Expressive Writing for Racism

(WW Trial)

Overseen By Tracy K Witte, PhD

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Auburn University

Disqualifiers: Under 18

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 7

Duration: 3 days

70 Participants Needed

Trial Summary

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications. It seems unlikely that you would need to stop, as the trial focuses on expressive writing rather than medication.

What data supports the idea that Expressive Writing for Racism is an effective treatment?

The available research does not provide specific data supporting the effectiveness of Expressive Writing for Racism as a treatment. Instead, it focuses on the impact of microaggressions and the need for better responses and support for those affected. There is a call for more research on interventions to help those suffering from microaggressions, but no specific evidence is presented for Expressive Writing for Racism. ^{1 2 3 4 5}

What safety data exists for Expressive Writing for Racism?

The provided research does not directly address safety data for Expressive Writing for Racism or similar treatments like Writing Wrongs or Expressive Writing for Microaggressions. The studies focus on adverse event reporting in healthcare settings, highlighting disparities in reporting by race, gender, and other factors. However, they do not provide specific safety data for the expressive writing interventions mentioned. ^{6 7 8 9 10}

Is the treatment 'Writing Wrongs' a promising treatment for dealing with racism?

Yes, 'Writing Wrongs' is a promising treatment because it helps people express their feelings about racial microaggressions, which are everyday insults or slights that can harm people of color. By writing about these experiences, individuals can process their emotions and potentially reduce the negative impact of these microaggressions on their mental health. ^{11 12 13 14 15}

What is the purpose of this trial?

Racial and ethnic based stressors, such as microaggressions, are pervasive, distressing, and result in lasting negative repercussions for minoritized students at predominantly white institutions (PWIs). These racial and ethnic based stressors are experienced in addition to the universally experienced stressors of higher education. Negative repercussions of microaggressions include increased drop out or transfer rates, distress, fatigue resulting in decreased academic performance, and depression and posttraumatic stress symptoms. Expressive writing (EW) may be a scalable intervention for addressing the negative repercussions resulting from microaggressions experienced by minoritized students at PWIs. Previous research suggests that EW for stressful life events results in benefits such as reduced depression and posttraumatic stress symptoms, improved coping strategies, and reduced activity restriction. Despite such benefits, EW was not designed to specifically address microaggressions in a minoritized student population. Informed by the ADAPT-ITT model, our research group conducted a pilot study with similar procedures. This pilot study demonstrated the acceptability of an adapted version of the EW intervention titled Writing Wrongs (WW), as well as recommended future modifications for WW. In the current study we aim to conduct a randomized-controlled trial to establish the efficacy of WW in alleviating clinical symptoms. We hypothesize that WW will improve symptoms of racial and discriminatory trauma and symptoms of depression, anxiety, and posttraumatic stress over time and compared to an assessment-only condition. We will conduct exploratory analyses to examine short-term changes in affect within and across sessions and across conditions. We will recruit minoritized students enrolled at a PWI. Participants will complete a pre-intervention assessment prior to being randomized into the two conditions. Participants in the intervention condition will engage in three sessions of WW and complete measures of clinical symptoms across multiple time points (i.e., pre-intervention, immediately after the final writing session, one week after the final session). Participants in the assessment-only condition will be administered the same measures at the same timepoints and given access to the WW after completing the study. If found to be efficacious, WW has the potential to be widely disseminated to minoritized college students who experience microaggressions.

Research Team

Tracy K Witte, PhD

Principal Investigator

Auburn University Department of Psychological Sciences

Eligibility Criteria

This trial is for full-time students at Auburn University who identify with a racial or ethnic minoritized group and are over the age of 18. It aims to help those experiencing stress from microaggressions, which can lead to negative effects like poor academic performance and mental health issues.

Inclusion Criteria

Identifies with a Racial/Ethnic Minoritized Group

Auburn University Full-time Student

Exclusion Criteria

I am under 18 years old.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

1 week

1 visit (virtual)

Pre-intervention Assessment

Participants complete a pre-intervention assessment to establish baseline measures

1 day

1 visit (virtual)

Treatment

Participants in the Writing Wrongs condition engage in three 20-minute writing sessions on consecutive days

3 days

3 visits (virtual)

Post-intervention Assessment

Participants complete a post-intervention assessment immediately after the final writing session

1 day

1 visit (virtual)

Follow-up

Participants are monitored for changes in symptoms one week after the intervention

1 week

1 visit (virtual)

Treatment Details

Interventions

• Writing Wrongs

Trial Overview The 'Writing Wrongs' intervention is being tested for its effectiveness in alleviating symptoms related to racial and discriminatory trauma, depression, anxiety, and posttraumatic stress. Participants will be randomly assigned to either engage in expressive writing sessions or an assessment-only condition.

Participant Groups

Group I: Writing Wrongs Experimental Treatment 1 Intervention

Writing Wrongs is an adaptation of expressive writing, a prolonged exposure practice targeting symptoms resulting from stressful life events. Writing Wrongs is specifically tailored to microaggressions experienced by minoritized students at predominantly White institutions. The intervention includes three 20-minute writing sessions occurring on three consecutive days. The Writing Wrongs writing activity asks participants to reflect on the facts and feelings associated with a microaggression they experienced.

Group II: Assessment Control Active Control 1 Intervention

The Assessment Control is administered the same measures during the same number of sessions as the Writing Wrongs condition without receiving the Writing Wrongs writing activity. The participants assigned to this arm of the study will receive the Writing Wrongs intervention following the completion of the study.

Who Is Running the Clinical Trial?

Auburn University

Lead Sponsor

Trials

81

Recruited

14,600+

Medical University of South Carolina

Collaborator

Trials

994

Recruited

7,408,000+

Findings from Research

Dr. Narayanaswamy, a pediatrician, experienced a microaggression from a patient's father during a consultation, which highlighted the challenges healthcare professionals face in addressing such incidents without jeopardizing their relationship with patients and families.

The incident prompted Dr. Narayanaswamy to seek institutional support for clinicians facing microaggressions, but her request to prevent automatic patient satisfaction surveys from being sent after such encounters was denied, indicating a need for better institutional policies to protect healthcare providers.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Let Me Spell It Out: The Impact of Microaggression on the Health Care Professional. Valdez, P., Kendrick-Allwood, S., Williams, TS., et al.[2023]

Microaggressions are linked to psychological and medical issues, and understanding them in context is crucial for identifying their impact on individuals, as highlighted by various longitudinal studies.

There is a significant need for further research on effective interventions to reduce microaggressions, respond to offenders, and support victims, as current literature lacks specific strategies for addressing these issues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Psychology Cannot Afford to Ignore the Many Harms Caused by Microaggressions. Williams, MT.[2020]

Microaggressions in the workplace can create a hostile learning environment for trainees, highlighting the need for faculty to be trained in recognizing and responding to these incidents.

The commentary provides a framework for managing microaggressions at an individual level and suggests strategies for addressing them at both programmatic and institutional levels, emphasizing the importance of support for affected learners.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Helping the learner to deal with microaggressions in the workplace: Individual, programmatic, and institutional-level responses. Miller, DT., Chen, EH.[2022]

The Racial Microaggression Scale distress subscales have been shown to be reliable and valid tools for measuring the perceived stressfulness of different types of microaggressions among a diverse sample, indicating their potential utility in health assessments.

The study found significant differences in distress levels among racial/ethnic groups, with African Americans experiencing higher distress from Environmental microaggressions, while Latinos reported more distress from several types, suggesting the need for tailored approaches in mental health care for these populations.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessing Racial Microaggression Distress in a Diverse Sample. Torres-Harding, S., Turner, T.[2022]

A scoping review identified 27 studies that provide recommendations and training for healthcare professionals to effectively respond to patient microaggressions, highlighting the importance of establishing a supportive culture and addressing these offenses directly.

While various training frameworks, such as the ERASE and ACTION models, show promise in equipping providers with tools to handle microaggressions, further evaluation of their effectiveness in real clinical settings is necessary.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Scoping Review of Recommendations and Training to Respond to Patient Microaggressions. Wittkower, LD., Bryan, JL., Asghar-Ali, AA.[2022]

A study involving 31 health professionals revealed significant gaps in knowledge and fear of punishment as major barriers to effectively reporting adverse events in a teaching hospital.

Improving communication and educational practices between leaders and healthcare professionals is essential to enhance the reporting of adverse events, which is crucial for patient safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The practice of reporting adverse events in a teaching hospital. Siman, AG., Cunha, SGS., Brito, MJM.[2019]

Voluntary event reporting (VER) systems significantly underestimate the incidence of safety events, particularly for patients from minoritized groups, who may experience more serious events but have lower reporting rates.

The review of 23 studies revealed disparities in safety event reporting based on race, gender, and age, indicating a need for further research and systematic changes to address these biases and improve equitable healthcare delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Disparities in Patient Safety Voluntary Event Reporting: A Scoping Review. Hoops, K., Pittman, E., Stockwell, DC.[2023]

The study used ethnographic methods, including observation and interviews, to investigate why two internal medicine departments reported adverse events at different frequencies.

Findings suggest that interpersonal relationships within the departments significantly influence how staff prioritize tasks and assess the severity of adverse events, impacting the overall reporting rates.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cultural Issues in Adverse Event Reporting - An ethnographic study. Harter, CD., Nøhr, C.[2018]

The introduction of a structured reporting model for adverse events led to a significant increase in reported incidents, from only 4 in the six months prior to 64 incidents in the following year, indicating improved awareness and acceptance of risk management.

This model not only encouraged reporting but also fostered a cultural change within the department, making staff feel more comfortable with reporting incidents, which is crucial for ongoing professional development and enhancing patient care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing a departmental culture for reporting adverse incidents. Bhatia, R., Blackshaw, G., Rogers, A., et al.[2019]

The study found that using a predefined list of harm scores in a voluntary medical incident reporting system can enhance the consistency and accuracy of reports, which is crucial for patient safety research.

Two coders achieved an 82% agreement rate when reviewing harm scores, indicating that a structured approach to reporting can significantly improve the quality of data collected for analysis.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Analyzing voluntary medical incident reports. Gong, Y., Richardson, J., Zhijian, L., et al.[2016]

Racial microaggressions are subtle, everyday insults or slights that can negatively impact people of color, often occurring without the perpetrator's awareness.

These microaggressions can hinder the development of therapeutic relationships, particularly in counseling settings, highlighting the need for better education and training in recognizing and addressing these behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Racial microaggressions in everyday life: implications for clinical practice. Sue, DW., Capodilupo, CM., Torino, GC., et al.[2023]

The concept of microaggressions, defined as subtle racial offenses, remains relevant and impactful on the health of people of color, as highlighted by a review of 32 studies.

The study proposes an expanded taxonomy of microaggressions, identifying 16 categories, including new ones like tokenism and environmental attacks, which can enhance understanding and interventions aimed at reducing these harmful behaviors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

After Pierce and Sue: A Revised Racial Microaggressions Taxonomy. Williams, MT., Skinta, MD., Martin-Willett, R.[2022]

Racial microaggressions should be defined as observable events that occur independently of the intention behind them and the impact they have on recipients, emphasizing the importance of perspectives from people of color in this definition.

The article proposes refining and expanding existing taxonomies of racial microaggressions to include various dimensions related to their experience, perpetration, and sociopolitical functions, which could enhance future research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Focusing the Lens to See More Clearly: Overcoming Definitional Challenges and Identifying New Directions in Racial Microaggressions Research. Mekawi, Y., Todd, NR.[2022]

The article critiques the traditional act-based understanding of microaggressions, highlighting its limitations in addressing the experiences of those affected.

It proposes a harm-based account of microaggressions, shifting the focus from the actions of the aggressor to the impact and harm experienced by the recipients, which could lead to more effective responses and interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Toward a Harm-Based Account of Microaggressions. Freeman, L., Stewart, H.[2022]

The review highlights that while there has been significant research on racial microaggressions since 2007, key conceptual and methodological issues still need to be addressed, particularly regarding their definition and impact.

Recommendations are proposed to enhance the scientific rigor of racial microaggressions research, aiming to deepen the understanding of their psychological relevance and consequences for racial minority groups.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The What, the Why, and the How: A Review of Racial Microaggressions Research in Psychology. Wong, G., Derthick, AO., David, EJ., et al.[2020]

References

1. United States pubmed.ncbi.nlm.nih.gov

Let Me Spell It Out: The Impact of Microaggression on the Health Care Professional. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Psychology Cannot Afford to Ignore the Many Harms Caused by Microaggressions. [2020]

3. United States pubmed.ncbi.nlm.nih.gov

Helping the learner to deal with microaggressions in the workplace: Individual, programmatic, and institutional-level responses. [2022]

4. United States pubmed.ncbi.nlm.nih.gov

Assessing Racial Microaggression Distress in a Diverse Sample. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

A Scoping Review of Recommendations and Training to Respond to Patient Microaggressions. [2022]

6. Brazil pubmed.ncbi.nlm.nih.gov

The practice of reporting adverse events in a teaching hospital. [2019]

7. Netherlands pubmed.ncbi.nlm.nih.gov

Disparities in Patient Safety Voluntary Event Reporting: A Scoping Review. [2023]

8. Netherlands pubmed.ncbi.nlm.nih.gov

Cultural Issues in Adverse Event Reporting - An ethnographic study. [2018]

9. England pubmed.ncbi.nlm.nih.gov

Developing a departmental culture for reporting adverse incidents. [2019]

10. United States pubmed.ncbi.nlm.nih.gov

Analyzing voluntary medical incident reports. [2016]

11. United States pubmed.ncbi.nlm.nih.gov

Racial microaggressions in everyday life: implications for clinical practice. [2023]

12. United States pubmed.ncbi.nlm.nih.gov

After Pierce and Sue: A Revised Racial Microaggressions Taxonomy. [2022]

13. United States pubmed.ncbi.nlm.nih.gov

Focusing the Lens to See More Clearly: Overcoming Definitional Challenges and Identifying New Directions in Racial Microaggressions Research. [2022]

14. United States pubmed.ncbi.nlm.nih.gov

Toward a Harm-Based Account of Microaggressions. [2022]

15. United States pubmed.ncbi.nlm.nih.gov

The What, the Why, and the How: A Review of Racial Microaggressions Research in Psychology. [2020]