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

Abstract

Background The high prevalence of diabetes distress and subclinical depression in adults with type 1 and type 2 diabetes mellitus (T1DM and T2DM, respectively) indicates the need for low-intensity self-help interventions that can be used in a stepped care approach to address some of their psychological needs. However, people with diabetes can be reluctant to engage in mental health care. Benefit-finding writing (BFW) is a brief intervention that involves writing about any positive thoughts and feelings concerning a stressful experience such as an illness, avoiding potential mental health stigma. It has been associated with increases in positive affect and positive growth and has demonstrated promising results in trials in other clinical populations. However, BFW has not been examined in people with diabetes. Objective This study aimed to evaluate the efficacy of a Web-based BFW intervention for reducing diabetes distress and increasing benefit finding in diabetic adults with T1DM or T2DM compared to a control writing condition. Methods Adults with T1DM or T2DM and diabetes distress were recruited online through the open access Writing for Health program. After completing baseline questionnaires, they were randomly allocated to receive online BFW or an active control condition of online writing about the use of time (CW). Both groups completed 15-minute online writing sessions, once per day, for 3 consecutive days. Online measures were administered at baseline, 1 month, and 3 months postintervention. Participants were also asked to rate their current mood immediately prior to and following each writing session. Results Seventy-two adults with T1DM or T2DM were recruited and randomly allocated to receive BFW (n=24) or CW (n=48). Participants adhered to the BFW regimen. Greater increases in positive affect immediately postwriting were found in the BFW group than in the CW group. However, there were no significant group-by-time interactions (indicating intervention effects) for benefit finding or diabetes distress at either the 1-month or 3-month follow-up. Both the BFW and CW groups demonstrated small, significant decreases in diabetes distress over time. Conclusions BFW was well tolerated by adults with diabetes in this study but did not demonstrate efficacy in improving diabetes distress or benefit finding compared to an active control writing condition. However, due to recruitment difficulties, the study was underpowered and the sample was skewed to individuals with minimal diabetes distress and none to minimal depression and anxiety at baseline. Future research should continue to investigate the efficacy of variants of therapeutic writing for adults with T1DM or T2DM, using larger samples of participants with elevated diabetes distress. Trial Registration Australiand New Zealand Clinical Trials Registry ACTRN12615000241538; https://www.anzctr.org.au/Tria...

Technology-Supported Integrated Care Innovations to Support Diabetes and Mental Health Care: Scoping Review

“…Eight studies had a follow-up outcome measurement beyond the end of the study time point. Of the 20 intervention studies, 12 focused on addressing mental health in people living with diabetes [25,27,[31][32][33]36,38,39,[41][42][43][44] and 8 addressed both diabetes and mental health conditions concurrently [23,24,26,[28][29][30]35,37].…”

ACTonDiabetes: study protocol of a pragmatic randomised controlled trial for the evaluation of an acceptance and commitment-based internet-based and mobile-based intervention for adults living with type 1 or type 2 diabetes

“…One reason for adding a writing intervention was to foster the feeling that the intervention is personalised for the individual, with space for reflections about life and living. Another reason was to support contact with positive aspects in life and inducing positive emotions following positive psychological writing approaches 55–58. Writing tasks include writings on the personal life story and benefit finding writing.…”

“…Another reason was to support contact with positive aspects in life and inducing positive emotions following positive psychological writing approaches. [55][56][57][58] Writing tasks include writings on the personal life story and benefit finding writing. The intervention consists of seven core elements: psychoeducation, exemplary people with diabetes, ACTbased exercises, for example, mindfulness exercises, diaries to document their progress, a therapeutic writing intervention, feedback from e-coaches (trained psychologist) and optional SMS coaching.…”

Study protocol of a randomised controlled trial on SISU, a software agent providing a brief self-help intervention for adults with low psychological well-being

“…Current mental health software agents are primarily based on cognitive-behavioural therapy. 43 However, other popular approaches with proven effectiveness in face-toface settings could also readily be realised in a digital form, such as writing interventions 51 and acceptance and commitment-based approaches. 52 Writing with the aim of improving health has a long history.…”

“… 53 In the current literature, the labelling of this kind of intervention varies. Terminology includes expressive writing, 54 55 benefit-finding or positive writing, 56 57 and therapeutic writing (eg, 58 ). Regardless of terminology, the writing intervention to be investigated in this study will refer to the process of freely and emotionally writing about a positive personal life event without paying attention to spelling or grammar.…”