Expressive Writing for Spinal Cord Injury

Overseen By Kimberly K

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Alabama at Birmingham

Disqualifiers: Severe cognitive impairments, Suicidal intent, Consistent psychotherapy, Congenital SCI, others

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

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 10

Duration: 10 weeks

60 Participants Needed

Trial Summary

What is the purpose of this trial?

The aim of this study is to evaluate the therapeutic benefits of a 10-week online coach-guided EEWP on psychosocial health among adults with SCI.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Expressive Emotional Writing, Expressive Writing Therapy, Emotional Expression Therapy for spinal cord injury?

Research shows that expressive writing can improve emotional and physical health in various groups, such as cancer patients and trauma survivors, by allowing them to express their deepest thoughts and feelings. This suggests it might also help people with spinal cord injuries by potentially enhancing their mental well-being and resilience. ^{1 2 3 4 5}

Is expressive writing safe for humans?

Expressive writing has been studied for over thirty years and is generally considered safe for humans, with research showing it can improve emotional and physical health in various populations. ^{4 5 6 7 8}

How does expressive writing differ from other treatments for spinal cord injury?

Expressive writing is unique because it focuses on helping individuals process emotions and grief through writing, rather than addressing physical rehabilitation directly. This approach is different from traditional treatments that prioritize physical recovery and functional rehabilitation. ^{9 10 11 12 13}

Research Team

Hon K Yuen, PhD

Principal Investigator

University of Alabama at Birmingham

Eligibility Criteria

Adults over 18 with spinal cord injury (SCI) who can use the internet and communicate in English are eligible for this trial. They must not be currently receiving consistent psychotherapy, participating in another clinical trial, or have severe cognitive impairments or emergency-level suicidal intent.

Inclusion Criteria

I am older than 18 years.

Access to the internet and a computer or to a smartphone that can perform videoconferencing

Sufficient English language and cognitive proficiency to complete self-report study questionnaires and understand program content in English, and able to communicate verbally or through writing

Exclusion Criteria

Congenital SCI (e.g., spinal bifida)

I have been in regular psychotherapy for the last 6 months.

I have severe difficulties with thinking or memory that prevent me from learning online.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants engage in a 10-week online coach-guided expressive emotional writing program

10 weeks

10 virtual sessions (1 per week)

Follow-up

Participants are monitored for psychosocial health improvements and reduction in grief intensity

3 months

Treatment Details

Interventions

• Expressive Emotional Writing

Trial Overview The study is testing a 10-week online program where adults with SCI engage in expressive emotional writing guided by a coach. The goal is to see if this activity helps improve their psychosocial health.

Participant Groups

Group I: Expressive writing Experimental Treatment 1 Intervention

Participation in a 10 weekly virtual expressive writing with 1 session per week

Group II: Waitlist control Active Control 1 Intervention

Participation in usual daily activities

Who Is Running the Clinical Trial?

University of Alabama at Birmingham

Lead Sponsor

Trials

1,677

Recruited

2,458,000+

Findings from Research

Expressive writing (EW) interventions showed a small but significant effect in relieving cancer symptoms among 1,718 patients, based on a meta-analysis of 14 trials.

While EW did not significantly improve psychological and cognitive outcomes, it did enhance health-related quality of life compared to usual care, suggesting potential benefits that may require further investigation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effects of Expressive Writing Interventions for Patients With Cancer: A Meta-Analysis. Oh, PJ., Kim, SH.[2017]

Expressive helping, which involves writing about personal experiences and then helping others, significantly reduced psychological distress and physical symptoms in stem cell transplant recipients, based on a study of 67 participants.

The positive effects of expressive helping were primarily mediated by the use of positive emotion words, particularly in participants who expressed a balanced amount of negative emotions, suggesting that both positive and negative emotional expression can be beneficial in coping with stress.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Helping Yourself by Offering Help: Mediators of Expressive Helping in Survivors of Hematopoietic Stem Cell Transplant. Williamson, TJ., Stanton, AL., Austin, JE., et al.[2019]

Expressive writing, involving four 20-minute sessions focused on emotional disclosure, significantly improved the quality of life for breast cancer patients undergoing chemotherapy, with noticeable effects observed two weeks after the intervention.

The study, which included 82 participants, also indicated that expressive writing positively influenced self-care self-efficacy over time, suggesting it is a beneficial and low-cost psychological intervention for patients lacking emotional support.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Structured Expressive Writing on Quality of Life and Perceived Self-Care Self-Efficacy of Breast Cancer Patients Undergoing Chemotherapy in Central China: A Randomized Controlled Trial. Wang, R., Li, L., Xu, J., et al.[2023]

In a study involving 1090 perinatal women affected by Hurricane Harvey, expressive writing did not show any significant improvement in post-traumatic stress symptoms compared to neutral writing or no writing.

Interestingly, participants who engaged in expressive writing reported increased feelings of anxiety and sadness during the intervention, suggesting that it may have worsened post-traumatic stress symptoms for some individuals.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Unexpected effects of expressive writing on post-disaster distress in the Hurricane Harvey Study: a randomized controlled trial in perinatal women. Paquin, V., Bick, J., Lipschutz, R., et al.[2021]

The 6-week expressive writing program, 'Transform Your Life: Write to Heal,' was found to be feasible and well-received by participants, with no adverse events reported, indicating it is a safe intervention for individuals with a history of trauma.

Participants showed significant improvements in resilience, with scores increasing from 64.3 to 74.2, and reductions in perceived stress, depression symptoms, and rumination, suggesting the program is effective in enhancing mental health outcomes for trauma survivors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Expressive writing to improve resilience to trauma: A clinical feasibility trial. Glass, O., Dreusicke, M., Evans, J., et al.[2019]

Expressive writing (EW) and enhanced writing (EW+) treatments significantly improve PTSD symptoms compared to waiting-list controls, with effect sizes indicating moderate efficacy, particularly for EW+ and PTSD psychotherapies.

Despite the positive outcomes, the study highlights considerable variability in results and a risk of bias across the included trials, suggesting that more rigorous and well-designed studies are needed to draw definitive conclusions about the effectiveness of these writing interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparative efficacy and acceptability of expressive writing treatments compared with psychotherapy, other writing treatments, and waiting list control for adult trauma survivors: a systematic review and network meta-analysis. Gerger, H., Werner, CP., Gaab, J., et al.[2022]

Expressive writing, which involves disclosing thoughts and emotions about significant topics, has been shown to positively impact well-being and psychological health, particularly after stressful or traumatic events.

The effectiveness of expressive writing as a therapeutic intervention for posttraumatic stress disorder (PTSD) varies based on the structure and content of the writing, with mechanisms like emotion regulation and narrative construction playing key roles in its efficacy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Writing therapy after traumatic events: therapeutic approaches and mechanisms of change]. Knaevelsrud, C., Böttche, M.[2013]

Participants with mood disorders who engaged in expressive writing, positive writing, or control writing all reported significant improvements in mental and physical health symptoms for at least 4 months after the writing sessions.

Combining expressive and positive writing into an 'emotional writing group' resulted in significantly lower stress levels compared to the control group, suggesting that writing about emotions can be beneficial for mental health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Expressive writing and positive writing for participants with mood disorders: an online randomized controlled trial. Baikie, KA., Geerligs, L., Wilhelm, K.[2018]

The videoconferencing coach-guided expressive writing program significantly reduced grief intensity and improved sleep and social participation among 24 adults with spinal cord injury, with benefits maintained at a 1-month follow-up.

Participants who had sustained their spinal cord injuries within the last 5 years experienced greater reductions in emotional distress and improved social role participation compared to those with longer-standing injuries.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of a coach-guided video-conferencing expressive writing program on facilitating grief resolution in adults with SCI. Yuen, HK., Kamp, EV., Green, S., et al.[2023]

Therapeutic songwriting can help individuals with spinal cord injuries (SCI) improve their identity and subjective well-being, as shown in a six-week intervention with eight participants in a rehabilitation facility.

Participants with less severe injuries tended to have more positive identity trajectories, suggesting that songwriting may be particularly beneficial for those with milder injuries, highlighting the need for further research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Personal identity narratives of therapeutic songwriting participants following Spinal Cord Injury: A case series analysis. Roddy, C., Rickard, N., Tamplin, J., et al.[2023]

The Turkish version of the Hospital Anxiety and Depression Scale (HADS) is a reliable tool for screening anxiety and depression in individuals with spinal cord injury (SCI), with high reliability scores (Cronbach's alpha of 0.90 for anxiety and 0.77 for depression).

In a study of 175 individuals with traumatic SCI, 40% experienced anxiety and 28% experienced depression, highlighting the need for rehabilitation teams to assess emotional well-being and provide appropriate interventions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reliability of the Turkish version of the hospital anxiety and depression scale in the people with traumatic spinal cord injury. Paker, N., Bugdayci, D., Midik, M., et al.[2022]

Participants with incomplete spinal cord injuries reported significant bodily changes during loco-motor training (LT), highlighting challenges such as impaired proprioception and struggles for bodily control.

Despite these challenges, participants also experienced positive bodily sensations, which were interpreted as signs of recovery, fostering hope and motivation for continued rehabilitation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Locomotor training: experiencing the changing body. Hannold, EM., Young, ME., Rittman, MR., et al.[2019]

Involving individuals with spinal cord injury (SCI) in research is crucial, as their insights can help design effective healthcare interventions, particularly regarding their return to work.

The study revealed that while work can be rewarding for adults with SCI, significant barriers exist due to insufficient societal and workplace support, highlighting the need for personalized strategies to navigate their return to employment.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mapping Out One's Own Paths Toward Work: Focus on Experiences of Return to Work After Spinal Cord Injury. Holmlund, L., Hultling, C., Asaba, E.[2019]

References

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

The Effects of Expressive Writing Interventions for Patients With Cancer: A Meta-Analysis. [2017]

2. England pubmed.ncbi.nlm.nih.gov

Helping Yourself by Offering Help: Mediators of Expressive Helping in Survivors of Hematopoietic Stem Cell Transplant. [2019]

3. Switzerland pubmed.ncbi.nlm.nih.gov

Effects of Structured Expressive Writing on Quality of Life and Perceived Self-Care Self-Efficacy of Breast Cancer Patients Undergoing Chemotherapy in Central China: A Randomized Controlled Trial. [2023]

4. England pubmed.ncbi.nlm.nih.gov

Unexpected effects of expressive writing on post-disaster distress in the Hurricane Harvey Study: a randomized controlled trial in perinatal women. [2021]

5. England pubmed.ncbi.nlm.nih.gov

Expressive writing to improve resilience to trauma: A clinical feasibility trial. [2019]

6. England pubmed.ncbi.nlm.nih.gov

Comparative efficacy and acceptability of expressive writing treatments compared with psychotherapy, other writing treatments, and waiting list control for adult trauma survivors: a systematic review and network meta-analysis. [2022]

7. Germany pubmed.ncbi.nlm.nih.gov

[Writing therapy after traumatic events: therapeutic approaches and mechanisms of change]. [2013]

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

Expressive writing and positive writing for participants with mood disorders: an online randomized controlled trial. [2018]

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

Effects of a coach-guided video-conferencing expressive writing program on facilitating grief resolution in adults with SCI. [2023]

10. England pubmed.ncbi.nlm.nih.gov

Personal identity narratives of therapeutic songwriting participants following Spinal Cord Injury: A case series analysis. [2023]

11. Netherlands pubmed.ncbi.nlm.nih.gov

Reliability of the Turkish version of the hospital anxiety and depression scale in the people with traumatic spinal cord injury. [2022]

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

Locomotor training: experiencing the changing body. [2019]

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

Mapping Out One's Own Paths Toward Work: Focus on Experiences of Return to Work After Spinal Cord Injury. [2019]