Effectiveness of expressive writing in the reduction of psychological distress during the Covid-19 pandemic: a randomized controlled trial

The COVID-19 pandemic brought mental health risks, and the need for scalable interventions which can reduce psychological distress was recognized. Expressive writing (EW) interventions were shown to be beneficial for different mental health conditions. The aim of this study was to assess the effectiveness of EW in the reduction of psychological distress in the context of the COVID-19 pandemic. A randomized controlled trial was applied, in which participants (N = 120) were randomly allocated to (1) the intervention group - completing 5 EW sessions over the 2 weeks, or (2) the control group, receiving treatment as usual (TAU). Primary and secondary outcome measures were assessed at baseline, post-treatment, and follow-up, one month after the treatment had ended. The primary outcome measure was the severity of psychological distress assessed at post-treatment, measured by Depression Anxiety Stress Scale (DASS), while secondary outcome measures were the severity of depression, anxiety, and stress measured by DASS subscales, well-being measured by WHO-5, and subjective perception of quality of life, assessed by SQOL scale, at post-treatment. The intervention group showed less favorable outcome on psychological distress (F(1, 101) = 5.600, p = .020, ηp2 = 0.053), and symptoms of stress (F(1, 101) = 16.360, p = .000, ηp2 = 0.139), after controlling for baseline scores. No significant difference was found between the groups on depression (F(1, 101) = 3.078, p = .082, ηp2 = 0.030), anxiety (F(1,101) = 0.115, p = .735, ηp2 = 0.001), well-being (F(1, 101) = 1.276, p = .261, ηp2 = 0.012), and subjective quality of life (F(1, 101) = 0.352, p = .554, ηp2 = 0.003) at post-treatment, nor at follow-up for any of the outcome measures. Moderation effects of age (F(1, 100) = 7.682, p = .007, ηp2 = 0.071), and gender (F(1, 92) = 6.989, p = .010, ηp2 = 0.071), with older and male participants scoring higher on distress measures was documented, indicating EW interventions may be particularly counterproductive for older and male participants. Engaging in EW during the pandemic elevates stress. Hence, EW or similar self-guided interventions should not be applied without prior evidence on their effects in stressful circumstances such as pandemic, due to their harmful effect.