Guilt and Expressive Writing for Reducing Alcohol Use in College Students

NCT02927132 | Unknown

• 2 other identifiers: 36607021R01AA023495-01
• Study Type: interventional
• Target: 600
• Locations: 0 countries
• Sites: N/A

Brief Summary

This research seeks to evaluate expressive writing as a novel intervention for problem drinking among college students. The vast majority of individually focused brief interventions targeting college drinking have focused on personalized feedback approaches and recent innovations have largely been limited to finer distinctions of these, which require assessment and programming for implementation. The present research proposes expressive writing as a novel alternative, which has been used extensively in other domains but not as an alcohol intervention strategy. H1a: Participants writing about negative drinking events will show reduced drinking and drinking-related negative consequences relative to students in the neutral control group. H1b: Participants writing about distressing non-alcohol events will show increased psychological wellbeing relative to students in the neutral control group. H1c: Participants writing about negative drinking events will show reduced drinking and consequences compared with an empirically-supported brief intervention (i.e., PNF). This is an exploratory hypothesis. H2a: Alcohol narratives will have stronger effects on alcohol outcomes relative to distress narratives. H2b: Alcohol guilt narratives will have the strongest effect on alcohol outcomes relative to all other conditions. H3a: Expression of guilt, assessed by self-report and by content coding with LIWC, will mediate intervention effects on drinking outcomes. H3b: Change thought, assessed by LIWC coding, will mediate intervention effects on drinking.

Conditions

Alcohol Consumption

Keywords

Drinking, Alcohol

Outcome Measures

Primary Outcomes (9)

• Change in Alcohol Consumption measured by The Timeline Follow-Back (TLFB)

  The TLFB is a calendar based measure assessing daily drinking (and abstinence) over a designated period of time. Number of drinks in the past month will be calculated as the sum of drinks recorded each day of the past month on the TLFB.

  Baseline, 1 month follow-up, 3 month follow-up, 6 month follow-up, 12 month follow-up

• Change in Drinking Intentions as measured by a modified version of the Daily Drinking Questionnaire (DDQ).

  Response options will be identical to the DDQ, but participants will be asked to indicate their intended drinking behaviors. Participants fill in the average number of standard drinks they intend to consume for each day of the week over the next month. Typical number of intended drinks per week will be calculated as the sum of typical number of drinks intended per day on the Daily Drinking Questionnaire.

  Baseline, 1 month follow-up, 3 month follow-up, 6 month follow-up, 12 month follow-up

• Change in Alcohol Consumption measured by Alcohol Use Disorders Identification Test (AUDIT).

  The AUDIT assesses for hazardous alcohol use, dependence symptoms, and harmful use. Scores for each question range from 0 to 4, with the first response for each question (e.g. never) scoring 0, the second (e.g. less than monthly) scoring 1, the third (e.g. monthly) scoring 2, the fourth (e.g. weekly) scoring 3, and the last response (e.g. daily or almost daily) scoring 4. For questions 9 and 10, which only have three responses, the scoring is 0, 2 and 4 (from left to right). A score of 8 or more is associated with harmful or hazardous drinking.

  Baseline, 1 month follow-up, 3 month follow-up, 6 month follow-up, 12 month follow-up

• Change in Alcohol Consumption measured by Quantity-Frequency-Peak Alcohol Use Index.

  The Quantity-Frequency-Peak Alcohol Use Index is a five-item questionnaire that includes two items addressing the occasion where respondents drank the most during the previous three months, two items addressing typical weekend drinking in the previous three months, and one item addressing typical number of drinking days per week in the previous three months. Drinking frequency will be assessed by item #5 of the Quantity/Frequency Questionnaire, which asks how many days during the past week participants have consumed alcohol.

  Baseline, 1 month follow-up, 3 month follow-up, 6 month follow-up, 12 month follow-up

• Change in Alcohol Consumption measured by the Daily Drinking Questionnaire (DDQ.

  Typical weekly drinking and typical drinks per occasion will be assessed with the DDQ. Participants fill in the average number of standard drinks they consumed and the time period of consumption for each day of the week over the previous three months. Typical number of drinks per week will be calculated as the sum of typical number of drinks per day on the Daily Drinking Questionnaire.

  Baseline, 1 month follow-up, 3 month follow-up, 6 month follow-up, 12 month follow-up

• Change in Drinking Intentions as measured by a modified version of the Quantity-Frequency-Peak Alcohol Use Index (QF).

  Response options will be identical to the QF, but participants will be asked to indicate their intended drinking behaviors. Intended drinking frequency will be assessed by item #5 of the Quantity/Frequency Questionnaire, which asks how many days during the next week participants intend to consume alcohol.

  Baseline, 1 month follow-up, 3 month follow-up, 6 month follow-up, 12 month follow-up

• Changes in Psychological Well-being Outcomes as measured by the Center for Epidemiological Studies Depression Scale (CES-D)

  Depression will be assessed by the Ces-D, a 20-item measure of depressive symptomatology in the general population. Answers are on a scale of 1 (rarely) to 4 (most or all of the time). A score of 11 is indicative of significant or mild depressive symptomology, and higher scores are indicative of greater symptoms.

  Baseline, 1 month follow-up, 3 month follow-up, 6 month follow-up, 12 month follow-up

• Changes in Psychological Well-being Outcomes as measured by Positive and Negative Affect Scale (PANAS)

  Mood will be assessed by the PANAS, a 22-item measure of the degree to which one experiences positive and negative affective states on a regular basis. For a positive affect score, items 1 (interested), 3 (excited), 5 (strong), 9 (enthusiastic), 10 (proud), 12 (alert), 14 (inspired), 16 (determined), 17 (attentive), and 19 (active) will be added, with higher scores representing higher levels of positive affect. For a negative affect score, items 2 (distressed), 4 (upset), 6 (guilty), 7 (scared), 8 (hostile), 11 (irritable), 13 (ashamed), 15 (nervous), 18 (jittery) and 20 (afraid) will be added, with lower scores representing lower levels of negative affect.

  Baseline, 1 month follow-up, 3 month follow-up, 6 month follow-up, 12 month follow-up

• Changes in Psychological Well-being Outcomes as measured by Satisfaction with Life Scale (SWLS).

  This short, 5-item measure is designed to measure cognitive judgments of satisfaction with one's life. Each item is rated on a scale of 1 (strongly disagree) to 7 (strongly agree). A score of 31-35 indicates that a participant is extremely satisfied, a score of 26-30 indicates that a participant is satisfied, a score of 21-25 indicates that a participant is slightly satisfied, a score of 20 indicates that a participant is neutral, a score of 15-19 indicates that a participant is slightly dissatisfied, a score of 10-14 indicates that a participant is dissatisfied, and a score of 5-9 indicates that a participant is extremely dissatisfied.

  Baseline, 1 month follow-up, 3 month follow-up, 6 month follow-up, 12 month follow-up

Study Arms (6)

Alcohol-Guilt Condition

EXPERIMENTAL

In this condition, participants are asked to write about an incident in which they drank heavily and experienced guilt. Participants in this condition will come into the lab one time each week for three weeks to complete the writing task. They will then complete follow-up surveys remotely, at 1 month, 3 months, 6 months, and 12 months.

Behavioral: Expressive Writing

Distress-Guilt Condition

EXPERIMENTAL

In this condition, participants are asked to write about an upsetting incident where they experienced guilt. Participants in this condition will come into the lab one time each week for three weeks to complete the writing task. They will then complete follow-up surveys remotely, at 1 month, 3 months, 6 months, and 12 months.

Behavioral: Expressive Writing

Alcohol-No Guilt Condition

EXPERIMENTAL

In this condition, participants are asked to write about a negative drinking incident that they had experienced. Participants in this condition will come into the lab one time each week for three weeks to complete the writing task. They will then complete follow-up surveys remotely, at 1 month, 3 months, 6 months, and 12 months.

Behavioral: Expressive Writing

Distress-No Guilt Condition

EXPERIMENTAL

In this condition, participants are asked to write about an upsetting experience that has affected their life. Participants in this condition will come into the lab one time each week for three weeks to complete the writing task. They will then complete follow-up surveys remotely, at 1 month, 3 months, 6 months, and 12 months.

Behavioral: Expressive Writing

Neutral Control Condition

NO INTERVENTION

In this condition, participants are asked to write about the laboratory room in which they are seated. Participants in this condition will come into the lab one time each week for three weeks to complete the writing task. They will then complete follow-up surveys remotely, at 1 month, 3 months, 6 months, and 12 months.

Personalized Normative Feedback

EXPERIMENTAL

Participants in the PNF condition will be given gender-specific personalized feedback regarding their alcohol use. Participants will be presented with the drinking estimates that they previously gave in addition to average gender-specific drinking estimates provided by 1124 students at the University of Houston. Feedback will be provided for drinking frequency (i.e., number of drinking days per week), and drinking quantity (i.e., the number of drinks consumed per week and number of drinks consumed per typical drinking occasion). Participants will also receive a printed a copy of the feedback for their records. PNF participants will receive feedback immediately after the baseline assessment. We also wanted to control for any differences that might be attributed to attention. Thus, participants will be scheduled to come in to the lab for two more sessions, during which time they will write about the laboratory room in which they are seated.

Behavioral: Personalized Normative Feedback

Interventions

Expressive Writing BEHAVIORAL

Expressive writing is a brief intervention that has been linked to various health and social benefits. Expressing emotions through writing can lead to decreased levels of stress and negative affect, thereby serving as a coping mechanism. Furthermore, expressive writing allows participants to reconstruct their traumatic experiences and reorganize their memory of these events into a narrative. Expressive writing has been used to target drinking. Research has found that students have reduced drinking intentions after writing about a negative drinking event compared to control,suggesting that a narrative intervention may be effective in reducing drinking. Other research suggests that feelings of guilt were more strongly associated with intentions to reduce drinking after writing about a negative drinking event, and that this event-related guilt mediated intervention effects.

Alcohol-Guilt Condition; Alcohol-No Guilt Condition; Distress-Guilt Condition; Distress-No Guilt Condition

Personalized Normative Feedback BEHAVIORAL

PNF approaches use information designed to correct normative misperceptions to reduce heavy drinking. Three pieces of information are necessary when providing personalized normative feedback: information about a student's own drinking, information about the student's perceptions of others' drinking, and information about others' actual drinking. The presentation of this information is designed to change students' perceptions of "normal" drinking by exposing their misperceptions of the norm as well as by comparing their behavior with "normal" behavior.

Personalized Normative Feedback

Eligibility Criteria

• Age: 18 Years - 26 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64)

You may qualify if:

• Being between 18-26 years of age
• Being a registered UH student.
• Scoring 5+ and 7+ on the AUDIT-C for women/men respectively
• Being 18-26 years of age
• Being a registered UH student
• Providing consent to participate in the study

Sponsors & Collaborators

• University of Houston: lead
• National Institute on Alcohol Abuse and Alcoholism (NIAAA): collaborator

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MeSH Terms

Conditions

Alcohol Drinking

Condition Hierarchy (Ancestors)

Drinking Behavior; Behavior

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: PREVENTION
• Intervention Model: FACTORIAL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor, Director of the Social Influences and Health Behaviors Lab

Study Record Dates

• First Submitted: May 26, 2016
• First Posted: October 6, 2016
• Study Start: September 1, 2016
• Primary Completion: August 1, 2019
• Study Completion: August 1, 2020
• Last Updated: June 20, 2018

Record last verified: 2018-06

Data Sharing

• IPD Sharing: Will not share