Writing for Health: Rationale and Protocol for a Randomized Controlled Trial of Internet-Based Benefit-Finding Writing for Adults With Type 1 or Type 2 Diabetes

Abstract

BackgroundDiabetes mellitus is Australia’s fastest growing chronic disease, and has high comorbidity with depression. Both subthreshold depression and diabetes distress are common amongst people with type 1 or type 2 diabetes, and are associated with poorer diabetes self-care. A need exists for low-intensity self-help interventions for large numbers of people with diabetes and diabetes distress or subthreshold depression, as part of a stepped-care approach to meeting the psychological needs of people with diabetes. Benefit-finding writing is a very brief intervention that involves writing about any positive thoughts and feelings about a stressful experience, such as an illness. Benefit-finding writing has been associated with increases in positive affect and positive growth, and has demonstrated promising results in trials amongst other clinical populations. However, benefit-finding writing has not yet been examined in people with diabetes.ObjectiveThe aim of this randomized controlled trial (RCT) is to evaluate the efficacy of an Internet-based benefit-finding writing (iBFW) intervention for adults with type 1 or type 2 diabetes (compared to a control writing condition) for reducing diabetes distress and increasing benefit-finding in diabetes, and also improving a range of secondary outcomes.MethodsA two-arm RCT will be conducted, using the online program Writing for Health. Adults with type 1 or type 2 diabetes living in Australia will be recruited using diabetes-related publications and websites, and through advertisements in diabetes services and general practitioners’ offices. Potential participants will be referred to the study-specific website for participant information and screening. All data will be collected online. Participants will be randomized to either iBFW about diabetes, or a control writing condition of writing about use-of-time. Both conditions involve three daily sessions (once per day for three consecutive days) of 15-minute online writing exercises. Outcome measures will be administered online at baseline, one-month, and three-month follow-ups.ResultsThis trial is currently underway. The primary outcomes will be diabetes distress and benefit-finding in diabetes. Secondary outcomes will be depression, anxiety, diabetes self-care, perceived health, and health care utilization. We aim to recruit 104 participants. All stages of the study will be conducted online using the Writing for Health program. Group differences will be analyzed on an intention-to-treat basis using mixed models repeated measures. Linguistic analyses of the writing exercise scripts, and examinations of the immediate emotional responses to the writing exercises, will also be undertaken.ConclusionsThis RCT will be the first study to examine iBFW for adults with type 1 or type 2 diabetes. If iBFW is found to be efficacious in reducing diabetes distress and improving diabetes self-care and other outcomes, iBFW may offer the potential to be a low-cost, easily accessible self-help intervention to improve the wellbeing of adults w...

Web-Based Benefit-Finding Writing for Adults with Type 1 or Type 2 Diabetes: Preliminary Randomized Controlled Trial

“…Two participants in the BFW group (8%) and two in the CW group (4%) were contacted by email following a high distress rating (≥5/6); all four participants reported that their distress was short-lived. Four participants in the BFW group (17%) and two in the CW group (4%) were contacted by telephone due to elevated scores on the PHQ-9 or GAD-7 at follow-up(s), in line with the study safety protocol [61]. One participant (in the BFW group) was referred to a mental health service after reporting a recurrence of previous depression at the 3-month follow-up.…”

“…The design consisted of a CONSORT-EHEALTH [60]–compliant, 2 (conditions) x 3 (time) RCT (Multimedia Appendix 1). The protocol for the trial has been published [61]. Participants were randomized to either internet-based BFW or internet-based CW (use-of-time writing).…”

“…Direct contact between participants and researchers did not occur in the standard course of the trial. However, in accordance with the study safety protocol [61], a study psychologist contacted a participant by email or telephone if he/she indicated distress after a writing session or scored in the severe range for depression or anxiety at the 1-month or 3-month follow-up, or indicated possible suicidal thoughts, to assess any need for psychological support and refer the participant to appropriate services, if required.…”

“…The 17-item Diabetes Distress Scale (DDS17) [61] is a self-report measure of psychosocial stress associated with diabetes, with four reliable subscales: Emotional Burden (feeling overwhelmed by diabetes), Physician-Related Distress (worries about access, trust, and care), Regime-Related Distress (concerns about diet, physical activity, and medications), and Interpersonal Distress (not receiving understanding and appropriate support from others). Cut-off points on the DDS17 have been established for little or no distress, moderate distress, and high distress [65].…”

A narrative perspective on peer-to-peer support websites for young people : effects of writing and reading personal narratives

“…These studies also make an important theoretical contribution to the literature on expressive writing theory. Previous positive writing instructions in literature on expressive writing have mainly focused on writing exclusively about positive experiences related to a distressing event (e.g., Crawford et al, 2017;Facchin et al 2014;Lichtenthal and Cruess, 2010;McCullough et al, 2006) or writing about a positive event (Baikie et al, 2012;Burton & King, 2004). However, according to research (Graci et al, 2018), a balance between the positive and the negative may be more essential.…”