also reduce health problems. Two promising reviews have indicated that the use of mental health services is associated with fewer medical visits, fewer days of hospitaliza- tion, and lower overall medical costs. In a summary of 15 stud- ies published between 1965 and 1980, Mumford, Schlesinger, and Glass (1981) found that individuals who underwent psy- chotherapy evidenced a 13% decrease in medical utilization rel- ative to nonpsychotherapy control subjects. Similarly, in a re- view of 13 studies of mental health services that were intro- duced into organizations, Jones and Vischi (1980) found that psychotherapy was associated with a 20% drop in medical utili- zation.
Examined whether writing about traumatic events would influence long-term measures of health as well as short-term indicators of physiological arousal and reports of negative moods in 46 introductory psychology students. Also examined were aspects of writing about traumatic events (i.e., cognitive, affective, or both) that were most related to physiological and self-report variables. Ss wrote about either personally traumatic life events or trivial topics on 4 consecutive days. In addition to health center records, physiological measures and self-reported moods and physical symptoms were collected throughout the experiment. Findings indicate that, in general, writing about both the emotions and facts surrounding a traumatic event was associated with relatively higher blood pressure and negative moods following the essays, but fewer health center visits in the 6 mo following the experiment. It is concluded that, although findings should be considered preliminary, they bear directly on issues surrounding catharsis, self-disclosure, and a general theory of psychosomatics based on behavioral inhibition. (24 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Research on dispositional optimism as assessed by the Life Orientation Test (Scheier & Carver, 1985) has been challenged on the grounds that effects attributed to optimism are indistinguishable from those of unmeasured third variables, most notably, neuroticism. Data from 4,309 subjects show that associations between optimism and both depression and aspects of coping remain significant even when the effects of neuroticism, as well as the effects of trait anxiety, self-mastery, and self-esteem, are statistically controlled. Thus, the Life Orientation Test does appear to possess adequate predictive and discriminant validity. Examination of the scale on somewhat different grounds, however, does suggest that future applications can benefit from its revision. Thus, we also describe a minor modification to the Life Orientation Test, along with data bearing on the revised scale's psychometric properties.
Prolonged and severe sleep deprivation is associated with alterations of natural and cellular immune function. To determine whether alterations of immune function also occur after even a modest loss of sleep, the effects of early-night partial sleep deprivation on circulating numbers of white blood cells, natural killer (NK) cell number and cytotoxicity, lymphokine-activated killer (LAK) cell number and activity, and stimulated interleukin-2 (IL-2) production were studied in 42 medically and psychiatrically healthy male volunteers. After a night of sleep deprivation between 10 P.M. and 3 A.M., a reduction of natural immune responses as measured by NK cell activity, NK activity per number of NK cells, LAK activity, and LAK activity per number of LAK precursors (CD16,56, CD25) was found. In addition, concanavalin A-stimulated IL-2 production was suppressed after sleep deprivation due to changes in both adherent and nonadherent cell populations. After a night of recovery sleep, NK activity returned to baseline levels and IL-2 production remained suppressed. These data implicate sleep in the modulation of immunity and demonstrate that even a modest disturbance of sleep produces a reduction of natural immune responses and T cell cytokine production.
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.
Sleep curtailment constitutes an increasingly common condition in industrialized societies and is thought to affect mood and performance rather than physiological functions. There is no evidence for prolonged or delayed effects of sleep loss on the hypothalamo-pituitary-adrenal (HPA) axis. We evaluated the effects of acute partial or total sleep deprivation on the nighttime and daytime profile of cortisol levels. Plasma cortisol profiles were determined during a 32-hour period (from 1800 hours on day 1 until 0200 hours on day 3) in normal young men submitted to three different protocols: normal sleep schedule (2300-0700 hours), partial sleep deprivation (0400-0800 hours), and total sleep deprivation. Alterations in cortisol levels could only be demonstrated in the evening following the night of sleep deprivation. After normal sleep, plasma cortisol levels over the 1800-2300-hour period were similar on days 1 and 2. After partial and total sleep deprivation, plasma cortisol levels over the 1800-2300-hour period were higher on day 2 than on day 1 (37 and 45% increases, p = 0.03 and 0.003, respectively), and the onset of the quiescent period of cortisol secretion was delayed by at least 1 hour. We conclude that even partial acute sleep loss delays the recovery of the HPA from early morning circadian stimulation and is thus likely to involve an alteration in negative glucocorticoid feedback regulation. Sleep loss could thus affect the resiliency of the stress response and may accelerate the development of metabolic and cognitive consequences of glucocorticoid excess.
Nonpharmacological treatments with little patient cost or risk are useful supplements to pharmacotherapy in the treatment of patients with chronic illness. Research has demonstrated that writing about emotionally traumatic experiences has a surprisingly beneficial effect on symptom reports, well-being, and health care use in healthy individuals.
To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using standardized quantitative outcome measures.
Randomized controlled trial conducted between October 1996 and December 1997.
Outpatient community residents drawn from private and institutional practice.
Volunteer sample of 112 patients with asthma (n = 61) or rheumatoid arthritis (n = 51) received the intervention; 107 completed the study, 58 in the asthma group and 49 in the rheumatoid arthritis group.
Patients were assigned to write either about the most stressful event of their lives (n = 71; 39 asthma, 32 rheumatoid arthritis) or about emotionally neutral topics (n = 41; 22 asthma, 19 rheumatoid arthritis) (the control intervention).
Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were clinically examined by a rheumatologist. Assessments were conducted at baseline and at 2 weeks and 2 months and 4 months after writing and were done blind to experimental condition.
Of evaluable patients 4 months after treatment, asthma patients in the experimental group showed improvements in lung function (the mean percentage of predicted forced expiratory volume in 1 second [FEV1] improved from 63.9% at baseline to 76.3% at the 4-month follow-up; P<.001), whereas control group patients showed no change. Rheumatoid arthritis patients in the experimental group showed improvements in overall disease activity (a mean reduction in disease severity from 1.65 to 1.19 [28%] on a scale of 0 [asymptomatic] to 4 [very severe] at the 4-month follow-up; P=.001), whereas control group patients did not change. Combining all completing patients, 33 (47.1%) of 70 experimental patients had clinically relevant improvement, whereas 9 (24.3%) of 37 control patients had improvement (P=.001).
Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences had clinically relevant changes in health status at 4 months compared with those in the control group. These gains were beyond those attributable to the standard medical care that all participants were receiving. It remains unknown whether these health improvements will persist beyond 4 months or whether this exercise will prove effective with other diseases.
This study is the first to experimentally examine the potential health benefits of expressive letter writing. College students (N = 108) were randomly assigned to one of three letter-writing tasks. Experimental participants wrote a letter to a socially significant other who either helped or hurt them, whereas control participants wrote a letter to a school official regarding an impersonal relational topic. At follow-up, experimental participants reported greater sleep duration and fewer days of illness-related activity restriction compared to controls. In addition, participants who wrote a letter to an offending individual reported better sleep quality relative to controls. Psychosocial outcomes did not vary according to group assignment. Findings point to the potential sleep-related health benefits of expressive writing.
Previous studies have found that writing about upsetting experiences can improve physical health. In an attempt to explain this phenomenon, 72 first-year college students were randomly assigned to write about either their thoughts and feelings about coming to college or about superficial topics for three consecutive days. Measures of language use within the writing samples and cognitive measures of accessibility and schematic organisation were collected in the weeks before and after writing. As in previous studies, writing about college was found to reduce health centre visits for illness and to improve subjects' grade point average. Text analyses indicated that the use of positive emotion words and changes in words suggestive of causal and insightful thinking were linked to health change. Improved grades, although not linked to these language dimensions, were found to correlate with measures of schematic organisation of college-relevant themes. Implications for using written language to understand cognitive and health processes are discussed.
This study is the first to experimentally examine the potential health benefits of expressive letter writing. College students (N=108) were randomly assigned to one of three letter-writing tasks. Experimental participants wrote a letter to a socially significant other who either helped or hurt them, whereas control participants wrote a letter to a school official regarding an impersonal relational topic. At follow-up, experimental participants reported greater sleep duration and fewer days of illness-related activity restriction compared to controls. In addition, participants who wrote a letter to an offending individual reported better sleep quality relative to controls. Psychosocial outcomes did not vary according to group assignment. Findings point to the potential sleep-related health benefits of expressive writing.
For the past decade, an increasing number of studies have demonstrated that when individuals write about emotional experiences, significant physical and mental health improvements follow. The basic paradigm and findings are summarized along with some boundary conditions. Although a reduction in inhibition may contribute to the disclosure phenomenon, changes in basic cognitive and linguistic processes during writing predict better health. Implications for theory and treatment are discussed.
Special issue: Methodological developments in personality research. Examines the usefulness of factor analysis (FA) in developing and evaluating personality scales that measure limited domain constructs. The approach advocated follows from the assumptions that a scale ought to measure a single construct, that FA ought to be applied routinely to new personality scales, and that the factors of a scale are important if they are differentially related to other measures. A detailed study of the Self-Monitoring Scale illustrates how FA can help determine what a scale measures. A 2nd example uses the self-esteem literature to illustrate how FA can clarify the proliferation of scales within a single content domain. Confirmatory techniques are also introduced as a means for testing specific hypotheses.
The present exploratory study evaluated the effect of stress (an examination period) on changes in mood and health related behaviours. 83 medical students completed measures of mood and health related bchaviours at baseline and four weeks later either during their examinations period (the stress condition) or after a comparative control period (the control condition). All subjects also completed ratings of stress mediating variables: social support, perceived control and coping style at baseline. The results showed deterioration in mood in terms of increases in depression and anxiety and changes in health related behaviours in terms of increased numbers of subjects who identified thcmsehes as smokers, and dcmascs in alcohol consumption, exercise and food intake in subjects in the stress condition. The results also suggest that social support moderated the effects of the examination stress and was related to greater decreases in smoking, decrcases in alcohol craving and increases in eating behaviour. In addition, an avoidance coping style (problem avoidance, wishful thinking) was related to greater decreases in eating behaviour. 'Ihe nsults an discussed in the context of the stress/illness link and the role of behavioural change.
We compared virus-specific antibody and T-cell responses to influenza virus vaccination in 32 caregivers of Alzheimer's disease (AD) patients and matched control subjects. Caregivers showed a poorer antibody response and virus-specific T-cell response following vaccination compared to the control subjects as measured by fourfold increases in antibody titers to the vaccine and lower levels of virus-induced IL-2 levels in vitro. We performed a second study in which forty-eight medical students were inoculated with a series of three injections of the hepatitis-B (HEP-B) vaccine to coincide with the third day of three, three-day examination blocks. Twelve of the 48 medical students seroconverted after the first injection; these students were characterized by falling into the lower stressed/lower anxiety group of students. Students who reported greater social support and lower anxiety and stress demonstrated a higher antibody response to the vaccine and a more vigorous T-cell response to HEP-B surface antigen at the end of the third examination experience. The differences in antibody and T-cell responses to HEP-B and influenza virus vaccinations provide a demonstration of how stress may be able to alter both the cellular and humoral immune responses to vaccines and novel pathogens in both younger and older adults.
The purpose of this experiment was to determine the effects of an audiotape series employing Relaxation with Guided Imagery (RGI) on the psychophysiologic stress response and wound healing in surgical patients. Twenty-four patients undergoing cholecystectomy were randomly assigned to either RGI or control (quiet period) conditions and measured against three indexes of recovery: state anxiety, urinary cortisol levels, and wound inflammatory responses. An analysis of variance for repeated measures revealed that the RGI group demonstrated significantly less state anxiety, lower cortisol levels one day following surgery, and less surgical wound erythema than the control group. Thus, the RGI tapes demonstrated stress-relieving outcomes closely associated with healing.
Being elderly is a risk factor for delayed wound healing. In aged skin, epidermal turnover is decreased by about 50%. This
is accompanied by reductions in vascularization, granulation tissue, collagen, elastin, mast cells and fibroblasts. Age-related
changes occur which impact all phases of healing. In general, the elderly have increased rates of infection and wound dehiscence,
decreases in wound strength, and slower healing times. This is primarily caused by reductions in re-epithelialization, angiogenesis,
macrophage infiltration, and collagen deposition. Paradoxically, wounds heal with less scarring in the aged. It is important
to note that healing is delayed but not impaired in the elderly, and the end result of healing, albeit slower, is similar
to that of young adults. However, concomitant risk factors for delays or impairments in healing (e.g., disease, medications,
malnutrition, immobility, obesity, stress) are more common in the elderly. Each of these risk factors should be tested for,
treated, and monitored accordingly prior to surgery to ensure maximal healing. It is not being elderly per se, but being elderly
and presenting additional risk factors, that predisposes an individual to impaired healing and poor surgical outcomes.
KeywordsAging-Elderly-Wound healing-Infection-Bacteria-Inflammation-Proliferation-Remodeling-Cytokine-Chemokine-Growth factor-Macrophage-Neutrophil-Fibroblast-Keratinocyte-Epithelial cell-Endothelial cell-Adhesion molecule-Matrix metalloproteinase-Tissue inhibitor of matrix metalloproteinase-Collagen-Elastin-Angiogenesis-Tensile strength-Scarring-Fibrosis-Intrinsic aging-Extrinsic aging-Re-epithelialization-Contraction-Menopause-Estrogen-Testosterone-Phagocytosis-Hormone replacement therapy-Stress-Sex differences-Mucosa-Dermis-Granulation tissue-Myocardium-Heart failure-Cardiac-Infarction-Bone-Fracture-Lung-Fibrosis-Atherosclerotic-Plaque-Ischemia-Hypoxia-Vascular-Oxygen
The current review aims to synthesize existing knowledge about the relationship between psychological stress and wound healing.
A systematic search strategy was conducted using electronic databases to search for published articles up to the end of October 2007. The reference lists of retrieved articles were inspected for further studies and citation searches were conducted. In addition, a meta-analysis of a subset of studies was conducted to provide a quantitative estimation of the influence of stress on wound healing.
Twenty-two papers met the inclusion criteria of the systematic review and a subsample of 11 was included in a meta-analysis. The studies assessed the impact of stress on the healing of a variety of wound types in different contexts, including acute and chronic clinical wounds, experimentally created punch biopsy and blister wounds, and minor damage to the skin caused by tape stripping. Seventeen studies in the systematic review reported that stress was associated with impaired healing or dysregulation of a biomarker related to wound healing. The relationship between stress and wound healing estimated by the meta-analysis was r=-0.42 (95% CI=-0.51 to -0.32) (P<.01).
Attention now needs to be directed towards investigating potential moderators of the relationship, mediating mechanisms underpinning the association, as well as the demonstration of a causal link by the development of experimental interventions in healthy populations.
This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
Although the elderly clinically have a higher rate of wound complications, the physiologic effect of age on wound healing in human beings is unknown.
Healthy young (18 to 55 years of age) and elderly (more than 65 years of age) human volunteers had a 2 x 2 cm, superficial, split-thickness wound created on the anterior aspect of the thigh, and the rate of epithelialization was assessed. For studies of fibroplasia, similar groups underwent subcutaneous implantation of polytetrafluoroethylene catheters, which were removed after 14 days. Biochemical analyses of the catheters included determinations of hydroxyproline, total alpha-amino nitrogen, and DNA.
The elderly volunteers had a significant delay of 1.9 days in epithelialization. Analyses of the subcutaneously implanted catheters showed no difference in DNA content or hydroxyproline-accumulation; however, the young volunteers had a significantly higher amount of total alpha-amino nitrogen.
In healthy humans, aging leads to delayed epithelialization. No effect of age on collagen synthesis was noted, although accumulation of wound noncollagenous protein was decreased. This decrease may impair the mechanical properties of scarring in aged human beings.
Providing long-term care for a demented relative profoundly affects caregivers' lives. We assessed changes in depression, immune function, and health in 69 spousal caregivers who had already been caregiving for an average of five years and 69 sociodemographically matched control subjects. Between the initial sample ("intake") and the follow-up data collected an average of 13 months later, caregivers showed decrements relative to controls on three measures of cellular immunity. Caregivers also reported significantly more days of infectious illness, primarily upper respiratory tract infections. Caregivers had a much greater incidence of depressive disorders than controls, with 25% of caregivers meeting syndromal criteria at intake and 32% at follow-up, compared with no cases among controls at intake and 6% at follow-up. Caregivers who reported lower levels of social support at intake and who were most distressed by dementia-related behaviors showed the greatest and most uniformly negative changes in immune function at follow-up.