Expressive writing as a therapeutic intervention for people with advanced disease: A systematic review

© The Author(s) 2019. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background Expressive writing involves writing about stressful or traumatic experiences. Despite trials in people with advanced disease, no systematic review to date has critiqued the evidence on expressive writing in this population. To synthesise the evidence of the effects of expressive writing on pain, sleep, depression and anxiety in people with advanced disease. Methods A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. CINAHL, CENTRAL, PsycINFO and PubMed were searched from January 1986 to March 2018. Other sources included clinical data registers and conference proceedings. Studies were included if they were randomised controlled trials that assessed the impact of an intervention involving expressive writing for adults with advanced disease and/or studies involving linguistic analysis on the expressive writing output. Methodological quality was assessed using the Cochrane risk of bias tool and the Mixed Methods Appraisal Tool. The Grading of Recommendations Assessment, Development and Evaluation tool was used to assess the level of evidence for the outcomes of interest. The protocol of this systematic review has been registered on PROSPERO (CRD42017058193). Results Six eligible studies with a total of 288 participants were identified, including four randomised controlled trials. All of the trials were in cancer and recruited predominantly women. None of the interventions were tailored to the population. Studies had methodological shortcomings and evidence was generally of low quality. Combined analysis of the four trials, involving 214 participants in total, showed no clear difference in the effect of expressive writing on sleep, anxiety or depression compared to an active control. Pain was not evaluated in the trials. In contrast, analysis of the four studies that included linguistic analysis alluded to linguistic mechanisms for potential effects. Conclusion Although the trial results suggest there is no benefit in expressive writing for people with advanced disease, the current evidence is limited. There is a need for more rigorous trials. It would be of benefit first to undertake exploratory research in trial design including how best to measure impact and in tailoring of the intervention to address the specific needs of people with advanced disease.Peer reviewedFinal Published versio

How do men and women write about their feelings and thoughts through Expressive Writing? A pluralistic narrative analysis

This doctoral portfolio consists of three components, a research thesis, a publishable journal article and a client case study and process report, all of which constitute necessary research and clinical practice components of the Professional Doctorate in Counselling Psychology programme. While these components are three independent pieces of work, they are all related thematically. The prominent theme throughout the work is the written and verbal expression of feelings in men’s and women’s stories and their ability to process, shift or broaden painful stories in order to find new meanings within them. Human beings accumulate a ‘repertoire of life stories’ during their lifetime which they strive to make sense of and give meaning to (Polkinghorne, 2004, p.53). As our Counselling Psychology field develops, it encourages more and more flexible therapy approaches that pay close attention to fundamental client factors, such as client preferences and expectations, which have been shown to influence therapy outcomes; this is always within the context of a trusting therapeutic relationship and the establishment of a professional emotional bond between therapists and clients (Scheel et al., 2018; Scheel and Conoley, 2012). The first section of this portfolio involves a pluralistic narrative analysis research consisting of two different analytical levels that examines how men and women express their feelings and thoughts in the course of a 50-minute Expressive Writing task. The findings present the underlying structure of men's and women's narratives as well as the types of stories produced within them, revealing the way they express their feelings and thoughts through the medium of writing. The findings of this study are not intended to underrate the existing types of therapy used in Counselling Psychology clinical practice. Rather, they are hoped to encourage Counselling Psychologists to enhance their creativity, flexibility and patience in engaging their clients in the therapeutic process so that they may facilitate their emotional expression and accommodate their individual needs through alternative means where appropriate. Also, as a result of the Covid-19 pandemic, recent studies have found that males experienced higher levels of stress and anxiety symptoms (Kumari and Singh, 2020) and difficulties in coping with them (Tsukamoto et al., 2021), and women experienced greater levels of depressive symptoms (Vloo et al., 2021) and domestic violence (Thibaut and Wijngaarden-Cremers, 2020). The results of this study may, therefore, contribute to the continued development of Counselling Psychology clinical practice and the increasing demands and responsibilities that currently faces, thereby allowing for a better level of counselling support for male and female clients. In addition, the results may serve as an opportunity to enhance Counselling Psychology educational programmes as well as explore new research avenues in the field. The second section of this portfolio presents a publishable article for the Journal of Poetry Therapy. This interdisciplinary journal was selected due to its commitment to the publication of research that focuses on the integration of literary arts into a variety of service settings and on healing and growth through language and symbolism including storytelling, writing and lyrics. The article presents the Evaluations identified in the narratives which is one of the six elements of Labov's Model of narrative analysis as well as the ‘Narratives of Love’, one of the three types of stories produced in the narratives based on a range of characteristics which resulted from the findings of Labov's Model. Compared to the rest of Labov’s Model elements, Evaluations represent the most fundamental element of Labov’s Model (Labov, 2013) which directly illustrate peoples’ feelings and the meanings they attribute to their experiences (Riessman, 2005). Also, ‘Narratives of Love’ demonstrate that while the narratives in this story type contained experiences of loss, the narrators used the EW task to produce stories about their feelings of love and express their tender thoughts for their loved ones who are no longer in their lives. Therefore, Evaluations and ‘Narratives of Love’ were selected for presentation since they both have fundamental implications for Counselling Psychology practice. To comply with the journal's guidelines, the entire analysis has been shortened; however, parts of both analytic lenses are presented in an effort to illustrate the pluralistic nature of this research and how the two levels of analysis complemented one another in exploring how men and women express their feelings and thoughts through Expressive Writing. The third section of this portfolio presents a combined client case study as well as a process report and a reflective discussion for a client I worked with drawing from Narrative Therapy. The work presented was undertaken as part of my clinical work in an NHS GP surgery. In the client case study each stage of the therapeutic process is described and the way the theoretical framework of Narrative Therapy was integrated with my clinical skills aimed at showing my ability to assess my client, formulate his concerns, create a treatment plan, adjust it to the clinical setting and evaluate my practice. The client case study highlights the importance of establishing a trusting therapeutic relationship based on openness and collaboration to enable a multifaceted exploration of concerns. It illustrates a range of Narrative Therapy interventions, and how these were used collaboratively with a client who aimed to understand his anger and worry towards his mother and explore alternative means of managing them. It shows how the client was allowed to share his narrative in his own words and how the problem he brought to therapy was separated from him through the externalisation process (White and Epston, 1990). It presents the process of deconstructing the problem by exploring its emergence and influence in the client's life, the meanings the client assigned to the problem, how certain cultural and social discourses and beliefs he grew up with may have influenced its development and maintenance as well as the exceptions to it (White and Epston, 1990). In addition, it demonstrates the exploration of other stories the client had that did not relate to the problem (White, 2000), such as his hobbies, dreams, hopes for the future, and relationships with others, while it illustrates the new, more powerful stories he started to develop with regards to the problem he brought to therapy. The fundamental role of supervision as well as the challenges encountered throughout the therapeutic work are also discussed. In the process report, a representative transcribed segment from my therapeutic work with the client is presented together with a reflective account and detailed analysis of it, aimed at showing the application of a Narrative Therapy intervention to my clinical practice. In particular, the process report demonstrates how the client was enabled to start separating himself from the problem through exploring a name for it which represented his experience and examining the impact of it on his life and sense of self. An evaluative commentary of the presented segment is provided, while the strengths and the limitations of it are also discussed together with my learnings from my experience and how these were reflected on and addressed. A reflective discussion concludes this section, which describes the connections between the case study and the process report, as well as providing a detailed reflection of the professional identity development I have experienced from my work with this client, including observations, professional and personal insights, and lessons learned. In conclusion, I consider the development of this doctoral portfolio with its three components to be an important part of my doctorate studies in Counselling Psychology, which contributed to my personal as well as professional identity as an emerging Counselling Psychologist. Τhis work has invited me to reflect on my personal starting point including my experiences and my beliefs about how men and women express their feelings, while it also allowed me to explore my interests and passions and develop my own flexibility and creativity. Throughout this professional training programme, I have gained significant learning opportunities and experience in understanding psychological processes from a variety of psychological approaches, and while this portfolio marks the end of this journey, I intend to continue my learning and development efforts. Sometimes, verbal expression alone might be difficult, and thus, it is my goal to continue creating open and collaborative therapeutic relationships with my clients in which they are able to express themselves through the mediums that are most comfortable for them. Lastly, I would also like to invite my Counselling Psychologist colleagues to maintain their curiosity and be attentive to their clients’ unique needs and preferences and to not hesitate to bring their creative sides and ideas into the therapeutic process and experiment them in order to meet their clients where they are

A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain

Low back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of physical and rehabilitation interventions (i.e. exercise therapy, back school, transcutaneous electrical nerve stimulation (TENS), low level laser therapy, education, massage, behavioural treatment, traction, multidisciplinary treatment, lumbar supports, and heat/cold therapy) for chronic LBP. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to 22 December 2008. Existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria. The search strategy outlined by the Cochrane Back Review Groups (CBRG) was followed. The following were included for selection criteria: (1) randomized controlled trials, (2) adult (≥18 years) population with chronic (≥12 weeks) non-specific LBP, and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery, or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias, and outcomes at short, intermediate, and long-term follow-up. The GRADE approach was used to determine the quality of evidence. In total 83 randomized controlled trials met the inclusion criteria: exercise therapy (n = 37), back school (n = 5), TENS (n = 6), low level laser therapy (n = 3), behavioural treatment (n = 21), patient education (n = 1), traction (n = 1), and multidisciplinary treatment (n = 6). Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. Behavioural treatment was found to be effective in reducing pain intensity at short-term follow-up compared to no treatment/waiting list controls. Finally, multidisciplinary treatment was found to reduce pain intensity and disability at short-term follow-up compared to no treatment/waiting list controls. Overall, the level of evidence was low. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy compared to usual care, there is low evidence for the effectiveness of behavioural therapy compared to no treatment and there is moderate evidence for the effectiveness of a multidisciplinary treatment compared to no treatment and other active treatments at reducing pain at short-term in the treatment of chronic low back pain. Based on the heterogeneity of the populations, interventions, and comparison groups, we conclude that there are insufficient data to draw firm conclusion on the clinical effect of back schools, low-level laser therapy, patient education, massage, traction, superficial heat/cold, and lumbar supports for chronic LBP

Low temperature chemical preparation of semiconducting transition metal chalcogenide films for energy conversion and storage, lubrication and surface protection

A simple technique is presented for the production of films of transition metal disulfides such as MoS2, WS2, FeS2, or RuS2 by the reaction of transition metal carbonyls e.g. Mo CO 6, W CO 6, Fe CO 5, Ru3 CO 12 with a sulfur source e.g. S, H2S in an organic solvent e.g. benzene, toluene, xylene, mesitylene 1,3,5 trimethyl benzene at temperatures ranging between 80 to 165 C. The quality of the materials and films has been investigated and some applications are discussed. They include use of the chemically prepared sulfides as photoactive materials e.g. MoS2, WS2, FeS2 , as lubricating films MoS2 , as electrodes for Li batteries MoS2, FeS2 and for corrosion protection RuS

Development of Hybrid Systems by Integrating an Adsorption Process with Natural Zeolite and/or Palygorskite into the Electrocoagulation Treatment of Sanitary Landfill Leachate

The effectiveness of a hybrid approach comprising electrocoagulation (EC) and adsorption (AD) (using natural zeolite and/or palygorskite) processes to treat raw sanitary landfill leachate (SLL) was investigated in terms of color, dissolved chemical oxygen demand (d-COD), nitrate nitrogen (NO3−-N) and ammonium nitrogen (NH4+-N) removal. Optimal EC conditions were found with a current density of 30 mA cm−2, Fe electrode material and pH 8. Implementation of the AD process using zeolite (ADzeo) as pre- or post-treatment for EC significantly increased the NH4+-N removal efficiency. The ADzeo-EC sequential treatment showed considerably higher color removal compared to the EC-ADzeo sequential treatment and was therefore determined to be the optimal sequential treatment. Integration of the AD process using palygorskite (ADpal) into the first or middle stage of the ADzeo-EC treatment system enhanced the overall NO3−-N removal efficiency. The hybrid ADzeo-ADpal-EC treatment system exhibited the highest simultaneous removal efficiencies of color, d-COD, NO3−-N and NH4+-N, corresponding to 95.06 ± 0.19%, 48.89 ± 0.89%, 68.38 ± 0.93% and 78.25 ± 0.61%, respectively. The results of this study indicate that the ADzeo-ADpal-EC hybrid system is a promising and efficient approach for treating raw landfill leachate