Can daily journaling reduce stress and anxiety in adults?

Daily Journaling and Stress Reduction in General Adult Populations

The evidence does not support recommending daily journaling as an effective intervention for reducing stress and anxiety in general adult populations. The most recent and highest quality guideline evidence from the Society for Integrative Oncology-ASCO (2023) explicitly recommends against expressive writing interventions, finding no significant benefit for anxiety or depression across 16 studies involving 2,392 participants 1.

Evidence Against General Journaling for Stress Reduction

Guideline-Level Evidence

The 2023 integrative oncology guidelines provide the strongest evidence against journaling interventions 1:

• Expressive writing failed to produce significant improvement in psychological well-being, anxiety, or depressive symptoms across multiple randomized controlled trials 1
• The intervention followed the established Pennebaker paradigm (writing about traumatic experiences for 15 minutes across 3-4 sessions over 2-3 weeks) 1
• Despite adequate sample sizes (total n=2,392 across 16 studies) and well-accepted psychological measurement tools, no consistent benefits emerged 1
• The guideline panel concluded that pursuing additional studies in this area is unlikely to change these negative findings 1

Research-Level Concerns

Supporting research reveals important limitations and potential harms 2, 3, 4:

• A 2022 systematic review and meta-analysis found only a 5% difference between intervention and control groups, with high heterogeneity (I² of 83.8% in intervention arms) and methodological flaws limiting definitive conclusions 2
• Writing about stressful events can be taxing and may worsen mood in the short term, particularly in patients with severe anxiety disorders 3
• One study found that focusing on emotions alone during journaling resulted in more severe illness symptoms compared to control conditions 4

Context-Specific Exceptions Where Journaling May Have Limited Benefit

ICU Family Members (Not General Population)

The only guideline-supported use of diary interventions applies to a highly specific population—family members of ICU patients 1:

• ICU diaries (written by relatives, nurses, and physicians about the patient's critical illness) may reduce post-traumatic stress at 3 and 12 months after patient discharge or death 1
• However, evidence quality is low (sample sizes of only 36 and 143 patients), and studies were single-center or two-site only 1
• This intervention is fundamentally different from personal stress journaling—it involves multiple authors documenting a patient's medical journey 1

Positive Affect Journaling (Specialized Format)

One small study (n=70) of positive affect journaling (PAJ)—which focuses specifically on positive experiences rather than stressful events—showed some benefit in medical patients with elevated anxiety 5:

• PAJ involved structured 15-minute sessions three times weekly for 12 weeks, focusing on positive emotions 5
• This differs substantially from traditional expressive writing about stressful events 5
• The study was preliminary with moderate adherence rates 5

Critical Distinctions and Common Pitfalls

Why Traditional Journaling Fails

The evidence suggests several reasons for lack of efficacy 1, 4:

• Brief interventions (2-3 weeks) are poorly matched to chronic conditions like stress and anxiety, which persist over months 1
• Focusing on negative emotional expression without adequate cognitive processing may worsen symptoms 4
• The intervention does not become a sustained habit, which would require weeks to establish 1

Avoiding Misapplication

Do not recommend journaling as a primary or adjunctive stress management strategy for general adult populations based on this evidence 1. The 2023 guidelines explicitly state that expressive writing should not be offered to improve depression or anxiety symptoms 1.

If patients inquire about journaling, consider directing them toward evidence-based alternatives with stronger support, such as mindfulness-based interventions, which have robust guideline-level recommendations for anxiety and depression management 1.

Potential Role as Symptom Tracking Only

While journaling about stressful events lacks therapeutic benefit, keeping diaries to track symptoms, triggers, and treatment responses may have organizational value in clinical care 1. This is distinct from therapeutic journaling and serves a documentation rather than intervention purpose 1.