Medical journaling has been shown to have numerous health benefits, both for patients and medical practitioners. For patients, it leads to a better understanding of their illnesses and treatments, provides a record of their reactions to changes in medications, and helps care providers spot symptoms that might otherwise have gone unnoticed.

For medical care providers, journaling is also helpful to relieve stress, review procedures, and demonstrate proficiency at a variety of tasks. Journaling is so highly thought of in Asian nations that it is taught in nursing schools.

A two-year study at Eastern Virginia Medical School in Norfolk, Virginia, looked at the impact of visual journaling on stress and anxiety for students and staff. The study involved 10 volunteers — half students, half staff. Researchers concluded that there was a decrease in stress and anxiety between pretest and posttest for those journaling, but the effect was small and the sample size inadequate to reach statistical significance.

The researchers cite numerous studies showing the benefits of journaling for college students, noting “journaling helped to reduce levels of anxiety in addition to improving academic performance.” Making art, or art journaling, might be the most effective form of medical journaling, according to researchers, who note in addition to decreased anxiety, stress and depression, an increase in positive emotions. In explaining how the process might work, researchers say:

[U]sing artwork to express stress-producing emotions could help to reverse the stress response, which would in turn relieve the body of tension, help to alleviate pain, and boost the immune system.

A similarly small study of positive affect journaling was conducted in 2013 and 2014 with 70 volunteer patients at the Pennsylvania State Hershey Medical Center. Patients who “reported a score of 8 to 15 on the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS)” were accepted into the trial. The HADS has a range of zero to 42. A score of 8-15 is considered mild to moderate. Severe scores were not accepted into the program.

The intervention involved 15-minute online writing sessions, three days per week for 12 consecutive weeks. Each session involves logging on, then answering one of seven randomly-chosen, positive affect prompts. Prompts included: “What are you thankful for?” and “What has someone else done for you?” Three of the 70 patients dropped out during the 12-week program, 67 completed it.

In addition to HADS scores, researchers looked at the following measures:

• The Brief Resilience Scale
• The Healthy Days Measure
• The Perceived Stress Scale
• The Positive and Negative Affect Schedule
• The Satisfaction with Life Scale
• The Social Provisions Scale

Participants completed self-reported assessments at the end of each of the first three months. Here are the findings:

Results indicated that the positive affect journaling intervention reduced mental distress and improved well-being. Specifically, the intervention group reported lower HADS-A at all 3 assessments (at the end of months 1 through 3), more resilience at the end of month 2, less perceived stress at all 3 assessment points, and a greater percentage (ie, 56.3% vs 31.3%) of participants reported better mental health at the end of the first month, relative to baseline.

On the other hand, “The intervention was not associated with improvements in depressive symptoms, satisfaction with life, [or] other indices of social support…”

Now let’s look at a recent meta-analysis and systematic review of the efficacy of journaling in the treatment of mental illness. This comes from four researchers at the Northeast Addiction and Mental Health Centre for Holistic Recovery in Calgary, Alberta, Canada. They found 20 peer-reviewed, randomized control trials out of nearly 3,800 articles retrieved. And the conclusions are agonizingly vague:

Our review suggests that while there is some randomised control data to support the benefit of journaling, high degrees of heterogeneity and methodological flaws limit our ability to definitively draw conclusions about the benefit and effect size of journaling in a wide array of mental illnesses.

For the time being, until there are more standardized measures for the assessing the effects of journaling, we can say that it provides marked improvement in some areas and inconclusive benefits in others. For medical patients and their care providers, it is a positive benefit. For mental health sufferers, it is inconclusive, and for substance use disorders, motivational interviewing, which is similar to journaling, has been found to have positive impacts.

Written by Steve O’Keefe. First published February 19, 2025.

Sources:

“Visual journaling: An intervention to influence stress, anxiety and affect levels in medical students,” The Arts in Psychotherapy, April 2010.

“Online Positive Affect Journaling in the Improvement of Mental Distress and Well-Being in General Medical Patients With Elevated Anxiety Symptoms: A Preliminary Randomized Controlled Trial,” JMIR Mental Health, October 12, 2018.

“Efficacy of journaling in the management of mental illness: a systematic review and meta-analysis,” Family Medicine and Community Health, March 18, 2022.

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