Using human and computer-based text analysis of clinical notes to understand military service members’ experiences with therapeutic writing

Abstract

Background: Therapeutic writing has been shown to improve both physical health and emotional well-being. This paper examines the usefulness of clinical notes as a data source, and presents two different analyses of individual clinical notes of therapeutic writing group sessions: analysis performed by a person and analysis by a computer-based program (Pennebaker et al., 2015). The therapeutic writing sessions were offered during the second week of treatment at the National Intrepid Center of Excellence (NICoE) as part of an integrative care model for service members (SMs) with traumatic brain injury and underlying psychological conditions to include post-traumatic stress disorder (PTSD).Method: Therapeutic writing sessions were facilitated in the art therapy studio at the NICoE. The sessions were documented in the military healthcare system’s patient record application by the art therapist and art therapy interns at the NICoE. Clinical notes were informed by SM self-report surveys and clinician observations. Notes from May 2012 to 2015 and were pulled and coded manually for emerging themes, then separately analyzed by a computer software text content analysis program (Pennebaker et al., 2015).Results: Overall, SMs reported more positive than negative, neutral, or mixed emotions during and after the therapeutic writing experience. Some reported a change from negative to positive emotions through the writing process, and many described experiencing relief during and after sessions. SMs wrote on a wide range of topics. Most SMs kept their writing pieces, although some destroyed them or shared them with others, and a few SMs gifted the pieces. Computerized-based analysis (Pennebaker et al., 2015) indicated that work and social were the most prominent content theme areas. It also showed that positive emotions were more evident than negative emotions in the clinical notes and that the focus of the writing pieces was primarily on the present rather than on the past or the future.Implications: Many SMs perceived the therapeutic writing experience as therapeutic, a relevant coping skill, and enjoyable. Some, however, preferred to work on art therapy projects they had begun in previous sessions (such as mask-making) during the writing sessions. The computer-based analysis of the clinical notes took much less time than the human analysis, but it did not produce results of comparable richness or nuance. Computer-based analysis of the actual therapeutic writing pieces may provide deeper insights into the content and themes that emerged during this therapeutic intervention.