GradedHealth

Journaling

Last reviewed October 2026 · Based on 15 studies

Bottom line

Expressive and gratitude writing give small, lasting relief from stress and low mood in several trials. The results vary a lot between studies, and writing did not clearly help in pregnancy or advanced illness. It has few reported harms.

What it helps with

  • Lowers stress, anxiety and low mood — Benefit, evidence grade B (Moderate). Meta-analysis of 31 RCTs (4,012 people); downgraded once for inconsistency, as effects varied with the gap between writing sessions.
  • Eases symptoms of mental illness — Benefit, evidence grade C (Limited). Meta-analysis of 20 RCTs; downgraded for high heterogeneity and methodological flaws.
  • Eases anxiety — Benefit, evidence grade C (Limited). Ten small trials in Chinese cancer patients plus one app-based trial with declared ties to the app's company; downgraded for small trials and indirectness.
  • Does not ease anxiety or stress in pregnancy — No effect, evidence grade C (Limited). Meta-analysis of 8 RCTs (929 women); downgraded for indirectness (pregnancy population) and inconsistency across outcomes.
  • Eases stress and low mood with a gratitude diary — Benefit, evidence grade C (Limited). One small trial (65 women) with a wait-list control; downgraded for small size.
  • Lifts wellbeing and positive mood — Benefit, evidence grade C (Limited). Systematic review of 51 studies rated poor or fair quality; downgraded for quality and inconsistency across outcomes.
  • Does not clearly improve sleep in advanced illness — No effect, evidence grade C (Limited). Four small trials (214 people) in advanced disease with low-quality evidence; downgraded for small sample and indirectness.

What it is

Journaling means writing regularly about thoughts and feelings. Expressive writing focuses on stressful experiences [1], while gratitude journaling focuses on things you are thankful for [2].

How it might work

Proposed: in a cancer trial, the effect on depressive and anxiety symptoms went through lower perceived stress [3].

What the research says

A review of 31 randomised trials found a small effect on depression, anxiety and stress (Hedges' g of −0.12) that appeared after a delay [1]. A review of 20 trials in people with mental illness found a small-to-moderate benefit, with high variation between studies [4]. In a small trial of 65 women, a gratitude diary improved stress and low mood more than a wait-list [5]. Writing about positive things lifted mood more than expressive writing in general populations [6].

Doses used in studies

In the Chinese cancer trials, expressive writing usually ran four to six sessions [7]. Sessions one to three days apart gave stronger results than longer gaps [1]. A gratitude diary was kept four times a week for three weeks [5].

Safety and interactions

Journaling is described as low risk, with few reported adverse effects [4]. Writing about a stressful experience can be painful, because it brings the memory back [8]. Studies in pregnancy and in people with advanced illness reported no clear benefit for anxiety or stress [9][10]. Anyone in crisis or living with a serious mental health condition should involve a clinician.

Caveats and open questions

Many trials are small, and quality varies [4]. Positive writing has more consistent results for wellbeing than for stress or anxiety [2]. The app trial that found strong short-term anxiety relief had authors with declared ties to the app's company [11].

References

  1. The delayed, durable effect of expressive writing on depression, anxiety and stress: A meta-analytic review of studies with long-term follow-ups.. Br J Clin Psychol, 2023.
  2. Positive expressive writing interventions, subjective health and wellbeing in non-clinical populations: A systematic review.. PLoS One, 2025.
  3. The effects of culturally adapted expressive writing interventions on depressive and anxiety symptoms among Chinese American breast cancer survivors: A randomized controlled trial.. Behav Res Ther, 2023.
  4. Efficacy of journaling in the management of mental illness: a systematic review and meta-analysis.. Fam Med Community Health, 2022.
  5. The effects of two novel gratitude and mindfulness interventions on well-being.. J Altern Complement Med, 2015.
  6. Efficacy of expressive writing versus positive writing in different populations: Systematic review and meta-analysis.. Nurs Open, 2023.
  7. The effect of expressive writing on Chinese cancer patients: A systematic review and meta-analysis of randomized control trails.. Clin Psychol Psychother, 2023.
  8. Writing about a stressful experience improves semantic clustering of memory in men, not women.. Stress Health, 2024.
  9. Effects of expressive writing intervention for women's PTSD, depression, anxiety and stress related to pregnancy: A meta-analysis of randomized controlled trials.. Psychiatry Res, 2020.
  10. Expressive writing as a therapeutic intervention for people with advanced disease: a systematic review.. BMC Palliat Care, 2019.
  11. The Immediate Impact of App-Based Psychotherapeutic Exercises on Anxiety: An RCT.. Depress Anxiety, 2025.