Writing for Depression in Health Care

By Cooper, Pauline | British Journal of Occupational Therapy, April 2013 | Go to article overview

Writing for Depression in Health Care


Cooper, Pauline, British Journal of Occupational Therapy


Introduction

The importance of hearing the client story and narrative has been highlighted in the United Kingdom (College of Occupational Therapists 2006, Department of Health 2009, 2011) to understand mental health problems better. The 'story' is understood to be the historical, linear tale of a series of events, and 'narrative' to mean the telling of part, or all, of the story to oneself or others (Bruner 1986).

A literature search highlighted a gap in knowledge; Hunt's and Sampson's (1998) 'three strands' elicited a core understanding from which to begin: 'literary' or product-oriented work (publications); 'writerly' or process-oriented work (creative arts activity); and 'therapeutic' work (therapy) used by therapists in the delivery of treatment.

The author explored story-telling in her own occupational therapy practice. In collaborative work over several years with mental health service users/ clients/writers citing loss of identity and inability to progress life issues, the writing exercises they reported to be of particular benefit during treatment were constantly reviewed and honed, evolving into a course of six sessions. Clients referred to this as 'using writing as therapy' (UWaT). A doctoral study comparing Creative Writing (CW) and the new course, UWaT, was undertaken to elicit similarities, differences and application in practice for therapists.

Literature review

The literature search from Medline, Cinahl, PsycINFO, AMED and Cochrane database, used the key words writing, depression, creative, expressive and emotional, highlighted more 'writers'. There are those wishing to be part of a study for a variety of reasons, such as undergraduates fulfilling research requirements for a degree, exploring problems with depression and ruminative thought (Sloan et al 2008), suicide (Kovac and Range 2002), bereavement (Moss 2010) and abuse (Holmes et al 2007), or health care users hoping to experience benefit for their condition, such as cancer (Low et al 2010), posttraumatic stress disorder (Sloan et al 2011) and life story writing with older adults (Mastell-Smith et al 2007).

The most researched therapeutic writing model in health care is Pennebaker's (1993, 1997) written emotional disclosure (WED) model, based on randomised controlled trials (RCTs), linguistic assessments, and health benefits to the immune system of high-functioning undergraduates entering university. WED research randomised participants to write for 20 minutes on three consecutive days about either stressful and emotional life-experiences or non-emotional life-events. Pennebaker (1993) based his work on theories of inhibition and cognitive change, although he later recognised that the initial theory, that disclosure of traumatic events reduces inhibition and improves health, had not been proven (1997). He maintained that linguistic analysis of writing can predict a coherent story, resulting in cognitive change.

Pennebaker's (1997) model has engendered much speculation and research. A meta-analysis by Frattaroli (2006) of 146 RCTs using WED confirmed benefits across health care and highlighted certain elements that improve outcomes and effect sizes that help validate the research.

The field is widening to incorporate work with carers (Duncan et al 2007) and practitioners, such as general practitioners (Bolton 2010). The scope of delivery has developed with technology: writing interventions are available online (Kraaj et al 2010). In the United States, where Poetry and Journal Therapy are recognised professional interventions, writing has been acknowledged as one of four primary creative arts therapies providing health benefits (Stuckey and Nobel 2010).

Theory of writing in this study

To understand writing as a tool to access and play with memories and imagination, a Neo-Freudian, humanistic, object relations frame of reference was used. It recognises that there is a relationship between a person's past and present experience of environment, mental cognitions and behaviour and that mechanisms operate to separate the conscious from the unconscious (Hagedorn 2001). …

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