Cookies and Privacy

To help offer the best experience possible, Guilford uses cookies on its site. By browsing here, you acknowledge our terms of use.
For more information, see our Cookie Policy. You can also read Guilford's Privacy Policy.

×
Skip to main content
Search
Search
Quick Search anywhere
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu

The Effect of COVID-Focused Expressive Writing on Symptoms of Depression, Anxiety, and Distress in College Students: A Randomized Controlled Trial

Published Online:June 2023https://doi.org/10.1521/jscp.2023.42.3.238

Abstract

Objective: The coronavirus disease of 2019 (COVID-19) pandemic has been associated with increased levels of distress for college students. This study aimed to assess the efficacy of a COVID-focused expressive writing intervention in reducing symptoms of depression, anxiety, and distress. Methods: A total of 169 college students were assigned either to a COVID-focused expressive writing intervention or to a nonwriting control group. All participants completed a 1-month follow-up assessment, and all study procedures were completed online due to COVID-19 restrictions. Depression was measured with the Beck Depression Inventory-II, anxiety was measured with the Beck Anxiety Inventory, and distress was measured with a Likert-scale question that measured distress specifically related to the COVID-19 pandemic. Results: Results indicated that participants in the expressive writing group demonstrated a significant decrease (b = -1.35) in anxiety symptoms whereas participants in the control group did not. None of the participants in either group demonstrated a significant decrease in depression symptoms. Ratings of distress in the expressive writing group were significantly lower (d = -0.51) at the 1-month follow-up when compared to the control group. Discussion: COVID-focused expressive writing is a relatively brief and inexpensive intervention that has been associated with lower symptoms of anxiety and distress in college students. Theoretical implications are discussed.

REFERENCES

  • Abramowitz J. S. (2013). The practice of exposure therapy: Relevance of cognitive-behavioral theory and extinction theory. Behavior Therapy, 44(4), 548–558. https://doi.org//10.1016/j.beth.2013.03.003 Crossref, Google Scholar
  • Alparone F. R., , Pagliaro S., , & Rizzo I. (2015). The words to tell their own pain: Linguistic markers of cognitive reappraisal in mediating benefits of expressive writing. Journal of Social and Clinical Psychology, 34(6), 495–507. https://doi.org/10.1521/jscp.2015.34.6.495 Link, Google Scholar
  • American College Health Association . (2020). American College Health Association-National College Health Assessment III: Reference Group Executive Summary Fall 2020. Google Scholar
  • Arnett J. J., , Žukauskienė R., , & Sugimura K. (2014). The new life stage of emerging adulthood at ages 18-29 years: Implications for mental health. The Lancet Psychiatry, 1(7), 569–576. https://doi.org/10.1016/S2215-0366(14)00080-7 Crossref, Google Scholar
  • Baker R. W., & Siryk B. (1989). Student Adaptation to College Questionnaire manual. Western Psychological Services. Google Scholar
  • Baum E. S., , & Rude S. S. (2013). Acceptance-enhanced expressive writing prevents symptoms in participants with low initial depression. Cognitive Therapy and Research, 37(1), 35–42. https://doi.org/10.1007/s10608-012-9435-x Crossref, Google Scholar
  • Beck A. T., , Rush A. J., , Shaw B. F., , & Emery G. (1979). Cognitive theory of depression. Guilford Press. Google Scholar
  • Beck A. T., & Steer R. A. (1993). Beck Anxiety Inventory: Manual. The Psychological Corporation. Google Scholar
  • Beck A. T., , Steer R. A., & Brown G. K. (1996). Manual for the Beck Depression Inventory-II. The Psychological Corporation. Google Scholar
  • Bickel R. (2007). Multilevel analysis for applied research: It's just regression! Guilford Press. Google Scholar
  • Booker J. A., , & Dunsmore J. C. (2017). Expressive writing and well-being during the transition to college: Comparison of emotion-disclosing and gratitude-focused writing. Journal of Social and Clinical Psychology, 36(7), 580–606. https://doi.org/10.1521/jscp.2017.36.7.580 Link, Google Scholar
  • Centers for Disease Control and Prevention (2023). COVID data tracker. https://covid.cdc.gov/covid-data-tracker/#datatracker-home Google Scholar
  • Craske M. G., , Treanor M., , Conway C. C., , Zbozinek T., & Vervliet B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. https://doi.org/10.1016/j.brat.2014.04.006 Crossref, Google Scholar
  • Creamer M., , Foran J., , & Bell R. (1995). The Beck Anxiety Inventory in a nonclinical sample. Behaviour Research and Therapy, 33(4), 477–485. https://doi.org/10.1016/0005-7967(94)00082-U Crossref, Google Scholar
  • DeRubeis R. J., , Hollon S. D., , Amsterdam J. D., , Shelton R. C., , Young P. R., , Salomon R. M., , O'Reardon J. P., , Lovett M. L., , Gladis M. M., , Brown L. L., , & Gallop R. (2005). Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry, 62(4), 409–416. https://doi.org/10.1001/archpsyc.62.4.409 Crossref, Google Scholar
  • Espiritu A. I., , Sy M. C. C., , Anlacan V. M. M., , & Jamora R. D. G. (2021). COVID-19 outcomes of 10,881 patients: Retrospective study of neurological symptoms and associated manifestations (Philippine CORONA study). Journal of Neural Transmission, 128(11), 1687–1703. https://doi.org/10.1007/s00702-021-02400-5 Crossref, Google Scholar
  • Faul F., , Erdfelder E., , Buchner A., , & Lang A.-G. (2009). Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behavior Research Methods, 41, 1149–1160. Crossref, Google Scholar
  • Frankfurt S., , Frazier P., , Litz B. T., , Schnurr P. P., , Orazem R. J., , Gravely A., , & Sayer N. (2019). Online expressive writing intervention for reintegration difficulties among veterans: Who is most likely to benefit? Psychological Trauma: Theory, Research, Practice, and Policy, 11(8), 861–868. https://doi.org/10.1037/tra0000462.supp Crossref, Google Scholar
  • Frattaroli J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychological Bulletin, 132(6), 823–865. https://doi.org/10.1037/0033-2909.132.6.823 Crossref, Google Scholar
  • Frisina P. G., , Borod J. C., , & Lepore S. J. (2004). A meta-analysis of the effects of written emotional disclosure on the health outcomes of clinical populations. Journal of Nervous and Mental Disease, 192, 629–634. https://doi.org/10.1097/01.nmd.0000138317.30764.63 Crossref, Google Scholar
  • Gellaitry G., , Peters K., , Bloomfield D., & Home R. (2010). Narrowing the gap: The effects of an expressive writing intervention on perceptions of actual and ideal emotional support in women who have completed treatment for early stage breast cancer. Psycho-Oncology, 19, 77–84. https://doi.org/10.1002/pon.1532 Crossref, Google Scholar
  • Green P., , & MacLeod C. J. (2016). simr: An R package for power analysis of generalized linear mixed models by simulation. Methods in Ecology and Evolution, 7, 493–498. Crossref, Google Scholar
  • Horn A. B., , Possel P., & Hautzinger M. (2010). Promoting adaptive emotion regulation and coping in adolescence. Journal of Health Psychology, 16, 258–273. https://doi.org/10.1177/1359105310372814 Crossref, Google Scholar
  • Hoyt L. T., , Cohen A. K., , Dull B., , Maker Castro E., , & Yazdani N. (2021). “Constant stress has become the new normal”: Stress and anxiety inequalities among US college students in the time of COVID-19. Journal of Adolescent Health, 68(2), 270–276. https://doi.org/10.1016/j.jadohealth.2020.10.030 Crossref, Google Scholar
  • Lane S., , & Hennes E. P. (2018). Power struggles: Estimating sample size for multilevel relationships research. Journal of Social and Personal Relationships, 35, 7–31. https://doi.org/10.1177/0265407517710342 Crossref, Google Scholar
  • López-Castro T., , Brandt L., , Anthonipillai N. J., , Espinosa A., , & Melara R. (2021). Experiences, impacts and mental health functioning during a COVID-19 outbreak and lockdown: Data from a diverse New York City sample of college students. PLoS ONE, 16(4). https://doi.org/10.1371/journal.pone.0249768 Crossref, Google Scholar
  • McGinty E. E., , Presskreischer R., , Han H., , & Barry C. L. (2020). Psychological distress and loneliness reported by US adults in 2018 and April 2020. JAMA: Journal of the American Medical Association, 324(1), 93–94. https://doi.org/10.1001/jama.2020.9740 Crossref, Google Scholar
  • Milbury K., , Lopez G., , Spelman A., , Wood C., , Matin S. F., , Tannir N. M., , Jonasch E., , Pisters L., , Wei Q., , & Cohen L. (2017). Examination of moderators of expressive writing in patients with renal cell carcinoma: The role of depression and social support. Psychooncology, 26(9), 1361–1368. https://doi.org/10.1002/pon.4148 Crossref, Google Scholar
  • Moerbeek M., , Van Breukelen G. J. P., , & Berger M. P. F. (2008). Optimal designs for multilevel studies. In Leeuw J. de, & Meijer E. (Eds.), Handbook of multilevel analysis (pp. 177–206). Springer. Crossref, Google Scholar
  • Mogk C., , Otte S., , Reinhold-Hurley B., & Kroner-Herwig B. (2006). Health effects of expressive writing on stressful or traumatic experiences—A meta-analysis. Psycho-Social Medicine, 3, 1–9. Google Scholar
  • Mok K. H., , Xiong W., & Rahman H. N. (2021). COVID-19 pandemic's disruption on university teaching and learning and competence cultivation: Student evaluation of online learning experiences in Hong Kong. International Journal of Chinese Education, January-April 2021, 1–20. https://doi.org/10.1177/22125868211007011 Google Scholar
  • Niles A. N., , Haltom K. B., , Mulvenna C. M., , Lieberman M. D., , & Stanton A. L. (2013). Randomized controlled trial of expressive writing for psychological and physical health: The moderating role of emotional expressivity. Anxiety, Stress & Coping: An International Journal, 27(1), 1–17. https://doi.org/10.1080/10615806.2013.802308 Crossref, Google Scholar
  • Pan H. (2020). A glimpse of university students’ family life amidst the covid-19 virus. Journal of Loss and Trauma, 25, 594–597. https://doi.org/10.1080/15325024.2020.1750194 Crossref, Google Scholar
  • Pennebaker J. W., , Colder M., , & Sharp L. K. (1990). Accelerating the coping process. Journal of Personality and Social Psychology, 58(3), 528–537. https://doi.org/10.1037/0022-3514.58.3.528 Crossref, Google Scholar
  • Pinheiro J., , Bates D., , DebRoy S., , Sarkar D., , & R Core Team (2017). nlme: Linear and nonlinear mixed effects models [R package version 3.1-131]. https://CRAN.R-project.org/package=nlme Google Scholar
  • Preacher K. J., , Curran P. J., , & Bauer D. J. (2006). Computational tools for probing interaction effects in multiple linear regression, multilevel modeling, and latent curve analysis. Journal of Educational and Behavioral Statistics, 31, 437–448. https://doi.org/10.3102/10769986031004437 Crossref, Google Scholar
  • Procaccia R., , Segre G., , Tamanza G., , Manzoni G. M. (2021). Benefits of expressive writing on healthcare workers’ psychological adjustment during the COVID-19 pandemic. Frontiers in Psychology, 12, Article 624176. https://doi.org/10.3389/fpsyg.2021.624176 Crossref, Google Scholar
  • R Core Team . (2016). R: A language and environment for statistical computing (version 3.3.2) [Computer software]. R Foundation for Statistical Computing. Retrieved October 31, 2016, from the comprehensive R archive network (CRAN): https://www.R-project.org/ Google Scholar
  • Radloff L. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. https://doi.org/10.1177/014662167700100306 Crossref, Google Scholar
  • Raudenbush S. W., , & Bryk A. S. (2001). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Sage Publications. Google Scholar
  • Reinhold M., , Bürkner P., , & Holling H. (2018). Effects of expressive writing on depressive symptoms—A meta-analysis. Clinical Psychology: Science and Practice, 25(1), Article e12224. https://doi.org/10.1037/h0101749.supp Crossref, Google Scholar
  • Robertson S. M. C., , Short S. D., , Asper A., , Venezia K., , Yetman C., , Connelly M., , & Trumbull J. (2019). The effect of expressive writing on symptoms of depression in college students: Randomized controlled trial. Journal of Social and Clinical Psychology, 38, 427–450. https://doi.org/10.1521/jscp.2019.38.5.427 Link, Google Scholar
  • Robertson S. M. C., , Short S. D., , Sawyer L., , & Sweazy S. (2020). Randomized controlled trial assessing the efficacy of expressive writing in reducing anxiety in first-year college students: The role of linguistic features. Psychology & Health, 36(9), 1041–1065. https://doi.org/10.1080/08870446.2020.1827146 Crossref, Google Scholar
  • Rodriguez L. M., , Stewart S. H., , & Neighbors C. (2021). Effects of a brief web-based interpersonal conflict cognitive reappraisal expressive-writing intervention on changes in romantic conflict during COVID-19 quarantine. Couple and Family Psychology: Research and Practice, 10(3), 212–222. https://doi.org/10.1037/cfp0000173.supp Crossref, Google Scholar
  • Rude S. S., , & Haner M. L. (2018). Individual differences matter: Commentary on “Effects of expressive writing on depressive symptoms—A meta-analysis.” Clinical Psychology: Science and Practice, 25(1), 1–5. Crossref, Google Scholar
  • Scherbaum C. A., , & Ferreter J. M. (2009). Estimating statistical power and required sample sizes for organizational research using multilevel modeling. Organizational Research Methods, 12, 347–367. https://doi.org/10.1177/1094428107308906 Crossref, Google Scholar
  • Sloan D. M., , Feinstein B. A., , & Marx B. P. (2009). The durability of beneficial health effects associated with expressive writing. Anxiety, Stress & Coping: An International Journal, 22(5), 509–523. https://doi.org/10.1080/10615800902785608 Crossref, Google Scholar
  • Smith C. A. (1991). The self, appraisal, and coping. In Snyder C. R., & Forsyth D. R. (Eds.), Handbook of social and clinical psychology (pp. 116–137). Pergamon Press. Google Scholar
  • Snijders T. A., , & Bosker R. J. (1993). Standard errors and sample sizes for two-level research. Journal of Educational Statistics, 18, 237–259. https://doi.org/10.2307/1165134 Crossref, Google Scholar
  • Snijders T. A. A., , & Bosker R. J. (2011). Multilevel analysis: An introduction to basic and advanced multilevel modeling (2nd ed.). Sage Publications. Google Scholar
  • Son C., , Hegde S., , Smith A., , Wang X., , & Sasangohar F. (2020). Effects of COVID-19 on college students’ mental health in the United States: Interview survey study. Journal of Medical Internet Research, 22(9), Article e21279. https://doi.org/10.2196/21279 Crossref, Google Scholar
  • Spera S. P., , Morin D. B., , Buhrfeind E. D., , & Pennebaker J. W. (1994). Expressive writing and coping with job loss. Academy of Management Journal, 3, 722–733. https://doi.org/10.2307/256708 Crossref, Google Scholar
  • Storch E. A., , Roberti J. W., , & Roth D. A. (2004). Factor structure, concurrent validity, and internal consistency of the Beck Depression Inventory-Second Edition in a sample of college students. Depression and Anxiety, 19(3), 187–189. https://doi.org/10.1002/da.20002 Crossref, Google Scholar
  • Tasso A. F., , Hisli Sahin N., , & San Roman G. J. (2021). COVID-19 disruption on college students: Academic and socioemotional implications. Psychological Trauma: Theory, Research, Practice, and Policy, 13(1), 9–15. https://doi.org/10.1037/tra0000996 Crossref, Google Scholar
  • Travagin G., , Margola D., , & Revenson T. A. (2015). How effective are expressive writing interventions for adolescents? A meta-analytic review. Clinical Psychology Review, 36, 42–55. https://doi.org/10.1016/j.cpr.2015.01.003 Crossref, Google Scholar
  • Twenge J. M., , & Joiner T. E. (2020). Mental distress among US adults during the COVID-19 pandemic. Journal of Clinical Psychology, 76(12), 2170–2182. https://doi.org/10.1002/jclp.23064 Crossref, Google Scholar
  • Vukčević Marković M. V., , Bjekić J., , & Priebe S. (2020). Effectiveness of expressive writing in the reduction of psychological distress during the COVID-19 pandemic: A randomized controlled trial. Frontiers in Psychology, 11, Article 587282. https://doi.org/10.3389/fpsyg.2020.587282 Crossref, Google Scholar
  • Zheng L., , Lu Q., , & Gan Y. (2019). Effects of expressive writing and use of cognitive words on meaning making and post-traumatic growth. Journal of Pacific Rim Psychology, 13, e5. https://doi-org.nuncio.cofc.edu/10.1017/prp.2018.31 Crossref, Google Scholar
  • Zhou F., , Yu T., , Du R., , Fan G., , Liu Y., , Liu Z., , Xiang J., , Wang Y., , Song B., , Gu X., , Guan L., , Wei Y., , Li H., , Wu X., , Xu J., , Tu S., , Zhang Y., , Chen H., , & Cao B. (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet, 395, 1054–1062. https://doi.org/10.1016/S1040-6736(20)30566-3 Crossref, Google Scholar
Previous article
Next article