Self-Compassion Writing for Adults with Mental Illness: Results from an RCT

Purpose: There has been an international push by the World Health Organization to find evidence-based, scalable mental health interventions, such as self-help material, to help people affected by adversity. Writing interventions offer great potential as scalable treatments for mental illness.  They can be used by people who may be unwilling or unable to participate in psychotherapy because they are inexpensive and portable.  Writing interventions may help ethnic groups who may be reluctant to engage in traditional Western talk therapy.  Studies have found that writing with self-compassion about a difficult event helps promote mental health and improve affect in college students and non-clinical populations.  One type of brief, accessible self-compassion intervention that has been used is self-compassion writing, the process of writing about a stressful event with kindness and understanding. This study investigated whether a self-compassion writing intervention would lead to increases in self-compassion and proactive coping and reductions in depression and physical symptoms in a sample of individuals with mental illness. 

Method: The study used an RCT design. Participants were randomized to an experimental group (self-compassion writing) or a control group (neutral writing).  The inclusion criteria for the study were: a diagnosis of major depressive disorder, bipolar disorder, schizophrenia and/or schizoaffective disorder.

Participants completed a demographic questionnaire, and a psychiatric health status measure (e.g, psychotic symptoms). Scales measuring self-compassion, coping ability, general mental health, positive affect and physical health were administered at the baseline, post-test and 1-month follow-up time points.  Linguistic analysis was administered immediately after the Wave 3 intervention as an implementation check.   A total of 216 participants completed the baseline, posttest, and 1 month follow-up assessment.

Results: A repeated measure ANOVA comparing self-compassion scores at baseline and 1-month follow up scores yielded a significant within-group effect, F(1,201)=13.65, p<0.01, η2=0.06, however, the between group comparison was not significant. Similarly, the proactive coping measure yielded a significant within-group effect with both groups showing significant grains at the baseline to 1-month follow up, F(1,201)=11.74, p<0.01, with a medium effect size (η2=0.06). Particularly interesting was the repeated measure ANOVA comparing depression scores at baseline and 1-month scores which yielded a significant within-group effect; F(1,201)=91.63, p<0.01. Depression decreased significantly from baseline to post-test for both the treatment and control groups, with a large effect size (η2=0.31), indicating the decreases were substantial.  Statistics comparing the groups on positive affect yielded a significant between group difference, F(1,201)=26.68, p<0.01, with a large effect size (η2=0.12).  A repeated measures ANOVA comparing physical symptoms also found significance (η2=0.27).

Conclusions and Implications:

Both the treatment and control groups showed significant improvements in self-compassion, proactive coping, general mental health and physical health following the intervention and both groups showed significant improvements in self-compassion, proactive coping and general mental health between the post-test and 1-month follow-up.  In addition, the self-compassion writing group’s positive affect improved significantly more than the control group.  Overall, the results suggest both self-compassion writing and open journal writing may be beneficial for individuals with mental illness.