Exploring the Impact of Expressive and Narrative Writing on Parent-Caregivers

The journey of parenting a child facing a life-threatening illness is a profound emotional challenge that extends beyond the initial diagnosis timeframe.  Often it is when families are discharged home from the hospital setting that parents are most vulnerable to the emotional toll and coping with the trauma of caring for a child with cancer or other life-threatening illness. Two recent studies, each employing distinct writing interventions, offer valuable insights into the nuanced experiences of parent-caregivers navigating these complexities. In this article, we explore the potential of expressive writing and narrative e-writing on the well-being of parent-caregivers.

Expressive Writing for Parents of Children with Leukemia

The first study we’ll review was published in Clinical Psychology in Europe (2022).  This study explored the effects of expressive writing through the Guided Written Disclosure Protocol (GWDP) on 23 parent-caregivers of children in the off-therapy phase of acute lymphoblastic leukemia in Italy.  Participants completed 3 writing sessions, each of 30 minutes duration and about 2 weeks in-between sessions.  Assessments were completed using the Profile of Moods self-report questionnaire before the intervention, 10-15 days after, and 40-45 days after the intervention. 

 Key Findings included:

1. Mothers reported higher negative mood states at baseline compared to fathers, highlighting existing emotional burdens even prior to the start of the writing intervention phase.

2. Mothers showed a more significant decline in symptom scores 10-15 days post-intervention, emphasizing the potential benefits of expressive writing, with a more profound symptom change noted in mothers as compared with fathers.

3. Both mothers and fathers exhibited consistent improvement following the writing intervention, suggesting positive correlations between expressive writing and enhanced well-being.

4. A few participants experienced an increase in symptoms, underscoring the need for personalized approaches.

 Narrative E-Writing for Parents of Children with Chronic Illness

The second study we’ll review was featured in BMC Palliative Care (2022).  This study explored the accessibility and feasibility of the Narrative E-Writing Intervention (NeW-I), a therapist-facilitated smartphone app, for 26 parent-caregivers of children with chronic life-threatening illnesses in Singapore.  This intervention consisted of 4 weekly writing sessions of 30 minutes duration, followed by a written response and feedback by a therapist.  Assessment included post-intervention qualitative interview feedback and evaluation surveys.

 Key Outcomes included:

1. Participants reported improved spiritual well-being, increased hopefulness, and perceived social support.

2. The intervention led to decreased feelings of sadness, depression, caregiver burden, and anxiety related to their child's illness.

3. Participants appreciated the flexibility of the smartphone app for structured narrative writing, accommodating their busy schedules.

4. Parent-caregivers found the intervention provided an opportunity for meaningful reflection, helping them process their emotions and experiences.

 In summary, both studies suggest that writing interventions may positively impact the emotional well-being of parent-caregivers. Expressive writing, as demonstrated in the first study, offers a structured approach to processing emotions, with notable improvements observed in mood states. The narrative e-writing intervention, showcased in the second study, emphasizes flexibility and the opportunity for meaningful reflection, resulting in improved spiritual well-being and reduced emotional distress.

 While both studies suggest positive potential for writing interventions in addressing parent-caregiver distress and trauma, these studies also acknowledge limitations in sample size, emphasizing the need for future research with larger and more diverse groups.  Additionally, the first study demonstrated individual variability in results with few parents experiencing worsening of symptom scores; this emphasizes the importance of personalized interventions, recognizing that one size may not fit all.

 In conclusion, expressive and narrative writing may serve as powerful tools for fostering resilience and emotional well-being among parent-caregivers of children with leukemia and chronic life-threatening illnesses.  As we continue to explore the complexities of parental caregiving, these studies pave the way for future research and the development of nuanced interventions that honor the diverse experiences of those facing the challenges of caring for the health of a child.

 Resources:

Christiansen DM, Martino ML, Elklit A, Freda MF. Sex Differences in the Outcome of Expressive Writing in Parents of Children With Leukaemia. Clin Psychol Eur. 2022 Mar 31;4(1):e5533. doi: 10.32872/cpe.5533. PMID: 36397745; PMCID: PMC9667348.

 Dutta O, Tan-Ho G, Low XC, Tan THB, Ganapathy S, Car J, Ho RM, Miao CY, Ho AHY. Acceptability and feasibility of a pilot randomized controlled trial of Narrative e-Writing Intervention (NeW-I) for parent-caregivers of children with chronic life-threatening illnesses in Singapore. BMC Palliat Care. 2022 Apr 29;21(1):59. doi: 10.1186/s12904-022-00945-0. PMID: 35488270; PMCID: PMC9052453.