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A Postdeployment Expressive Writing Intervention for Military Couples: A Randomized Controlled Trial
Abstract
The current study tested the effectiveness of a brief expressive writing intervention on the marital adjustment of 102 military couples recently reunited following a deployment to Iraq or Afghanistan. Active duty soldiers and their spouses were randomly assigned to write about either their relationship or a nonemotional topic on 3 occasions on a single day. The resulting design included 4 couple-level writing topic conditions: soldier-expressive/spouse-expressive, soldier-expressive/spouse-control, soldier-control/spouse-expressive, and soldier-control/spouse-control. Participants completed marital adjustment measures before writing, 1 month, and 6 months after writing. When soldiers, but not spouses, did expressive writing, couples increased in marital satisfaction over the next month, particularly if the soldier had had high combat exposure.
... Table 2 shows the characteristics and violence outcomes assessed for all studies included in this review. Of these 15 studies, five utilized the randomized control study design (Baddeley & Pennebaker, 2011;Salivar et al., 2020;Slep et al., 2021;Taft et al., 2016aTaft et al., , b, 2021, five case-controlled (Creech et al., 2018;Nowlan et al., 2017;Schaffer, 2015;Taft et al., 2013Taft et al., , 2014, one non-experimental retrospective case study design (Kaye et al., 2022), two pilot trials (Creech et al., 2022;Khalifian et al., 2022), and two quasi-experimental study designs (Anderson et al., 2013;Slep et al., 2022). Among these 15 studies, 6 utilized non-randomized comparison groups. ...
... Thirteen out of fifteen studies utilized validated measures including the Anger Management Scale (AMS), CDC National Intimate Partner and Sexual Violence Survey, Conflict Tactics Scale (CTS) and the Revised CTS (CTS2), Multidimensional Measure of Emotional Abuse (MMEA), Family Maltreatment Measure (FM) Domestic Violence/Abuse Screen (DV/AS). The remaining studies utilized participant self-report to record the frequency of yelling and physical violence between military spouses in addition to other forms of partner abuse (emotional or sexual) (Baddeley & Pennebaker, 2011;Slep et al., 2022). One study (Kaye et al., 2022) utilized case files and family reports to identify factors that contribute to family violence revictimization. ...
... All studies reported positive intervention outcomes, which ranged from improved anger management skills, including reduced yelling (Anderson et al., 2013;Baddeley & Pennebaker, 2011), reductions in physical and psychological IPV (Creech et al., 2018;Nowlan et al., 2017;Schaffer, 2015;Slep et al., 2021;Taft et al., 2013Taft et al., , 2014Taft et al., , 2016aTaft et al., , 2021, decreases in parenting practices that could potentially become violent (Creech et al., 2022), improvement in overall couples functioning (Salivar et al., 2020), and increased relationship satisfaction (Anderson et al., 2013;Khalifian et al., 2022). This is encouraging as a variety of treatment modalities, including group-based (Anderson et al., 2013;Creech et al., 2018Creech et al., , 2022Taft et al., 2013Taft et al., , 2014, individual (Schaffer, 2015;Slep et al., 2021), couples-based (Baddeley & Pennebaker, 2011;Nowlan et al., 2017;Salivar et al., 2020;Taft et al., 2014Taft et al., , 2016aTaft et al., , b, 2021Khalifian et al., 2022), in-person (Baddeley & Pennebaker, 2011;Creech et al., 2018;Nowlan et al., 2017;Schaffer, 2015;Slep et al., 2021;Taft et al., 2013Taft et al., , 2014Taft et al., , 2016aTaft et al., , b, 2021, and virtual or self-paced workbook or adaptable treatments (Anderson et al., 2013;Khalifian et al., 2022;Salivar et al., 2020) were all shown to be effective. ...
Purpose
Family violence, encompassing intimate partner violence (IPV) and child maltreatment (CM), is a considerable public health issue affecting a large subset of the U.S. population. Military families may be exposed to unique risk factors for experiencing family violence. Interventions to address family violence that are specific to military and Veteran populations are critical to the military family wellbeing as they address the unique military context as well as military stressors. Though a number of these programs exist, to our knowledge, there has been no systematic effort to describe and evaluate these interventions. To address this issue, the present study employs systematic review methods to explore the following research questions: (1) What military family violence interventions are reported in the peer-reviewed literature? (2) What are the characteristics of these interventions? (3) How effective are these interventions?
Methods
This study utilized a systematic review following the PROSPERO (the International Prospective Register of Systematic Reviews) protocol, registration code CRD42022296207.
Results
The initial search returned 3,666 sources. From these, 15 sources evaluating thirteen military family violence interventions were identified. About half of the studies evaluated interventions for Veterans and/or their partners ( n = 7), one study was for both Veterans and Active Duty service members and/or their partners, four were solely for Active Duty service members and/or their partners and families, two studies were for Veterans alone, and one study addressed a system-level intervention. Only three studies examined child-level outcomes. All studies reported positive intervention outcomes covering a variety of treatment modalities (i.e., group, couples, individual, online, in-person), which ranged from improved anger management skills, including reduced yelling, reductions in physical and psychological IPV, decreases in parenting practices that could potentially become violent, improvement in overall couples functioning, and increased relationship satisfaction. While all studies reported positive outcomes, their effect sizes ranged from small to large.
Conclusion
This study had three main findings: (1) The majority of interventions were for Veterans and/or their partners rather than active service personnel; (2) All interventions reported positive outcomes in the reduction of self-reported IPV, with the majority of these outcomes maintained over time; (3) While we intended to assess military family-level interventions that targeted IPV and CM, we only found three studies that targeted or included CM. Future research should explore how different treatment modalities (e.g., couples, individual, group, in-person, online) could affect long-term IPV treatment outcomes and should focus on how to best incorporate children, including documenting if there are children in the household, into IPV treatments/programs for military families.
... Seven studies with a comparison group reported outcomes related to marriage and family. Three of these studied interventions specifically aimed at marriage (Baddeley and Pennebaker, 2011) or parenting (Julian et al., 2018a;Pinna et al., 2017) issues. Pooling was not possible; results are displayed in Table 3.7. ...
... In brief, a multifamily therapy group (Julian et al., 2018a) did not have significant effects at two months, while the ADAPT program had significant effects for mothers but not fathers . A brief relationship-focused expressive-writing program had significant effects on marital satisfaction at one month (Baddeley and Pennebaker, 2011), as did stress-management training one year postintervention (controlling for combat exposure) (McKibben et al., 2009). Two other programs aimed at military stress control had no long-term effects on marriage or family (Sipos et al., 2014;Sharpley et al., 2008). ...
... An RCT of expressive writing (Baddeley and Pennebaker, 2011) was conducted with active duty soldiers returning to Fort Hood, Texas, after deployment. Expressive-writing instructions were "to write about one's deepest thoughts and feelings," while control writing instructions were to describe one's physical health activities. ...
Military personnel, police officers, firefighters, and other first responders must prepare for and respond to life-threatening crises on a daily basis. This lifestyle places stress on personnel, and particularly so on military personnel who may be isolated from support systems and other resources. The authors conducted a systematic review of studies of interventions designed to prevent, identify, and manage acute occupational stress among military, law enforcement, and first responders. The body of evidence consisted of 38 controlled trials, 35 cohort comparisons, and 42 case studies with no comparison group, reported in 136 publications. Interventions consisted of resilience training, stress inoculation with biofeedback, mindfulness, psychological first aid, front-line mental health centers, two- to seven-day restoration programs, debriefing (including critical incident stress debriefing), third-location decompression, postdeployment mental health screening, reintegration programs, and family-centered programs. Study limitations (risk of bias), directness, consistency, precision, and publication bias were considered in rating the quality of evidence for each outcome area. Overall, interventions had positive effects on return to duty, absenteeism, and distress. However, there was no significant impact on symptoms of psychological disorders such as PTSD, depression, and anxiety. Because of study limitations, inconsistency of results, indirectness, and possible publication bias, there was insufficient evidence to form conclusions about the effects of most specific intervention types, components, settings, or specific populations.
... Seven studies with a comparison group reported outcomes related to marriage and family. Three of these studied interventions specifically aimed at marriage (Baddeley and Pennebaker, 2011) or parenting (Julian et al., 2018a;Pinna et al., 2017) issues. Pooling was not possible; results are displayed in Table 3.7. ...
... In brief, a multifamily therapy group (Julian et al., 2018a) did not have significant effects at two months, while the ADAPT program had significant effects for mothers but not fathers . A brief relationship-focused expressive-writing program had significant effects on marital satisfaction at one month (Baddeley and Pennebaker, 2011), as did stress-management training one year postintervention (controlling for combat exposure) (McKibben et al., 2009). Two other programs aimed at military stress control had no long-term effects on marriage or family (Sipos et al., 2014;Sharpley et al., 2008). ...
... An RCT of expressive writing (Baddeley and Pennebaker, 2011) was conducted with active duty soldiers returning to Fort Hood, Texas, after deployment. Expressive-writing instructions were "to write about one's deepest thoughts and feelings," while control writing instructions were to describe one's physical health activities. ...
Military personnel, police officers, firefighters, and other first responders must prepare for and respond to life-threatening crises on a daily basis. This lifestyle places stress on personnel, and particularly so on military personnel who may be isolated from support systems and other resources. The authors conducted a systematic review of studies of interventions designed to prevent, identify, and manage acute occupational stress among military, law enforcement, and first responders. The body of evidence consisted of 38 controlled trials, 35 cohort comparisons, and 42 case studies with no comparison group, reported in 136 publications. Interventions consisted of resilience training, stress inoculation with biofeedback, mindfulness, psychological first aid, front-line mental health centers, two- to seven-day restoration programs, debriefing (including critical incident stress debriefing), third-location decompression, postdeployment mental health screening, reintegration programs, and family-centered programs. Study limitations (risk of bias), directness, consistency, precision, and publication bias were considered in rating the quality of evidence for each outcome area. Overall, interventions had positive effects on return to duty, absenteeism, and distress. However, there was no significant impact on symptoms of psychological disorders such as PTSD, depression, and anxiety. Because of study limitations, inconsistency of results, indirectness, and possible publication bias, there was insufficient evidence to form conclusions about the effects of most specific intervention types, components, settings, or specific populations.
... While 10 articles met the criteria for this study, only four met traditional experimental methodological standards (used randomized clinical trial design) (Allen, Stanley, Rhoades, Markman, & Loew, 2011;Baddeley & Pennebaker, 2011;Dunford, 2000;Glynn et al., 1999). Research designs were equally divided between experimental (n = 3), pretest-posttest using a nonrandomized comparison group (n = 3), pretestposttest without a comparison group (n = 3), and finally one study uses a posttest design (n = 1). ...
... While all measured the state of the marital relationship, some used measures that were not previously validated (Schumm, Resnick, Silliman, & Bell, 1998;Schumm et al., 2000) and others used court records instead of validated assessment tools (Dunford, 2000). The Dyadic Adjustment Scale was the most frequently utilized dyadic assessment measure (n = 3) (Glynn et al., 1999;Monson, Schnurr, Stevens, & Guthrie, 2004;Rotunda, O'Farrell, Murphy, & Babey, 2008), while others included the ENRICH assessment (Kotrla & Dyer, 2008), the Kansas Marital Satisfaction Scale (KMSS) (Stanley et al., 2005), the Marital Adjustment Test (MAT) (Locke & Wallace, 1959), Relationship Assessment Scale (RAS) (Baddeley & Pennebaker, 2011), and the Marital Satisfaction Inventory (MSI) (Ford, Shaw, Sennhauser, & Greaves, 1993). All but one project required both partners to complete self-report measurements. ...
... While CBT, skills-based approaches, and premarital counseling saw mixed results, systems-based therapy demonstrated positive improvements. The interventions that related to increased marital satisfaction for at least one partner included CBT (Rotunda et al., 2008), CCBT (Monson et al., 2004), BSRF/PREP (Allen et al., 2011;Stanley et al., 2005), Active Military Life Skills Program (AMLS) (Kotrla & Dyer, 2008) psychosocial debriefing and systems therapy (Ford et al.,1993), expressive writing (Baddeley & Pennebaker, 2011), and skill-building (Neidig, 1986). Specific outcomes from each study are summarized in Table 1. ...
Military members and their spouses experience unique stressors compared with civilian couples, making them distinctively vulnerable to a number of marital and mental health concerns. However, the amount and quality of intervention research to guide treatment for military couples are unknown. Therefore, a systematic literature search of interventions for military couples was completed resulting in 10 articles that met the study's inclusion and exclusion criteria. Further, a rubric to assess dyadic methodology was created and utilized to determine the dyadic quality of the methodology of the sampled articles. The results of the systematic literature review revealed that (a) there are few evidence-based interventions for military couples in which both members of the dyad are included and (b) the methodology by which treatments are evaluated largely do not employ systemic or dyadic measures. Recommendations for future research with military couples includes the need for couple-focused interventions using experimental methodology, systemic theories to guide intervention and research, and appropriate dyadic assessment and analysis tools to determine the effectiveness of couple's interventions for military, reserve, and veteran populations.
... Moreover, expressive-writing interventions are cost-effective, not time-intensive, and require no commitment to a therapist or cost to the individual. They also do not require the participation by a partner; in fact, expressive writing has largely been utilized as an individually focused activity with a variety of beneficial outcomes, including improved immune response (e.g., Pennebaker et al., 1988), physical and mental health (e.g., Francis & Pennebaker, 1992), and relationship satisfaction (Baddeley & Pennebaker, 2011). The current research provides a brief, cost-effective intervention targeting romantic conflict during a time of higher stress and conflict (e.g., Mazza et al., 2020). ...
... Upon further inspection, it seems possible that this condition may have elicited more conflict. Although the Pennebaker expressive-writing paradigm has been successful in improving individual health and depression after reflecting on traumatic events (Baddeley & Pennebaker, 2011;Pennebaker et al., 1988), it has not been applied to the authors' knowledge to romantic relationships or other interpersonal conflicts specifically. Comparing both sets of instructions highlights the immersion that takes place in the Pennebaker paradigm in contrast to the self-distancing in the cognitive reappraisal paradigm. ...
Romantic conflict is known to have escalated during the lockdown period of the COVID-19 pandemic. This research investigates whether a single-session online writing intervention results in changes in romantic conflict among American adults cohabitating during COVID-19 quarantine (May 2020). Participants (N = 716, 50% female; mean age = 51.8 years) completed a baseline assessment which was followed by a brief (5–8 min) writing task in Qualtrics. Participants were randomized to one of five conditions, where they were asked to write about (a) a conflict with their romantic partner using cognitive reappraisal; (b) a conflict with their romantic partner expressing their deepest thoughts and feelings; (c) a conflict with someone other than their partner using cognitive reappraisal; (d) a conflict with someone other than their partner and a conflict with their partner expressing their deepest thoughts and feelings; or (e) mundane tasks like laundry, house cleaning, or lawn care. In the reappraisal conditions, participants were asked to use this perspective with the target person in the upcoming weeks. Two weeks later, participants were invited to complete a follow-up survey identical to baseline, where they were asked about conflict with their partner during the follow-up period. Results indicated that participants in the romantic partner cognitive reappraisal condition reported fewer disagreements, fewer relationship aggression events, and lower levels of conflict relentlessness with their partner relative to at least one of the control conditions. Results demonstrate preliminary support for a brief, cost-effective, and accessible tool that can help couples mitigate downstream effects of negative interactions during this stressful time.
... Although EW interventions have been associated with multiple benefits in the short-term, most effects faded after a few months, 13,28 or changed over time. 14,[37][38][39] We, however, found that many of the original 3MMM study participants continued to use EW to deal with stress after this single intervention. ...
... ere also appear to be multiple moderators of EW benefit, including gender, culture, personality, writing content, nature of trauma/stressor, health condition, disease severity, and level of available social support. 7,12,23,24,28,29,38,[40][41][42][43][44][45][46][47] Research related to the 3MMM likely faces similar challenges, although the current study did not evaluate these factors. ...
Background:
An expressive writing intervention, the Three-minute Mental Makeover (3MMM), was previously associated with reduced stress for practitioners, patients, and families. The goal of this follow-up study was to evaluate long-term use of writing and perspectives after participation in the 3MMM.
Methods:
The original study involved patients and families in the neonatal and pediatric Intensive Care Units, inpatient units, and outpatient clinics of a children's hospital. Health-care practitioners led the intervention, writing concurrently with patients and families using the 3MMM intervention. Follow-up contact by phone was attempted for all original patient/family participants 12 to 18 months after completing the exercise. Practitioners were contacted via email 24 months after the original study. Participants were surveyed about the 3MMM and continued use of writing to cope with stressful situations. Original and follow-up survey responses were compared using the Mann-Whitney test.
Results:
Of the 96 original patient/family members, 61 individuals were reached, remembered the 3MMM, and agreed to participate in the follow-up study. Among the 61 participants, 52 (85%) agreed that the 3MMM had been helpful. Thirty-six (59%) reported using writing to help cope with stress at follow-up, compared to only 23 (38%) at baseline (P = 0.005). The majority of clinicians (87%) also continued to use the 3MMM in clinical practice following the original 3MMM study period and ranked it as both feasible (75%) and worth the time investment (75%).
Conclusion:
The 3MMM demonstrated long-term perceived benefits and behavior changes. Findings provide preliminary support for using the 3MMM in routine clinical practice.
... Thus, the sample was drawn from a population of adults who were having difficulty in response to a major life stressor. In expressive writing, individuals are asked to reflect on meaningful life experiences, and to write about their thoughts and feelings around such events (Baddeley & Pennebaker, 2011). The resulting written material often includes information about how one's identity was affected by important life experiences. ...
... Participants responded to the following expressive writing prompt, which was similar to the prompt used in a previous writing intervention with military couples (Baddeley & Pennebaker, 2011): ...
Most research and theory on identity integration focuses on adolescents and young adults under age 30, and relatively little is known about how identity adjusts to major life events later in life. The purpose of the present study was to operationalize and investigate identity disruption, or a loss of temporal identity integration following a disruptive life event, within the developmental context of established adulthood and midlife. We used a mixed-methods approach to examine identity disruption among 244 Afghanistan and Iraq war veterans with reintegration difficulty who participated in an expressive writing intervention. Participants completed measures of social support, posttraumatic stress disorder (PTSD) symptom severity, satisfaction with life, and reintegration difficulty at baseline right before writing, and 3 and 6 months after the expressive writing intervention. The expressive writing samples were coded for identity disruption using thematic analysis. We hypothesized that identity disruption would be associated with lower social support, more severe PTSD symptoms, lower satisfaction with life, and greater reintegration difficulty at baseline. Forty-nine percent (n = 121) of the sample indicated identity disruption in their writing samples. Identity disruption was associated with more severe PTSD symptoms, lower satisfaction with life, and greater reintegration difficulty at baseline, and with less improvement in social support. The findings suggest that identity disruption is a meaningful construct for extending the study of identity development to established adult and midlife populations, and for understanding veterans' adjustment to civilian life. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
... Researchers have investigated the effects of therapeutic and expressive writing with a variety of subject groups, including healthy adults, college students, people with medical diseases, people with traumatic brain injuries, and trauma survivors, including veterans with and without post-traumatic stress disorder (Connolly Baker & Mazza, 2004;Hoyt & Yeater, 2011;Lowe, 2006;Mosher & Danoff-Burg, 2006;Sloan et al., 2005;Sloan, Marx, & Greenberg, 2011;Smyth, Hockemeyer, & Tulloch, 2008). They have also explored the effects of various contexts for expressive writing, including individual and group therapy (2007, Connolly Baker & Mazza, 2004Lowe, 2006;Mosher & Danoff-Burg, 2006;Nevinski, 2013;Sayer et al., 2015;Sloan et al., 2005Sloan et al., , 2011Smyth & Pennebaker, 2008), family therapy (Baddeley & Pennebaker, 2011;Nevinski, 2013), and independent therapeutic writing for self-help, both in traditional written form (Smyth & Helm, 2003) and using the Internet as an interface (Sayer et al., 2015;Stockton, Joseph, & Hunt, 2014). In a recent study (Sayer et al., 2015, pp. ...
... Congruent with the literature (Baddeley & Pennebaker, 2011;Connolly Baker & Mazza, 2004;Harrington, 2012;Hoyt & Yeater, 2011;Lowe, 2006;Mosher & Danoff-Burg, 2006;Nevinski, 2013;Sayer et al., 2015;Sloan et al., 2011;Smyth & Helm, 2003;Stockton et al., 2014) and per the clinical coded notes, SMs derived benefit and enjoyment from attending therapeutic writing group sessions. Some general trends included a larger number of negative emotion descriptors (n = 25) during writing compared to a much smaller set of negative emotion descriptors (n = 8) after writing. ...
Background: Therapeutic writing has been shown to improve both physical health and emotional well-being. This paper examines the usefulness of clinical notes as a data source, and presents two different analyses of individual clinical notes of therapeutic writing group sessions: analysis performed by a person and analysis by a computer-based program (Pennebaker et al., 2015). The therapeutic writing sessions were offered during the second week of treatment at the National Intrepid Center of Excellence (NICoE) as part of an integrative care model for service members (SMs) with traumatic brain injury and underlying psychological conditions to include post-traumatic stress disorder (PTSD).
Method: Therapeutic writing sessions were facilitated in the art therapy studio at the NICoE. The sessions were documented in the military healthcare system’s patient record application by the art therapist and art therapy interns at the NICoE. Clinical notes were informed by SM self-report surveys and clinician observations. Notes from May 2012 to 2015 and were pulled and coded manually for emerging themes, then separately analyzed by a computer software text content analysis program (Pennebaker et al., 2015).
Results: Overall, SMs reported more positive than negative, neutral, or mixed emotions during and after the therapeutic writing experience. Some reported a change from negative to positive emotions through the writing process, and many described experiencing relief during and after sessions. SMs wrote on a wide range of topics. Most SMs kept their writing pieces, although some destroyed them or shared them with others, and a few SMs gifted the pieces. Computerized-based analysis (Pennebaker et al., 2015) indicated that work and social were the most prominent content theme areas. It also showed that positive emotions were more evident than negative emotions in the clinical notes and that the focus of the writing pieces was primarily on the present rather than on the past or the future.
Implications: Many SMs perceived the therapeutic writing experience as therapeutic, a relevant coping skill, and enjoyable. Some, however, preferred to work on art therapy projects they had begun in previous sessions (such as mask-making) during the writing sessions. The computer-based analysis of the clinical notes took much less time than the human analysis, but it did not produce results of comparable richness or nuance. Computer-based analysis of the actual therapeutic writing pieces may provide deeper insights into the content and themes that emerged during this therapeutic intervention.
... Unfortunately, little research has extended expressive writing to veterans. One study examined its effects on marital adjustment in military couples and found that when soldiers, but not spouses, wrote expressively, the couple's marital satisfaction increased over the following month (Baddeley & Pennebaker, 2011).Whether expressive writing can improve symptoms and functioning among veterans with readjustment difficulties is unknown. ...
... The writing instructions for the expressive writing arm were highly similar to those used in a study of expressive writing for military couples (Baddeley & Pennebaker, 2011). Participants were instructed to explore their deepest thoughts and feelings about their transition to civilian life, including current challenges and reasons for these challenges. ...
We examined the efficacy of a brief, accessible, nonstigmatizing online intervention-writing expressively about transitioning to civilian life. U.S. Afghanistan and Iraq war veterans with self-reported reintegration difficulty (N = 1,292, 39.3% female, M = 36.87, SD = 9.78 years) were randomly assigned to expressive writing (n = 508), factual control writing (n = 507), or no writing (n = 277). Using intention to treat, generalized linear mixed models demonstrated that 6-months postintervention, veterans who wrote expressively experienced greater reductions in physical complaints, anger, and distress compared with veterans who wrote factually (ds = 0.13 to 0.20; ps <.05) and greater reductions in PTSD symptoms, distress, anger, physical complaints, and reintegration difficulty compared with veterans who did not write at all (ds = 0.22 to 0.35; ps ≤.001). Veterans who wrote expressively also experienced greater improvement in social support compared to those who did not write (d = 0.17). Relative to both control conditions, expressive writing did not lead to improved life satisfaction. Secondary analyses also found beneficial effects of expressive writing on clinically significant distress, PTSD screening, and employment status. Online expressive writing holds promise for improving health and functioning among veterans experiencing reintegration difficulty, albeit with small effect sizes.
... However, disclosure of combat events (rather than associated emotions) was not associated with symptoms of posttraumatic stress in an early study of Desert Storm veterans (Southwick et al., 2000). Among veterans of the conflicts in Afghanistan and Iraq, emotionally expressive writing on the effects of deployment on the relationship decreased marital conflict and increased marital satisfaction, primarily among veterans with high combat exposure (Baddeley & Pennebaker, 2011). In blogs about traumatic events, negative rumination about traumatic military experiences was associated with more rated symptoms of posttraumatic stress, whereas positive disclosures were associated with fewer rated symptoms of posttraumatic stress (Hoyt & Pasupathi, 2008). ...
... Previous literature suggested the importance of breaking down disclosure based on whether or not the listener has been exposed to a similar trauma (Bolton et al., 2003;Greenberg et al., 2003) and whether or not the disclosure involves positive or negative emotions (Baddeley & Pennebaker, 2011;Hoyt & Pasupathi, 2008). In a previous study combining these factors, Hoyt et al. (2010) found that increased shared experience is associated with greater likelihood of disclosure, and disclosure of positive emotions is significantly more likely than disclosure of negative emotions. ...
Recent research has shown a relationship between self-disclosure and symptoms of posttraumatic stress in combat veterans. However, previous research has not controlled for posttraumatic stress disorder (PTSD) symptoms prior to disclosure, leaving the directionality of this association in question. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veteran service members from the Utah National Guard and Reserves (n = 81) and partners of service members (n = 80) completed survey measures of combat exposure, PTSD symptoms, social support, and emotional disclosure at two separate time points after deployment. Greater disclosure of positive emotions regarding combat deployment to support figures without shared combat exposure predicted lower symptoms of PTSD, even when controlling for prior symptoms of PTSD and perceived social support. In contrast, greater disclosure to support figures who also experienced combat predicted greater symptoms of PTSD, even when controlling for prior PTSD symptoms. Disclosure of positive emotions associated with combat deployment may serve as a protective factor against the development and maintenance of posttraumatic stress symptoms, particularly when that disclosure includes individuals without shared deployment experiences. (PsycINFO Database Record (c) 2014 APA, all rights reserved)
... Modifications to writing instructions have included asking participants to produce a coherent narrative, to write about specific or general elements of the event under consideration (Danoff-Burg, Mosher, Seawell, & Agee, 2010;Vrielynck, Philippot, & Rimé, 2010), to cognitively reappraise themselves and the stressor, to make meaning of the event by identifying benefits (Lichtenthal & Creuss, 2010;Lu & Stanton, 2010) or to focus on sources of emotional self-efficacy in their writing (Kirk, Shutte, & Hine, 2011). Modifications to the process have included asking participants to read through previous disclosures prior to subsequent writing, providing participants with immediate, tailored feedback on the emotional content of their writing, group discussions of expressive writing, and, writing by both military personnel and their spouses (Baddeley & Pennebaker, 2011;Carmack et al., 2011;Owen et al., 2011;Pachankis & Goldfried, 2010). In some instances these manipulations have not enhanced the effects seen over and above those produced by standard expressive writing (i.e., reading previous disclosures or spouses writing about the same event; Baddeley & Pennebaker, 2011;Pachankis & Goldfried, 2010). ...
... Modifications to the process have included asking participants to read through previous disclosures prior to subsequent writing, providing participants with immediate, tailored feedback on the emotional content of their writing, group discussions of expressive writing, and, writing by both military personnel and their spouses (Baddeley & Pennebaker, 2011;Carmack et al., 2011;Owen et al., 2011;Pachankis & Goldfried, 2010). In some instances these manipulations have not enhanced the effects seen over and above those produced by standard expressive writing (i.e., reading previous disclosures or spouses writing about the same event; Baddeley & Pennebaker, 2011;Pachankis & Goldfried, 2010). In all other cases however to varying degrees the modification to standard expressive writing led to enhanced outcomes. ...
Objectives
This study explored athletes' experiences of expressive writing about competitive sport stressors using standard expressive writing and reversal theory framed writing (Apter, 2001).DesignThe study employed a qualitative approach including narrative analysis of expressive writing and semi-structured interviews with athletes.Method
Sixteen athletes were randomly allocated to a standard expressive writing or a reversal theory framed writing group. Both groups completed expressive writing about a stressor using standardised instructions. The reversal theory writing group were instructed on reversal theory states and imagery use to recreate them which they employed to write from different state perspectives in four subsequent sessions. Standard writing group participants completed four sessions following usual expressive writing instructions. Both groups completed a final session following these instructions and were interviewed about expressive writing and their perceptions of the stressor.ResultsKey outcomes were: re-evaluation and perspective changes, self development, stressor confrontation, problem solving, emotion management and, future uses of expressive writing.Conclusions
Expressive writing may be a technique that is useful for some athletes and recommendations for its application are made.
... Regarding military contexts, Baddeley and Pennebaker (2011) tested the effectiveness of a brief expressive writing intervention on the marital adjustment of 102 military couples after deployment in a RCT. Participants completed a baseline measurement on their marital satisfaction before deployment and 1 and 6-months after deployment, respectively. ...
... Re-evaluation uses expressive writing, which can help people manage negative emotions and make people systematically re-evaluate their stress, thereby reducing the burden of worry on working memory. [18] This method of reevaluation can reduce personal anxiety, [19] increase happiness, [20] and improve relationship satisfaction. [21] Kizilcec and others' research shows that self-affirmation interventions can help students reduce the threat brought by stereotypes and narrow their academic gap with others. ...
Massive open online courses (MOOC) have witnessed a surge in popularity in recent years, affording learners the convenience and adaptability to access top-tier educational resources. Despite the myriad advantages MOOC offer, the global and Chinese completion rates linger at a modest level. Recent data reveals a worldwide average completion rate of approximately 10%, underscoring the challenge of retaining learners throughout their enrolled courses. In China, a parallel scenario unfolds, with completion rates fluctuating around 5%–10%. This study delves into the examination of social-psychological factors contributing to China’s low MOOC completion rates. In study 1, we found a disparity in MOOC completion and scores between first-generation college students and non-first generation college students, and underpinned social threat as one contributing factor to this disparity. In the experiment, we nudge college students towards enhancing their participation and elevating completion rates within MOOC learning. This research conducted a comparative analysis of two cognitive nudge methodologies, revealing the superiority of the value affirmation intervention over the reappraisal intervention. Moreover, hierarchical intervention strategies were recommended to enhance students’ learning experiences more efficiently.
... The reduction paradigm was also based on previous research on emotional expressive writing (e.g., Baddeley & Pennebaker, 2011;Gortner et al., 2006;Pennebaker & Beall, 1986;Pennebaker & Francis, 1996;Ramirez & Beilock, 2011;Sayer et al., 2015;Schroder et al., 2018). ...
Enhanced amplitudes of the error-related negativity (ERN) have been suggested to be a transdiagnostic neural risk marker for internalizing psychopathology. Previous studies propose worry to be an underlying mechanism driving the association between enhanced ERN and anxiety. The present preregistered study focused on disentangling possible effects of trait and state worry on the ERN by utilizing a cross sectional observational and a longitudinal randomized controlled experimental design. To this end, we examined the ERN of n = 90 students during a flanker task (T0), which were then randomly assigned to one of three groups (worry induction, worry reduction, passive control group). Following the intervention, participants performed another flanker task (T1) to determine potential alterations of their ERN. Manipulation checks revealed that compared to the control group, state worry increased in the induction but also in the reduction group. ERN amplitudes did not vary as a function of state worry. An association of trait worry with larger ERN amplitudes was only observed in females. Furthermore, we found larger ERN amplitudes in participants with a current or lifetime diagnosis of internalizing disorders. In summary, our findings suggest that the ERN seems to be insensitive to variations in state worry, but that an elevated ERN is associated with the trait-like tendency to worry and internalizing psychopathology, which is consistent with the notion that the ERN likely represents a trait-like neural risk associated with anxiety.
... 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
... A more coherent narrative, in turn, should be easier to share. Accordingly, the social effects of expressive writing have been reported testing the assumption that expressive writing provides a "preprocessing" that improves communication and social exchange in romantic couples after challenging experiences (Lepore and Greenberg, 2002;Slatcher and Pennebaker, 2006;Baddeley and Pennebaker, 2011;Finkel et al., 2013). To conclude, solitary written disclosure is supposed to reduce rumination. ...
Background: Retirement is a central transition in late adulthood and requires adjustment. These processes not only affect the retired individuals but also their romantic partners. The aim of this study is to investigate the interplay of intrapersonal emotion regulation (rumination) with interpersonal regulation processes (disclosure quality). Furthermore, the associations of daily retirement-related disclosure with adjustment symptoms in disclosing and the listening partner will be investigated. It is expected that the effects of disclosure alter after providing the couples with a self-applied solitary written disclosure task in order to support their intrapersonal emotion regulation.
Methods: In this dyadic online-diary study, 45 couples (N = 45) with one partner perceiving the adjustment to a recent retirement as challenging reported rumination, perceived disclosure quality (repetitive, focused on negative content, hard to follow, disclosing partner open for common/authentic), retirement-related disclosure, and ICD-11 adjustment symptoms preoccupation and failure to adapt were assessed at the end of the day over 14 days. In the middle of this assessment period, couples performed a modified online-expressive writing about their thoughts and feelings regarding the transition to retirement.
Results: The double-intercept multilevel Actor–Partner Interdependence Models (APIM) reveal that on days with more daily rumination, the spouse perceived that disclosure of the retiree is more difficult to follow, more negative, and repetitive. In contrast, the retiree perceived less authenticity and openness to comments during disclosure on days when the spouse reports more rumination. Retirement-related disclosure showed no within-couple association with failure to adapt but actor effects on preoccupation. Moreover, a partner effect of disclosure of the retirees on the preoccupation of spouses could be observed. This contagious effect of the retiree disclosure, however, disappeared during the week after writing.
Conclusion: Our results support the notion that disclosure processes are altered during maladaptive intrapersonal emotion regulation processes. This in turn seems to lead to less effective interpersonal regulation and contagious spilling over of symptoms.
Supporting intrapersonal emotion regulation seems to have the potential to allow more favorable interpersonal regulation processes and to free interpersonal resources for an individual adjustment. This has implications for further planning of support for couples facing life transitions and aging-related changes.
... Narratives or stories reveal both the individual and collective resilience strategies (71). Short bursts of expressive writing (i.e., 15-20 min) were shown to be sufficient to allow for emotional disclosure, the active ingredient in the intervention (70,(72)(73)(74), and to improve biochemical markers of physical and immune functioning as well as other physical health outcomes and healthcare utilization (75)(76)(77)(78)(79)(80)(81)(82)(83). Each subject in this study was randomly assigned to one of three treatment groups developed in consultation with J. Pennebaker: (1) the expressive writing group, writing about their innermost feelings (active group), (2) a writing group addressing non-emotional issues of healthy lifestyle (nonexpressive writing group), and (3) women who did not receive any writing instructions (control or no-intervention group). ...
Introduction: Data show that maternal stress triggered by exposure to a natural disaster before, during or just after pregnancy is associated with adverse pregnancy and newborn outcomes. In this paper, the first aim is to describe our efforts to test a simple, low-cost intervention to large numbers of women following a major natural disaster. The second aim is to outline the challenges faced and lessons learned during the execution of this natural disaster study.
Methods: The setting was the May 2016 Fort McMurray Wood Buffalo wildfire in northern Alberta, Canada. Women who were pregnant or preconception at the time of the disaster were invited to participate via social media. This prospective cohort study included a randomized controlled trial to test the effectiveness of an expressive writing intervention on the levels of prenatal maternal stress and maternal, birth, and early childhood outcomes. At recruitment and at multiple timepoints postpartum, a battery of questionnaires was administered to evaluate objective and subjective stress exposure to the fire as well as maternal mental health, resilience and its contributing factors as well as infant developmental milestones. Qualitative content analysis of the expressive writing was conducted.
Discussion: There is an increasing need to develop effective, wide-spread, rapid, and low-cost interventions to reduce prenatal maternal stress, increase resilience, and improve pregnancy outcomes following a natural disaster. Though analysis of data is ongoing, we highlight the strengths of this study which include strong community participation, rapid recruitment of eligible participants, low-cost intervention and data acquisition, and successful testing of the intervention. We acknowledge the challenges we encountered including the high rate of participant disqualifications or losses due to incomplete collection of online data; evacuation, dispersal, and inconsistent return to homes; and the high levels of stress accumulated post-disaster which led to inability to complete the study. Despite potential challenges, there remains a need for such research amid natural disasters.
... 2 More precisely, the traditional expressive writing intervention is designed to facilitate sensemaking by prompting people to process their emotions and thoughts about the aversive experience through the creation of a narrative about their experiences (Pennebaker, 1997). This intervention has been associated with beneficial outcomes for a wide range of life experiences, including illnesses (Willmott et al., 2011) and marital adjustment (Baddeley & Pennebaker, 2011). Within workplace contexts, expressive writing has heavily focused on reducing negative outcomes, such as anger and retaliation (Barclay & Skarlicki, 2009), absenteeism (Francis & Pennebaker, 1992), and incivility (Kirk et al., 2011). ...
Decades of research have demonstrated that experiencing workplace unfairness can result in profound negative consequences for employees. Integrating conservation of resources theory with meaning-finding perspectives, we argue that engaging in meaning-finding in the aftermath of unfairness can foster state resilience and promote positive outcomes. To promote meaning-finding, we develop and test a new expressive writing intervention (i.e. a guided writing technique that facilitates the processing of negative experiences). Results indicate that the meaning-finding expressive writing intervention is associated with higher resilience than traditional expressive writing. Moreover, resilience mediates the relationship between meaning-finding (vs. traditional) expressive writing and willingness to reconcile, positive relationships with others, and life satisfaction. Theoretically, our findings highlight that engaging in meaning-finding can transform aversive experiences into opportunities to foster resilience and positive outcomes. Practically, meaning-finding expressive writing provides an effective, simple, and cost-effective tool that can be used by employees and counseling programs to promote recovery.
... 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. ...
Childhood cancer is a stressful experience. No pediatric patient, however, should be made to feel as if their concerns and feelings about their cancer experience must be bottled up inside. Importantly, talking and writing about one's illness has myriad implications for young cancer patients and survivors. The most salient of these may include increased understanding of one's condition as well as improved physical and cognitive symptoms (e.g., lowered depression, decreased anxiety, and an enhanced quality of life overall). This literature review explores three promising avenues for verbal therapy in the pediatric oncology setting: expressive writing, video narratives, and bibliotherapy exercises. Several recent studies, covering verbal therapy methods from illness blogging to book interventions, are referenced and discussed. Ultimately, we conclude that expressive writing, video narratives, and bibliotherapy exercises are valuable, feasible, inexpensive, and acceptable tools for patients and survivors of childhood cancer to facilitate self-expression—and to find meaning in the uncertainty and anxiety that cancer inherently fosters. We recommend that future studies investigate this theme so that we may improve quality of life and mental health for pediatric cancer patients and survivors worldwide.
... One such paradigm is expressive writing. Expressive writing is a brief interven tion that has been linked to various health and social benefits [4,8,20,31]. In the traditional expressive writing paradigm, participants are instructed to reflect on a stressful experience and write about their deepest thoughts and feelings about that experience for 20 min per session for up to four sessions [32]. ...
The current proposed study aims to evaluate expressive writing as a novel intervention for reducing problematic drinking among college students. College students are at increased risk for alcohol misuse compared to other adults, and the development of efficacious intervention approaches is an urgent priority. The vast majority of individually focused brief interventions targeting college drinking have focused on personalized feedback approaches and recent innovations have largely been limited to refinements of this paradigm, which require large-scale assessment and intricate programming for implementation. The present research proposes expressive writing as a novel alternative, which has been used extensively in other domains but not as an alcohol intervention strategy. We propose a theoretically-based approach that incorporates expression of the self-conscious emotion of guilt and the written analogue of change talk as proposed mechanisms of intervention efficacy. We will also examine individual differences in guilt-proneness as a moderator of intervention efficacy. Heavy drinking college students (N = 600) will be randomly assigned to one of six expressive writing conditions based on a 2 (alcohol vs. distress) × 2 (guilt vs. no guilt) + 1 (control writing) + 1 (personalized feedback) design. Participation in the study involves completion of a screening assessment, a baseline assessment, three in-lab intervention sessions, post-intervention assessments, and follow-up assessments one-month, three-months, six months, and twelve-months later. If effective, this novel intervention approach would not require any pre-assessment or programming of personalized feedback, and would serve as a more easily disseminable alternative to existing approaches.
... In fact, engaging in professional development on a regular basis is recommended for therapist self-care (Knapp et al. 2017), and is increasingly being made mandatory by professional associations. Other practices that can promote flexibility are setting and reappraising goals (Wityk 2003), engaging in expressive writing or journaling (Baddeley and Pennebaker 2011;Warren et al. 2010), and engaging in Acceptance and Commitment Therapy (Rudaz et al. 2017). ...
Stress, burnout, and professional impairment are prevalent among mental health professionals and can have a negative impact on their clinical work, whilst engagement in self-care can help promote therapist well-being. This literature review examines the role of self-care in the promotion of well-being among mental health practitioners. Specifically, empirical research is presented in relation to specific domains of self-care practice, including awareness, balance, flexibility, physical health, social support, and spirituality. Findings from this review underscore the importance of taking a proactive approach to self-care and, in particular, integrating self-care directly into clinical training programs and into the quality assurance processes of professional organizations within the field of mental health.
... 15-20 min) are sufficient to allow for emotional disclosure (the active ingredient in the intervention), [24][25][26][27][28] and to improve biochemical markers of physical and immune functioning. [29][30][31][32][33][34] As a self-reflective learning activity, expressive writing allows for review and cognitive processing of innermost thoughts and feelings. Worries are offloaded from working memory and, as a result, anxiety is relieved. ...
The preconception, pregnancy and immediate postpartum and newborn periods are times for mothers and their offspring when they are especially vulnerable to major stressors – those that are sudden and unexpected and those that are chronic. Their adverse effects can transcend generations. Stressors can include natural disasters or political stressors such as conflict and/or migration. Considerable evidence has accumulated demonstrating the adverse effects of natural disasters on pregnancy outcomes and developmental trajectories. However, beyond tracking outcomes, the time has arrived for gathering more information related to identifying mechanisms, predicting risk and developing stress-reducing and resilience-building interventions to improve outcomes. Further, we need to learn how to encapsulate both the quantitative and qualitative information available and share it with communities and authorities to mitigate the adverse developmental effects of future disasters, conflicts and migrations. This article briefly reviews prenatal maternal stress and identifies three contemporary situations (wildfire in Fort McMurray, Alberta, Canada; hurricane Harvey in Houston, USA and transgenerational and migrant stress in Pforzheim, Germany) where current studies are being established by Canadian investigators to test an intervention. The experiences from these efforts are related along with attempts to involve communities in the studies and share the new knowledge to plan for future disasters or tragedies.
... In addition, when an individual feels burdened by a specific stressor he/she may be more willing to verbally express feelings. The use of emotion words between romantic partners has been found to be positively associated with relationship satisfaction (Slatcher and Pennebaker, 2006) as well as relationship adjustment (Baddeley and Pennebaker, 2011). ...
Stress in romantic relationships is an all-too-common phenomenon that has detrimental effects on relationship well-being. Specifically, stress can lead to negative interactions between partners and ultimately decrease relationship functioning. The systemic-transactional model of dyadic coping posits that by effectively communicating stress and coping with one’s romantic partner, couples can mitigate the deleterious effects of stress. Specifically, partners can engage in positive dyadic coping, which may foster couples’ sense of “we-ness,” strengthen their emotional connection, and facilitate their understanding of each other’s stressful experiences. However, these associations have not yet been examined during partners’ real-time stress conversations. When assessing dyadic coping, a particular aspect of interest is partners’ language use (i.e., pronouns, emotion words, and cognition words), as it may reflect the types of support they communicate to one another. Using real-time interaction data from 41 heterosexual couples, this study examined how couples’ stress and coping processes affect perceived interaction quality following discussions of stress. Specifically, language use (i.e., pronouns, emotion words, and cognition words) was assessed as a mediator on the association between observed stress communication and perceived interaction quality. Overall, results supported our hypotheses; when one partner communicated stress, the other partner responded with language use indicative of different types of dyadic coping (i.e., more you-talk and use of emotion words, less we-talk, I-talk, and use of cognition words), which were in turn associated with interaction quality in mixed directions. Implications of these findings for romantic couples are discussed.
... For example, studies coded as non-combat active duty include September 11th Pentagon attack survivors (Litz et al., 2007), British Royal Naval personnel serving on warships, and a range of otherwise broadly described in-tact small units (Cacioppo et al., 2015) or a mix of individuals from different military branches (Gould et al., 2007) with little or no occupational duty information. Studies coded as representing intervention evidence from the military families sub-population included samples of military couples pre-deployment (Van Breda, 1999) and post-deployment (Baddeley & Pennebaker, 2011), military parents and their children (Saltzman, et al., 2016), and veteran and family member dyads (Monk, Ogolsky, & Bruner, 2016;Sherman et al., 2015). ...
In recent years, a wide range of psychosocial health interventions have been implemented among military service members and their families. However, there are questions over the evaluative rigor of these interventions. We conducted a systematic review of this literature, rating each relevant study (k = 111) on five evaluative rigor scales (type of control group, approach to participant assignment, outcome quality, number of measurement time points, and follow-up distality). The most frequently coded values on three of the five scales (control group type, participant assignment, and follow-up distality) were those indicating the lowest level of operationally defined rigor. Logistic regression results indicate that the evaluative rigor of intervention studies has largely remained consistent over time, with exceptions indicating that rigor has decreased. Analyses among seven military sub-populations indicate that interventions conducted among soldiers completing basic training, soldiers returning from combat deployment, and combat veterans have had, on average, the greatest evaluative rigor. However, variability in mean scores across evalua-tive rigor scales within sub-populations highlights the unique methodological occuPational stress and well-Being in military contexts Occupational stress and Well-being in Military contexts research in Occupational stress and Well being, Volume 16, 129-156 130 adam J. vanhove et al. hurdles common to different military settings. Recommendations for better standardizing the intervention evaluation process are discussed.
... These data were collected as part of a larger study testing the efficacy of an EW intervention aimed at improving relationship satisfaction and individual well-being in military couples (Baddeley & Pennebaker, 2011). In the EW intervention, individuals were asked to write about their deepest thoughts and feelings about transitioning from deployment to being reunited at home with their spouse. ...
... We did not receive any comments from newcomers that the survey was too diffi cult; rather, spontaneous comments were uniformly positive (e.g., "Thank you for this study that allows me to get it all out of my system," "Thank you for the opportunity to let me share a little of my story."). These results agree with prior studies (Baddeley and Pennebaker, 2011;Danoff-Burg et al., 2010) showing that distressed participants may perceive benefi ts from sharing their experiences, often in the hope of helping other people with similar struggles. ...
Objective:
Empirical knowledge is lacking about Al-Anon Family Groups (Al-Anon), the most widely used form of help by people concerned about another's drinking, partly because conducting research on 12-step groups is challenging. Our purpose was to describe a new method of obtaining survey data from 12-step group attendees and to examine influences on initial Al-Anon attendance and attendees' recent life contexts and functioning.
Method:
Al-Anon's World Service Office sent a mailing to a random sample of groups, which subsequently yielded surveys from newcomers (n = 359) and stable members (n = 264).
Results:
Reasons for groups' nonparticipation included having infrequent newcomers and the study being seen as either contrary to the 12 Traditions or too uncomfortable for newcomers. Main concerns prompting initial Al-Anon attendance were problems with overall quality of life and with the Al-Anon trigger (a significant drinking individual), and being stressed and angry. Goals for Al-Anon attendance were related to the following concerns: better quality of life, fewer trigger-related problems, and less stress. Members reported better functioning in some of these domains (quality of life, relationship with the trigger) but did not differ from newcomers on physical and psychological health. Newcomers were more likely to have recently drunk alcohol and to have obtained treatment for their own substance misuse problems.
Conclusions:
This method of collecting data from 12-step group attendees yielded valid data and also was seen by many in Al-Anon as consistent with the Traditions. Both newcomers and members had aimed to improve their overall quality of life and well-being through Al-Anon, and, indeed, members were more satisfied with their quality of life than were newcomers.
... For military peacekeepers in the United Kingdom, talking about their experiences was associated with less psychological distress, with most turning to peers and family members (Greenberg et al., 2003). Additionally, written expression paradigms have demonstrated beneficial effects of the soldiers' expressive writing on marital satisfaction for active duty soldiers and their spouses (Baddeley & Pennebaker, 2011). ...
Although previous research has shown a negative relation between partner support and posttraumatic stress disorder (PTSD) symptom severity among military service members following deployment, the mediating mechanisms of this effect remain poorly understood. This study examined willingness to disclose deployment- and combat-related experiences as a mediating mechanism underlying the linkage between intimate partner support and PTSD symptom severity in a sample of 76 U.S. Air Force service members deployed to Iraq in a year-long, high-risk mission. Airmen's reports of overall social support, and partner support specifically, significantly predicted concurrent postdeployment PTSD symptom severity. Subsequent mediation analyses demonstrated that level of disclosure of deployment- and combat-related experiences by service members to their intimate partners accounted for a significant portion of the relation between partner support and postdeployment PTSD symptom severity. The level of Airmen's disclosure was also inversely related to levels of relationship distress. Implications of these findings for prevention and intervention strategies and for further research are discussed. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
... 976) to determine whether such disclosure would create distress or understanding. A recent study by Baddeley and Pennebaker (2011) has also demonstrated that a deployment-specific expressive writing intervention with military couples resulted in decreases in aggressive behavior and gains in marital satisfaction for soldiers, but no gains in marital satisfaction for romantic partners. Thus, the available literature suggests that, not only might partners not share the benefits that service members receive from trauma-related communication, but they also may become distressed as a result of such communication. ...
Emerging literature shows a consistent pattern of relationship and psychological distress in spouses or partners of combat veterans with symptoms of posttraumatic stress disorder (PTSD). One possible mechanism of partners' distress posited in clinical literature is that excessive discussion of traumatic events from deployment may have negative effects on partners. At the extreme, some partners are suggested to develop PTSD-like symptoms, or secondary traumatic stress. Despite these hypotheses, there have been few empirical tests of the effects of communicating about such events. In a sample of 465 combat veterans and their spouses who participated in the Family Interview Component of the National Vietnam Veterans Readjustment Study, we explored how the extent of couples' deployment-related communication was associated with partner relationships and psychological distress, and whether such associations were moderated by the severity of veterans' PTSD symptoms. Results showed that Vietnam-specific communication correlated negatively with relationship distress, but the effect was negligible after controlling for overall communication in the relationship. On the other hand, Vietnam-specific communication did not correlate with psychological distress, but the association was significantly moderated by veterans' PTSD symptom severity. Specifically, communication about Vietnam was increasingly and positively associated with partners' psychological distress as veterans' symptoms of PTSD rose into the clinical range, but nonsignificantly and negatively associated with such distress as PTSD symptoms decreased below this level. The findings support previous clinical recommendations that couples' discussions of potentially traumatic events be approached cautiously, and they suggest a need to attend to the content of couples' communications when conducting dyadic interventions for PTSD.
Purpose
The Love Together, Parent Together (L2P2) program is a brief, online couple’s intervention designed to prevent relationship deterioration by targeting maladaptive psychological processes.
Methods
The current study used a parallel-group randomized controlled trial of L2P2 to examine its feasibility, acceptability, and preliminary effectiveness. One-hundred forty couples with young children (< 6 years old) were randomly assigned to L2P2 or a control group. In three writing sessions over nine weeks, all couples completed fact-based summaries about recent conflicts; the L2P2 group also responded to three writing prompts eliciting conflict reappraisal. Participants completed baseline, post-intervention, and 1- and 3-month follow-up assessments.
Results
Goals related to feasibility and acceptability were met. In addition, the control group, but not the L2P2 group, showed deteriorating relationship quality from baseline to post-intervention.
Conclusions
L2P2 shows promise as a brief intervention to attenuate declines in relationship quality in couples.
Clinicaltrials.gov Registration
NCT05261022.
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.
The purpose of the current investigation was to examine deployment-related risks, resources, and mediators contributing to military spouse perception of readiness for future service member deployments. We used data from 5,748 spouses and service members with two to five years of service (90% female spouses, M age = 27.54), all having experienced at least one deployment. The impact of deployment risks (number of prior deployments, combat exposure, deployment injury) and resources (formal and informal support, communication during the last deployment) were analyzed within a path modeling framework. Mediators of these relations were investigated, including service member and spouse mental health and spouse deployment-related personal growth. We found a well-fitting model suggesting a combination of direct and indirect effects on spouse perception of deployment readiness. Findings indicated that service member combat and injury negatively impacted spouse perception of deployment readiness through detriments to service member and spouse mental health. However, informal support and deployment communication were positively related to mental health for both partners, leading to improved spouse-perceived deployment readiness. Additionally, all resources contributed to spouses’ personal growth, a relatively strong mechanism for spouse-perceived deployment readiness. These findings suggest application through promotion of resources or by directly targeting mediating mechanisms to offset deployment risk.
The chapter provides an overview of the challenges facing military families and, in particular, the impact of wartime deployment of a parent for the family. We review the literature on the impact of deployment and its sequelae (e.g., posttraumatic stress symptoms) on children, couples, parent–child relationships/parenting, and the family as a whole. Conceptual models including military family stress models, social interaction learning theory, and ecological models provide explanations for how and why deployment and related stressors disrupt family and child functioning. Approaches to working with military families are reviewed, with a focus on programs that are theoretically informed and evidence based and that target parenting, children, and the couple relationship. Future directions and implications for research and practice are discussed.
The chapter provides an overview of the challenges facing military families and, in particular, the impact of wartime deployment of a parent for the family. We review the literature on the impact of deployment and its sequelae (e.g., posttraumatic stress symptoms) on children, couples, parent–child relationships/parenting, and the family as a whole. Conceptual models including military family stress models, social interaction learning theory, and ecological models provide explanations for how and why deployment and related stressors disrupt family and child functioning. Approaches to working with military families are reviewed, with a focus on programs that are theoretically informed and evidence based and that target parenting, children, and the couple relationship. Future directions and implications for research and practice are discussed.
Objective
To examine the relationship between marital satisfaction and two linguistic elements in the context of writing: use of personal pronouns and affective language.
Background
Expressive writing (EW) is an effective way of identifying and processing thoughts and emotions. It also promotes individual, physical, and psychological health. However, much less literature has examined the relationship between EW and relationship health.
Method
We used the Linguistic Inquiry and Word Count (LIWC2007) to examine the writing of 78 married, heterosexual couples who were instructed to write freely on a topic they felt strongly about in their relationship. Multilevel modeling within SPSS was used to examine our research questions.
Results
Findings suggest a relationship between marital satisfaction and use of (a) first‐person plural pronouns (we, us, our, ours), (b) positive affective language, and (c) linguistic indicators of anger when writing about one's relationship.
Conclusion
The results provide further impetus for examining relationship processes within an EW framework and, in particular, for examining the merits of EW as a potential intervention for couples.
Implications
Findings suggest that expressive writing may be a potentially important indicator of mutuality (we‐ness), the ability to up‐regulate positive emotion, and negative affective processes (i.e., anger).
The purpose of this study is to describe how emerging adult (EA) women describe their views-of-self in troubled relationships. Fourteen EA women (ages 18–25 years) wrote four stories about their troubled relationships during a guided-writing intervention. Qualitative descriptive methods and content analysis were used to identify common views-of-self. Four views-of-self in troubled relationships and contrasting views-of-self emerged: (i) silent self-vocal self, (ii) sacrificing self-prioritized self, (iii) caretaking self-boundary-setting self, and (iv) insecure self-secure self. Mental health nurses and other clinicians can use these views-of-self pairs to guide their discussions with EA young women who are involved in troubled relationships.
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.
There has been little qualitative research into the experiences of UK partners of veterans with PTSD. This study therefore aimed to explore how partners constructed their experiences of living with the condition. Fifteen female partners of male UK veterans were recruited and interviewed. Using a social constructionist thematic analysis, five themes were constructed: the women's need to subdue own emotional and behavioral responses; dilemmas about whether the veteran was unwell or ‘bad’; attempts at negotiating multiple roles; challenging the narrative of veterans as heroes; and the relational struggle with the transition to nonmilitary life. This study highlighted the importance of considering the veteran as existing within a relational and cultural context, and the need to include partners in therapeutic interventions.
Exposure to stressful and potentially traumatic experiences is a risk for military personnel and for some this may increase susceptibility to reduced well-being. The aim of this systematic review was to examine the effectiveness of interventions to promote the well-being of military personnel adjusting to civilian life. Electronic databases were searched including MEDLINE, Embase, HMIC, PsycINFO, Pilots and CINAHL. Twelve articles, all conducted in the USA, were included in the review. Articles were synthesised narratively and assessed for bias against established criteria. The studies evaluated the effectiveness of interventions for current and former military personnel. The interventions included expressive writing, anger management, cognitive training, psycho-education, and techniques to promote relaxation, connection in relationships and resilience. Interventions had some significant positive effects mostly for veterans adjusting to civilian life and other family members. There was much heterogeneity in the design and the outcome measures used in the studies reviewed. The review highlights the need for future robust trials examining the effectiveness of well-being interventions in military groups with diverse characteristics; in addition qualitative research to explore a conceptualisation of well-being for this group and the acceptability of interventions which may be perceived as treatment. The results of the review will be of interest to a number of stakeholders in military, public health and mental health settings.
PROSPERO Registration number: CRD42015026341
Firefighters are routinely exposed to situations involving contact with deceased or injured children, burned and seriously injured bodies, and high-uncertainty calls. Thus, many firefighters suffer debilitating consequences including depression, dysfunctional drinking, and posttraumatic stress disorder. Using an identity tensions framework, we sought to understand the challenges firefighters encounter as they cope with exposure to traumatic events. We interviewed 27 members of a rural fire department and used a constant comparative method to analyze their responses. We found trauma was induced when occupational identity intersected futile situations and those involving children; tensions emerged between traditional and newer, emergent firefighting cultures; and firefighters experience tensions in negotiating how and when to express emotion. Based on these findings, we offer a number of practical implications centering on an occupational identity tensions framework to encourage reflexivity in firefighters and moving beyond older, enduring stereotypes of what it means to be a firefighter.
Expressive writing interventions have shown positive physical and psychological health benefits over time, with the presumed mechanism being emotional disclosure. However, work utilizing expressive writing in behavior change has been minimal. The current research applied the expressive writing paradigm to reduce drinking intentions among college students, and evaluated the role of event-related guilt and shame in intervention effects. College students (N = 429) completed a baseline survey and were randomly assigned to one of three conditions: Negative (write about a heavy drinking event that was negative); Positive (write about a heavy drinking event that was positive); or Neutral (write about their first day of college). After writing, readiness to change and future drinking intentions were assessed. Results revealed intervention effects on intended drinks per week and intended number of drinks during peak and typical drinking occasions. Participants in the negative condition also displayed higher levels of event-related guilt and shame. Results showed that guilt mediated intervention effects on readiness to change, which also mediated the association between guilt-reparative behavior and drinking intentions. Results provide initial support for an expressive writing intervention on alcohol use and underscore the importance of eliciting emotions associated with reparative behavior when considering negative past experiences and future behavior change.
Copyright © 2015 Elsevier Inc. All rights reserved.
To help address the relationship needs of service members, there have been a number of programs offered within active duty and veteran contexts. One program, offered within the Strong Bonds portfolio delivered by Army Chaplains, is PREP for Strong Bonds (PREP = the Prevention and Relationship Education Program). PREP has a number of empirically based and tested variants. This article reviews the disseminated research regarding results from a large randomized clinical trial designed to test the effectiveness of PREP for Strong Bonds. From a sample of 662 Army couples drawn from two sites, outcome papers have focused on different subsamples, marital outcomes, follow up time points, and moderators. Reviewing these disseminated outcomes, we conclude that PREP for Strong Bonds has significant divorce reduction effects at one site; these divorce effects were found at both 1 and 2 years post intervention, and were moderated by factors such as minority status, economic strain, and cohabitation history of the couple. In terms of marital quality outcomes, some modest overall effects were found pre to post intervention, but there were no overall marital quality outcome effects 2 years post intervention. However, marital quality outcomes are significantly moderated by infidelity and cohabitation history, with couples reporting these risk factors showing greater positive marital quality outcomes. These results to date are discussed in terms of clinical and research implications as well as directions for future work, such as examining longer term preventative effects.
Previous studies indicate that changing pronoun use can moderate the health benefits of expressive writing. Participants who change their pronoun use from essay to essay benefit more from the exercise. The current experiment attempted to improve the expressive writing paradigm by altering subjects’ focus (specifically self- and other-related focus) through text-based instructions. The automated language-based system was simple to implement, and it successfully changed participants’ pronoun use, but the intervention had no mood-related or subjective benefits. While the automated intervention system has promise in guiding people’s natural writing, future research must address the broader question of the inherent links between language use and substantive psychological change.
Context
The Primary Care Evaluation of Mental Disorders (PRIME-MD) was developed
as a screening instrument but its administration time has limited its clinical
usefulness.Objective
To determine if the self-administered PRIME-MD Patient Health Questionnaire
(PHQ) has validity and utility for diagnosing mental disorders in primary
care comparable to the original clinician-administered PRIME-MD.Design
Criterion standard study undertaken between May 1997 and November 1998.Setting
Eight primary care clinics in the United States.Participants
Of a total of 3000 adult patients (selected by site-specific methods
to avoid sampling bias) assessed by 62 primary care physicians (21 general
internal medicine, 41 family practice), 585 patients had an interview with
a mental health professional within 48 hours of completing the PHQ.Main Outcome Measures
Patient Health Questionnaire diagnoses compared with independent diagnoses
made by mental health professionals; functional status measures; disability
days; health care use; and treatment/referral decisions.Results
A total of 825 (28%) of the 3000 individuals and 170 (29%) of the 585
had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those
of independent mental health professionals (for the diagnosis of any 1 or
more PHQ disorder, κ = 0.65; overall accuracy, 85%; sensitivity, 75%;
specificity, 90%), similar to the original PRIME-MD. Patients with PHQ diagnoses
had more functional impairment, disability days, and health care use than
did patients without PHQ diagnoses (for all group main effects, P<.001). The average time required of the physician to review the
PHQ was far less than to administer the original PRIME-MD (<3 minutes for
85% vs 16% of the cases). Although 80% of the physicians reported that routine
use of the PHQ would be useful, new management actions were initiated or planned
for only 117 (32%) of the 363 patients with 1 or more PHQ diagnoses not previously
recognized.Conclusion
Our study suggests that the PHQ has diagnostic validity comparable to
the original clinician-administered PRIME-MD, and is more efficient to use.
Figures in this Article
Mental disorders in primary care are common, disabling, costly, and
treatable.1- 5
However, they are frequently unrecognized and therefore not treated.2- 6
Although there have been many screening instruments developed,7- 8
PRIME-MD (Primary Care Evaluation of Mental Disorders)5
was the first instrument designed for use in primary care that actually diagnoses
specific disorders using diagnostic criteria from the Diagnostic
and Statistical Manual of Mental Disorders, Revised Third Edition9(DSM-III-R) and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition10(DSM-IV).
PRIME-MD is a 2-stage system in which the patient first completes a
26-item self-administered questionnaire that screens for 5 of the most common
groups of disorders in primary care: depressive, anxiety, alcohol, somatoform,
and eating disorders. In the original study,5
the average amount of time spent by the physician to administer the clinician
evaluation guide to patients who scored positively on the patient questionnaire
was 8.4 minutes. However, this is still a considerable amount of time in the
primary care setting, where most visits are 15 minutes or less.11
Therefore, although PRIME-MD has been widely used in clinical research,12- 28
its use in clinical settings has apparently been limited. This article describes
the development, validation, and utility of a fully self-administered version
of the original PRIME-MD, called the PRIME-MD Patient Health Questionnaire
(henceforth referred to as the PHQ).
DESCRIPTION OF PRIME-MD PHQ
ABSTRACT
|
DESCRIPTION OF PRIME-MD PHQ
|
STUDY PURPOSE
|
METHODS
|
RESULTS
|
COMMENT
|
REFERENCES
The 2 components of the original PRIME-MD, the patient questionnaire
and the clinician evaluation guide, were combined into a single, 3-page questionnaire
that can be entirely self-administered by the patient (it can also be read
to the patient, if necessary). The clinician scans the completed questionnaire,
verifies positive responses, and applies diagnostic algorithms that are abbreviated
at the bottom of each page. In this study, the data from the questionnaire
were entered into a computer program that applied the diagnostic algorithms
(written in SPSS 8.0 for Windows [SPSS Inc, Chicago, Ill]). The computer program
does not include the diagnosis of somatoform disorder, because this diagnosis
requires a clinical judgment regarding the adequacy of a biological explanation
for physical symptoms that the patient has noted.
A fourth page has been added to the PHQ that includes questions about
menstruation, pregnancy and childbirth, and recent psychosocial stressors.
This report covers only data from the diagnostic portion (first 3 pages) of
the PHQ. Users of the PHQ have the choice of using the entire 4-page instrument,
just the 3-page diagnostic portion, a 2-page version (Brief PHQ) that covers
mood and panic disorders and the nondiagnostic information described above,
or only the first page of the 2-page version (covering only mood and panic
disorders) (Figure 1).
Figure 1. First Page of Primary Care Evaluation
of Mental Disorders Brief Patient Health QuestionnaireGrahic Jump Location+View Large |
Save Figure |
Download Slide (.ppt)
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View in Article ContextCopyright held by Pfizer Inc, but may be photocopied ad libitum.
For office coding, see the end of the article.
The original PRIME-MD assessed 18 current mental disorders. By grouping
several specific mood, anxiety, and somatoform categories into larger rubrics,
the PHQ greatly simplifies the differential diagnosis by assessing only 8
disorders. Like the original PRIME-MD, these disorders are divided into threshold
disorders (corresponding to specific DSM-IV diagnoses,
such as major depressive disorder, panic disorder, other anxiety disorder,
and bulimia nervosa) and subthreshold disorders (in which the criteria for
disorders encompass fewer symptoms than are required for any specific DSM-IV diagnoses: other depressive disorder, probable alcohol
abuse or dependence, and somatoform and binge eating disorders).
One important modification was made in the response categories for depressive
and somatoform symptoms that, in the original PRIME-MD, were dichotomous (yes/no).
In the PHQ, response categories are expanded. Patients indicate for each of
the 9 depressive symptoms whether, during the previous 2 weeks, the symptom
has bothered them "not at all," "several days," "more than half the days,"
or "nearly every day." This change allows the PHQ to be not only a diagnostic
instrument but also to yield a measure of depression severity that can be
of aid in initial treatment decisions as well as in monitoring outcomes over
time. Patients indicate for each of the 13 physical symptoms whether, during
the previous month, they have been "not bothered," "bothered a little," or
"bothered a lot" by the symptom. Because physical symptoms are so common in
primary care, the original PRIME-MD dichotomous-response categories often
led patients to endorse physical symptoms that were not clinically significant.
An item was added to the end of the diagnostic portion of the PHQ asking
the patient if he or she had checked off any problems on the questionnaire:
"How difficult have these problems made it for you to do your work, take care
of things at home, or get along with other people?" As with the original PRIME-MD,
before making a final diagnosis, the clinician is expected to rule out physical
causes of depression, anxiety and physical symptoms, and, in the case of depression,
normal bereavement and history of a manic episode.
STUDY PURPOSE
ABSTRACT
|
DESCRIPTION OF PRIME-MD PHQ
|
STUDY PURPOSE
|
METHODS
|
RESULTS
|
COMMENT
|
REFERENCES
Our major purpose was to test the validity and utility of the PHQ in
a multisite sample of family practice and general internal medicine patients
by answering the following questions:
Are diagnoses made by the PHQ as accurate as diagnoses
made by the original PRIME-MD, using independent diagnoses made by mental
health professionals (MHPs) as the criterion standard?Are the frequencies of mental disorders found by
the PHQ comparable to those obtained in other primary care studies?Is the construct validity of the PHQ comparable
to the original PRIME-MD in terms of functional impairment and health care
use?Is the PHQ as effective as the original PRIME-MD
in increasing the recognition of mental disorders in primary care patients?How valuable do primary care physicians find the
diagnostic information in the PHQ?How comfortable are patients in answering the questions
on the PHQ, and how often do they believe that their answers will be helpful
to their physicians in understanding and treating their problems?
Considerable evidence now supports the psychological and health benefits of written emotional disclosure when pursued in an individual context. However, the literature has largely emphasized intrapersonal processes and outcomes to the neglect of interpersonal applications of the written disclosure paradigm, despite the fact that painful and traumatic emotional events frequently occur in the context of intimate personal relationships. In this commentary, we describe an extension of the written disclosure paradigm to the treatment of couples struggling to recover from an extramarital affair. Preliminary findings offer promise for integrating mutual written disclosure as an intervention component in treating relationship trauma.
Field combat stress clinics and research have identified the signature event that precedes thoughts of suicide and homicide in combat soldiers in Iraq and Afghanistan: a distressing personal relationship event with a stateside partner. In response to this alarming information, we have identified critical factors and precipitating incidents as well as critical social skills that form the basis for changing communication between soldiers and their stateside partners. A pilot program is described that proved effective with small groups of soldiers who were led by a male-female professional team and given structured reading and social skills training exercises based on Gottman and Silver's (1999) book The seven principles for making marriage work. Recommendations for future training are made based upon our assessment of the family issues facing the combat soldier in Iraq and Afghanistan. In conclusion, we describe the family fitness interventions and program elements of the skill building trainings within the family component of the Comprehensive Soldier Fitness program, which can be delivered via online interactive technology as well as face to face with families.
The current combat operations in Iraq and Afghanistan have involved US military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans.
We studied members of 4 US combat infantry units (3 Army units and a Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or 3 to 4 months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and posttraumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments.
Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6% to 17.1%) than after duty in Afghanistan (11.2%) or before deployment to Iraq (9.3%); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23% to 40% sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care.
This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. The recent military operations in Iraq and Afghanistan, which have involved the first sustained ground combat undertaken by the United States since the war in Vietnam, raise important questions about the effect of the experience on the mental health of members of the military services who have been deployed there. Research conducted after other military conflicts has shown that deployment stressors and exposure to combat result in considerable risks of mental health problems, including posttraumatic stress disorder, major depression, substance abuse, impairment in social functioning and in the ability to work, and the increased use of healthcare services. One study that was conducted just before the military operations in Iraq and Afghanistan began found that at least 6% of all US military service members on active duty receive treatment for a mental disorder each year. Given the ongoing military operations in Iraq and Afghanistan, mental disorders are likely to remain an important healthcare concern among those serving there. Many gaps exist in the understanding of the full psychosocial effect of combat. The all-volunteer force deployed to Iraq and Afghanistan and the type of warfare conducted in these regions are very different from those involved in past wars, differences that highlight the need for studies of members of the armed services who are involved in the current operations. Most studies that have examined the effects of combat on mental health were conducted among veterans years after their military service had ended. A problem in the methods of such studies is the long recall period after exposure to combat. Very few studies have examined a broad range of mental health outcomes near to the time of subjects' deployment. Little of the existing research is useful in guiding policy with regard to how best to promote access to and the delivery of mental health care to members of the armed services. Although screening for mental health problems is now routine both before and after deployment and is encouraged in primary care settings, we are not aware of any studies that have assessed the use of mental health care, the perceived need for such care, and the perceived barriers to treatment among members of the military services before or after combat deployment. We studied the prevalence of mental health problems among members of the US armed services who were recruited from comparable combat units before or after their deployment to Iraq or Afghanistan. We identified the proportion of service members with mental health concerns who were not receiving care and the barriers they perceived to accessing and receiving such care.
Researchers have found that there is an increase in mental heath problems as a result of military-related traumatic events, and such problems increase in the months following return from combat. Nevertheless, researchers have not assessed the impact of early intervention efforts with this at-risk population. In the present study, the authors compared different early interventions with 2,297 U.S. soldiers following a year-long deployment to Iraq. Platoons were randomly assigned to standard postdeployment stress education, Battlemind debriefing, and small and large group Battlemind training. Results from a 4-month follow-up with 1,060 participants showed those with high levels of combat exposure who received Battlemind debriefing reported fewer posttraumatic stress symptoms, depression symptoms, and sleep problems than those in stress education. Small group Battlemind training participants with high combat exposure reported fewer posttraumatic stress symptoms and sleep problems than stress education participants. Compared to stress education participants, large group Battlemind training participants with high combat exposure reported fewer posttraumatic stress symptoms and lower levels of stigma and, regardless of combat exposure, reported fewer depression symptoms. Findings demonstrate that brief early interventions have the potential to be effective with at-risk occupational groups.
Much research has shown that spouses of combat veterans with posttraumatic stress disorder (PTSD) have higher rates of psychological and marital distress than do spouses of veterans without PTSD; however, very few studies have examined potential mechanisms of this increased vulnerability. The current study examined spouses of National Guard soldiers recently returned from deployments in Iraq. In addition to documenting elevated levels of psychological symptoms in these spouses, the authors found that spouses experienced greater symptom severity when they perceived high levels of symptoms in soldiers but the soldiers endorsed low levels of symptoms. Furthermore, spouses' marital satisfaction was negatively linked to soldiers' self-reported symptom severity only when spouses perceived that soldiers had experienced low levels of combat activity while deployed. When spouses perceived high levels of such activity, soldiers' self-reported symptoms had no relationship with spouses' marital satisfaction. These findings highlight the importance of interpersonal perceptions in intimate relationships and are consistent with the notion that uncontrollable attributions for a relative's mental health problems may provide a buffer against relationship distress. (PsycINFO Database Record (c) 2008 APA, all rights reserved).
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)
In the current study, the authors examined the effects of systematically varying the writing instructions for the written emotional disclosure procedure. College undergraduates with a trauma history and at least moderate posttraumatic stress symptoms were asked to write about (a) the same traumatic experience, (b) different traumatic experiences, or (c) nontraumatic everyday events across 3 written disclosure sessions. Results show that participants who wrote about the same traumatic experience reported significant reductions in psychological and physical symptoms at follow-up assessments compared with other participants. These findings suggest that written emotional disclosure may be most effective when individuals are instructed to write about the same traumatic or stressful event at each writing session, a finding consistent with exposure-based treatments.
Writing about emotional experiences is associated with a host of positive outcomes. This study extended the expressive-writing paradigm to the realm of romantic relationships to examine the social effects of writing. For 3 consecutive days, one person from each of 86 dating couples either wrote about his or her deepest thoughts and feelings about the relationship or wrote about his or her daily activities. In the days before and after writing, instant messages were collected from the couples. Participants who wrote about their relationship were significantly more likely to still be dating their romantic partners 3 months later. Linguistic analyses of the instant messages revealed that participants and their partners used significantly more positive and negative emotion words in the days following the expressive-writing manipulation if the participants had written about their relationship than if they had written about their daily activities. Increases in positive emotion words partially mediated the relation between expressive writing and relationship stability.
Disclosing information, thoughts, and feelings about personal and meaningful topics (experimental disclosure) is purported to have various health and psychological consequences (e.g., J. W. Pennebaker, 1993). Although the results of 2 small meta-analyses (P. G. Frisina, J. C. Borod, & S. J. Lepore, 2004; J. M. Smyth, 1998) suggest that experimental disclosure has a positive and significant effect, both used a fixed effects approach, limiting generalizability. Also, a plethora of studies on experimental disclosure have been completed that were not included in the previous analyses. One hundred forty-six randomized studies of experimental disclosure were collected and included in the present meta-analysis. Results of random effects analyses indicate that experimental disclosure is effective, with a positive and significant average r-effect size of .075. In addition, a number of moderators were identified.
Attempting to understand the body’s signals is similar to trying to interpret the noises and sensations of the automobile that we drive. We do not have a computer printout of either the current physiological status of our body or the condition of the various systems of our car. Given this, we are in the position of attempting to understand a large array of ambiguous sensations about which we have at best a modicum of knowledge. Whether we are dealing with human bodies or inanimate cars, the awareness and reporting of symptoms are dependent on psychological or perceptual processes. Throughout this book, a large number of studies have outlined some of the parameters that determine when and why symptoms are reported. Before discussing some of the implications of symptom research, we present the following brief review of our current knowledge about the perception of physical symptoms.
Physical symptoms are fascinating phenomena to examine. We all experience them, use them as signals to guide our behavior, and usually assume that they accurately represent underlying physiological activity. At the same time, we implicitly know that bodily sensations are often vague, ambiguous, and subject to a variety of interpretations. It is not surprising, then, that there is often a disparity between what we think is going on in our bodies and what is objectively occurring. In short, phenomena such as physical symptoms are the stuff of psychology. My own research into physical symptoms started by accident several years ago. In a hastily devised experiment dealing with the effects of noise on behavior, I had to write a post-experimental questionnaire that would be long enough to allow the experimenter time to calibrate some equipment for a later portion of the study. I included some physical symptoms on the questionnaire as fillers. The experiment was a total failure, with the exception of the symptom reports. People's perceptions of symptoms were easily influenced by our manipulations, even though their actual physiological state had not changed. And so began the present inquiry. Despite the pervasiveness, importance, and sheer amount of time and money devoted to discussing and curing common physical symptoms and sensations, very little empirical work has been devoted to examining the psychological and perceptual factors related to sensory experience. Occa sional papers have tested a specific theory, such as cognitive dissonance, wherein physical symptoms served as an interesting dependent measure."
The variety of interpersonal relationships in contemporary society necessitates the development of brief, reliable measures of satisfaction that are applicable to many types of close relationships. This article describes the development of such a measure. In Study I, the 7-item Relationship Assessment Scale (RAS) was administered to 125 subjects who reported themselves to be "in love." Analyses revealed a unifactorial scale structure, substantial factor loadings, and moderate intercorrelations among the items. The scale correlated significantly with measures of love, sexual attitudes, self-disclosure, commitment, and investment in a relationship. In Study II, the scale was administered to 57 couples in ongoing relationships. Analyses supported a single factor, alpha reliability of .86, and correlations with relevant relationship measures. The scale correlated .80 with a longer criterion measure, the Dyadic Adjustment Scale (Spanier, 1976), and both scales were effective (with a subsample) in discriminating couples who stayed together from couples who broke up. The RAS is a brief, psychometrically sound, generic measure of relationship satisfaction.
This prospective study examined: (a) the effects of Iraq War deployment versus non-deployment on pre- to postdeployment change in PTSD symptoms and (b) among deployed soldiers, associations of deployment/postdeployment stress exposures and baseline PTSD symptoms with PTSD symptom change. Seven hundred seventy-four U.S. Army soldiers completed self-report measures of stress exposure and PTSD symptom severity before and after Iraq deployment and were compared with 309 soldiers who did not deploy. Deployed soldiers, compared with non-deployed soldiers, reported increased PTSD symptom severity from Time 1 to Time 2. After controlling for baseline symptoms, deployment-related stressors contributed to longitudinal increases in PTSD symptoms. Combat severity was more strongly associated with symptom increases among active duty soldiers with higher baseline PTSD symptoms.
Among male veterans and their female partners seeking therapy for relationship issues, three violence profiles were identified based on self-reports of physical violence: nonviolent, in which neither partner reported perpetrating physical violence (44%); one-sided violent, in which one partner reported perpetrating violence (30%); and mutually violent, in which both partners reported perpetrating physical violence (26%). Profiles were distinguished based on the veteran's psychiatric diagnosis, woman's age, and both partners' reports of the frequency and severity of violence. Men and women in mutually violent couples reported more verbal and physical aggression than did men or women in any other group. The three groups reported comparable rates of sexual aggression. Appraisals of marital satisfaction and intimacy were not different based on violence profile. No gender differences emerged in the self-reports of frequency and severity of verbal, physical, and sexual aggression.
Treating affair couples: Extending the written disclosure paradigm to relationship trauma Clinical Psychology: Science and Practice Validation and util-ity of a self-report version of prime-MD: The PHQ primary care study
- D K Snyder
- K C Gordon
- D H Baucom
- R L Spitzer
- K Kroenke
Snyder, D. K., Gordon, K. C., & Baucom, D. H., (2004). Treating affair couples: Extending the written disclosure paradigm to relationship trauma. Clinical Psychology: Science and Practice, 11, 155–159. doi:10.1093/clipsy/bph066 Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). Validation and util-ity of a self-report version of prime-MD: The PHQ primary care study. JAMA: Journal of the American Medical Association, 282, 1737–1744.
Bat-tlemind debriefing and battlemind training as early interventions with soldiers returning from Iraq: Randomization by platoon Experimental disclosure and its moderators
- R E F E R E N C E S Adler
- A Bliese
- P D Mcgurk
- D Hoge
- C W Castro
R E F E R E N C E S Adler, A., Bliese, P. D., McGurk, D., Hoge, C. W., & Castro, C. A. (2009). Bat-tlemind debriefing and battlemind training as early interventions with soldiers returning from Iraq: Randomization by platoon. Journal of Consulting and Clinical Psychology, 77, 928–940. doi:10.1037/a0016877 Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis.
NORM: multiple imputation of incomplete multivariate data under a normal model (Version 2.03) [Computer software
- J L Schafer
Schafer, J. L. (1999). NORM: multiple imputation of incomplete multivariate
data under a normal model (Version 2.03) [Computer software]. Retrieved
from http://www.stat.psu.edu/∼jls/misoftwa.html#mi
Violence between therapy-seeking veterans and their partners: Prevalence and characteristics of nonviolent, mutually violent, and one-sided violent couples
- Teten
Teten, A. L., Sherman, M. D., & Han, X. (2009). Violence between therapy-seeking
veterans and their partners: Prevalence and characteristics of nonviolent, mutually violent, and one-sided violent couples. Journal of Interpersonal Violence,
24, 111-127. doi:10.1177/0886260508315782