JMIR Publications

ABSTRACT

Background:

Barriers to accessing treatment for Major Depressive Disorder (MDD) highlight a need for scalable interventions that can be administered online. One such intervention is expressive writing (EW), which typically involves daily sessions of writing for at least 20 minutes about a personal problem or issue. EW has been shown to alleviate MDD symptoms and related difficulties in various samples, including those with or at-risk for MDD. Its simple format also makes it amenable to online administration.

Objective:

We conducted a multi-methods study to evaluate the feasibility, efficacy, and perceived utility of online EW in patients with MDD.

Methods:

We recruited a sample of 54 patients diagnosed with MDD from a large academic psychiatry hospital. Half were randomized to complete four 20-minute sessions of EW online and the other half were randomized as controls. All participants completed outcome measures before and after the intervention, and at a one-month follow up. Our primary outcome was MDD symptom severity, and secondary outcomes were symptom severity of Generalized Anxiety Disorder (GAD), functional impairment, and the perceived complexity of personal problems. We used mixed effect models to assess the impact of group (i.e., EW or control), time, and their interaction on each outcome. We also completed qualitative interviews with participants assigned to EW about their experiences and conducted a reflexive thematic analysis of these qualitative interviews.

Results:

Most EW participants (n=20, 74%) completed at least three EW sessions, but only 6 (22%) wrote for the full 20 minutes. There was no evidence that condition interacted with time to impact MDD symptoms (F=0.28, P=.753), GAD symptoms (F=0.21, P=.811), functional impairment (F=0.99, P=.376), or perceived complexity of problems (F=0.66, P=.519). In qualitative interviews, some participants reported EW allowed them to offload or process negative emotions and thoughts, whereas others reported it to be unhelpful. Suggestions to improve EW included offering more specific guidance and flexibility in its duration.

Conclusions:

EW was feasible to administer online to patients with MDD, with some reported benefits for emotional and cognitive processing. However, EW was not associated with improvements in MDD symptoms and personal functioning and may not be an effective online intervention for MDD in its current state. Providing more specific instructions or guidance, with some clinical oversight or support, may be a promising approach to modifying the intervention for evaluation in future work.