Expressive Writing for Depression and Anxiety

(EWMS Trial)

Recruiting in Palo Alto (17 mi)

Overseen by Kelly L Harper, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Recruiting

Sponsor: VA Office of Research and Development

Must be taking: Psychotropic

Disqualifiers: Suicidal plan, Unstable mania, Psychosis, Severe substance use, Cognitive impairment

Trial Summary

What is the purpose of this trial?

Sexual minority stressors (e.g., sexual minority identity-based discrimination) contribute to greater risk for and severity of depression, anxiety, substance use disorders and suicide among sexual minority Veterans. However, no brief, scalable, one-on-one interventions targeting sexual minority stressor-related distress are available in Veterans Affairs (VA) for sexual minority Veterans. The proposed research will examine the feasibility, acceptability, and preliminary effectiveness of a brief, 3-session expressive writing intervention to target distress related to sexual minority stressor exposure among sexual minority Veterans. The results of this work will advance knowledge about a promising brief and easy to implement intervention focused on reducing depressive and anxiety symptoms among sexual minority Veterans. This proposal aligns with VA's and CSR\&D's commitment to providing equitable services to sexual minority Veterans and the aim of reducing health disparities among underserved Veteran groups.

Do I need to stop my current medications to join the trial?

The trial requires that participants be stable on their psychotropic medication for at least 4 weeks, so you do not need to stop taking your current medications if they are stable.

What data supports the effectiveness of the treatment Expressive Writing for Depression and Anxiety?

Research suggests that culturally-tailored writing interventions can help manage stress and improve mental health outcomes among African Americans by addressing justice and injustice, which may be relevant to the Expressive Writing treatment for depression and anxiety. ^{1 2 3 4 5}

Is expressive writing safe for humans?

The research articles provided do not contain specific safety data for expressive writing interventions, but generally, expressive writing is considered a low-risk activity for most people. ^{2 5 6 7 8}

How does the treatment Expressive Writing for Minority Stressors differ from other treatments for depression and anxiety?

Expressive Writing for Minority Stressors is unique because it involves writing about personal experiences related to minority stress, which can help reduce depression and anxiety by allowing individuals to process and express their emotions. Unlike traditional therapies that may involve direct interaction with a therapist, this treatment can be done privately and may be particularly beneficial for those who are socially inhibited or prefer not to engage in face-to-face therapy. ^{9 10 11 12 13}

Research Team

Kelly L Harper, PhD

Principal Investigator

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

Eligibility Criteria

This trial is for sexual minority Veterans experiencing significant depression or anxiety, who have faced discrimination due to their sexuality. They must score above 10 on specific mental health scales and identify as non-heterosexual. Those with severe substance use disorders, cognitive impairments, suicidal plans/intent, or unstable mania/psychosis cannot participate.

Inclusion Criteria

Participants must endorse clinically significant depressive or anxiety symptoms (score above 10 on the PHQ-9 or GAD-7)

Participants will be Veterans who identify as a sexual minority (i.e., identify as gay, lesbian, bisexual, pansexual, queer, or another identity other than heterosexual)

Participants must report a history of sexuality-based minority stressor exposure based on endorsement of at least one item on a modified version of the Everyday Discrimination Scale (EDS) that is contributing to distress per Veteran report ('yes' on EDS item 11)

Exclusion Criteria

Veterans with current substance use disorder, severe (assessed via the Structured Interview for DSM-5)

Veterans with clear and current suicidal plan and/or intent (assessed via the Columbia Suicide Severity Rating Scale)

Veterans with current presentation of unstable mania and/or psychosis (assessed via the Structured Interview for DSM-5)

Trial Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants undergo a 3-session expressive writing intervention targeting distress related to sexual minority stressors

3-4 weeks

3 sessions (in-person or remote)

Follow-up

Participants are monitored for safety and effectiveness after treatment

3 months

1 visit (in-person or remote)

Treatment Details

Interventions

• Expressive Writing on Minority Stressors (Behavioural Intervention)
• Neutral Writing (Behavioural Intervention)

Trial Overview The study tests a brief expressive writing intervention aimed at reducing distress from sexual minority stressors versus neutral writing. It involves three sessions designed for sexual minority Veterans to see if it can lessen symptoms of depression and anxiety.

Participant Groups

Group I: Expressive Writing on Minority Stressors Experimental Treatment 1 Intervention

The EWMS protocol will consist of 3 sessions delivered by a therapist (either in-person or remotely via telehealth platform) to sexual minority Veterans. The intervention will begin with an overview of the intervention, brief psychoeducation about expressive writing, and a review of the potential benefits of expressive writing. The initial session will also consist of psychoeducation on sexual minority stressors and common reactions to these stressors (i.e., universal stress reactions and minority-identity specific reactions) and how this relates to psychological outcomes, such as depression and anxiety, and high-risk behaviors, such as substance use and suicidal ideation. The initial session will be 60 minutes (introduction, psychoeducation, and first writing exercise) and the following two sessions (feedback, writing exercises, and check-ins) will take approximately 40 minutes.

Group II: Neutral Writing Placebo Group 1 Intervention

To be comparable to EWMS, the control intervention will also be a 3-session individual intervention involving engaging in a writing exercise per session. For the control writing exercises, participants will be asked to write for 30 minutes about their daily activities since waking up that day based on Pennebaker's standard writing paradigm (Pennebaker \& Beall, 1987). Individuals in the control condition will also be given information about the purpose of the writing exercises to be comparable to the psychoeducation information provided in EWMS. Similar to EWMS, the clinician will check in with the participant about the writing session, such as asking how the session went and how it felt to do the writing, following the 30 minutes of writing.

Find a Clinic Near You

Research Locations Nearby Select from list below to view details:

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA Boston, MA

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1691

Patients Recruited

3,759,000+

Findings from Research

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

How Racism "Gets Under the Skin": An Examination of the Physical- and Mental-Health Costs of Culturally Compelled Coping. Brownlow, BN.[2023]

The study developed two brief writing interventions focused on justice and injustice, showing that these prompts can significantly influence how African Americans respond to acute social stress, particularly during a stress test.

Results indicated that men benefited from the personal justice-only condition with improved emotional responses and lower blood pressure reactivity, while women showed more negative emotional responses and poorer performance, highlighting the need to consider gender differences in stress coping strategies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Writing about justice and injustice: Complex effects on affect, performance, threat, and biological responses to acute social stress among african American women and men. Lucas, T., Yamin, JB., Krohner, S., et al.[2023]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Digital Music-Based Mindfulness Intervention ("healing attempt") for Race-Based Anxiety in Black Americans. Jones, G., Castro-Ramirez, F., McGuire, T., et al.[2023]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

EMBRace: Developing a Racial Socialization Intervention to Reduce Racial Stress and Enhance Racial Coping among Black Parents and Adolescents. Anderson, RE., McKenny, MC., Stevenson, HC.[2023]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

An Evidence-Based Approach for Treating Stress and Trauma due to Racism. Williams, MT., Holmes, S., Zare, M., et al.[2023]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Outcomes of People of Color in an Efficacy Trial of Cognitive-Behavioral Treatments for Anxiety, Depression, and Related Disorders: Preliminary Evidence. Cardona, ND., Ametaj, AA., Cassiello-Robbins, C., et al.[2023]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Posttraumatic stress disorder in African American and Latinx adults: Clinical course and the role of racial and ethnic discrimination. Sibrava, NJ., Bjornsson, AS., Pérez Benítez, ACI., et al.[2022]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Mitigating the health effects of systemic racism: Evaluation of the Race-Based Stress and Trauma Empowerment intervention. Wang, C., Malaktaris, A., McLean, CL., et al.[2023]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Efficacy of expressive writing versus positive writing in different populations: Systematic review and meta-analysis. Lai, J., Song, H., Wang, Y., et al.[2023]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Benefits of expressive writing in lowering rumination and depressive symptoms. Gortner, EM., Rude, SS., Pennebaker, JW.[2022]

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]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Online writing about positive life experiences reduces depression and perceived stress reactivity in socially inhibited individuals. Allen, SF., Wetherell, MA., Smith, MA.[2020]

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of culturally adapted expressive writing interventions on depressive and anxiety symptoms among Chinese American breast cancer survivors: A randomized controlled trial. Lu, Q., Yeung, NCY., Tsai, W., et al.[2023]

References

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

How Racism "Gets Under the Skin": An Examination of the Physical- and Mental-Health Costs of Culturally Compelled Coping. [2023]

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

Writing about justice and injustice: Complex effects on affect, performance, threat, and biological responses to acute social stress among african American women and men. [2023]

3. Canada pubmed.ncbi.nlm.nih.gov

A Digital Music-Based Mindfulness Intervention ("healing attempt") for Race-Based Anxiety in Black Americans. [2023]

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

EMBRace: Developing a Racial Socialization Intervention to Reduce Racial Stress and Enhance Racial Coping among Black Parents and Adolescents. [2023]

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

An Evidence-Based Approach for Treating Stress and Trauma due to Racism. [2023]

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

Outcomes of People of Color in an Efficacy Trial of Cognitive-Behavioral Treatments for Anxiety, Depression, and Related Disorders: Preliminary Evidence. [2023]

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

Posttraumatic stress disorder in African American and Latinx adults: Clinical course and the role of racial and ethnic discrimination. [2022]

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

Mitigating the health effects of systemic racism: Evaluation of the Race-Based Stress and Trauma Empowerment intervention. [2023]

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

Efficacy of expressive writing versus positive writing in different populations: Systematic review and meta-analysis. [2023]

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

Benefits of expressive writing in lowering rumination and depressive symptoms. [2022]

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

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

12. Ireland pubmed.ncbi.nlm.nih.gov

Online writing about positive life experiences reduces depression and perceived stress reactivity in socially inhibited individuals. [2020]

13. England pubmed.ncbi.nlm.nih.gov

The effects of culturally adapted expressive writing interventions on depressive and anxiety symptoms among Chinese American breast cancer survivors: A randomized controlled trial. [2023]