Assessing the Psychosocial Impact of Expressive Writing on Adults With Spinal Cord Injury: Qualitative Study
Background: Spinal cord injury (SCI) results in significant physical, emotional, and social consequences, often leading to profound grief and unresolved emotional burdens. As individuals with SCI must navigate these challenges daily for the rest of their lives, there is a pressing need for accessible and effective support programs. While expressive writing has shown potential in facilitating emotional processing and aiding coping after trauma, loss, and health-related adversity, its impact on individuals who have suddenly lost physical abilities due to SCI remains underexplored. Objective: The study aimed to examine the experiences of adults with SCI who participated in a 10-week virtual coach-guided expressive writing program to understand its impact using a qualitative research design with a phenomenological approach. Methods: Participants were recruited through various outreach strategies based on a set of predefined criteria. Fifty individuals from 23 states expressed interest in the expressive writing program. Of those who met the eligibility criteria, 29 completed the pre-program questionnaire. Five participants did not complete the post-program 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 post-program semi-structured interviews and analyzed using thematic analysis to identify themes related to participants’ experiences and program impact. The analysis was conducted without any pre-set theoretical framework of reference. Results: A total of 24 adults with SCI, aged between 34 and 76 years (average age, 51 years; SD, 12 years), participated in the expressive writing program and the exit interview. Nineteen were White, and 17 were female. Eighteen had sustained a traumatic SCI; of these,10 had quadriplegia, 12 had paraplegia, and two 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, greater sense of community, and profound positive changes, expressing the desire to continue writing beyond the program. Conclusions: The sudden onset of lifelong disability due to SCI leads to profound physical, mental, and social challenges. The coach-guided expressive writing program enhanced emotional processing and articulation, coping mechanisms, and overall well-being in the participants. These results highlight the potential of expressive writing programs as accessible and valuable rehabilitative interventions for individuals with SCI. Clinical Trial: NCT04721717