The Effectiveness of Online Thematic Expressive Writing on Prolonged Grief Disorder, Anxiety, Depression, and Positive Mental Health among Refugees in the Transition Stage of Asylum Seeking.

Abstract

Prolonged grief disorder (PGD) is a recently recognized disorder, and there is a growing need for adapted-related interventions to contexts at higher risk. Bereaved refugees in the transition stages of asylum-seeking due to unavailable mental health services and cultural language barriers necessitate adaptive, accessible PGD interventions. Thematic expressive writing (EW), as a promising guided self-help tool, can increase integrated grief and prevent mental health deterioration. This study aims to investigate the effectiveness of online guided thematic EW based on the dual process model (DPM) of coping with bereavement in decreasing PGD, depression, and anxiety and in increasing positive mental health (PMH). An experimental longitudinal design included 116 adult bereaved refugees. Participants who resided in Jordan were randomly assigned to the experimental groups received one online psychoeducation session, followed by daily online thematic EW tasks using Pennebaker's writing paradigm over one week. The first group applied tasks related to loss, the second applied restoration-oriented tasks, the third applied a combination of both tasks, and there was one control group. Longitudinal data was collected through online self-report surveys over three time points: baseline, post-intervention, and one-week follow-up. Findings showed that the combination of the loss and restoration-oriented group had a significant within-subject effect on PGD, depression, anxiety, and PMH, while the restoration-oriented group had a significant effect on PGD. However, only PMH improved between the group conditions, and there was no significant interaction effect between time and the experimental conditions. The present results confirm that EW as a scalable intervention for bereaved refugees in the transition stage has a positive but not durable influence on mental health. Guided self-help tools can overcome refugees' challenges related to accessibility to mental health services and can be a promising, scalable intervention.