Psychological Support Journal Writing As a Complementary Therapy for Reactive Depression: A Rehabilitation Teaching Program Carol E. Smith, PhD RN Carolyn Holcroft, PhD RN Shelby L. Rebeck, MS RN Noreen C. Thompson MSN RN CSARNP Marilyn Werkowitch, BSN RN Brief, recurrent, reactive, or situational depression is a common and costly comorbidity that affects chronically ill patients and their family members. This article describes a program that teaches those individuals how to monitor and cope with symptoms of depression by writing daily in a jour- nal. Twenty patients and family members attended teaching sessions at which videotaped scenes of other patients manag- ing symptoms of depression were shown. After viewing the six scenes, participants wrote about their reactions to each scene and listed the emotions they had experienced that were simi- lar to those shown in the tape. They were then asked to record daily for 4 months their emotions and reactions to situations and to also daily self-rate their levels of energy. They were also provided with a list of recommended activities in which to engage when they were depressed. Two psychiatric nurses evaluated the writings and concluded that the program was Brief, reactive, or situational depression is a common and costly comorbidity that affects many rehabilitation patients and their family members. (Schoenfeld, Malmrose, Blazer, Gold, & Seeman, 1994). Healthcare professionals can provide emo- tional support and information on how to cope with the de- pression (Wells, Stewart, & Hays, 1989); however, patients and their families are often reluctant to accept professional coun- seling (Taylor & Lobel, 1989; Toseland, Rossiter, Peak, & Smith, 1990). Although such external support can be benefi- cial, many patients and family members have found relief through self-recognition of the onset of situational depression and working through that depression by writing in ajournal, or diary, about their emotions and moods. This article describes in detail a complementary therapy pro- gram of journal writing that has been successful in decreasing depressive symptoms in patients undergoing long-term reha- bilitation. We reviewed literature about writing as a therapeutic intervention, the high costs incurred in treating depression, and the use of videotapes of families working to manage the prob- lem (c. Smith, 2000). We suggest that rehabilitation nurses of- fer this complementary therapy teaching program to all cogni- tively intact patients and their family members, because all are at risk of depression during rehabilitation. 170 Rehabilitation Nursing> Volume 25. Number 5· SeptJOct 2000 Keywords briefdepressive, complementary therapy, journaling, rehabilitation, self-monitoring, therapeutic writing influential in helping patients and families overcome many emotionally draining reactions to adverse circumstances. Dr. Carol Smith is a professor in the School of Nursing at the University of Kansas Medical Center, Kansas City, KS. Dr. Carolyn Holcroft is a research technician with the Department of Molecular Genetics at the University of Kansas, Lawrence. Shelby Rebeck was with the Nursing Edu- cation Department of the Shawnee Mission Medical Center, Shawnee Mission, KS, at the time of this study. Noreen Thompson is a psychiatric consultation liaison nurse with the Department of Nursing at the University of Kansas Medical Center. Marilyn Werkowitch is a research coordinator in Home Care Research at the University of Kansas Medical Center. Address correspondence to Carol E. Smith, 13220 w: 102nd Street, Lenexa, KS 66215. Recurrent depressive symptoms: Complications and costs Brief depressive episodes are described in the Diagnostic and Statistical Manual ofMental Disorders (DSM-N) (Amer- ican Psychiatric Association [APA], 1994) as being distinct from major depression. They are characterized by depressed mood, sense of loss, no pleasure in daily activities, or impairment in social and daily function. In one study (Carney, Freedland, Eisen, Rich, & Jaffe, 1995) depressive symptoms reoccurred in the majority of patients involved in rehabilitation; in other studies health professionals were able to readily identify these symp- toms (Davis & Jensen, 1988; Simon & VonKorff, 1995). Physical symptoms that interfere with rehabilitation, such as fatigue, insomnia, and poor concentration, are characteristic of reactive depression, which can lead to treatment noncompliance and poor motivation (Camey et al., 1995; Stoller, Forster, & Por- tugal, 1993). A large-scale study of 11,242 outpatients who were receiving care at three healthcare sites compared rehabilitation outcomes in patients with major depressive disorders, depres- sive symptoms, and chronic medical conditions with healthy persons (Mulsant, Ganguli, & Seaberg, 1997). Patients with de- pressive symptoms, but without a major depressive disorder, had lower physical, social, and role function scores than patients with major depression. Spiegel (1999) found that patients with depressive symptoms perceived their current health status as