Situations associated with admission to an acute care inpatient psychiatric unit.

This study examined whether stressful events occurred during the week preceding admission to an inpatient psychiatric unit in a sample of 97 adults with serious mental illness. The study also examined whether patients who had been readmitted within 30 days reported different stressful events than patients who had lived in the community for at least 6 months prior to admission. A structured interview was developed to obtain information about depressive and psychotic symptoms, stressful events, substance use, and aggressive and disruptive behaviors. Suicide risk was the most common reason for hospitalization (65%). Between 25% and 38% of patients reported interpersonal problems with family members or people outside their family, and about 50% reported financial problems immediately before hospitalization. Comparison of patients who had been readmitted within 30 days with patients who had been living in the community for at least 6 months since their last hospitalization found few differences between these groups. Results indicate that most patients were admitted to an inpatient psychiatric unit because of suicide risk, and interpersonal events seemed to precipitate hospital admission for these patients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expressive writing for gay-related stress: Psychosocial benefits and mechanisms underlying improvement.

Objective: This study tested the effectiveness of an expressive writing intervention for gay men on outcomes related to psychosocial functioning. Method: Seventy-seven gay male college students (mean age = 20.19 years, SD = 1.99) were randomly assigned to write for 20 min a day for 3 consecutive days about either (a) the most stressful or traumatic gay-related event in their lives or (b) a neutral topic. We tested an exposure-based hypothesis of written emotional expression by asking half of the participants who were assigned to write about gay-related stress to read their previous day’s narrative before writing, whereas the other half did not. Posttest and 3-month follow-up outcomes were assessed with common measures of overall psychological distress, depression, physical health symptoms, and positive and negative affect. Gay-specific social functioning was assessed with measures of gay-related rejection sensitivity, gay-specific self-esteem, and items regarding openness and comfort with one’s sexual orientation. Results: Participants who wrote about gay-related stress, regardless of whether they read their previous day’s writing, reported significantly greater openness with their sexual orientation 3 months following writing than participants who wrote about a neutral topic, F(1, 74) = 6.66, p     

Individual differences in memory associations involving the positive and negative outcomes of alcohol use.

In previous studies of memory association and alcohol use, the authors found that positive outcomes of drinking were associated in memory with alcohol concepts among heavier drinkers. The present study examined whether previous alcohol use predicted associative memory responses to negative, as well as positive, outcomes of drinking. It also examined whether the normative frequency of positive and negative outcomes affected responses. In the present sample of 609 students, previous alcohol use, normative frequency of outcome, and the number of outcomes listed strongly predicted alcohol-related associative responses to positive outcomes and, to a lesser extent, negative outcomes. The results suggest that repetitive alcohol use strengthens the association in memory between alcohol concepts and both positive and negative outcomes. However, thoughts about potential positive outcomes may be more readily cued by situational factors and events. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Further Examination of the Exposure Model Underlying the Efficacy of Written Emotional Disclosure.

In the current study, the authors examined the effects of systematically varying the writing instructions for the written emotional disclosure procedure. College undergraduates with a trauma history and at least moderate posttraumatic stress symptoms were asked to write about (a) the same traumatic experience, (b) different traumatic experiences, or (c) nontraumatic everyday events across 3 written disclosure sessions. Results show that participants who wrote about the same traumatic experience reported significant reductions in psychological and physical symptoms at follow-up assessments compared with other participants. These findings suggest that written emotional disclosure may be most effective when individuals are instructed to write about the same traumatic or stressful event at each writing session, a finding consistent with exposure-based treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analysis of single subject design writing intervention research.

There is considerable concern that students do not develop the writing skills needed for school, occupational, or personal success. A frequent explanation for this is that schools do not do a good job of teaching this complex skill. A recent meta-analysis of true- and quasi-experimental writing intervention research (S. Graham & D. Perin, 2007a) addressed this issue by identifying effective instructional writing practices. The current review extends this earlier work by conducting a meta-analysis of single subject design writing intervention studies. The authors located 88 single subject design studies where it was possible to calculate an effect size. They calculated an average effect size for treatments that were tested in 4 or more studies, using a similar outcome measure in each study. This resulted in the identification of 9 writing treatments that were supported as effective. These were strategy instruction for planning/drafting, teaching grammar and usage, goal setting for productivity, strategy instruction for editing, writing with a word processor, reinforcing specific writing outcomes, use of prewriting activities, teaching sentence construction skills, and strategy instruction for paragraph writing. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Health effects of emotional disclosure in rheumatoid arthritis patients.

This study examined the effects of emotional disclosure of stressful events on the pain, physical and affective dysfunction, and joint condition of patients with rheumatoid arthritis (RA). Patients were randomly assigned to talk privately about stressful events (disclosure group, n?=?36) or about trivial topics (control group, n?=?36) for 4 consecutive days. Disclosure resulted in immediate increases in negative mood. At 2 weeks the 2 groups did not differ on any health measure, but at 3 months disclosure patients had less affective disturbance and better physical functioning in daily activities. There was no main effect of disclosure on pain or joint condition, but among the disclosure patients, those who experienced larger increases in negative mood after talking demonstrated improvements in the condition of their joints. This study concludes that, among RA patients, verbal disclosure and emotional processing of stressful life events induces an immediate negative mood followed by improved psychological functioning. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of written emotional expression: The role of positive expectancies.

Objective: Writing in an emotional way about stressful or traumatic experiences has beneficial effects on emotional well-being and physical health. Yet the mechanisms that underlie these effects still need to be explored. Integrating research on the effects of positive expectancies, the authors suggest that positive effects of written emotional expression may, in part, depend on expectancies induced by writing about emotional experiences. Design: Two studies were conducted to test this hypothesis. In both studies, participants wrote about either an upsetting event or trivial issues. After the writing period, participants rated their expectancies that the writing intervention would improve (or impair) their emotional well-being over time. Main Outcome Measures: Study 1 assessed the emotional impact of an upsetting event, whereas Study 2 assessed subjective reports of physical symptoms. In both studies, outcome variables were collected both before and 6 weeks after the writing intervention. Results: The results showed that (a) writing about upsetting experiences induced higher positive expectancies than writing about trivial issues and (b) expectancies associated with written emotional expression were related to a reduction in the emotional impact of an upsetting event (Study 1) and to a reduction in physical symptoms (Study 2). Conclusions: There may be 2 alternative ways to render written emotional expression effective in reducing negative emotions: (a) by rendering an emotional experience more meaningful and (b) by inducing positive affect regulation expectancies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Autobiographical memory processes and the course of depression.

The authors report a 6-month follow-up study of clinically depressed patients. At baseline, 2 indexes of autobiographical memory functioning were assessed: the presence of spontaneous intrusive memories of stressful life events and performance on the Autobiographical Memory Test (J. M. G. Williams & K. Broadbent, 1986), which measures overgeneral memory. The index of overgeneral memory was associated with greater levels of spontaneous intrusion of stressful memories. Overgeneral memory did not predict outcome, but depression at follow-up was predicted by the amount of intrusion and avoidance of stressful memories, even after controlling for initial severity of psychiatric symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of The Writing Cure: How Expressive Writing Promotes Health and Emotional Well-Being.

The reviewer notes that this book (S. J. Lepore and J. M. Smyth [Eds.], 2002; see record 2002-01516-000) consists of 14 chapters exploring the therapeutic implications of expressive writing. The book succeeds in its efforts to present and evaluate current research on the health benefits of writing. The contributors chart new directions for future research and suggest the clinical and therapeutic applications of writing. One common theme running throughout the book is that writing facilitates cognitive integration. Another theme is that writing leads to self-mastery. The Writing Cure is a groundbreaking book, but the reviewer wishes that the editors had widened their focus to include research in the humanities, particularly literary studies and rhetoric and composition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A longitudinal study of stress buffering for adolescent problem behaviors.

A 2-wave longitudinal design, with a 6-mo interval between occasions of measurement, was used to study the interrelations between stressful life events, perceived social support from family and friends, and the internalizing (e.g., depressive symptoms) and externalizing (e.g., alcohol use and delinquent activity) of problems of a sample of 277 middle adolescents (mean age?=?15.7 yrs). Although little support was found for the stress-buffering effects of either family or friend social support, the main effects of stressful life events and low family support were significant prospective predictors of problem behaviors for adolescent girls but not adolescent boys. Results are discussed with regard to mechanisms of differential gender socialization, such as the adolescent gender intensification hypothesis (J. P. Hill and M. W. Lynch, 1983). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reacting to and recovering from a stressful situation: The negative affectivity-physiological arousal relationship.

Although it is one of the most widely researched personality correlates of psychological reactions, the relationship between negative affectivity (NA) and physiological arousal has received little attention. This study examined the associations between NA and physiological outcomes of heart rate, skin temperature, and muscle tension. The authors hypothesized that when individuals are in a stressful situation, persons high in NA experience more heightened physiological arousal than those low in NA. After personality and demographic data were collected, 230 individuals participated in a stressful intervention. Individuals high in NA experienced a significantly greater rate of increase in electromyogram during the stress intervention and a lesser rate of decrease in electromyogram after the stressful event than those low in NA. In regard to skin temperature, those high in NA did not recover from the stress intervention as well as those low in NA. Negative affectivity was not related to heart rate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of disclosure of traumatic events on illness behavior among psychiatric prison inmates.

To assess the health effects of writing about traumatic events in a clinical population, 98 psychiatric prison inmates were randomly assigned to 1 of 3 conditions in which they were asked to write about their deepest thoughts and feelings surrounding upsetting experiences (trauma writing condition), write about trivial topics (trivial writing control), or go about their daily routine without writing (no-writing control). Both writing groups wrote for 20 min per day for 3 consecutive days. Participants in the trauma condition reported experiencing more physical symptoms subsequent to the intervention relative to those in the other conditions. Despite this, controlling for prewriting infirmary visits, sex offenders in the trauma writing condition decreased their postwriting infirmary visits. These results are congruent with predictions based on stigmatization and inhibition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Modification of depression risk factors: A solution-focused approach.

M. Seligman (1990) postulated that 3 meaning frames determine whether temporary sad feelings persist and eventually evolve into clinical depression: the permanence, pervasiveness, and personal causation of negative or stressful events. Successful treatment is thought to consist of interventions that modify these 3 meaning frames that contribute to depression. The authors combine Seligman's observations with 3 types of intervention questions used by therapists in solution-focused psychotherapy: exception, outcome, and coping and/or externalization questions. It is suggested that use of certain classes of intervention from solution-focused psychotherapy may shorten and potentiate treatment of depression. Solution-focused psychotherapy techniques are illustrated using a case study of a 69-yr-old man treated for depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of writing therapy in comparison to EMD/R on traumatic stress: The relationship between hypnotizability and client expectancy to outcome.

Many psychologists encourage clients to engage in journal writing to supplement individual psychotherapy. Empirical evidence supports the use of writing when targeted at traumatic memories. The most thoroughly researched writing strategy, developed by J. Pennebaker (1989), suggests that writing is most effective when it targets a specific memory along with the emotional components of that memory. Effective writing therapy is thus procedurally similar to effective exposure therapy for fear and traumatic memories. This investigation examined structured writing as a self-contained treatment by comparing it to eye movement desensitization and reprocessing, and it was found to be effective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stability of attachment representations: The transition to marriage.

This study examined the stability of adult attachment representations across the transition to marriage. One hundred fifty-seven couples were assessed using the Adult Attachment Interview (AAI; C. George, N. Kaplan, & M. Main, 1985), the Current Relationship Interview (J. A. Crowell & G. Owens, 1996), and measures describing relationship functioning and life events 3 months prior to their weddings and 18 months into their marriages. The authors tested the hypotheses that attachment classifications are stable and that change is related to experiences in the relationship and/or life events; 78% of the sample received the same primary AAI classification (secure, preoccupied, and dismissing) at both times. Change was toward increased security and was associated with feelings and cognitions about the relationship. Only 46% of participants initially classified as unresolved retained the classification. Stability of the unresolved classification was associated with stressful life events and relationship aggression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Are traumatic events necessary to elicit symptoms of posttraumatic stress?

A diagnosis of posttraumatic stress disorder (PTSD) has been conceptualized as being precipitated by a particularly traumatic stressor (e.g., combat exposure, rape, and violent assault). Recent research suggests that common stressful events (e.g., relational problems, divorce, and expected death of a loved one) may also be capable of eliciting posttraumatic symptomatology. The current study replicated and extended these previous findings, examining three groups of event exposure: those who reported experiencing only traumatic events in the past year, those who reported experiencing only significant stressful life events in the last year, and those who experienced both types of events. Consistent with previous findings, we found that all three groups of event exposure, including those experiencing only stressful life events, experienced similar amounts of PTSD symptomatology across symptom clusters. These data add to the growing literature that suggests that the type of events that cause symptoms of PTSD may be broader than the current diagnostic criteria indicate, and as such calls for more rigorous research in this area to better understand the diagnostic implications of these findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stress and alcohol use: A daily process examination of the stressor–vulnerability model.

The authors used a daily diary methodology to examine over 60 days how the within-person associations among event stress, alcohol consumption, and desire to drink varied as a function of gender, positive and negative alcohol-outcome expectancies,' and avoidant coping in a sample of 88 regular drinkers. Multilevel regression analyses indicated that men who more strongly anticipated positive outcomes or a sense of carelessness from drinking drank relatively more on stressful days compared with low-stress days. Similar results were found predicting desire to drink. Men who anticipated greater impairment from drinking drank relatively less on stressful days. In general, these effects did not hold for women. Little evidence was found for the predicted effects for avoidant coping style, and some results showed that avoidant coping style buffered the exacerbating effects of careless unconcern expectancies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Brief motivational intervention with homeless adolescents: Evaluating effects on substance use and service utilization.

A brief motivational intervention with 117 homeless adolescents was evaluated using a randomized design and 3-month follow-up. The intervention was designed to raise youths' concerns about their substance use, support harm reduction, and encourage greater service utilization at a collaborating agency. The study was designed to strengthen initial promising results of an earlier study (P. L. Peterson, J. S. Baer, E. A. Wells, J. A. Ginzler, & S. B. Garrett, 2006). Several modifications in the clinical protocol were included to enhance engagement with the intervention. Analyses revealed no significant benefits for intervention participants when homeless youths' substance use rates were compared with those of control participants. Service utilization during the intervention period increased for those receiving the intervention but returned to baseline levels at follow-up. Participants reported overall reductions in substance use over time. Differences between sampling methods for the current and previous study are discussed, as are the limitations of brief interventions with this population. Future research needs to elucidate mechanisms of change and service engagement for highly vulnerable youth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)