Speaker: Franziska Hartung @FranHartung
Affiliation: Newcastle University
Title: Can fiction improve wellbeing?
Abstract (long version below): Engaging with stories can help individuals and communities to process traumatic experiences and build resilience. Bibliotherapy has become a promising low-cost and non-invasive wellbeing intervention. We tested whether wellbeing can be improved in adult volunteers over a 6-week intervention in bibliotherapy or creative writing. Our results show that both reading and writing have positive effects on wellbeing and are promising and cost effective tools in public health.
Long abstract
Engaging with stories can help individuals and communities to process pain and traumatic experiences, build resilience and connections, learn about the world and other people, and escape into alternative worlds. Bibliotherapy has become popular as a promising low-cost and non-invasive intervention that can improve wellbeing, e.g., in cancer patients. Reading, either as shared reading in groups or individually, especially in conjunction with group discussions about the reading contents can help individuals to process distressing thoughts and feelings indirectly in a safe fictional space without direct confrontation of personal traumatic events. Similarly, writing as a creative exercise also seems to be a promising tool in wellbeing interventions. What is less clear from existing research is what components of wellbeing are improved by reading or writing and whether individual differences affect the effectiveness of bibliotherapy or creative writing wellbeing interventions.
We tested the effectiveness of 2 types of bibliotherapy (trauma-relevant vs trauma-irrelevant fiction reading) and creative writing as group-based wellbeing interventions and a control group that completed the bibliotherapy interventions without group meetings. The study was preregistered at https://aspredicted.org/c86c7.pdf. We recruited 2 cohorts of adult volunteers with varying degrees of mental wellbeing at baseline for this study: Creative Writing (N=36), Reading and weekly meetings (N=81), and Reading and weekly online surveys (Control Group, N=38; only for cohort 2, not part of the preregistration).
All groups apart from the control group participated in 6 weekly 1h zoom meetings with their intervention group. The reading group discussed the experiences while reading their book and reading in general in a semi structured discussion while the writing group did creative writing exercises together and also group discussions linked to the topics discussed in the reading group. Participants in the control group completed the same discussions individually via weekly online questionnaires. Since agency is critical to wellbeing, participants chose their preferred intervention type (writing or reading) and book or writing journal from a list. Participants choosing the reading intervention were randomly allocated to the trauma (e.g. dystopian Sci Fi, trauma centered contemporary fiction) or non-trauma (e.g. romance, classics, historic fiction) fiction list and chose a book they would like to read from that list. Each list contained 15 titles from a variety of genres. Participants choosing the writing intervention chose a journal or daily planner of their choice. We provided the books for the reading group and writing journals for the writing group and shipped them directly to the participants. If participants finished their reading before the intervention ended, they could pick another book of their choice from the same list.
Before and after the intervention, wellbeing was assessed with a battery of standardized measures such as WHO Quality of Life survey, diagnostic questionnaires for depression and anxiety, mental resilience, optimism, and life satisfaction via a Qualtrics survey. After the intervention, we additionally measured aesthetic experiences and the Story World Absorption Scale for the reading group in reference to their chosen books. We hypothesized that participants in every intervention group would experience improvement in some aspects of their wellbeing. All volunteers who completed the intervention received a 25£ Amazon voucher as a thank you.
Qualitative data from participant feedback revealed that almost every participant who completed the study reported subjective feelings of improvement on different aspects of life. The themes that came up the most in discussions and on the final feedback were escapism (such as finding time for yourself), learning (about other people, ideas, and cultures), reflection (about yourself and characters), and catharsis (processing difficult emotions). The quantitative data from the questionnaires also shows improvement in wellbeing for every group in the study. The creative writing group showed the largest improvement for life satisfaction and physical quality of life. The reading group who met weekly online showed the largest improvement in resilience and state optimism. The most improvement, however, was shown in the control group who read the same books without meeting online and instead filled out weekly questionnaires about the same topics we covered in the discussion. This group showed improvement in health satisfaction, state optimism, and almost all aspects of quality of life (physical, social, and environmental, but not psychological) as well as decreased levels of depression and anxiety. We think the main difference between the reading group that met online and the control group is that the people who met up weekly were mostly people who already read a lot regularly while many people in the control group started reading regularly again. Improvement in all participants in the reading groups was linked to narrative engagement. Increased attention during reading was linked to more improvement in depression and higher transportation scores predicted more improvement in anxiety symptoms. High mental imagery was associated with lesser improvement in depression symptoms and more improvement in resilience. Stronger plot related emotions also predicted better improvement in anxiety symptoms.
Finally, with respect to the trauma fiction and non-trauma fiction, we find that non-trauma fiction such as historic, romance, adventure and classics have more benefits for wellbeing than trauma fiction such as dystopian sci-fi, war fiction, or family trauma drama. This benefit was significant for health satisfaction, life satisfaction, social quality of life, and resilience. This suggests that escapism is more important for our (mental) health than trauma processing, at least for healthy adults.
In summary, our hypothesis is confirmed that both reading and writing have positive effects on wellbeing and are promising and cost effective tools in public health. Our results emphasize the need for more research on fiction and public health, including research with patients and other vulnerable populations. Additionally, we highlight the importance of joy in reading experience as predictors of intervention effectiveness and the need for access to reading particularly for vulnerable populations such as children, prisoners, and refugees. Future research should explore the relationship between reading and writing materials and wellbeing outcomes.