Effects of directed written disclosure on grief and distress symptoms among bereaved individuals

Abstract

Bereavement-specific written disclosure trials have generally demonstrated null effects, but these studies have not directed the focus of writing. This randomized controlled trial compared directed writing that focused on either sense-making or benefit-finding, both associated with adjustment to loss, to traditional, non-directed emotional disclosure and a control condition. Bereaved undergraduates (n = 68) completed three 20-min writing sessions over 1 week. Intervention effects were found on prolonged grief disorder, depressive, and posttraumatic stress symptoms 3 months postintervention, and the benefit-finding condition appeared particularly efficacious. Physical health improved over time in all treatment groups. Findings suggested that directing written disclosure on topics associated with adjustment to bereavement may be useful for grieving individuals.

FIGURE 1

Study flowchart. Note: T1 = baseline assessment; T2 = postintervention assessment; T3 = follow-up assessment; ED = emotional disclosure; BF = benefit-finding; SM = sense-making; and CC = control condition.

FIGURE 2

Written disclosure instructions.

FIGURE 3

Prolonged grief disorder, depressive, and posttraumatic stress disorder symptoms over time. Top left panel: estimated marginal mean ICG-R-SF scores over time, covarying for current psychotherapy and relationship to deceased, for total sample in top panel (N = 68). Group Time interaction effect, p = .009. Top right panel: estimated marginal mean CES-D scores over time, covarying for current psychotherapy (n = 68). Group × Time interaction effect, p = .016. Bottom panel: estimated marginal mean PCL-C scores over time, covarying for current psychotherapy (n = 68). Group × Time interaction effect, p = .001. PGD symptoms measured with Inventory of Complicated Grief–Revised-Short Form. Depressive symptoms measure with Center for Epidemiologic Studies Depression Scale. PTSD symptoms measured with PTSD Checklist-Civilian Version. ED = emotional disclosure condition; BF benefit-finding condition; SM = sense-making condition; and CC = control condition.