Why do brief online writing interventions improve health? Examining mediators of expressive writing and self-affirmation intervention efficacy among sexual minority emerging adults.

Abstract

A limited number of studies have examined mechanisms undergirding interventions that mitigate mental health problems or health-risk behaviors that disproportionately burden sexual minorities. A recent trial of expressive writing and self-affirmation writing found that these brief interventions had salubrious effects on mental health and health-risk behaviors; the present research examines the putative mechanisms underlying these effects. Sexual minority emerging adults (N = 108) completed a brief online expressive writing, self-affirmation writing, or neutral control writing intervention and, at baseline and 3-month follow-up, completed measures of mental health, health-risk behaviors, stress, and self-regulation. Expressive writing yielded improvements in mental health and these effects were mediated by reductions in perceived stress. Self-affirmation caused improvements in health-risk behaviors, though neither stress nor self-regulation mediated these effects. This finding provides preliminary novel evidence regarding a mechanism underlying a widely used psychological intervention with documented mental health benefits for sexual minorities and other populations disproportionately affected by stress.

Expressive writing treatments to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed sexual minority women and transgender/nonbinary people: Study protocol for a mixed-method pilot trial

“…Over the past two decades, research has increasingly focused on mechanisms underlying the efficacy of EW in the general population [ 54 ] and in sexual minority emerging adults [ 55 ]. As previously noted, identifying mechanisms of intervention effects can advance knowledge of how health disparities emerge and are ameliorated [ 55 ].…”

“…Over the past two decades, research has increasingly focused on mechanisms underlying the efficacy of EW in the general population [ 54 ] and in sexual minority emerging adults [ 55 ]. As previously noted, identifying mechanisms of intervention effects can advance knowledge of how health disparities emerge and are ameliorated [ 55 ]. EW may work through exposure-based mechanisms, including habituation (decreased fear over repeated exposures, such as as reduced physiological reactivity) [ 48 ].…”

“…EW may work through exposure-based mechanisms, including habituation (decreased fear over repeated exposures, such as as reduced physiological reactivity) [ 48 ]. Yet, little evidence has documented habituation as a mediator of EW treatment efficacy [ 55 , 56 ]. Therefore, contemporary models of exposure therapy have increasingly relied on inhibitory learning theory to explain efficacy of EW and other exposure treatments [ 48 , 56 ].…”

“…Inhibitory learning may be evident among sexual minority populations as well. Specifically, one recent study demonstrated that engaging in expressive writing about difficult or painful experiences due to having a sexual minority identity yielded reductions in perceived stress and subsequently, improvements in depression, distress, and anxiety among sexual minority emerging adults [ 55 ]. Providing sexual minority emerging adults with opportunities to increase awareness and integration of sexual minority stressors in a safe environment—stressors which may have been avoided previously—may have helped to reduce pervasive fear and improve tolerance of minority stress responses.…”

“…Providing sexual minority emerging adults with opportunities to increase awareness and integration of sexual minority stressors in a safe environment—stressors which may have been avoided previously—may have helped to reduce pervasive fear and improve tolerance of minority stress responses. Moreover, engaging in expressive writing about sexual minority stigma may promote learning of extinction or inhibitory signals (e.g., that stigma-based rejection does not always occur when stigma cues, such as internalized stigma, are encountered) [ 55 ], resulting in reduced perceived stress [ 39 , 55 ]. Nevertheless, additional research is needed to elucidate symptom change processes in EW treatments by clarifying the temporal ordering of change in perceived stress, PTSD, and negative alcohol-related outcomes following EW treatments among SMW and TNB individuals [ 55 ].…”