Elsevier

Journal of Affective Disorders

Volume 150, Issue 3, 25 September 2013, Pages 1148-1151
Journal of Affective Disorders

Preliminary communication
An everyday activity as a treatment for depression: The benefits of expressive writing for people diagnosed with major depressive disorder

https://doi.org/10.1016/j.jad.2013.05.065Get rights and content

Abstract

Background

The benefits of expressive writing have been well documented among several populations, but particularly among those who report feelings of dysphoria. It is not known, however, if those diagnosed with Major Depressive Disorder (MDD) would also benefit from expressive writing.

Methods

Forty people diagnosed with current MDD by the Structured Clinical Interview for DSM-IV participated in the study. On day 1 of testing, participants completed a series of questionnaires and cognitive tasks. Participants were then randomly assigned to either an expressive writing condition in which they wrote for 20 min over three consecutive days about their deepest thoughts and feelings surrounding an emotional event (n=20), or to a control condition (n=20) in which they wrote about non-emotional daily events each day. On day 5 of testing, participants completed another series of questionnaires and cognitive measures. These measures were repeated again 4 weeks later.

Results

People diagnosed with MDD in the expressive writing condition showed significant decreases in depression scores (Beck Depression Inventory and Patient Health Questionnaire-9 scores) immediately after the experimental manipulation (Day 5). These benefits persisted at the 4-week follow-up.

Limitations

Self-selected sample.

Conclusions

This is the first study to demonstrate the efficacy of expressive writing among people formally diagnosed with current MDD. These data suggest that expressive writing may be a useful supplement to existing interventions for depression.

Introduction

Expressive writing is a technique whereby individuals engage in deep and meaningful writing about a traumatic or troubling event (Pennebaker and Beall, 1986). Over the past 25 years, a vast literature has documented robust physical and psychological benefits associated with expressive writing among several populations (e.g., undergraduate students, inmates, victims of partner abuse), that extend up to 6 months following intervention (Gortner et al., 2006, Koopman et al., 2005, Pennebaker and Francis, 1996, Richards et al., 2000). Compared to groups assigned to write about trivial or non-traumatic events, people who engage in expressive writing experience reduced medical visits (Pennebaker and Francis, 1996), improvements in immune function (Pennebaker et al., 1988), increases in antibody production (Petrie et al., 1995), increases in psychological wellbeing (Lepore, 1997, Murray and Segal, 1994) reduced anxiety (Sloan et al., 2005, Sloan et al., 2007), and reduced depressive symptoms among both control and psychologically at-risk populations (Gortner et al., 2006, Graf et al., 2008, Koopman et al., 2005, Pennebaker and Chung, 2011, Sloan and Marx, 2004, Sloan et al., 2005, Sloan et al., 2007, Sloan et al., 2008, Stice et al., 2007). Of particular interest is that the mood-related benefits of expressive writing seem to be particularly notable among people who report higher levels of depression and anxiety (Baikie et al., 2012, Gortner et al., 2006, Koopman et al., 2005, Sloan et al., 2007). For example, women with high baseline depression, people scoring highly on suppression measures, and people who are likely to be suffering from mood disorders, especially benefit from expressive writing (Baikie et al., 2012, Gortner et al., 2006, Koopman et al., 2005). At this time, however, there has been no research examining the therapeutic qualities of expressive writing among people who have been formally diagnosed with current Major Depressive Disorder (MDD). The potential value of expressive writing as a supplement for existing treatments for depression is significant. Expressive writing is an activity that could be implemented by most any willing participant. Moreover, it is grounded in a rigorous, and comprehensive scientific tradition (Klein and Boals, 2001, Pennebaker and Beall, 1986, Sloan and Marx, 2004, Sloan et al., 2005). The sizable and meaningful effects observed in other populations (Smyth, 1998) suggest that expressive writing may well be an effective, time- and cost-efficient therapy to supplement existing treatments for depression (see Kazdin and Blase, 2011).

The purpose of this study was to determine if people diagnosed with current MDD would benefit from expressive writing just as non-clinical populations have been shown to benefit in the past. In addressing this question, the dependent measure we focused on was change in depressive symptoms over time—precisely the outcome that one would hope to see an effective intervention for depression influence over time. We tested whether three consecutive days of expressive writing would significantly reduce depression as indexed by the Beck Depression Inventory (BDI; Beck et al., 1996) and the Patient Health Questionnaire-9 (PHQ; Spitzer et al., 1999), two canonical and widely used measures of depressive symptoms.

Section snippets

Participants

Forty-four people diagnosed with current MDD were recruited for the study. Four participants (3 in the expressive group and 1 in the control group) dropped out of the study before its completion, leaving a total of 20 participants in each group. Twenty people were randomly assigned to the Expressive Writing (EW) group (15 females, 5 males, mean age=28 years), and 20 to the Control Writing (CW) group (16 females, 4 males, mean age=29 years). Data on ethnicity and socioeconomic status was not

BDI

Relative to people in the CW condition, people in the EW group showed decreases in BDI depression scores immediately post test, and at 4-weeks post intervention. As seen in Fig. 1, repeated measures ANOVA on BDI scores revealed a significant effect of Time F(2, 38)=10.16, p<.001, ηp2=.21, and Condition F(1, 38)=6.41, p=.02, ηp2=.14, but no significant Interaction (F=1.03, p=.36). To further investigate the effect of time, repeated measures ANOVAs were run separately for the EW and CW groups.

Discussion

To our knowledge, this is the first study to examine the effects of expressive writing among people formally diagnosed with current Major Depressive Disorder. It was unclear a priori whether having people write expressively and explore their private thoughts and feelings would reduce depressive symptoms, as it does in populations of dysphoric individuals, or propel the ruminative process and worsen the depression. Consistent with earlier work, expressive writing reduced depression scores among

Role of funding source

This work was supported by NIMH grant MH060665 to John Jonides. This work was also supported by the University of Michigan Advanced Rehabilitation Research Training Program (Grant #H133P090008) funded by the National Institute on Disability Rehabilitation Research (NIDRR), Office of Special Education and Rehabilitation Services (OSERS) of the U.S. Department of Education, Washington, DC. The grants were used to pay the post-doctoral fellow's stipend (Katherine M. Krpan), research assistants’

Conflict of interest

The authors’ have no conflicts of interest to report.

Acknowledgments

We would especially like to thank all the people who participated in the study. We also thank Alexa Erickson and Catherine Cherny for their help with data collection; Sue Li for her help in processing data; Phillip Cheng, Hyang Sook Kim, Teresa Nguyen and Savanna Mueller for diagnostic interviewing.

References (23)

  • S.J. Lepore

    Expressive writing moderates the relation between intrusive thoughts and depressive symptoms

    Journal of Personality and Social Psychology

    (1997)
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