Journaling Therapy: Types, Effectiveness, and Benefits

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Journaling Therapy: Types, Effectiveness, and Benefits

THC Editorial Team December 9, 2021
An old man seated and writing in a book (an evangelist?), 17th century, Anonymous, The Metropolitan Museum of Art (article on journaling therapy)
An old man seated and writing in a book (an evangelist?) 17th century, Anonymous, The Metropolitan Museum of Art

Contents

Writing therapy, a form of expressive therapy in which people write about their thoughts and feelings relating to traumatic moments and other mental health concerns, has gained popularity because of its enumerated benefits, including reduced stress and improved physical health.1 One common and accessible form of this practice is journaling therapy.

What Is Journaling Therapy?

Journaling therapy combines the value of talk therapy and writing therapy.2 Usually journaling therapy consists of exploring one’s thoughts and emotions through writing. It provides an element of privacy, as writing is only a shared activity if the product is disclosed to a therapist or loved one. More than a diary-like, surface-level account of one’s day or week, journaling is a deep, internal process in which people express their emotions, reactions, and perceptions.

How Does Journaling Therapy Work?

There are many ways for a therapist to incorporate journaling into a therapy session, often referred to as interactive journaling. It combines methods from bibliotherapy and writing therapy. In a professional counseling scenario, it is usually used in combination with talk therapy.2

For example, some therapists might give their clients a written “homework” assignment to work on between sessions. Some might begin sessions with a short writing exercise to check in with a client and allow them to express how they’re feeling, what they want to work on during the session, or other things happening in their life. Others use guided journaling, where the therapist guides the client through a written exercise that addresses the topic they want to cover during the session for about 10 minutes and then uses the rest of the session to discuss the journal entry.5

Pennebaker developed a writing protocol for journaling that consisted of asking a client to write about a stressful, traumatic, or emotional experience over three to five sessions for 15–20 minutes each instance.3

One model of an interactive journaling session includes reading the client a section of a sample journal entry, which may be one published in a study or available online, as an example of what they might want to write about.6 The short narrative is then followed by a related prompt for the client’s reflection.

Prompts may include:6

  • childhood
  • questions that go through the client’s mind
  • fears
  • support
  • sadness
  • hope

Once the client has finished writing or the allotted writing time has elapsed, the processing stage begins. This is when the client shares what they’re comfortable disclosing of what they’ve written, and the client and therapist discuss and reflect upon it. The therapist might ask questions or prompt discussion with questions and statements like “I noticed how you took your time to really reflect on this. I wonder what you were experiencing at that time,” or “Does your work have a title?”6

One of the benefits of journaling therapy is that it does not require a mental health professional to be effective. Although the most effective medium of journaling therapy is professionally supported, long-term, specific expressive writing,7 people can enjoy the benefits of journaling with minimal or no therapeutic assistance. As long as a person is consistent and dedicated to writing and reflecting deeply about current and past traumas, other major life events, and their honest emotions, they can enjoy the positive benefits of journaling therapy.8

Types of Therapeutic Journaling

Although journaling therapy traditionally consists of delving into one’s emotions and traumatic experiences, different types of journaling have developed and been shown to have various benefits.

Gratitude Journaling

A gratitude journal is a place to reflect upon and write down things one is thankful for. This can be as detailed as an entry for each item or as simple as a daily list. Researchers have found that this journaling method can bring improved health and happiness; it can help people cope with stress, increase sleep quality, and promote generosity.9

Reflective Journaling

Reflective journaling is often used in an academic or counseling setting. Entries focus on the person’s internal processes surrounding an event, like the discussion that took place during a class or counseling session, including personal values, beliefs, and experiences. It is meant to help people discover ways to create meaning in their lives.10

Cognitive Behavioral Therapy Journaling

A person must first learn about cognitive behavioral therapy (CBT), a common therapeutic practice, and different CBT skills for this journaling method. Then, as the person uses and integrates these skills into their life, they can write about instances in which they’ve used CBT. This may be a helpful self-guided method of therapy because it includes the benefits of CBT in combination with those of journaling therapy.11

Health Journaling

In health journaling, people journal about their current health issues. This is commonly used throughout lengthy and difficult illnesses like cancer. Research shows that writing about the negative emotions associated with a medical condition can reduce depression and anxiety symptoms.11

Goal Journaling

This structured form of journaling is based on setting goals and plans and tracking activities. Setting manageable goals has shown effectiveness in building self-confidence because it sets a person up for successful experiences.12 Many set “SMART” goals—those that are specific, measurable, attainable, realistic, and timely.13

Effectiveness of Journaling Therapy

Journaling therapy can be very effective in helping people understand themselves and their psyches more deeply. It can allow those with difficulties processing and communicating verbally to express themselves more effectively.14 This can help a psychotherapist diagnose conditions stemming from traumatic experiences and memories. The practice has shown effectiveness for people with chronic and life-threatening illnesses, addictions, eating disorders, and repairing relationships.3

Journaling therapy has also shown particular effectiveness in adolescents, as they may be wary of adults and therefore have resistance to therapy. They see it as less threatening than traditional talk therapies because it creates distance between the client and the narrative they create in their writing. They can test out externalizing their thoughts and feelings to see whether it causes them pain or brings comfort. This form of therapy also enables the client and therapist to slowly build a relationship over time, until the teen feels more comfortable disclosing to the therapist.6

Conditions Improved by Journaling Therapy

Because journaling therapy delves into clients’ personal traumas and inner states, it is often used to treat trauma and posttraumatic stress disorder (PTSD) in various populations. It has also shown effectiveness for other conditions and difficulties, such as poor body image, asthma, and bereavement.

Posttraumatic Stress Disorder

Journaling therapy has shown effectiveness in treating many different groups of people with PTSD, including veterans. Some veterans find it helpful to write about their traumatic and often violent experiences to lend a sense of permanence and physicality to them. After writing, they have a tangible expression of their memory and emotions that they can pick up and hold or examine; it represents a physical uncovering of what once festered within. It can also bring about a sense of clarity; in their writing, veterans can sort through the details of their experiences.

Overall, journaling therapy helps to break down the compartmentalization and suppression of traumatic memories—defense mechanisms commonly employed by people with PTSD—by reducing the fear and anxiety surrounding these memories and experiences through externalizing them.15

Journaling therapy has also shown effectiveness in treating PTSD in refugees. In a 2020 U.S. case study, a group of siblings used visual journaling, a branch of journaling therapy that draws from art therapy, to describe their experiences. Prompts provided by the researchers guided them. The researchers found that this journaling experience promoted the spontaneous disclosure of trauma, identified spirituality as a form of resilience, and reinforced cultural family dynamics.16

Body Image

A 2002 study conducted by researchers from Appalachian State University in North Carolina sought to determine whether a writing intervention akin to that suggested by Pennebaker could positively affect body image. The participants consisted of 48 women split into two groups, one of which wrote about their body image and the other about their bedroom for four days. Surprisingly, both the control and experimental groups reaped the benefits of the journaling therapy intervention, which included improvements in dieting behaviors, eating disorder symptoms, body image, and mood.17 This suggests that even surface-level journaling can have benefits.

Asthma

Researchers from the United States Department of Veteran Affairs Health Care System and Stanford University in California conducted a study in 2005 to extend research about the effect of journaling on pulmonary function in people with asthma. The participants, 137 adult outpatients with asthma, were asked to write once a week for 20 minutes over 3 weeks about stressful experiences, positive experiences, or neutral experiences. The researchers used spirometry, a common type of pulmonary function or breathing test,18 to determine the effectiveness of the intervention before the intervention, directly after, and at a two-month follow up. They found that the group that wrote about stressful experiences had the largest improvement in pulmonary function, followed by the control group, and then finally the positive-writing group.19

Grief

Nearly everyone feels or has felt grief and loss; they are some of the most prevalent emotional states that mental health practitioners encounter. Practitioners have found journaling therapy to be effective in treating these clients, especially when used in conjunction with bibliotherapy methods. Journaling can help clients create meaning after a loss because it allows them to create their own narratives surrounding the event.20

Outlook

Journaling therapy is an accessible medium—all a person needs to start is something to write (or type) on and a willingness to listen within and perhaps dig deep. It can help to improve one’s mental and physical health with as small a time commitment as just 15 minutes each day or a few times a week.

References

  1. THC Editorial Team. (2021, August 7). An overview of writing therapy. The Human Condition.
    https://thehumancondition.com/writing-therapy/
  2. Miller, W. R. (2014). Interactive journaling as a clinical tool. Journal of Mental Health Counseling, 36(1), 31–42.
    https://doi.org/10.17744/mehc.36.1.0k5v52l12540w218
  3. Veterans Affairs. (2021, March 3). Therapeutic journaling. U.S. Department of Veterans Affairs. Accessed November 19, 2021, from
    https://www.va.gov/WHOLEHEALTHLIBRARY/tools/therapeutic-journaling.asp
  4. Moy, J. D. (2017). Reading and writing one’s way to wellness: The history of bibliotherapy and scriptotherapy. In Higler, S. (Ed.), New directions in literature and medicine studies (pp. 15–30). Palgrave Macmillan.
    https://doi.org/10.1057/978-1-137-51988-7_2
  5. Adams, K. (1999). A brief history of journal writing. Center for Journal Therapy. Accessed November 22, 2021, from
    https://journaltherapy.com/get-training/short-program-journal-to-the-self/journal-to-the-self/journal-writing-history/
  6. Garza, Y., & Utley, A. (2011). The therapeutic use of journaling with adolescents. Journal of Creativity in Mental Health, 6(1), 29–41.
    https://doi.org/10.1080/15401383.2011.557312
  7. Bürkner, P., Holling, H., & Reinhold, M. (2018). Effects of expressive writing on depression symptoms: A meta-analysis. Journal of Clinical Psychology Science and Practice, 25(1), Article e12224.
    https://doi.org/10.1111/cpsp.12224
  8. Frattaroli, J. (2006). Experimental disclosure and its moderators: A meta-analysis. Psychology Bulletin, 132(6), 823–865.
  9. THC Editorial Team. (2021, June 26). Gratitude meditation and similar practices. The Human Condition.
    https://thehumancondition.com/gratitude-meditation
  10. Brand, C. F., & Hubbs, D. L. (2005). The paper mirror: Understanding reflective journaling. The Journal of Experiential Education, 28(1), 60–71.
    https://doi.org/10.1177/105382590502800107
  11. Davis, T. (n.d.). Daily journaling: Prompts, ideas, questions, and topics. Berkeley Well-Being Institute. Accessed November 22, 2021, from
    https://www.berkeleywellbeing.com/daily-journaling.html
  12. Preston, D. L. (2010). 365 steps to self-confidence (4th ed.). HowToBooks.
  13. Lawlor, B. K., & Hornyak, M. J. (2012). Smart goals: How the application of smart goals can contribute to achievement of student learning outcomes. Developments in Business Simulation and Experiential Learning, 39.
    https://absel-ojs-ttu.tdl.org/absel/index.php/absel/article/view/90
  14. Colori, S. (2018). Journaling as therapy. Schizophrenia Bulletin, 44(2), 226–228.
    https://doi.org/10.1093/schbul/sbv066
  15. Capps, R. (2013). Writing by service members and veterans. In Platoni, K. T., & Scurfield, R. M. (Eds.) Healing war trauma: A handbook of creative approaches (pp. 115-127). Routledge.
  16. Khatib, I., & Potash, J. S. (2021). Visual journaling using art therapy with refugees. The Arts in Psychotherapy, 74.
    https://doi.org/10.1016/j.aip.2021.101805
  17. Ballard, M. E., Curtin, L., Earnhardt, J. L., & Martz, D. M. (2002). A writing intervention for negative body image: Pennebaker fails to surpass the placebo. Journal of College Student Psychotherapy, 17(1), 19–36.
    https://doi.org/10.1300/J035v17n01_04
  18. American Lung Association. (n.d.). Spirometry. Accessed November 22, 2021, from
    https://www.lung.org/lung-health-diseases/lung-procedures-and-tests/spirometry
  19. Faul, J., Harris, A. H. S., Humphreys, K., & Thorensen, C. E. (2005). Does writing affect asthma? A randomized trial. Psychosomatic Medicine, 67(1), 130–136.
    https://doi.org/10.1097/01.psy.0000146345.73510.d5
  20. Briggs, C. A., & Pehrsson, D. (2011). Use of bibliotherapy in the treatment of grief and loss: A guide to current counseling practices. Adultspan Journal, 7(1), 32–42.
    https://doi.org/10.1002/j.2161-0029.2008.tb00041.x

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