Vukčević Marković Maša, Bjekić Jovana, Priebe Stefan
Department of Psychology, Faculty of Philosophy, University of Belgrade, Belgrade, Serbia.
Psychosocial Innovation Network (PIN), Belgrade, Serbia.
Front Psychol. 2020 Nov 10;11:587282. doi: 10.3389/fpsyg.2020.587282. eCollection 2020.
Due to the wide impact of the COVID-19 pandemic on mental health, the need for scalable interventions that can effectively reduce psychological distress has been recognized. Expressive writing (EW) can be beneficial for different conditions, including depression, suicidal ideation, and coping with trauma. Therefore, we aim to assess the applicability and effectiveness of an online format of EW in the reduction of psychological distress in context of the COVID-19 pandemic.
In this parallel-group, randomized controlled trial, participants ( = 120) were randomly allocated to (1) the intervention group-who completed five EW sessions over the 2 week period-or (2) the control group-who received treatment as usual (TAU). Participants were assessed for primary and secondary outcome measures at baseline, post-treatment, and follow-up-1-month after the treatment. The primary outcome was severity of psychological distress assessed at post-treatment, operationalized as Depression Anxiety Stress Scale (DASS) summary score. Secondary outcomes were severity of depression, anxiety, and stress (DASS subscale scores), well-being (WHO-5), subjective perception of quality of life (SQOL), and subjective evaluation of difficulties coping with pandemic, which were also assessed at post-treatment. Per protocol, analysis was conducted with available cases only.
A less favorable outcome was found in the intervention group on psychological distress, and symptoms of stress, after controlling for baseline scores. Increased stress was recorded in the treatment group, with no effect in the control group. There was no significant difference between the groups on depression, anxiety, well-being, and subjective quality of life. No group effect for any of the outcomes measures was recorded at follow-up. Additional analysis revealed moderation effects of age and gender with older and male participants scoring higher on distress measures.
Engaging in EW during the pandemic was found to elevate stress; thus, when applied in the context of the COVID-19 pandemic, it may be harmful. Hence, EW or similar self-guided interventions should not be applied without prior evidence on their effects in the context of a pandemic and similar stressful and unpredictable circumstances.
This study is approved by the Institutional Ethics Committee (Protocol number #2020-20), and a trial has been registered at ISRCTN registry https://www.isrctn.com/ISRCTN17898730.
由于新冠疫情对心理健康产生广泛影响，人们已经认识到需要有可扩展的干预措施来有效减轻心理困扰。表达性写作（EW）对包括抑郁症、自杀意念和应对创伤在内的不同情况可能有益。因此，我们旨在评估在线形式的表达性写作在减轻新冠疫情背景下心理困扰方面的适用性和有效性。
在这项平行组随机对照试验中，参与者（n = 120）被随机分配到：（1）干预组，在两周内完成五次表达性写作课程；（2）对照组，接受常规治疗（TAU）。在基线、治疗后以及治疗后1个月的随访时对参与者进行主要和次要结局指标评估。主要结局是治疗后评估的心理困扰严重程度，以抑郁焦虑压力量表（DASS）总分来衡量。次要结局包括抑郁、焦虑和压力的严重程度（DASS分量表得分）、幸福感（WHO-5）、生活质量主观感受（SQOL）以及应对疫情困难的主观评价，这些也在治疗后进行评估。按照方案，仅对可用病例进行分析。
在控制基线分数后，干预组在心理困扰和压力症状方面的结局较差。治疗组记录到压力增加，而对照组没有效果。两组在抑郁、焦虑、幸福感和主观生活质量方面没有显著差异。随访时未记录到任何结局指标的组间效应。进一步分析显示年龄和性别有调节作用，年龄较大和男性参与者在困扰指标上得分更高。
发现在疫情期间进行表达性写作会增加压力；因此，在新冠疫情背景下应用时，它可能是有害的。因此，在没有关于其在疫情及类似压力大且不可预测情况下效果的先前证据时，不应应用表达性写作或类似的自我指导干预措施。
本研究已获得机构伦理委员会批准（方案编号#2020 - 20），并已在ISRCTN注册中心https://www.isrctn.com/ISRCTN17898730进行了试验注册。
