There is a need for new and creative psychological therapies for anorexia in particular, as it has the highest bed cost and the highest mortality rate of any psychiatric condition, and few NICE recommended clinical treatments. Interventions which can work with clients’ ambivalence towards recovery are particularly needed. Therapeutic writing is a psychological intervention that uses creative or expressive writing for therapeutic means, often in a group format, and is already being used in a variety of eating disorder treatment programmes. Further evidence is needed to establish whether therapeutic writing could form a part of stepped care treatment programmes for anorexia.
For this review, 15 databases were searched for studies with adult participants with symptoms of or risk factors for anorexia. 12 studies carried out in the UK, US and Australia with general / student or clinical populations were identified by two reviewers, and were critically appraised for methodological quality. Data was extracted from the quantitative studies and synthesised narratively in light of the quality assessment, followed by a secondary analysis of the data extracted from the qualitative studies.
The quantitative results overall were mixed, with six of the eight studies, including two of the high quality studies, suggesting that expressive writing tasks can improve known risk factors for anorexia, and two other high quality studies indicating that expressive writing may not be helpful for those at risk of developing an eating disorder. The results of the qualitative studies were less contradictory, and began to describe an emerging causal pathway for the benefits of therapeutic writing as a disinhibitory or cathartic effect, due to increased expression of emotional experiences.
Overall, the evidence from this review indicates that therapeutic writing deserves consideration and further exploration in clinical practice and research. However, clinicians need to proceed with the implementation of such interventions cautiously. It is not known whether therapeutic writing interventions affect change by facilitating emotional expression, enhancing group cohesion, through a de-centring process, or through a process of distraction. Therefore, writing tasks need to be allocated appropriately based on individual clinical need.