The purpose of this study was to assess empirically the effectiveness of writing therapy with patients in a psychiatric hospital.

An impressive body of research indicates expressive writing (Pennebaker & Beall, 1986) produces physiological and psychological benefits. One study found that expressive writing decreases depressive symptoms among formerly depressed college students (Gortner, Rude, & Pennebaker, 2006). Gortner et al. (2006) argue that expressive writing may produce changes by reducing negative evaluations of emotional experiences and self-judgment, often associated with depression, through instructions encouraging participants to delve into their “deepest thoughts and feelings.” In other words, the standard writing instructions appear to send an implicit message that individuals be accepting and non-judgmental towards emotions and cognitions. The mindfulness literature suggests that making this message explicit may improve the preventative power of expressive writing in depression-vulnerable populations (Baer, 2003; Kingston, Dooley, Bates, Lawlor, & Malone, 2007; Teasdale et al., 2000; Toneatto & Nguyen, 2007). Therefore, the specific goal of the present study was to examine the effects of a mindfulness-enhanced expressive writing intervention among depression-prone individuals. Depression-vulnerable participants (e.g., dysphoric or formerly depressed) were randomly assigned to one of three groups. Although writing instructions varied for each group, all participants wrote for 20 minutes across a three-day period. The mindfulness condition received writing instructions that encouraged participants to be non-judgmental, accepting, and self-compassionate as they wrote about distressing events. Participants in the traditional writing condition received standard writing instructions, which consisted of writing about their deepest thoughts and feelings related to an emotional incident. Finally, students in the control condition were instructed to write about what they did the previous day. Results showed marginally significant decreases in depressive symptoms among participants in the mindfulness group compared to the control condition. In addition, results indicated that low suppressive depression-vulnerable individuals in the mindfulness condition marginally improved their cognitive processing biases compared to their counterparts in the traditional and control groups. Results failed to support hypotheses that predicted improvements on self-compassion, rumination, and mindfulness skills. Further, self-compassion was not found to mediate the effects of treatment on depressive symptoms and rumination. Obviously more research needs to be conducted, however preliminary results suggest that brief mindfulness interventions may be beneficial for a depression-vulnerable population. / text

Effective writing rehabilitation for people with acquired dysgraphia following a stroke could lead to more opportunities to communicate, reduce isolation and improve quality of life. Previous research has suggested that both impairment-focused spelling therapies and assistive technologies can support writing rehabilitation, although the strength of the evidence is limited. The central aim of this PhD study was to investigate whether a combined approach to writing therapy, including impairment-based therapies and assistive technologies, could improve the email writing of participants with varying severity of acquired dysgraphia. An email writing assessment was developed for outcome measurement and data from 42 control participants were collated to determine the neuro-typical range of email writing performance on this task. A within-participants, multiple case design was used to evaluate the effects of two different approaches to therapy with participants with dysgraphia. In the first study, two impairment-based therapies (uni-modal and multi-modal) were compared with eight participants with dysgraphia and the effects of these on spelling accuracy of treated and untreated words were measured. The functional outcomes (email writing, written picture description, writing frequency and perception of disability) of these therapies were also investigated in a second study. The third study evaluated the effects of training eight participants with dysgraphia (six of whom had participated in the first two studies) to use an assistive writing technology for functional writing. There was a wide range of performance in neuro-typical participants on email writing, with both age and education emerging as determinants of performance. Within the clinical studies, there were no significant differences between uni-modal and multi-modal therapies with respect to spelling accuracy, but these lexical therapies led to significant improvements to accuracy of treated and untreated words, written picture description and word length within emails. Training and use of assistive writing software resulted in significant improvements in spelling accuracy and word length within emails. All participants with dysgraphia showed some responsiveness to intervention. Both impairment-based and compensatory approaches to writing rehabilitation were found to have benefit, although the effects varied across participants and outcome measures. This study has highlighted the need for further research into assessments and therapies for writing in aphasia, specifically focusing on candidacy for specific approaches to writing rehabilitation.

Past research indicates a causal relationship between emotional writing and health benefits (Smyth, 1998). At present, little is known about the mechanisms underlying change or if the emotional writing paradigm may be applied to a clinical setting. This present study reviewed current models of trauma and hypothesised three mechanisms of change leading to future health benefits: exposure, devaluation, and benefit-finding. Instructions for the standard writing paradigm were manipulated to isolate and increase engagement with each of these processes. It was hypothesised that if any one of these processes were to underlie health benefits, participants assigned to that condition would obtain more benefit than standard writing participants. Individual differences were also hypothesised to interact with each process to amplify or detract from their influence in leading to future benefit. A total of 201 university students were recruited from Griffith University. Participants were assigned to one of five writing conditions: Control, Standard, Exposure, Devaluation, and Benefit-Finding. Sessions were conducted once a week for three weeks. Physiological and self-report measures were taken before, during and after writing sessions. Follow-up assessments of psychological and physical health were taken at 2 and 6-months post-writing. Essay content analysis suggested that participants wrote in the instructed manner. Participants assigned to each of the groups experienced expected amounts of distress and affect changes. Overall, results failed to replicate the beneficial health effects for the standard emotional writing paradigm. There were no significant physical or psychological benefits for the standard trauma-writing participants in comparison to control. However, a trend in the appropriate direction was noted for illness visits at 6-months. Furthermore, in support of Greenberg and Stone's (1992) findings, standard writing participants who disclosed more severe and personal experiences evidenced significant illness visit reductions in comparison to control. Comparisons between standard and experimental trauma writing groups failed to support hypotheses that any one mechanism was responsible for physical health benefits. Examination of psychological self-report measures indicated exposure participants experienced the greatest reduction on the Impact of Events Scale at two months. However, these participants experienced greater reduction of positive affect and growth for the experience. They also became more anxious, depressed, and stressed at six-months follow-up. Process variables were examined within the exposure condition to explain these findings. Habituation was found to be strongly associated with the alternate outcomes. Individual differences. Including alexithymia, absorption, and negative affect, were also related to outcome. Benefit-finding participants experienced the greatest increase on a measure of post-traumatic growth at two-months and positive affect for the experience, but the finding was significant only in comparison to exposure and devaluation groups. The results of this study failed to identify the process of change, but suggest specific areas for future research. The findings demonstrate the importance of comprehensive health research to avoid blanket statements that suggest a paradigm either does or does not lead to health benefits. The results also support the manipulation of the writing paradigm to examine the role of emotion processing in trauma and health research.

Made available in DSpace on 2016-04-28T20:38:59Z (GMT). No. of bitstreams: 1 Divina de Fatima dos Santos.pdf: 3004508 bytes, checksum: c79cae78c782bb49ee526add52bbe8e7 (MD5) Previous issue date: 2015-03-09 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This thesis analyzed the benefits of an exchange of letters between very different generations, investigating how the act of writing about events of everyday life may be associated with a better self perception of the participants in the process. We try to understand the meaning of an exchange of letters occurred between children and elderly people, in the city of Caraguatatuba, on the northern coast of São Paulo, and its effects on their subjectivities. The study analyzed the participation of eight pairs, each one consisted of a student from the 4th or 5th year of a Primary School and aged between 9 and 11 years, and an elderly, over 60 years of age, from a Reference Center for the Elderly, in 2011 and 2012. Its specific objectives were: to identify whether the words written and exchanged between children and the elderly promote moments of gratification and joy, as well as opportunities to see themselves in the world; to provide and to analyze moments of social interaction between participants, thereby contributing to the construction of a memory about this experience and stage of their lives; to promote the opportunity for inter-relationship, providing both for the child and for the elderly a sense of social inclusion; to create in the participants alternatives of self-expression, validating their experiences of social sharing. A qualitative research was made with letters and questionnaires used as instruments and considered from the perspective of content analysis focused on meanings, and this strategy was methodologically complemented by participant observation. The experience of an exchange of letters produced positive psychological effects for its participants, both immediate and remote, by contributing to the expansion of the view about the world and themselves. For the elderly, expanding the memory of significant experiences, associated with written records and the possibility of using them in moments of weakness, produced psychological benefits that were observed by the research. The experience of living positive emotions brought comfort to the aging process because it attenuated to the old people the perception of social exclusion and loneliness, by reviving the feeling of usefulness and social inclusion, by providing a real life experience and by meeting the needs of this phase of life. The possibility of self-expression also favored the maturation and psychosocial development of children, as the correspondence produced an interlocutor that listen carefully and seek to understand the demands that are specific to childhood / Esta tese analisou os benefícios da troca de cartas entre gerações muito distintas, investigando o quanto o ato de escrever sobre acontecimentos da vida cotidiana pode estar associado a uma melhor autopercepção dos participantes do processo. Procurou-se compreender o significado de uma troca de correspondências ocorrida entre crianças e idosos, residentes na cidade de Caraguatatuba, no litoral norte de São Paulo, e os seus efeitos sobre suas subjetividades. O trabalho analisou a participação de oito duplas, cada uma composta por um aluno do 4º ou 5º ano de uma Escola de Ensino Fundamental e com idade entre 9 e 11 anos, e por um idoso, acima dos 60 anos, de um Centro de Referência para Idosos, nos anos de 2011 e 2012. Seus objetivos específicos foram: identificar se as palavras escritas e trocadas entre crianças e idosos promovem momentos de gratificação e alegria, bem como oportunidades de se perceberem no mundo; propiciar e analisar os momentos de interação social existentes entre os interlocutores, contribuindo assim para a construção de uma memória sobre esta experiência e fase de suas vidas; promover a oportunidade de inter-relação, propiciando tanto para a criança quanto para o idoso a sensação de inserção social; criar nos interlocutores alternativas de autoexpressão, validando suas experiências pela partilha social. Foi feita uma pesquisa qualitativa, com cartas e questionários utilizados como instrumentos e considerados sob a perspectiva da análise de conteúdo focada em significados, estratégia esta que foi complementada metodologicamente pela observação participante. A experiência de troca de cartas produziu efeitos psicológicos positivos para seus participantes, tanto imediatos quanto remotos, ao contribuir para a ampliação da visão acerca do mundo e de si mesmos. Para os idosos, a ampliação da memória de experiências significativas, associada ao seu registro escrito e à possibilidade de recorrer a ele em momentos de fragilidade, produziu benefícios psicológicos que foram observados pela investigação. A experiência de viver emoções positivas trouxe conforto para o processo de envelhecimento na medida em que atenuou para o idoso a percepção de exclusão social e de solidão, ao lhe reavivar a sensação de utilidade e inserção social, ao oferecer uma experiência de vida real e ao atender às necessidades desta fase da vida. A possibilidade de autoexpressão favoreceu também o amadurecimento e o desenvolvimento psicossocial de crianças, pois a troca de correspondências produziu um interlocutor que as ouvisse com atenção e que procurasse compreender as demandas que são específicas da infância

Background: Postnatal PTSD affects between 1 and 6% of women, whereas 30% are partially symptomatic. The mental health of new mothers is of public health concern as it could affect the marital relationship and the behavioural and emotional health of children. Little research has explored emotional regulation difficulties as predictors for postnatal PTSD. Treatments such as Cognitive Behavioural Therapy (CBT) have long waiting list times and may be hard to access for new mothers. Aim: The relationship between key predictors especially those associated with emotional regulation and PTSD in postnatal women was investigated. The feasibility of using internet based writing therapy for women with postnatal PTSD was assessed. Exploration of women's views about writing therapy as a therapeutic tool and their lived experience of PTSD was undertaken. Methods: Two literature reviews were conducted; firstly to identify the types of therapy previously used for women with postnatal PTSD, secondly to identify necessary conditions for effective writing therapy. The quantitative phase used measures for key predictors of PTSD and incorporated a feasibility study for a writing intervention. Regression analysis for a variety of predictors and PTSD and general and psychological health was conducted on data from 211 women. In the qualitative phase narrative analysis was used on interview transcripts from seven non-writers exploring access to writing and their experience of PTSD. An in depth case study was conducted on a woman who participated in the intervention and who was interviewed. Findings: The quantitative phase showed that planning the pregnancy; whether the baby slept or fed as expected; maternal confidence; past trauma; attachment patterns; self-efficacy; social support and partner support correlated with PTSD. However, the pain component of the birth experience mediated the effect of affects and alexithymia on general and psychological health. Most women did not access writing therapy. The qualitative phase showed that complicating factors and relationships with staff and mothers affect women's experience of PTSD and their view of themselves. Social media was used by women for support. Conclusion: Emotion regulation difficulties could impact postnatal mental health. Antenatal screening for alexithymia may be useful. Women value good relationships with staff during labour. The role of social media for postnatal mental health support should be investigated.

This exploratory and descriptive investigation used the case study as research strategy to indi cate how writing may be used as a specialised form of therapy for an adolescent in the phase of mid-adolescence. The study researched and consolidated a body of knowledge concerning writing in a therapeutic context, while highlighting the Gestalt therapeutic approach. Its empirical integration culminated in a method for the use of therapists who irrespective of their therapeutic orientation wish to apply writing in therapy with adolescents. The dissertation argues that writing practised from a Gestalt therapeutic perspective should move gradually from being a tool of self-expression to becoming one of self-nurturing. It should guide the client through a process of self-regulation to a point of self-support. In such a process, writing in therapy will evolve into writing as therapy, a therapy practised by the client her- or himself as a means of achieving equilibrium. / Social Work / M. Diac. (Play Therapy)

This exploratory and descriptive investigation used the case study as research strategy to indi cate how writing may be used as a specialised form of therapy for an adolescent in the phase of mid-adolescence. The study researched and consolidated a body of knowledge concerning writing in a therapeutic context, while highlighting the Gestalt therapeutic approach. Its empirical integration culminated in a method for the use of therapists who irrespective of their therapeutic orientation wish to apply writing in therapy with adolescents. The dissertation argues that writing practised from a Gestalt therapeutic perspective should move gradually from being a tool of self-expression to becoming one of self-nurturing. It should guide the client through a process of self-regulation to a point of self-support. In such a process, writing in therapy will evolve into writing as therapy, a therapy practised by the client her- or himself as a means of achieving equilibrium. / Social Work / M. Diac. (Play Therapy)