Good reasons for bad behavior: a randomized controlled experiment on the impact of narrative reading and writing on empathic concern, perspective-taking, and attitude.

Background: Empathic concern and perspective-taking may contribute to avoiding stigmatization of adverse health behavior. Narrative writing has been shown to be effective in promoting perspective-taking and empathy. But since narrative writing is time consuming, we tested in the present study narrative reading as an alternative, more parsimonious approach. Methods: In a randomized controlled experiment, we compared writing a narrative text about a fictitious person who displays disapproved of health behavior to reading such a text and to a control condition in which participants wrote about an unrelated topic. With a sample of n = 194 participants, we investigated the impact of writing and reading a narrative text on promoting empathic concern and perspective-taking as well as on attitude change. Results: We found that both writing and reading a narrative text about the fictitious character increased empathic concern, F(1, 191) = 32.85, p < 0.001, part. η2 = 0.15, and perspective-taking, F(1, 191) = 24.76, p < 0.001, part. η2 = 0.12, more strongly than writing about an unrelated topic. Writing and reading a narrative text also resulted in a more positive attitude toward this person, F(1, 191) = 17.63, p < 0.001, part. η2 = 0.08. Simply reading a narrative text was equally efficient as narrative writing with respect to empathic concern, p = 0.581, perspective-taking, p = 0.629, and attitude, p = 0.197. Conclusion: The finding that narrative reading is as effective as narrative writing suggests that the readers appear to be able to comprehend and engage with the story being told. When narrative reading is as effective as narrative writing, it can succeed with reduced effort in increasing empathic concern, perspective-taking, and attitude. We discuss the benefits of this approach for reducing stigmatization of adverse health behavior.

Investigating cognitive and motivational proximal outcomes in a randomized clinical trial of writing about the future self to reduce drinking.

BACKGROUND: Drinking identity (the extent to which one links the self with drinking alcohol) is a unique risk factor for college students' hazardous drinking that is not directly targeted by existing interventions. We conducted a study that aimed to decrease drinking identity among college students with hazardous drinking. We adapted a writing task about the future self and tested whether three writing sessions could decrease drinking identity and change drinking. We also investigated whether two additional factors (writing perspective and inclusion of participants' social networks) would enhance task impact. The present study evaluated whether posited proximal cognitive and motivational outcomes (drinking identity, self-efficacy, readiness to change, and drinking intentions) changed immediately after each writing session. METHOD: The study is a randomized clinical trial in which hypotheses and analyses were pre-registered. Participants were 328 college students who met hazardous drinking criteria. The study had a 2 (narrative writing topic: low-risk drinker vs. reduced smartphone use) × 2 (writing perspective: first-person vs. non-first-person) × 2 (social network instruction: instructed to include vs. not) factorial design. Proximal outcomes were drinking identity, self-efficacy, readiness to change, and drinking intentions. The clinical outcome was alcohol consumption. Participants completed three laboratory sessions at weekly intervals that included the writing task and pre- and post-task assessments. RESULTS: Results were largely null, except that readiness to reduce drinking was higher in the low-risk drinker condition and increased over the lab sessions. Time effects indicated that reductions in drinking identity, drinking intentions, and alcohol consumption, and increases in self-efficacy were observed but did not change above and beyond control conditions. CONCLUSIONS: Findings indicate the need to strengthen the writing task and select a more appropriate control task to target proposed proximal outcomes. Future studies might try personalizing the task, evaluating its efficacy with individuals motivated to change their drinking, and using a control task that does not involve imagining a future self.

Writing about the future self to shift drinking identity: An experimental investigation.

College student drinking is prevalent and costly to public and personal health, leading to calls to identify and target novel mechanisms of behavior change. We aimed to manipulate drinking identity (a cognitive risk factor for hazardous drinking) via three sessions of narrative writing about a future self. We tested whether writing could shift drinking identity and would be accompanied by changes in alcohol consumption and problems. Participants were college students meeting hazardous drinking criteria (N = 328; Mage = 20.15; 59% women, 40% men, 1% gender-diverse; 60% white; 23% Asian; 12% multiple races; 2% other racial groups; 8% identified as Hispanic/Latino/a/x). The study had a 2 [narrative writing topic: low-risk drinker vs. reduced smartphone use] × 2 [writing perspective: first person vs. non-first-person] × 2 [social network instruction: instructed to include vs. not] factorial design. Outcomes were drinking identity, drinking refusal self-efficacy, alcohol consumption, alcohol-related problems, and craving. Participants completed three writing sessions and online follow-up assessments at 2, 4, and 12 weeks. The study is a registered clinical trial; hypotheses and analyses were preregistered (https://osf.io/vy2ep/). Contrary to predictions, narrative writing about a future self as a low-risk drinker did not significantly impact outcomes. Null results extended to expected interactions with writing perspective and social network instructions. The narrative writing task did not shift drinking or alcohol-related outcomes. Future experimental work may benefit from greater flexibility in conceptualizing a future self, recruiting individuals interested in behavior change, and more sensitive measures of drinking identity.

The effect of "Narrative writing reflection" method on the hope of patient with COVID-19: A health promotion intervention.

BACKGROUND: Corona virus disease disease as a life-threatening respiratory disease causes psychological problems including hopelessness in patients. So the aim of this study was to determine the effect of Narrative writing reflection on hope of patient with COVID-19. MATERIALS AND METHODS: The study was experimental with a pre-test-post-test and with the control group design. The subjects were randomly divided into the intervention (n = 30) and control (n = 30) groups. The intervention group received Narrative writing reflection. The control group was receiving routine care. Before and after the intervention, the patients were asked to complete the 12-item Herth Hope Index. Data were analyzed with by using spss software and paired t test and independent t-test with a significance level of P < 0.05. RESULTS: Independent t-test showed that the hope scores before intervention in both intervention and control groups were not statistically significant (P > 0.05), whereas there was a significant difference between two groups after the intervention (P < 0.05). CONCLUSION: The results of this study showed that the use of mindfulness methods such as narrative writing in hospitalized and quarantined patients who are unable to communicate with the outside environment could increase the hope in patient.

"Getting Started": A Pilot Introductory Narrative Writing Session for Interprofessional Faculty in Academic Health Sciences.

Purpose: We designed and implemented a pilot introductory narrative writing session with the two-fold goal of fostering the dissemination of faculty writing for submission to peer-reviewed journals and other publication venues while simultaneously creating a framework for establishing collaborative and empathic interprofessional teams by enhancing narrative-related competencies. Methods: The session was open to interprofessional faculty at our academic health sciences center. Participants were accepted via a competitive application process, with group size limited to 18 individuals due to the workshop-style format. Learners were reflective of our diverse campus regarding sex, race/ethnicity, department, rank, and professional role. The session began with an experiential seminar providing instruction on writing theory and practice, discussion questions, and reflective writing prompts. The seminar was followed by a writing workshop. We conducted a mixed-methods evaluation to gauge participant satisfaction and educational efficacy. Results: The mixed-methods evaluation revealed that faculty reported high satisfaction with the session as a designated space to contemplate, discuss, practice, share, and critique narrative writing. All learners (18, 100%) rated it "very good" or "excellent" in overall quality and value as well as in relevance to personal growth. Participants reported growth in communication (13, 72%), self-reflection (12, 67%), active listening (12, 67%), writing confidence (11, 61%), perspective-taking (11, 61%), writing skills (10, 56%), and empathy (8, 44%). Discussion: Faculty valued the session as a venue for improving their writing skills and sharing with a diverse group of colleagues about the significance of narrative in relation to their professional lives. Conclusion: Seminar outcomes suggest that narrative-based education for interprofessional health sciences faculty can be effective in achieving the two-fold goal of enhancing writing competencies while simultaneously fostering essential skills for building collaborative and empathic teams to promote high-quality education, research, and whole person clinical care.

Predictors of narrative text quality in students with hearing loss.

AIM: Students with hearing loss (HL) often fall behind hearing peers in complex language tasks such as narrative writing. This study explored the effects of school grade, gender, cognitive and linguistic predisposition and audiological factors on narrative text quality in this target group. METHOD: Eleven students with HL in Grades 5-6 and 7-8 (age 12-15) who took part in a writing intervention wrote four narrative texts over six months. A trained panel rated text quality. The effects of the students' working memory capacity, language comprehension, reading comprehension, school grade and gender and the intervention were analyzed as a mixed-effects regression model. Audiological factors were considered separately. RESULTS: The analysis showed that throughout the period, texts written by female students in Grade 7-8 received the highest text quality ratings, while those written by male students in Grade 7-8 received the lowest ratings. There was no effect of the intervention, or of the linguistic and cognitive measures. The students with the lowest text quality ratings received amplification later than those with high ratings, but HL severity was not associated with text quality. CONCLUSION: Hearing loss severity was not a decisive factor in narrative text quality. The intervention which the students took part in is potentially effective, with some adaptation to the special needs of students with HL. The strong gender effects are discussed.

Evaluation of the effect of narrative writing on the stress sources of the fathers of preterm neonates admitted to the NICU.

OBJECTIVE: Identification of the nurses and fathers' understanding of the stress sources facilitates nursing interventions and increases parental satisfaction. MATERIALS AND METHODS: The quasi experimental study with pretest and posttest was administered to a sample size of 70 fathers with preterm neonates hospitalized in the NICUs of Gorgan University of Medical Sciences in 6 months. The Parental Stressor Scale (PSS) was used. The data were analyzed using descriptive and analytical statistical methods. RESULTS: Evaluation of the differences in the domains showed that narrative writing had significant effects on all three domains. The results showed that the highest stress reduction was observed in parents' relationship followed by infant behavior and appearance while the lowest stress reduction was observed in the sights and sounds in the intervention group. CONCLUSION: Narrative writing may be considered an efficient supportive intervention to reduce the fathers' stress, infant behavior and appearance in the NICUs.

The effect of narrative writing on fathers' stress in neonatal intensive care settings.

Objective: This study was conducted to examine the effect of narrative writing on fathers' stress in the Neonatal Intensive Care Units (NICUs) during infants' hospitalization.Methods: A quasi-experimental study was conducted among two groups of fathers with preterm infants in the NICUs of two teaching hospitals of Gorgan University of Medical Sciences. Pre- and post-tests were administered to a sample size of 70 during 6 months. The Parental Stressor Scale (PSS) was used. The data were analyzed using descriptive and analytical statistical methods.Results: The mean total stress score was 74.05 ± 17.39 in the control and 80.11 ± 15.82 in the intervention group on the 3rd day, suggesting no significant difference. In other words, both groups had a similar stress level before the intervention (p-value = .13, t = 1.52). However, the mean total stress score was 85.45 ± 16.91 in the control group and 48.00 ± 10.49 in the intervention group on the 10th day, suggesting a significant reduction in the stress level in the intervention group following the intervention (p-value = .001, t = -11.01).Conclusion: According to the findings, the narrative writing may be considered as an efficient supportive intervention to reduce the fathers' stress in the NICUs. However, more research is needed to justify its implementation.

Comparison of the effect of narrative writing and art therapy on maternal stress in neonatal intensive care settings.

Objective: This study was conducted to examine the effect of narrative writing and art therapy on maternal stress in the neonatal intensive care units (NICUs) during infants' hospitalization.Material and Methods: randomized controlled clinical trial with three parallel arms study was conducted among three groups of mothers with preterm infants in the NICUs of two teaching hospitals of Shahroud University of Medical Sciences. Pre- and post-tests were administered to a sample size of 105 during 9 months. The parental stressor scale (PSS) was used. The data were analyzed using descriptive and analytical statistical methods.Results: The mean maternal stress score was 54.94, 47.08, and 47.57 in the art therapy, narrative writing, and control before the intervention respectively, indicating no significant difference between the groups (p = .28). There was also no significant difference in the mean score of stress between the groups after the intervention (p = .92). Also, we found no significant difference in the mean score of parental role and parents' relationship and sights and sounds between the three groups on the second day (p = .22 and p = .12, respectively) but there was a significant difference in the mean score of infant behavior and appearance between the three groups (p = .05). There was no significant difference in parental role and parents' relationship (p = .31), infant behavior and appearance (p = .58), and sights and sounds (p = .67) between the three groups on the sixth day of intervention.Conclusions: Narrative writing and art therapy are only effective on the subscale of infant behavior and appearance in the PSS: NICU.

Narrative writing as a strategy for nursing ethics education in Japan.

OBJECTIVES: The purpose of this study was to explore the effectiveness of learning ethics of nursing practice using narrative writing. METHODS: Study design was qualitative descriptive research. The participants were 90 graduate students who took nursing ethics classes, of whom 86 graduate students (4 males and 82 females) agreed to this study. The data gathered for analysis were their narratives described as feeling uncomfortable in clinical settings and their comment sheets after narrative group work in nursing ethics classes. We used qualitative content analysis to identify graduate students' awareness gained through narrative writing and narrative group work. RESULTS: As a feature of the scenes described by graduate students, there were often conflicts that patients' autonomy were not respected, or that they were not able to engage in sincere engagement. The narrative writing was effective to make graduate students aware of the following two aspects: 1) habits and trends in one's own thoughts and 2) organizational and administrative issues related to ethical issues. CONCLUSIONS: Learning ethics of nursing practice using narrative writing that focused on nurses' sentiments helped reveal nurses' thoughts as well as their attitudes and approaches to patients. These findings suggest that narrative writing in nursing ethics education could lead to ethical practice. Additionally, our results indicate that narrative writing in research may be helpful as a strategy to clarify ethical issues and the awareness of nurses in clinical settings.

Assessment of narrative writing by Persian-speaking students with hearing impairments.

OBJECTIVE: Previous studies have highlighted that narrative skill is critical to the development of the literacy skills by children. Children with cochlear implants (CI) and hearing aids (HA) may have problems in narrative development compared to peers with healthy hearing (HH). There is no exact data about the narrative writing ability of Persian-speaking students who are hearing-impaired. This study was undertaken to compare the microstructure and macrostructure scores for narrative writing of Persian-speaking students who are hearing-impaired and peers with HH. DESIGN: This was a cross-sectional descriptive-analytical study. SETTING: The subjects were recruited from elementary schools in the city of Tehran. PARTICIPANTS: A total of 144 elementary school students were participated. OUTCOME MEASURES: The written narratives were elicited using a wordless pictorial storybook story. Three-way ANOVA with post hoc adjusted Bonferroni test was applied to determine the main effects and interactions of grounded variables on the microstructure and macrostructure components of narrative writing. RESULTS: No significant differences were observed in the macrostructure components of narrative writing between hearing-impaired and HH students. Factors analysis showed that the 4th grade HH students had significantly the highest scores, and the 3rd grade HA students had significantly the lowest scores in microstructure components of narrative writing. CONCLUSION: The findings revealed that hearing-impaired students similarly to their HH peers can transmit the main idea (macrostructure) of narrative writing, but show critical difficulties when using complete grammatical elements (microstructures) to form sentences to convey the idea in the narrative.

Narrative writing: Effective ways and best practices.

A narrative is a brief summary of specific events experienced by patients, during the course of a clinical trial. Narrative writing involves multiple activities such as generation of patient profiles, review of data sources, and identification of events for which narratives are required. A sponsor outsources narrative writing activities to leverage the expertise of service providers which in turn requires effective management of resources, cost, time, quality, and overall project management. Narratives are included as an appendix to the clinical study report and are submitted to the regulatory authorities as a part of dossier. Narratives aid in the evaluation of the safety profile of the investigational drug under study. To deliver high-quality narratives within the specified timeframe to the sponsor can be achieved by standardizing processes, increasing efficiency, optimizing working capacity, implementing automation, and reducing cost. This paper focuses on effective ways to design narrative writing process and suggested best practices, which enable timely delivery of high-quality narratives to fulfill the regulatory requirement.

Evaluation of the effect of narrative writing on the stress sources of the parents of preterm neonates admitted to the NICU.

OBJECTIVE: Identification of the nurses' and families' understanding of the stresses in the facilitates nursing interventions and increases parental satisfaction. MATERIAL AND METHODS: The quasiexperimental study with pretest and posttest was administered to a sample size of 70 mothers with preterm neonates hospitalized in the NICUs of two teaching hospitals of Tehran University of Medical during 6 months. The Parental Stressor Scale (PSS) was used. The data were analyzed using descriptive and analytical statistical methods. RESULTS: Evaluation of the differences in the domains of the questionnaire between the 3rd and 10th day of admission using a multivariate analysis showed that narrative writing had significant effects on all three domains (Roys' largest root = 2.141, F = 47.11, p values < 0.001). The results showed that the highest stress reduction was observed in Infant Behavior and Appearance (-11.847) followed by Sights and Sounds of the Unit (-11.352) while the lowest stress reduction was observed in the Parental Role Alterations (-6.149) in the intervention group, while the control mothers experienced a stress increase in all domains. CONCLUSION: According to the findings, narrative writing may be considered an efficient supportive intervention to reduce the maternal stress Infant behavior and appearance in the NICUs. However, more research is needed to justify its implementation.

The management of cohesion in written narratives in students with specific language impairment: Differences between childhood and adolescence.

The goal of this study was to investigate the management of cohesion by children and adolescents with specific language impairment (SLI) when writing a narrative in a communicative situation. Twelve children with SLI (from 7 to 11 years old) and 12 adolescents with SLI (from 12 to 18 years old) were chronological age-matched with 24 typically developing (TD) children and 24 TD adolescents. All participants attended mainstream classes: children in elementary schools and adolescents in middle and high schools. Analyses of cohesion focused on both density and diversity of connectives, punctuation marks and anaphors. Results attested that children with SLI were greatly impaired in their management of written cohesion and used specific forms previously observed in narrative speech such as left dislocations. By contrast, and not expected, the management of written cohesion by adolescents with SLI was close to that of their TD peers. The communicative writing situation we set up, which engaged participants to take into account the addressee, also made possible for adolescents with SLI to manage cohesion in writing.

Efficacy of Narrative Writing as an Intervention for PTSD: Does the Evidence Support Its Use?

Although a number of effective psychotherapies for posttraumatic stress disorder (PTSD) are available, there is a need to develop alternative treatments for those who may not respond optimally to these treatments or who may not have access to clinicians who can competently deliver them. Narrative writing, which involves repeated recounting about a traumatic event in writing, is one treatment that deserves further examination as a potential alternative. In this paper, we describe the most commonly used narrative writing treatment protocols for those with either a diagnosis of PTSD or probable PTSD and discuss the available efficacy data for each of these protocols. We conclude with recommendations for using narrative writing to treat those with PTSD and offer recommendations for future work in this area.

Writing Impairments in Japanese Patients with Mild Cognitive Impairment and with Mild Alzheimer's Disease.

BACKGROUND/AIMS: We investigated writing abilities in patients with the amnestic type of mild cognitive impairment (aMCI) and mild Alzheimer's disease (AD). To examine the earliest changes in writing function, we used writing tests for both words and sentences with different types of Japanese characters (Hiragana, Katakana, and Kanji). METHODS: A total of 25 aMCI patients, 38 AD patients, and 22 healthy controls performed writing to dictation for Kana and Kanji words, copied Kanji words, and wrote in response to a picture story task. Analysis of variance was used to test the subject group effects on the scores in the above writing tasks. RESULTS: For the written Kanji words, the mild AD group performed worse than the aMCI group and the controls, but there was no difference between the aMCI group and the controls. For the picture story writing task, the mild AD and aMCI groups performed worse than the controls, but the difference between the AD and the aMCI groups was not significant. CONCLUSIONS: The mild AD group showed defects in writing Kanji characters, and the aMCI group showed impairments in narrative writing. Our study suggests that narrative writing, which demands complex integration of multiple cognitive functions, can be used to detect the subtle writing deficits in aMCI patients.

Conflicts in Learning to Care for Critically Ill Newborns: "It Makes Me Question My Own Morals".

Caring for critically ill and dying patients often triggers both professional and personal growth for physician trainees. In pediatrics, the neonatal intensive care unit (NICU) is among the most distressing settings for trainees. We used longitudinal narrative writing to gain insight into how physician trainees are challenged by and make sense of repetitive, ongoing conflicts experienced as part of caring for very sick and dying babies. The study took place in a 45-bed, university-based NICU in an urban setting in the United States. From November 2009 to June 2010 we enrolled pediatric residents and neonatology fellows at the beginning of their NICU rotations. Participants were asked to engage in individual, longitudinal narrative writing about their "experience in the NICU." Thematic narrative analysis was performed. Thirty-seven physician trainees participated in the study. The mean number of narratives per trainee was 12; a total of 441 narratives were available for analysis. Conflict was the most pervasive theme in the narratives. Trainees experienced conflicts with families and conflicts with other clinicians. Trainees also described multiple conflicts of identity as members of the neonatology team, as members of the medical profession, as members of their own families, and as members of society. Physician trainees experience significant conflict and distress while learning to care for critically ill and dying infants. These conflicts often led them to question their own morals and their role in the medical profession. Physician trainees should be educated to expect various types of distress during intensive care rotations, encouraged to identify their own sources of distress, and supported in mitigating their effects.

The effect of narrative writing on maternal stress in neonatal intensive care settings.

OBJECTIVE: This study was conducted to examine the effect of narrative writing on maternal stress in the Neonatal Intensive Care Units (NICUs) during infants' hospitalization. METHODS: A quasi-experimental study was conducted among 2 groups of mothers with preterm infants in the NICUs of two teaching hospitals of Tehran University of Medical Sciences. Pre- and post-tests were administered to a sample size of 70 during 6 months. The Parental Stressor Scale (PSS) was used. The data were analyzed using descriptive and analytical statistical methods. RESULTS: The mean stress level in the control group was 73.9 ± 16.7 at the beginning of the study, and 82.5 ± 19.5 at the end of the study (on the 10th day). Paired t-test results in the control group showed that there was a statistically significant difference between the 3rd and the 10th day of the hospitalization (p < 0.001). In the intervention group, the mean stress level at the beginning of the study and on the 10th day of the hospitalization was 78.9 ± 16 and 48.8 ± 14.1, respectively (p < 0.001). The results revealed statistically significant difference between the 2 groups on the 10th day of the study (p < 0.001). CONCLUSION: According to the findings, the narrative writing may be considered as an efficient supportive intervention to reduce the maternal stress in the NICUs. However, more research is needed to justify its implementation.