Online Expressive Writing Program May Improve Well-Being in Adults With Inflammatory Bowel Disease

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Researchers explored the preliminary efficacy and feasibility of an online writing intervention against distress in people with IBD during the COVID-19 pandemic.

Online expressive writing may be feasible and acceptable in patients with inflammatory bowel disease (IBD) and distress, according to a study in Complementary Therapies in Clinical Practice.

The parallel, randomized, double-blind controlled trial evaluated the feasibility, acceptability, and preliminary efficacy of a brief facilitator-delivered online expressive writing intervention (WriteforIBD) to reduce distress in patients with IBD during the COVID-19 pandemic.

Eligibility criteria included being an adult diagnosed with IBD by a gastroenterologist, having mild to moderate distress on the Kessler Psychological Distress Scale (K10) (scores 20-29), and being able to read and write in English. The study participants were randomly assigned 1:1 to either WriteforIBD or an active control intervention group.

A total of 21 adults were included in the study, and 19 remained until the 3-month follow-up (WriteForIBD, n=10 [mean age, 41.90 years; 10 women]; control group, n=9 [mean age, 41.56 years; 7 women]). After randomization, the retention rate was 100% for the WriteforIBD group and 81.8% for the active control group.

The WriteforIBD group participated in a 4-day writing program using software such as Zoom for 30 minutes and did not share their writing with the study authors to ensure free expression. The active control group wrote about trivial topics provided by the researchers for 4 consecutive days.

For both groups, 84.2% of participants were satisfied (scores 7-10) or neutral (scores 4-6) with the writing instructions. In the WriteforIBD group, 90% of participants were satisfied (70%) or neutral (20%) (7.22±1.39). No significant between-group differences were observed in satisfaction (t [17] = -1.08, P =.270).

The 2 groups were equal on all baseline values, except for QOL scores for independent living and mental health, with the WriteforIBD group having higher scores (P =.025 and P =.016, respectively).

The researchers found a significant main effect for time on the IBD-control measure (R2=0.19, P =.008). Both groups had significantly improved IBD control from baseline to postintervention (control, Glass g: 0.69 [0.02, 1.37]; experimental, Glass g: 0.92 [0.26, 1.57]).

A significant interaction of group*time for resilience was observed (R2=0.19, P <.001). For the control group, a significant reduction in reported resilience from the first follow-up to 3 months was found (Glass g: -1.12 [-1.84, -0.4]). No significant change occurred in resilience during the same period for the experimental group, although a significant between-group difference was observed at 3 months (Glass g: 1.4 [0.66, 2.12]), and the WriteforIBD group reported higher resilience at the final follow-up.

Study limitations included a small final cohort size due to low recruitment. Baseline mean stress, anxiety, and depression scores were also relatively low, which may have affected the ability to establish the intervention’s preliminary efficacy on distress.

“The expressive writing intervention delivered online is potentially feasible and acceptable to people with IBD but had no preliminary effect on distress, [QOL], self-efficacy, or perceived social support,” the researchers concluded. “Online expressive writing interventions targeting distress at the time of pandemic-like events may have a potential to improve outcomes in IBD and should be further studied.”

Disclosure: This research was supported in part by a Janssen educational grant. Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Skvarc D, Evans S, Cheah S, et al. Can an online expressive writing program support people with inflammatory bowel disease? A feasibility randomised controlled trial. Complement Ther Clin Pract. Published online June 9, 2022. doi:10.1016/j.ctcp.2022.101616

This article originally appeared on Gastroenterology Advisor