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Expressive Writing Is a Promising Therapeutic Modality for the Management of IBS: A Pilot Study
Abstract and Figures
We sought to test the effectiveness of expressive writing about irritable bowel syndrome (IBS) on disease severity, IBS-related cognition (perceived control over the illness or adaptive cognition), and IBS-specific quality of life.
This was an exploratory pilot study, during which subjects with IBS were asked to write at an online portal for 30 min on 4 consecutive days about their deepest thoughts, emotions, and beliefs regarding the disease and their perception of its effects (writing group). The IBS severity scale (IBSSS), functional bowel disease-related cognition (CG-FBD), catastrophizing/coping (CT3), and IBS-specific quality of life (IBS-QOL) were measured at baseline and at 1 and 3 months' follow-up. Subjects who did not start writing for 3 weeks were asked to complete questionnaires without writing (non-writers group). Within-group comparisons pre- and post-assessment were compared. In addition, the writing and non-writers groups were compared. Linear mixed-effects models were used to assess the outcome measures over time (1 and 3 months).
A total of 103 subjects were enrolled in the study (writing group, n=82; non-writers group, n=21). The mean age of all participants was 43 years (s.d. ±12), and the majority (91%) were female. The mean duration of IBS was 6.8 years (s.d. ±3.5); 102 subjects (99‰) had received physician-directed care for the disease. There were no significant differences between the writing and non-writers groups in baseline measurements. For the writing group at 1 and 3 months, the IBSSS improved significantly (+37.4 (±10.8), P=0.0012 and +53.8 (±13), P=0.0002, respectively) and this was not seen in the non-writers group. Similarly, the CG-FBD improved in the writing group by 0.58 (±0.2, P=0.006) at 3 months, although the changes in IBS-QOL did not reach clinical or statistical significance.
In this exploratory study, expressive writing improved IBS disease severity and cognition in subjects with longer-term duration of the disease. A large, controlled study is warranted to evaluate the therapeutic potential of this novel modality for adjunctive management of IBS in the outpatient setting.
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... Pennebaker's expressive writing intervention has been one of the first and most influential expressive writing interventions to date [16], comprising four short writing sessions, with its various derivatives tested widely [8]. In the context of gastroenterology, it has been piloted in one non-randomised trial, which included patients with irritable bowel syndrome (IBS, n = 103) [17]. Significant improvements at 1 and 3 months were observed in IBS severity. ...
... Expressive writing offers promise for IBD patients since it may improve immune functions and reduce distress [8]. Following the recommendations from the meta-analyses on expressive writing and the relevant study on IBS [8,17,18], we propose to adapt Pennebaker's evidence-based intervention by adding an element of gratitude writing. Although good-quality systematic reviews are lacking on the effect of gratitude writing, some early trials (n = 293) reported its significant benefits [19] on mental health as compared to no intervention controls or expressive writing controls. ...
... Other studies have found expressive writing interventions, for example, to reduce viral load and increase lymphocyte counts in HIV patients (Petrie et al. 2004); to lower Epstein-Barr virus antibody titers (Esterling et al. 1994); to increase the level of antibodies against a hepatitis B vaccine (Petrie et al. 1995); to improve liver function (Francis and Pennebaker 1992); to improve the state of the disease in irritable bowel syndrome (Halpert, Rybin and Doros 2010); to relieve pain in fibromyalgia patients (Broderick, Junghaenel and Schwartz 2005); to reduce health care utilization among healthy populations (Harris 2006); and to provide a host of other health benefits in various medical conditions such as cancer, sleep disorders and chronic pain (Baikie and Wilhelm 2005). ...
A large body of experimental evidence in the empirical sciences shows that writing about life experiences can be beneficial for mental and physical health. While empirical data regarding the health benefits of writing interventions have been collected in numerous studies in psychology and biomedicine, this literature has remained almost entirely disconnected from scholarship in the humanities and cognitive neuropsychology. In this paper, I review the literature from psychological and biomedical writing interventions, connect these findings to views from philosophy, cognitive neuropsychology and narratology and argue that examining established regularities in how narratives are structured can shed further light on the psychological processes engaged during writing interventions. In particular, I argue that the narratological concept of conflict can be applied to resolve patterns of seemingly conflicting empirical findings in psychological studies. More generally, I propose that an interdisciplinary perspective can provide a broader theoretical basis for understanding the psychological processes underlying the health benefits of autobiographical writing and provide directions for future research in psychology and biomedicine.KeywordsAutobiographical writingLife writingExpressive writingConflictNarratologyPsychology
... The CS-FBD is a valid and reliable scale that can be used as an outcome measure in evaluating the efficacy of different forms of psychotherapeutic intervention for functional bowel disorders (e.g., IBS, functional diarrhea/constipation), and can also serve as a helpful assessment tool for health professionals working with patients diagnosed with IBS [8]. CS-FBD has been used in many previous studies, including clinical trials of CBT [9][10][11][12][13][14]. The VSI [6] has been developed to assess gastrointestinal-specific anxiety, cognitive, affective, and behavioral responses to fear of GI sensations, symptoms, and the context in which they occur, and it has been translated into Japanese [15]. ...
Background
The Cognitive Scale for Functional Bowel Disorders (CS-FBD) and Irritable Bowel Syndrome-Behavioral Responses Questionnaire (IBS-BRQ) are a useful measures to assess cognitive-behavioral aspects in individuals with IBS. This study aimed to confirm the reliability and validity of the Japanese versions of the CS-FBD (CS-FBD-J) and IBS-BRQ (IBS-BRQ-J).
Methods
Participants comprised 192 students and 22 outpatients diagnosed with irritable bowel syndrome (IBS). There were 76 students who met the diagnostic criteria for IBS and two students who received treatment for IBS. Participants completed questionnaires containing the CS-FBD-J, IBS Severity Index (IBS-SI), Visceral Sensitivity Index (VSI), 24-item Dysfunctional Attitudes Scale (DAS-24), Hospital Anxiety and Depression Scale (HADS), and Social Adaptation Self-evaluation Scale (SASS).
Results
Our exploratory factor analysis revealed that the CS-FBD-J had a unidimensional factor structure and that the factor loadings for two of the 25 items were less than 0.4. The IBS-BRQ-J had a two-factor structure, and the factor loadings for eight of the 26 items were less than 0.4. The confirmatory factor analysis for the 18-item version of IBS-BRQ-J showed that the model fit indices were not sufficient. The CS-FBD-J and IBS-BRQ-J had significant, moderate correlations with the IBS-SI and VSI in the IBS and control groups. Correlation between the DAS-24 and the CS-FBD-J was not significant. The CS-FBD-J and IBS-BRQ-J were significantly correlated to the HADS and SASS (IBS-BRQ-J) only in the IBS group. The scores of CS-FBD-J and IBS-BRQ-J showed significant group differences between the IBS patient group, non-patient IBS group, and control group. The internal consistencies of the CS-FBD-J and IBS-BRQ-J were high. The item-total correlation analysis for the CS-FBD-J and IBS-BRQ-J showed that the correlations between each item and the total score were significant.
Conclusion
This study confirmed the reliability and validity of the 23-item version of the CS-FBS-J and the 18-item version of the IBS-BRQ-J with the deletion of items with low factor loadings. Regarding the IBS-BRQ-J, two factor structures were confirmed (factor 1: behavior obsessed with abdominal symptoms, factor 2: avoidance of abdominal symptoms and associated difficulties) although the model fit of the structure needs further study.
... Frattaroli [24] found that expressive writing is effective for distress, immune-related factors and disease-specific outcomes, which are all highly relevant for those living with IBD. A randomised controlled trial evaluating expressive writing involving 103 people with irritable bowel syndrome (IBS), found significant improvements for severity of IBS symptoms at one and three months, with a small significant increase in IBS-specific QoL [29]. Given that IBS and IBD share some physiological and psychological features, the results of this pilot trial are promising for IBD populations in potentially reducing distress and improving IBD-related stress and QoL. ...
Background
We explored feasibility, acceptability and preliminary efficacy of an online writing intervention (WriteforIBD) against an active control condition for distress in people with inflammatory bowel disease (IBD) at the time of the COVID-19 pandemic.
Methods
A feasibility RCT was conducted in 19 adults (89.5% female, aged 20–69 years) with IBD and mild-moderate distress. Participants allocated to the WriteForIBD group completed a 4-day 30-min writing program adapted for IBD. The active control group wrote about trivial topics provided by researchers. Feasibility was established based on the recruitment and retention while acceptability based on completion rates and a numeric rating scale. All participants completed measures of mental health and disease activity before and after the intervention (one week) and at follow-up three months after the study commencement.
Results
The retention rate in the study was high (100% WriteForIBD; 82% control). All participants attended every session. 84.2% of participants were satisfied with the intervention. All participants reported a significant improvement in IBD-Control immediately after the intervention; F (2, 33.7) = 7.641, p = .002. A significant interaction of group*time for resilience was noted, R² = 0.19, p < .001, with the active control group reporting a significant decline in resilience from the first follow-up to three months while no significant change in resilience for the WriteForIBD group was recorded.
Conclusions
Online expressive writing is potentially feasible and highly acceptable to people with IBD who report distress. Future large-scale trials should explore the intervention that is adapted from this feasibility study.
Registration: id
ACTRN12620000448943p.
... As such, while integrated interventions exist, not all GBM can access such intervention programming. Expressive writing-a therapeutic process involving, "writing about important personal experiences in an emotional way" [16] can lead to significant physical and mental health benefits without a trained provider [17][18][19] or even a physical location and may thus be a more scalable and flexible approach. ...
This pilot randomized controlled trial evaluated the feasibility, acceptability, and preliminary efficacy of expressive writing to reduce HIV-related sexual risk taking and symptoms of drug dependence among emerging adult gay and bisexual men (EAGBM) through linguistic mechanisms involving use of words associated with cognitive processing (e.g., think, cause), positive emotion (e.g., love, nice), and negative emotion (e.g., hurt, shame). Between 2014 and 2015, EAGBM (n = 78; aged 18–29) completed a baseline survey and were randomized to complete three 15-min expressive writing or equivalent control-group writing sessions and follow-up assessments 2 months post-baseline. EAGBM in the expressive writing condition utilized significantly more positive emotion, negative emotion, and cognitive processing words. Path model results indicated the intervention condition resulted in significant reductions in symptoms of drug dependence and frequency of condomless anal sex (CAS) through paths mediated by positive emotion words, and significant increases in CAS through a path mediated by negative emotion words.
... Excitingly, EW has shown particular promise with specific subpopulations of individuals, such as pediatric cancer patients and survivors. These include, but are not limited to the following: individuals with irritable bowel syndrome (17), postdeployment military couples (18), women with a history of childhood sexual abuse (19), and women with breast cancer (20)(21)(22)(23)(24)(25). In later sections of this review, we evaluate four studies on EW and its related forms (narrative writing, illness blogs, and online illness support groups) in the pediatric oncology setting. ...
Background & purpose
The COVID-19 pandemic has negatively impacted mental health in the general population. In this trial, our objective was to assess whether a 6-week expressive writing intervention improves resilience in a sample from the general population in the midst of the COVID-19 pandemic.
Materials & methods
This 6-week trial was conducted online. Eligible participants (n=63) were a sample of adults who self-identified as having been significantly affected by the COVID-19 pandemic.
Primary outcome
Connor-Davidson Resilience Scale (CD-RISC).
Secondary outcomes
Perceived Stress Scale – 10-Item (PSS-10); Center for Epidemiologic Studies Depression Scale – Revised (CESD-R); Post-Traumatic Growth Inventory (PTGI).
Results
Resilience measures (CD-RISC) increased from baseline (66.6 ± 14.9) to immediately post-intervention (73.0 ± 12.4; p=0.014; Cohen’s d =0.31), and at a 1- month follow-up (72.9 ± 13.6; p=0.024; Cohen’s d =0.28). Across the same timepoints, perceived stress scores (PSS-10) decreased from baseline (21.8 ± 6.6) to immediately post-intervention (18.3 ± 7.0; p=0.008; Cohen’s d =0.41), and at the 1- month follow-up to (16.8 ± 6.7; p=0.0002; Cohen’s d =0.56). Depression symptoms (CESD-R) decreased from baseline (23.3 ± 15.3) at 6 weeks (17.8 ± 15.4; p=0.058; Cohen’s d =0.22), and 10 weeks (15.5 ± 12.7; p=0.004; Cohen’s d =0.38). Posttraumatic growth (PTGI) increased from baseline (41.7 ± 23.4) at 6 weeks (55.8 ± 26.4; p=0.004; Cohen’s d =0.44), and at the 1-month follow-up (55.9 ± 29.3; p=0.008; Cohen’s d =0.49).
Conclusion
An online expressive writing intervention was effective at improving resilience in the midst of the COVID-19 pandemic.
NCT#
NCT04589104
College students who experience chronic pain are a frequently overlooked population. This research attempts to provide insight into the language that college students use to describe their experiences with chronic pain, challenges they face and coping strategies they use. Over the course of 4 consecutive days, participants responded to an expressive writing prompt asking them to reflect on their emotions and thoughts related to being a college student with chronic pain. Writing samples were then analysed to identify themes pertaining to words with a positive or negative emotional valence, terms used to characterise pain, metaphors used to describe pain, challenges faced, and positive and negative coping strategies used. Results showed that participants were more likely to use negatively valenced words than positively valenced words to describe their pain. Several common words and phrases were used to characterise pain, including metaphors. Finally, participants reported a number of challenges associated with their lived-experience of chronic pain, as well as positive and negative strategies used to cope with those challenges. These findings help to put into perspective the language used to understand, and attempt to cope with, the challenges faced by college students experiencing chronic pain. Research must continue to investigate the needs of this population so that they can be properly supported physically, emotionally, socially and academically.
Children and adolescents face many challenges in today’s fast changing society and constantly have to overcome increasing levels of adversity in order to achieve success. Enhancing the ability of young people to cope with adversity by training in resilience skills has been the objective of several interventions and programs in the past years. Resilience programs promote the development of protective and preventive factors, both at a personal and social level, that can help to overcome socio-emotional challenges in a positive and adaptive way. Past work has shown the importance of training resilience of youth by leveraging on relevant activities they typically perform in formal and informal learning environments. This Frontiers Research Topics eBook presents 20 peer reviewed papers published in Frontiers in Psychiatry on promoting resilience in young people, with a particular focus on evidence-based resilience programs in promoting mental well-being in youth, both in the short and long term. Several contributions present evaluations of existing and new resilience programs for children and young people.
Background & Aims Irritable Bowel Syndrome (IBS) is one of the most common gastrointestinal disorders that significantly affects patients' quality of life. This study aimed to determine the effect of written expression on the severity of gastrointestinal symptoms in patients with IBS. Materials & Methods This clinical trial study was conducted in 2019 on 71 patients with IBS who were referred to the gastrointestinal clinics of Firoozgar and Rasoul Akram hospitals in Tehran, were selected
using a continuous sampling method based on inclusion criteria and randomly (permuted block randomization) assigned to two control and intervention groups. A questionnaire on demographic characteristics and symptom severity index (SI-IBS) was completed by both groups. A white booklet with a particular format was given to each participant to express their emotions in writing in the intervention group. A weekly written expression of the patient's feelings for 15-30 min was done at home for one month. After one month, the SI-IBS questionnaire was completed again by both groups. Finally, the questionnaires
were analyzed using SPSS v. 16 software. Results After the intervention, the severity of gastrointestinal symptoms in the experimental group decreased significantly compared to before the intervention (P= 0.016). However, there was no statistically significant difference between the mean scores of gastrointestinal symptoms in the experimental and control groups one month after the intervention (P= 0.438).
Conclusion Execution of written expression in this study did not cause a statistically significant difference in the score of gastrointestinal symptoms in patients with irritable bowel syndrome but was associated with a decrease in the severity of gastrointestinal symptoms in patients in the experimental group. This non-pharmacological intervention can be considered a practical and easy method and pharmacological treatment for patients with this syndrome.
Background
The benefits of written expressive disclosure (WED) to health are documented in a variety of healthy and clinical populations. This study investigates the effect of WED on health-related outcomes in irritable bowel syndrome (IBS).
Methods
Adults (N=189) meeting Rome III criteria for IBS were randomly assigned to write about their: (1) deepest thoughts and feelings about the most stressful life event of the past five years (n=67), (2) deepest thoughts and feelings about their IBS (n=61) or (3) daily activities in an objective manner (control condition; n=61). Participants completed four 20-minute writing sessions over 2-6 weeks. Gastrointestinal (GI) symptoms, healthcare utilization, health-related quality of life (HR-QOL), pain catastrophizing, and pain self-efficacy were assessed at baseline, one month post-writing completion, and three months post-writing completion.
Results
A significant group (combined WED vs. control) X time interaction was detected for healthcare utilization, F(1,147)=6.16, p=0.014, η² =0.04. Specifically, number of GI-related medical appointments significantly increased from baseline to 3-month follow-up in the control group, while no significant change was observed in the combined WED group. Among the WED group, individuals assigned to write about their IBS experienced greater improvements in pain self-efficacy than those assigned to write about a life stressor, F(1,92)=3.89, p =0.024, η²=0.08. GI symptom severity, HR-QOL, and pain catastrophizing improved significantly across groups over time, with no significant between-groups differences.
Conclusion
Writing about one’s deepest thoughts and feelings about IBS may increase pain self-efficacy and reduce healthcare utilization compared to control writing in adults with IBS.
The study examined how social constraints on discussion of a traumatic experience can interfere with cognitive processing of and recovery from loss. Bereaved mothers were interviewed at 3 weeks (T1), 3 months (T2), and 18 months (T3) after their infants' death. Intrusive thoughts at T1, conceptualized as a marker of cognitive processing, were negatively associated with talking about infant's death at T2 and T3 among socially constrained mothers. The reverse associations were found among unconstrained mothers. Controlling for initial level of distress, there was a positive relation between T1 intrusive thoughts and depressive symptoms over time among socially constrained mothers. However, higher levels of T1 intrusive thoughts were associated with a decrease in T3 depressive symptoms among mothers with unconstrained social relationships.
Our objective was to obtain national data of the estimated prevalence, sociodemographic relationships, and health impact of persons with functional gastrointestinal disorders. We surveyed a stratified probability random sample of U.S householders selected from a data base of a national market firm (National Family Opinion, Inc.). Questions were asked about bowel symptoms, sociodemographic associations, work absenteeism, and physician visits. The sampling frame was constructed to be demographically similar to the U.S. householder population based on geographic region, age of householder, population density, household income and household size. Of 8250 mailings, 5430 were returned suitable for analysis (66% response). The survey assessed the prevalence of 20 functional gastrointestinal syndromes based on fulfillment of multinational diagnostic (Rome) criteria. Additional variables studied included: demographic status, work absenteeism, health care use, employment status, family income, geographic area of residence, population density, and number of persons in household. For this sample, 69% reported having at least one of 20 functional gastrointestinal syndromes in the previous three months. The symptoms were attributed to four major anatomic regions: esophageal (42%), gastroduodenal (26%), bowel (44%), and anorectal (26%), with considerable overlap. Females reported greater frequencies of globus, functional dysphagia, irritable bowel syndrome, functional constipation, functional abdominal pain, functional biliary pain and dyschezia; males reported greater frequencies of aerophagia and functional bloating. Symptom reporting, except for incontinence, declines with age, and low income is associated with greater symptom reporting. The rate of work/school absenteeism and physician visits is increased for those having a functional gastrointestinal disorder. Furthermore, the greatest rates are associated with those having gross fecal incontinence and certain more painful functional gastrointestinal disorders such as chronic abdominal pain, biliary pain, functional dyspepsia and IBS. Preliminary information on the prevalence, socio-demographic features and health impact is provided for persons who fulfill diagnostic criteria for functional gastrointestinal disorders.
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.
Anyone who has ever entrusted a troubling secret to a journal, or mourned a broken heart with a friend, knows the feeling of relief that expressing painful emotions can bring. This book presents evidence that personal self-disclosure is not only good for our emotional health, but boosts our
physical health as well.
The author has conducted controlled clinical research that sheds light on the mind–body connection. This book interweaves his findings with case studies on secret-keeping, confession, and the hidden price of silence. "Opening Up" explains: How writing about your problems can improve your health; How long-buried trauma affects the immune system; Why it's never too late to heal old emotional wounds; and When self-disclosure may be risky—and how to know whom to trust. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
There is now good evidence from several sources that hypnotherapy can relieve the symptoms of irritable bowel syndrome in the short term. However, there is no long term data on its benefits and this information is essential before the technique can be widely recommended. This study aimed to answer this question.
204 patients prospectively completed questionnaires scoring symptoms, quality of life, anxiety, and depression before, immediately after, and up to six years following hypnotherapy. All subjects also subjectively assessed the effects of hypnotherapy retrospectively in order to define their "responder status".
71% of patients initially responded to therapy. Of these, 81% maintained their improvement over time while the majority of the remaining 19% claimed that deterioration of symptoms had only been slight. With respect to symptom scores, all items at follow up were significantly improved on pre-hypnotherapy levels (p<0.001) and showed little change from post-hypnotherapy values. There were no significant differences in the symptom scores between patients assessed at 1, 2, 3, 4, or 5+ years following treatment. Quality of life and anxiety or depression scores were similarly still significantly improved at follow up (p<0.001) but did show some deterioration. Patients also reported a reduction in consultation rates and medication use following the completion of hypnotherapy.
This study demonstrates that the beneficial effects of hypnotherapy appear to last at least five years. Thus it is a viable therapeutic option for the treatment of irritable bowel syndrome.