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The Effects of Expressive Writing and Compassionate Letter Writing on Emotional Distress Intolerance

The Effects of Expressive Writing and Compassionate Letter Writing on Emotional Distress Intolerance: A Brief Randomized Controlled Trial

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT05284578
Enrollment
424
Registered
2022-03-17
Start date
2021-07-04
Completion date
2022-07-21
Last updated
2025-06-04

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Distress Intolerance

Brief summary

Perceived emotional distress intolerance is a transdiagnostic marker of psychopathology associated with psychological and interpersonal dysfunction, and the development of interventions for perceived emotional distress intolerance is of prime importance. One potential intervention is a behavioural experiment, i.e. a cognitive behaviour therapy technique where clients undergo an exercise designed to test a maladaptive belief, e.g., that negative emotions are unbearable, and adjust their belief to accommodate any disconfirmatory information that arises through the exercise. This study examines the effects of a one-session self-compassion writing behavioural experiment compared to a one-session expressive writing behavioural experiment on low perceived distress tolerance. Participants were recruited from the University of Waterloo and Prolific, and were randomly assigned to the self-compassion condition, expressive writing condition, or a control condition.

Detailed description

The study consisted of two online surveys. During the first survey, participants answered a set of questionnaires. Then, they were prompted to think of an upsetting situation and the associated unpleasant emotions, and they were then randomly assigned to a brief self-compassionate writing, expressive writing, or neutral writing task. They then answered a series of questionnaires immediately after completing the writing task. During the second survey, one week later, participants answered a brief set of questionnaires.

Interventions

OTHERSelf-compassionate writing intervention

Participants assigned to this intervention were asked to engage in one brief online self-compassionate writing session, where they were asked to write about and experience their feelings from the perspective of an inner compassionate observer.

Participants assigned to this intervention were asked to engage in one brief online expressive writing session, where they were asked to explore their deepest thoughts and emotions surrounding an upsetting situation through writing.

OTHERControl writing task

Participants assigned to this condition were asked to engage in a neutral time management writing task.

Sponsors

University of Waterloo
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)

Masking description

The participant did not know prior to their study participation that there are three different study conditions, and they did not find out which condition they were randomized to until the end of their study participation.

Intervention model description

1/3 of the study participants (43 from UWaterloo, 98 from Prolific) were placed into the self-compassionate writing intervention group, 1/3 of the study participants (42 from UWaterloo, 100 from Prolific) were placed into the expressive writing intervention group, and 1/3 of the study participants (41 from UWaterloo, 100 from Prolific) were placed into the control group.

Eligibility

Sex/Gender
ALL
Healthy volunteers
No

Inclusion criteria

for University of Waterloo sample: * Undergraduate students with a SONA account who are high in emotional distress intolerance (i.e. a lower-than-average score on the Distress Tolerance Scale; mean based on SONA student sample) Inclusion Criteria for Prolific sample: * Adults with a Prolific account who are high in emotional distress intolerance (i.e. a lower-than-average score on the Distress Tolerance Scale; mean based on Prolific sample) * First language English speakers

Exclusion criteria

* None

Design outcomes

Primary

MeasureTime frameDescription
Distress Tolerance ScaleChange from baseline to one week post-interventionSelf-report questionnaire with 15 questions on a 5-point Likert scale (scored 1-5, with 4 subscales). Mean scores range from 1-5, with higher increase in score indicative of increased perceived distress tolerance.
Distress Tolerance Scale (short form)Immediately post-interventionSelf-report questionnaire with 4 questions on a 5-point Likert scale (scored 1-5). Mean scores range from 1-5, with higher score indicative of greater perceived distress tolerance.
Endorsement and Discomfort Scale (adapted)Immediately post-interventionSelf-report questionnaire with 10 questions on a 9-point Likert scale (scored 1-9). Total scores range from 10-90, with higher score indicative of greater acceptability of intervention.
Compassionate Engagement and Action ScaleChange from baseline to one week post-interventionSelf-report questionnaire with 13 questions on a 10-point Likert scale (scored 1-10). Three questions are reverse-scored and not included in scoring. Total scores range from 10-100, with higher increase in score indicative of increased emotional engagement

Secondary

MeasureTime frameDescription
Soothing affect measures (researcher-generated) - Adapted from the Serenity Subscale of the PANAS-X and the Safe/Warmth Positive Affect Subscale of the Types of Positive Affect Scale (TPAS)Immediately post-intervention (assessed as a mediator)Self-report questionnaire with 7 questions on a 5-point Likert scale (scored 1-5). Total scores range from 7-35, with higher score indicative of more soothing affect.

Countries

Canada

Outcome results

None listed

Source: ClinicalTrials.gov · Data processed: Feb 4, 2026