Journaling improves the mental health of teens with CF

Youngsters in study look past physical symptoms and ponder psychological stresses

Steve Bryson, PhD avatar

by Steve Bryson, PhD |

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Journaling — writing thoughts and feelings to understand them more clearly — improved the mental health of adolescents with cystic fibrosis, results from a feasibility study reveal.

All teens with cystic fibrosis (CF) who completed post-therapy surveys said journaling helped them express their feelings and recommended others with CF write about the topics included in the study.

“We hope this study design can be expanded to more participants in a formal study,” researchers wrote in the study, “The positive impact of journaling on adolescents with cystic fibrosis,” which was published in the journal Pediatric Pulmonology.

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Beyond the numerous physical symptoms experienced by people with CF, many face psychological stresses, such as anxiety, depression, feelings of isolation, and difficulties navigating relationships. These additional factors are associated with worse therapy adherence, lung function, and other health outcomes.

One promising approach to address these challenges is narrative therapy, which involves journaling. Research has demonstrated that journaling to delve into psychologically distressing matters can enhance self-awareness and comprehension, laying the groundwork for positive cognitive change.

Still, little research has focused on children and/or adolescents, especially those with chronic illnesses like CF.

That’s why investigators at Children’s Hospital Los Angeles, in California, tested the feasibility of narrative therapy for CF adolescents with the goal of improving their mental and physical health.

Teens with cystic fibrosis were ages 12-17

A group of eight adolescents, ages 12-17, were recruited through the hospital. Participants were emailed weekly for eight weeks to encourage journaling that explored topics such as living with CF, treatment adherence, feeling different with CF, limitations, anxiety, depression, and relationships.

They also completed surveys, before and after narrative therapy, about their experiences. Wellness also was assessed using the Pediatric Symptom Checklist (PSC-17), a questionnaire to identify changes in emotional and behavioral problems in young people. Higher scores, particularly those above 28, are signs of significant behavioral or emotional challenges.

Across the study period, PSC-17 scores dropped from a mean of 29 to 23.5, representing a 5.5-point decrease, meaning a lessening of behavioral or emotional problems. These results were seen despite slight reductions in mean lung function and weight loss during the study.

Improvements in most mental health questions were found in post-intervention surveys compared to before therapy. There were fewer days when participants self‐reported their physical and mental health as poor and interfering with their daily activities. A decrease in days with pain, sadness, anxiety, and not getting enough sleep also was reported.

Before therapy, two of the four participants who completed the entire study answered “Yes” to the question, “Are you limited in any way in any activities because of any impairment or health problem?” At the same time, one said, “Don’t Know/Not Sure,” and one responded, “No.” After therapy, two of the participants answered, “No,” and two responded, “Don’tKnow/Not Sure.”

When asked about other topics participants wanted to write about, participants said “What our relationships or friendships are like with CF” and “More positive things about my CF about how you can have a healthy outlook on it or how there may be some things that CF patients have an advantage in.”

Post-therapy surveys

When asked what they liked about the study, participants responded “The week we have to turn it in,” and the topics provided varied. When asked about problems/changes with the study, participants felt pressured to complete the prompts within one week, and two specifically mentioned wanting to write about more positive topics.

All those who completed post-therapy surveys said the study helped them express their feelings, and all recommended that others with CF write about study topics. Three of four said they enjoyed participating in the research and that their writings could help providers know them better. Three also responded that the study helped them with CF-related anxiety and depression. Only one said the study helped them manage CF better.

Participant feedback included: “I enjoyed participating in this study because I felt as though I had a safe space to talk about my troubles and obstacles I faced with my CF [along] with my accomplishments and any positive things that have happened with my CF.”

Thinking about CF ‘in a different light’

Also, “I liked participating in the journaling study since it helped me to think about my CF in a different light. Usually, I avoid thinking and talking about my CF or thinking of the things that make me different from everyone else. This study helped me to realize that I am not the only one with CF who may have those experiences,” and “I liked it because it helped me explore and understand.”

“This feasibility pilot study to implement a journaling intervention for individuals with CF was successful,” the researchers concluded. “Our expected level of participation and completion of the study was exceeded.”

A study limitation mentioned by the team was that the patients had a relatively preserved lung function at study start and low average hospitalizations in a year, which means that the participants included “may not be the most representative of all individuals with CF.”