title: Writing for Health: Rationale and Protocol for a Randomized Controlled Trial of Internet-Based Benefit-Finding Writing for Adults With Type 1 or Type 2 Diabetes.
abstract: BACKGROUND
  Diabetes mellitus is Australia's fastest growing chronic disease, and has high comorbidity with depression. Both subthreshold depression and diabetes distress are common amongst people with type 1 or type 2 diabetes, and are associated with poorer diabetes self-care. A need exists for low-intensity self-help interventions for large numbers of people with diabetes and diabetes distress or subthreshold depression, as part of a stepped-care approach to meeting the psychological needs of people with diabetes. Benefit-finding writing is a very brief intervention that involves writing about any positive thoughts and feelings about a stressful experience, such as an illness. Benefit-finding writing has been associated with increases in positive affect and positive growth, and has demonstrated promising results in trials amongst other clinical populations. However, benefit-finding writing has not yet been examined in people with diabetes.
  
  
  OBJECTIVE
  The aim of this randomized controlled trial (RCT) is to evaluate the efficacy of an Internet-based benefit-finding writing (iBFW) intervention for adults with type 1 or type 2 diabetes (compared to a control writing condition) for reducing diabetes distress and increasing benefit-finding in diabetes, and also improving a range of secondary outcomes.
  
  
  METHODS
  A two-arm RCT will be conducted, using the online program Writing for Health. Adults with type 1 or type 2 diabetes living in Australia will be recruited using diabetes-related publications and websites, and through advertisements in diabetes services and general practitioners' offices. Potential participants will be referred to the study-specific website for participant information and screening. All data will be collected online. Participants will be randomized to either iBFW about diabetes, or a control writing condition of writing about use-of-time. Both conditions involve three daily sessions (once per day for three consecutive days) of 15-minute online writing exercises. Outcome measures will be administered online at baseline, one-month, and three-month follow-ups.
  
  
  RESULTS
  This trial is currently underway. The primary outcomes will be diabetes distress and benefit-finding in diabetes. Secondary outcomes will be depression, anxiety, diabetes self-care, perceived health, and health care utilization. We aim to recruit 104 participants. All stages of the study will be conducted online using the Writing for Health program. Group differences will be analyzed on an intention-to-treat basis using mixed models repeated measures. Linguistic analyses of the writing exercise scripts, and examinations of the immediate emotional responses to the writing exercises, will also be undertaken.
  
  
  CONCLUSIONS
  This RCT will be the first study to examine iBFW for adults with type 1 or type 2 diabetes. If iBFW is found to be efficacious in reducing diabetes distress and improving diabetes self-care and other outcomes, iBFW may offer the potential to be a low-cost, easily accessible self-help intervention to improve the wellbeing of adults with diabetes.
  
  
  BACKGROUND
  Australia and New Zealand Clinical Trials Registry (ACTRN12615000241538).
authors.affiliation: Faces in the Street, Urban Mental Health Research Institute, St. Vincent's Health Australia, Sydney, Australia.|School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Joanna
authors.identifier: http://orcid.org/0000-0002-4947-1626
authors.initials: J
authors.lastname: Crawford
authors.affiliation: Faces in the Street, Urban Mental Health Research Institute, St. Vincent's Health Australia, Sydney, Australia.|School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.|Consultation Liaison Psychiatry, St. Vincent's Health Australia, Sydney, Australia.
authors.forename: Kay
authors.identifier: http://orcid.org/0000-0002-8542-6478
authors.initials: K
authors.lastname: Wilhelm
authors.affiliation: Faces in the Street, Urban Mental Health Research Institute, St. Vincent's Health Australia, Sydney, Australia.|Consultation Liaison Psychiatry, St. Vincent's Health Australia, Sydney, Australia.
authors.forename: Lisa
authors.identifier: http://orcid.org/0000-0002-0288-1564
authors.initials: L
authors.lastname: Robins
authors.affiliation: School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, Australia.|Black Dog Institute, Sydney, Australia.
authors.forename: Judy
authors.identifier: http://orcid.org/0000-0002-3872-9871
authors.initials: J
authors.lastname: Proudfoot
keywords: Internet intervention; diabetes-related distress; randomized controlled trial; type 1 diabetes; type 2 diabetes; writing