Assessing the Psychosocial Impact of Expressive Writing on Adults With Spinal Cord Injury: Qualitative Study
Abstract BackgroundSpinal cord injury (SCI) results in significant physical, emotional, and social consequences, often leading to profound grief and unresolved emotional burdens. While expressive writing has shown potential in facilitating emotional processing and in aiding co...
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JMIR Publications
2025-06-01
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| Series: | JMIR Formative Research |
| Online Access: | https://formative.jmir.org/2025/1/e71162 |
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| author | Shelly M Xie Molly McKenna Kendall Veach Sydney Williams Mary Grace Jones Elizabeth Vander Kamp Salaam Green Lauren Edwards Kimberly Kirklin Benjamin A Jones Hon K Yuen |
| author_facet | Shelly M Xie Molly McKenna Kendall Veach Sydney Williams Mary Grace Jones Elizabeth Vander Kamp Salaam Green Lauren Edwards Kimberly Kirklin Benjamin A Jones Hon K Yuen |
| author_sort | Shelly M Xie |
| collection | DOAJ |
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Abstract
BackgroundSpinal cord injury (SCI) results in significant physical, emotional, and social consequences, often leading to profound grief and unresolved emotional burdens. While expressive writing has shown potential in facilitating emotional processing and in aiding coping after trauma, loss, and health-related adversity, its impact on individuals who have suddenly lost physical abilities due to SCI remains underexplored.
ObjectiveThe study aimed to examine the experiences of adults with SCI who participated in a 10-week web-based coach-guided expressive writing program to understand its impact using a qualitative research design with a phenomenological approach.
MethodsParticipants were recruited through various outreach strategies based on a set of predefined criteria. A total of 50 individuals from 23 states expressed interest in the expressive writing program. Of those who met the eligibility criteria, 29 individuals completed the preprogram questionnaire. A total of 5 participants did not complete the postprogram assessments, including the exit interview. The program sessions were structured with reflective prompts designed to explore their emotions and life experiences related to their conditions. Qualitative data were collected through postprogram semistructured interviews and analyzed using thematic analysis to identify themes related to participants’ experiences and program impact. The analysis was conducted without any preset theoretical framework of reference.
ResultsA total of 24 adults with SCI, aged between 34 and 76 years (average age 51, SD 12 years), participated in the expressive writing program and the exit interview. Of these, 19 participants were White, and 17 were female. In total, 18 participants had sustained a traumatic SCI; of these, 10 had quadriplegia, 12 had paraplegia, and 2 had monoplegia. Qualitative analysis revealed three overarching themes: (1) supportive environment: the program provided participants a space that encouraged open reflection on past events and personal struggles, and the guidance of patient and empathetic coaches offered a sense of comfort, direction, and motivation. (2) Cathartic experience: the program helped them process complex emotions, reframe their perspectives, and cultivate a more positive outlook on life and their injury. Many participants, new to guided expressive writing, found the process therapeutic and transformative. (3) Acceptance of life: the cumulative impact of the sessions fostered self-compassion, forgiveness, empowerment, and self-advocacy. Participants reported reduced feelings of loneliness, a greater sense of community, and profound positive changes, expressing the desire to continue writing beyond the program.
ConclusionsThe sudden onset of lifelong disability due to SCI leads to profound physical, mental, and social challenges. The coach-guided expressive writing program enhanced the emotional processing and articulation, coping mechanisms, and overall well-being of the participants. These results highlight the potential of expressive writing programs as accessible and valuable rehabilitative interventions for individuals with SCI. |
| format | Article |
| id | doaj-art-7dcb6b77da44476f8f06d830443a2ef7 |
| institution | DOAJ |
| issn | 2561-326X |
| language | English |
| publishDate | 2025-06-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Formative Research |
| spelling | doaj-art-7dcb6b77da44476f8f06d830443a2ef72025-08-20T02:43:43ZengJMIR PublicationsJMIR Formative Research2561-326X2025-06-019e71162e7116210.2196/71162Assessing the Psychosocial Impact of Expressive Writing on Adults With Spinal Cord Injury: Qualitative StudyShelly M Xiehttp://orcid.org/0000-0003-2231-4062Molly McKennahttp://orcid.org/0009-0003-9659-2126Kendall Veachhttp://orcid.org/0009-0007-3902-8069Sydney Williamshttp://orcid.org/0009-0000-6546-0057Mary Grace Joneshttp://orcid.org/0009-0002-6955-2690Elizabeth Vander Kamphttp://orcid.org/0009-0007-6182-8193Salaam Greenhttp://orcid.org/0009-0005-3426-8210Lauren Edwardshttp://orcid.org/0000-0002-8620-0972Kimberly Kirklinhttp://orcid.org/0000-0002-8325-3446Benjamin A Joneshttp://orcid.org/0000-0001-9360-0811Hon K Yuenhttp://orcid.org/0000-0001-5696-1845 Abstract BackgroundSpinal cord injury (SCI) results in significant physical, emotional, and social consequences, often leading to profound grief and unresolved emotional burdens. While expressive writing has shown potential in facilitating emotional processing and in aiding coping after trauma, loss, and health-related adversity, its impact on individuals who have suddenly lost physical abilities due to SCI remains underexplored. ObjectiveThe study aimed to examine the experiences of adults with SCI who participated in a 10-week web-based coach-guided expressive writing program to understand its impact using a qualitative research design with a phenomenological approach. MethodsParticipants were recruited through various outreach strategies based on a set of predefined criteria. A total of 50 individuals from 23 states expressed interest in the expressive writing program. Of those who met the eligibility criteria, 29 individuals completed the preprogram questionnaire. A total of 5 participants did not complete the postprogram assessments, including the exit interview. The program sessions were structured with reflective prompts designed to explore their emotions and life experiences related to their conditions. Qualitative data were collected through postprogram semistructured interviews and analyzed using thematic analysis to identify themes related to participants’ experiences and program impact. The analysis was conducted without any preset theoretical framework of reference. ResultsA total of 24 adults with SCI, aged between 34 and 76 years (average age 51, SD 12 years), participated in the expressive writing program and the exit interview. Of these, 19 participants were White, and 17 were female. In total, 18 participants had sustained a traumatic SCI; of these, 10 had quadriplegia, 12 had paraplegia, and 2 had monoplegia. Qualitative analysis revealed three overarching themes: (1) supportive environment: the program provided participants a space that encouraged open reflection on past events and personal struggles, and the guidance of patient and empathetic coaches offered a sense of comfort, direction, and motivation. (2) Cathartic experience: the program helped them process complex emotions, reframe their perspectives, and cultivate a more positive outlook on life and their injury. Many participants, new to guided expressive writing, found the process therapeutic and transformative. (3) Acceptance of life: the cumulative impact of the sessions fostered self-compassion, forgiveness, empowerment, and self-advocacy. Participants reported reduced feelings of loneliness, a greater sense of community, and profound positive changes, expressing the desire to continue writing beyond the program. ConclusionsThe sudden onset of lifelong disability due to SCI leads to profound physical, mental, and social challenges. The coach-guided expressive writing program enhanced the emotional processing and articulation, coping mechanisms, and overall well-being of the participants. These results highlight the potential of expressive writing programs as accessible and valuable rehabilitative interventions for individuals with SCI.https://formative.jmir.org/2025/1/e71162 |
| spellingShingle | Shelly M Xie Molly McKenna Kendall Veach Sydney Williams Mary Grace Jones Elizabeth Vander Kamp Salaam Green Lauren Edwards Kimberly Kirklin Benjamin A Jones Hon K Yuen Assessing the Psychosocial Impact of Expressive Writing on Adults With Spinal Cord Injury: Qualitative Study JMIR Formative Research |
| title | Assessing the Psychosocial Impact of Expressive Writing on Adults With Spinal Cord Injury: Qualitative Study |
| title_full | Assessing the Psychosocial Impact of Expressive Writing on Adults With Spinal Cord Injury: Qualitative Study |
| title_fullStr | Assessing the Psychosocial Impact of Expressive Writing on Adults With Spinal Cord Injury: Qualitative Study |
| title_full_unstemmed | Assessing the Psychosocial Impact of Expressive Writing on Adults With Spinal Cord Injury: Qualitative Study |
| title_short | Assessing the Psychosocial Impact of Expressive Writing on Adults With Spinal Cord Injury: Qualitative Study |
| title_sort | assessing the psychosocial impact of expressive writing on adults with spinal cord injury qualitative study |
| url | https://formative.jmir.org/2025/1/e71162 |
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