JMIR Publications

ABSTRACT

Background:

The high prevalence of diabetes distress and subclinical depression in adults with type 1 and type 2 diabetes (T1DM and T2DM) indicates a 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 diabetes 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 benefit-finding writing (BFW) or an active control condition of online writing about use-of-time (CW). Both groups completed 15-minute online writing sessions, once per day, for three consecutive days. Online measures were administered at baseline, one-month and three-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). BFW was adhered to by participants. Greater increases in positive affect immediately post-writing were found in the BFW group than the CW group. However, there were no significant group by time interactions (indicating intervention effects) for benefit-finding or diabetes distress at either one-month or three-month follow-ups. 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. 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. Clinical Trial: Prospectively registered with the Australia and New Zealand Clinical Trials Registry (ACTRN12615000241538); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368146&isReview=true; (Archived by WebCite at http://www.webcitation.org/75JNQmCg6)