4. Discussion
death, traumatic, PTSD, depression, trauma
EVENT
In this study, we investigated psychological adjustment in Italian HCWs during the COVID-19 pandemic and the efficacy of an EW intervention in improving their mental health. We also set out to identify the linguistic predictors of psychological adjustment in the participants’ narrative accounts. In relation to our first research hypothesis, we observed high levels of depression and moderate levels of PTSD in the Italian healthcare workers in our sample. This confirmed previous findings about the psychological impact of the COVID-19 emergency among HCWs. Studies both in Italy and elsewhere [In terms of possible interventions, our findings confirmed that expressive writing can boost the psychological wellbeing of healthcare staff [However, during writing, what specific mechanisms come into play that lead to gains in mental health? The answer to this question can usefully inform targeted therapeutic interventions for both healthcare practitioners and the general population. The expressive writing method already gives very good therapeutic results and could be used with little effort for all healthcare workers, but its long-term effectiveness has not yet been sufficiently explored. In addition, it is a short-term intervention that cannot replace the deeper elaboration promoted by a traditional therapy. For these reasons, it becomes interesting to reflect on linguistic predictors because they can indicate the subjects and the themes on which to concentrate subsequent clinical interventions, favoring the optimization of therapeutic efficacy. Our findings confirmed the role of four processes that can be implicated in the elaboration of trauma and that wield differential effects on PTSD and depression symptoms. We found that cognitive elaboration, emotional elaboration, perceived threat to life, and self-immersed processing were all sensitive to the writing condition variable. More specifically, in the final writing session (as compared to the first), the narratives of the EW participants—which were focused thoughts and feelings—featured more terms reflecting insight, a moderate increase in negative emotion terms, and decreases in both death-related terms and first-person references. Changes in linguistic markers were associated with changes in symptomatology, in keeping with previous studies [Thus, Hence, cognitive processing is implicated in meaning making. However, authors including Castiglioni and Gaj [For example, in relation to depression, which is one of the most likely and harmful consequences of the COVID-19 public health emergency, Jacobs [However, the leading linguistic predictor of PTSD in our sample of HCWs was perceived threat to life. This is in continuity with previous findings by Pennebaker [A possible explanation for these findings is that death words may reflect a sense of mental defeat. In other words, those who use these terms may desire death or be resigned to dying, having forfeited or lost their self-will or autonomy. For individuals with a defeatist outlook, reliving a traumatic experience through exposure therapy or, as in our study, through iterative writing, may confirm their negative beliefs about the nature and implications of the traumatic event rather than leading to health improvements [In relation to PTSD, emotional elaboration also predicts adjustment at the post-writing stage. From a psychodynamic perspective, encouraging the expression of emotion as a form of cathartic release is a crucial component of therapy [Saliently to the role of emotional elaboration, researchers have investigated the role of HCWs’ coping strategies in the psychological outcomes associated with exposure to the COVID-19 emergency [Now, classic studies on coping strategies [Again, in relation to emotional elaboration, we confirmed our own previous finding in traumatized women [Turning now to self-immersed processing, this approach to narrating traumatic experience strongly predicted post-writing outcomes, in keeping with previous evidence that the use of first-person singular pronouns is positively correlated with depression [This dynamic appears to be in contrast with studies suggesting that the narrative revisiting of trauma benefits health. As we have seen, in narrative research of this kind, it is assumed that developing explanations for negative experiences mitigates distress about them. On the other hand, it has also been argued that people’s attempts to understand their feelings can foster rumination and make them feel worse [