Who responds To Journal Writing?

What Does The Science Show?

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Who responds to journal writing is an important question. If you are like many of my patients with busy lives and more to get done in a day, you do not want to waste time on an activity not likely to bring you benefits.

While this article will outline some broad strokes related to specific characteristics of people who have benefited from embarking on journal writing from an asthma perspective, I would not let it stop you from beginning this journey.

I have almost never found a patient who did not benefit from a journal writing experience in some form or fashion. Maybe you will not see improvements in your FEV1 or a decrease in your medications, but you are likely to see other benefits such as decreased stress, better connection with your values, increased insight/ clarity, and personal growth.

Journal Writing and Health

With an explosion of complementary and alternative medicine (CAM), I am constantly asked about options for CAM in asthma patients. One of the difficulties physicians face is identifying which interventions will benefit which patients.

Unlike some forms of CAM that can have significant side effects, journal writing is an easy recommendation for me. When done correctly, there is the potential for benefit not only to your asthma, but other aspects of your life. I feel that it is a great adjunctive treatment with benefits beyond what it may do for your asthma.

Predicting Responders and Non-Responders

Journaling was part of an integrative medicine approach (meaning patients continued their regular treatments) in an intervention that included nutrition education and yoga in 75 patients randomized to the intervention compared to usual care. While the study did not demonstrate any improvement in outcomes such as FEV1, there were significant improvements in quality of life in the treatment group compared to the control.


Among patients receiving the intervention, several characteristics were identified that seemed to identify people who responded versus those who did not. These characteristics included:

1. Leadership

In interviews, patients demonstrating benefit were more likely to think of themselves as leaders. These patients viewed themselves as “independent” and were more likely to “take charge” of their healthcare.

Non-responders, on the other hand, did not express the self concepts of individuality or leadership. Non-responders were more likely to describe themselves as “indecisive” or “anxious.” The non-responders were easily swayed and easily changed their minds.

2. Control

Responders to the integrative medicine intervention were more likely to believe that, despite having asthma, they were not going to allow asthma defeat them, or prevent them from doing things they wished to. Responders were more proactive and struck a balance between accepting asthma and feeling they had control over healthcare choices.

Non-responders were more anxious, fearful, and insecure related to asthma. The feeling that asthma controlled them, not having control of their health related to asthma, and fear of asthma were more prevalent. This group was more likely to use denial as a way to manage their asthma.

3. Prior Experience With CAM

Patients with prior positive successful or previous CAM experiences were more likely to respond in this trial. Additionally, patients feeling that integrative medicine approaches were part of “their being or inner self” were more likely to respond. Several responders indicated that the integrative medicine approach increased their feeling of self determination related to asthma. None of the non-responders had this sort of description of previous CAM experiences.

4. Prior Experience With Conventional Medicine

Both groups desired less conventional medications for their asthma– a sentiment I commonly find with patients with diseases other than asthma. Responders, however, reported many more negative experiences with healthcare. Responders more commonly reported poor interactions with their physicians and “being scolded and disrespected” by their physicians. Responders wanted a more personalized approach to their asthma compared to their perceptions of a cookie cutter one size fits all approach to their asthma care. While both responders and non-responders described poor interactions with their physicians, the main difference was responders having a ”fighting” attitude to “find something different” that would make an effective change for their asthma.

5. Making Change

Both groups found the change associated with the integrative medicine intervention difficult. However, responders had a much more positive attitude about the change. The idea that change was productive and valuable despite being difficult was much more common among responders. Responders were also more likely to discuss this difficult but valuable attitude in other areas of their life. Non-responders were more likely to see the difficulty without an associated value proposition and focus on the time required to make the changes the intervention demanded.

Exceptions

While this study looked at general feelings and character traits, there were exceptions. Some patients who responded to the intervention felt as though asthma was an “albatross.” On the other hand, some of the non-responders failed despite demonstrating the ‘‘can-do acceptance’’ of the responder group.

Surprisingly, neither the concept of spirituality or “personal transformation” appeared to play a role. It was thought that these concepts might be more commonly expressed among responders
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What Does This Mean For Me?

There was substantial overlap in the character traits that described both responders and non-responders. While you may be more likely to benefit from journaling and other integrative medicine approaches if you more closely align yourself with the character traits and descriptions of the responders, it is no guarantee.

I believe that this study does indicate certain character traits that we may want to strive towards. Coping with chronic illness is difficult and, in my own practice, patients demonstrating a “take charge” attitude seem to do better in the long run. Likewise, believing that you can control your health outcomes despite a chronic illness also seems to identify patients who do better in the long term.

Sources

Kligler B, McKee MD, Sackett E, Leveson H, Kenney J, Karasz A. An Integrative Medicine Approach to Asthma: Who Responds?. Accessed on December 28, 2014.

Kligler B, Homel P, Blank AE, et al. Randomized trial of the effect of an integrative medicine approach to the management of asthma in adults on disease-related quality of life and pulmonary function. Altern Ther Health Med 2011; 17:10–15. Accessed on December 28, 2014.

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