Comparing Targets of Expressive Writing

Expressive writing involves writing about one's deepest thoughts and feelings surrounding an emotional event. The current literature on the efficacy of expressive writing is mixed and warrants further investigation into how, when, and for whom expressive writing is an effective intervention. The goal of this study is to compare the efficacy of expressive writing interventions in young adults when people imagine that they're writing to themselves vs. a loved one. Participants will carry out an expressive writing exercise for 14 consecutive days. Participants are randomized into 3 groups: Self, Other, and Control. The Self group is instructed to write as if they were talking to themselves. The Other group is instructed to direct their writing to someone they feel close to. The Control group is asked to write down a factual description of their routine that day, and direct this writing to themselves. We will recruit participants until we have usable data from 53 participants per group (i.e., 159 in total).

Study Overview

• Status: Recruiting
• Conditions: Depression; Healthy; Anxiety
• Intervention / Treatment: Behavioral: Expressive Writing: Self; Behavioral: Expressive Writing: Other; Behavioral: Factual Writing

• Study Type: Interventional
• Enrollment (Estimated): 159
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Claire Whiting, MRes; Phone Number: (609) 258-5064; Email: lemolab@princeton.edu

Study Locations

• United States
  • New Jersey
    • Princeton, New Jersey, United States, 08540
      • Recruiting
      • Peretsman Scully Hall
      • Contact: Claire Whiting, MRes; Email: claire.whiting@princeton.edu
      • Sub-Investigator: Claire Whiting, MRes
      • Principal Investigator: Erik Nook, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• US-based
• Fluent English
• Combined GAD-7 and PHQ-8 score of ≥ 5

Exclusion Criteria:

• "Completion" of a writing session requires participants to spend at least 15 minutes on the writing page. We will monitor completion of the daily writing exercise, and will contact participants who miss or spend less than 15 minutes on the exercise. Participants who fail to complete 3 consecutive daily writing sessions will be deemed non-compliant, removed from the study, and paid a prorated amount for the tasks they have completed in the study.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Self; The Self group is instructed to carry out the expressive writing exercise as if they were writing to themselves.	Behavioral: Expressive Writing: Self; This intervention consists of a daily expressive writing exercise carried out for 14 consecutive days, for 15 minutes each day. Expressive writing involves asking participants to write about their deepest thoughts and feelings surrounding an emotional event. Participants in this condition will write as if they are writing to themselves.
Experimental: Other; The Other group is instructed to carry out the expressive writing exercise as if they were writing to someone they feel close to.	Behavioral: Expressive Writing: Other; This intervention consists of a daily expressive writing exercise carried out for 14 consecutive days, for 15 minutes each day. Expressive writing involves asking participants to write about their deepest thoughts and feelings surrounding an emotional event. Participants in this condition will write as if they are writing/talking to someone they're close to.
Placebo Comparator: Control; The Control group is asked to write down a factual description of their routine that day, as if they were writing to themselves.	Behavioral: Factual Writing; This intervention consists of a daily factual writing exercise carried out for 14 consecutive days, for 15 minutes each day. Participants are asked to give a factual description of their day. This is a standard control for Expressive writing studies. Participants in this condition will be asked to direct their writing to themselves.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Anxiety	Generalized Anxiety Disorder-7 (GAD-7). Scores range from 0-21, with higher scores indicating more severe anxiety.	Initial visit (day 1), mid-point (day 7) final visit (day 15), 1-month follow-up (1 month after day 14)
Depression	Patient Health Questionnaire-8 (PHQ-8). Scores range from 0-24, with higher scores indicating more severe depression.	Initial visit (day 1), mid-point (day 7), final visit (day 15), 1-month follow-up (1 month after day 14)

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Sleep Quality	Pittsburgh Sleep Quality Index (PSQI). Total scores range from 0-21, with higher scores indicating poorer sleep quality.	Initial visit (day 1), final visit (day 15), 1-month follow-up (1 month after day 14)
Depression, Anxiety, and Stress	Depression, Anxiety, and Stress-21 (DASS-21). Scores for each of the three subscales range from 0-42, with higher scores indicating greater severity.	Initial visit (day 1), final visit (day 15), 1-month follow-up (1 month after day 14)
Alexithymia (TAS)	Toronto Alexithymia Scale-20 (TAS-20). Scores range from 20-100, with higher scores indicating greater alexithymia.	Initial visit (day 1), final visit (day 15), 1-month follow-up (1 month after day 14)
Alexithymia (PAQ)	Perth Alexithymia Questionnaire (PAQ). Total scores range from 24-168, with higher scores indicating greater alexithymia.	Initial visit (day 1), final visit (day 15), 1-month follow-up (1 month after day 14)
Emotion Regulation	Emotion Regulation Questionnaire (ERQ). Scores for the reappraisal and suppression subscales range from 6-42 and 4-28 respectively. Higher scores indicate greater use of the strategy.	Initial visit (day 1), final visit (day 15), 1-month follow-up (1 month after day 14)
Interpersonal Regulation	Interpersonal Regulation Questionnaire (IRQ). Total scores range from 16-112, with higher scores indicating greater tendency to use/efficacy of interpersonal emotion regulation.	Initial visit (day 1), final visit (day 15), 1-month follow-up (1 month after day 14)
Social Desirability	Marlow-Crowne Social Desirability Scale (MC-SDS). Scores range from 0-33, with higher scores indicating greater social desirability.	Initial visit (day 1), final visit (day 15), 1-month follow-up (1 month after day 14)
Social Connectedness	Social Connectedness Scale (SCS). Scores range from 8-48, with higher scores indicating greater connectedness to others.	Initial visit (day 1), final visit (day 15), 1-month follow-up (1 month after day 14)
Daily Sleep	Consensus Sleep Diary (CSD). Items are used to derive estimates of sleep indices, such as time in bed and total sleep time.	Daily from day 1 to day 14
Sleepiness	Karolinska Sleepiness Scale (KSS). Scores on this single-item scale range from 1-10, with higher scores indicating greater sleepiness.	Daily from day 1 to day 14

Collaborators and Investigators

• Sponsor: Trustees of Princeton University
• Investigators: Principal Investigator: Erik Nook, PhD, Princeton University

Publications and helpful links

General Publications

• Pennebaker JW, Beall SK. Confronting a traumatic event: toward an understanding of inhibition and disease. J Abnorm Psychol. 1986 Aug;95(3):274-81. doi: 10.1037//0021-843x.95.3.274. No abstract available.

Study record dates

Study Major Dates

• Study Start (Estimated): November 1, 2023
• Primary Completion (Estimated): November 1, 2024
• Study Completion (Estimated): November 1, 2024

Study Registration Dates

• First Submitted: November 6, 2023
• First Submitted That Met QC Criteria: November 6, 2023
• First Posted (Actual): November 13, 2023

Study Record Updates

• Last Update Posted (Actual): November 15, 2023
• Last Update Submitted That Met QC Criteria: November 13, 2023
• Last Verified: November 1, 2023

More Information

Terms related to this study

• Keywords: mental health; expressive writing; journaling
• Additional Relevant MeSH Terms: Behavioral Symptoms; Depression
• Other Study ID Numbers: Princeton15734

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Upon study completion, a subset of the de-identified data will be transferred to OSF, which will provide public access to this data. Writing content will not be transferred to OSF, though we will make thoroughly de-identified data available to researchers who have completed appropriate ethics training, agree to confidentiality restrictions, and whose research goals are in line with the purpose of this study.
• IPD Sharing Time Frame: Beginning after publication of results with no end date.
• IPD Sharing Access Criteria: A subset of the de-identified data will be publicly available on the OSF.
• IPD Sharing Supporting Information Type: SAP; ANALYTIC_CODE

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No