Why Do Brief Online Writing Interventions Improve Health? Examining Mediators of Expressive Writing and Self-Affirmation Intervention Efficacy Among Sexual Minority Emerging Adults

A limited number of studies have examined mechanisms undergirding interventions that mitigate mental health problems or health-risk behaviors that disproportionately burden sexual minorities. A recent trial of expressive writing and self-affirmation writing found that these brief interventions had salubrious effects on mental health and health-risk behaviors; the present research examines the putative mechanisms underlying these effects. Sexual minority emerging adults (N = 108) completed a brief online expressive writing, self-affirmation writing, or neutral control writing intervention and, at baseline and 3-month follow-up, completed measures of mental health, health-risk behaviors, stress, and self-regulation. Expressive writing yielded improvements in mental health and these effects were mediated by reductions in perceived stress. Self-affirmation caused improvements in health-risk behaviors, though neither stress nor self-regulation mediated these effects. This finding provides preliminary novel evidence regarding a mechanism underlying a widely used psychological intervention with documented mental health benefits for sexual minorities and other populations disproportionately affected by stress. Public Significance Statement This study found that writing about difficult or painful sexual identity-related experiences reduced perceived stress which, in turn, improved mental health among LGBTQ+ young adults in a high-stigma, low-resource context. This finding may be helpful to psychologists, practitioners, policymakers, and funders who aim to design and disseminate programs capable of addressing mental health inequities among sexual minority and other stress-exposed communities.