THERAPEUTIC JOURNALING

​WHAT IS THERAPEUTIC JOURNALING?

Therapeutic journaling is the process of writing down our thoughts and feelings about our personal experiences. This kind of private reflection allows us to sort through events that have occurred and problems that we may be struggling with. It allows us to come to a deeper understanding about ourselves, with a different perspective on these difficulties. Therapeutic journaling differs from more traditional diary writing, which involves recording the details of daily events. In contrast, therapeutic journaling is an internal process of using the written word to express the full range of emotions, reactions and perceptions we have related to difficult, upsetting, or traumatic life events. Along the way, this process can mean writing ourselves to better emotional and physical health and a greater sense of well-being.

​THERAPEUTIC WRITING PROTOCOLS

Therapeutic journaling can be done by keeping a regular journal to write about events that bring up anger, grief, anxiety, or joy that occur in daily life. It can also be used more
therapeutically to deal with specific upsetting, stressful, or traumatic life events. An expressive writing protocol developed by Dr. James Pennebaker is the most widely used and researched method utilized in clinical practice. This writing protocol has been linked to improvements in both physical and psychological health. It has been used in non-clinical and clinical populations. The expressive writing protocol consists of asking someone to write about a stressful, traumatic or emotional experience for three to five sessions, over four consecutive days, for 15-20 minutes per session. Research has found it to be useful as a stand-alone tool or as an adjunct to traditional psychotherapies.

Other forms of expressive writing include autobiographical writing where a person reflects on important life events to give meaning to them and build a sense of personal identity.[1] This type of writing assists a person in recognizing themselves as the authors of their experiences with a feeling of personal agency and allows reflection on their life path to better understand the present situation.[2] McAdams developed a therapeutic writing technique, the “Guided Autobiography,” aimed at exploring, in the span of ten weekly two-hour sessions, the most important events of a person’s life around a specific life theme (i.e. family, money, work, health, spirituality, death, aspirations)[3]. This Guided Autobiography exercise has been found to be an effective method to enable participants to understand and appreciate their life stories to increase optimism and self-esteem.[4]

One additional form of therapeutic writing is gratitude expression exercises, including a Gratitude Letter where a person writes a letter to a person they have never sincerely thanked and Gratitude Journaling, where a person identifies at least three good things that happened that day and reflects on their causes and impact. (Refer to the “Creating a Gratitude Practice” tool.)
​ www.va.gov/WHOLEHEALTHLIBRARY/tools/creating-gratitude-practice.asp

Gratitude journal interventions have been proven to increase well-being, positive affect, social relationships, optimism, life satisfaction, and to lower negative affect and depressive symptoms.[5] A gratitude journal intervention was also found to improve veterans' gratitude over time, and to have positive effects on their psychological well-being.[6]

​HOW IT WORKS

Emotional expression has been found to be good for our health. It enhances our immune system functioning. When upsetting or traumatic events occur, we often are not able to fully process what happened, and the event and the emotions around what occurred become stuck in our memory. The simple act of expressing thoughts and feelings on paper about challenging and upsetting events can allow us to move forward by openly acknowledging, accepting, expressing and letting go of the feelings involved. Expressive writing also provides an opportunity to construct a meaningful personal narrative about what happened. It brings clarity and enables us to place our experience into the context of our larger place in the world. Expressive writing helps to make cause and effect links between life events and increases our capacity for self-reflection, awareness and resilience. 

The benefits of writing also include self-regulation, clarifying life goals, gaining insight, finding meaning and exploring different points of view.[7] Writing can foster positive emotions as putting feelings and thoughts into words widens our scope of attention, sparks the search for solutions and allows the mind to be more flexible.[8]

Writing about traumatic or particularly painful situations, may also generate forgiveness in interpersonal conflict and can promote feelings of wisdom and hope in difficult situations as it assists us in going beyond our suffering to reaching more positive perspectives. [9,10] (Refer to the “Forgiveness” tool.)
www.va.gov/WHOLEHEALTHLIBRARY/tools/forgiveness-the-gift-we-give-ourselves.asp

In expressive writing, an important element consists of feeling completely honest and free to write anything, in a safe and private context without necessarily sharing the content with another person. Conversely, the outcome of talking about difficult or traumatic life experiences depends on the listener’s capability to comprehend and accept the patient’s narrative.[11] As a result, the interactions with a therapist could be particularly stressful for individuals discussing particularly painful topics or sensitive experiences or for those who have social anxiety and feel anxious sharing vulnerable things with another person.[12]

According to Pennebaker, who first investigated therapeutic journaling for traumatic events, but later expanded the focus to general emotional events or specific experiences, what makes writing therapeutic is that the writer openly acknowledges and accepts their emotions and becomes able to give voice to his/her blocked feelings and to construct a meaningful story in a safe environment.[11

Expressive writing has been concluded to be beneficial also as a “stand alone” technique for the treatment of anxiety and post-traumatic stress disorder symptoms and to a lesser extent for depression and anxiety. [36,37] In one study, enhanced expressive writing (i.e., writing with scheduled contacts with a therapist) was found to be as effective as traditional psychotherapy for the treatment of trauma in patients. Expressive writing without additional talking with a therapist was found to be only slightly inferior. The researchers concluded that expressive writing could provide a useful tool to promote mental health with only minimal contact with a therapist.[22]

Therapeutic journaling constitutes a useful treatment alternative for patients who do not respond to other evidence-based therapies. It may be especially useful for reaching trauma survivors in need of evidence-based mental health care who live in remote areas. Therapeutic journaling can also be a way to reach people who are unwilling or unable to engage in psychotherapy.

Expressive writing may be contraindicated for individuals who do not typically express emotions or who have severe trauma histories or psychiatric disorders. [38-40] When therapeutic journaling causes very intense levels of distress or cognitive rumination, it is not advisable to continue the writing exercise.[11] .

​THERAPEUTIC JOURNALING INSTRUCTIONS

This writing exercise is useful for dealing with emotional upheavals or traumas. It is a fourday writing program that has proven effective for improving mental and physical health. It is best to do your writing in a meaningful place, time, and atmosphere, so think about finding a location where you will be undisturbed by others, your phone, e-mail, etc.

It is important to think about what your writing topic will be. You might pick an emotionally upsetting event that is bothering you. If you have faced a massive trauma, it is best not to write about it for several weeks afterwards, as it may be too difficult to deal with some of the emotions that arise around what happened. Trust where your writing takes you. You might start writing about a traumatic experience and then find yourself writing about something entirely different.

For the next four days, please write about an emotionally upsetting or traumatic event that has had a strong impact on you. During your writing, you are encouraged to explore your deepest emotions and thoughts about this difficult life experience. As you write about this topic, you might tie it to your relationships with others. You may relate it to your past, present, or future, or you may connect it with who you may have been, who you would like to be, or who you are now. You may write about the same general issues or experiences on all days of writing, or you may choose to write about different topics each day.

Keep in mind these few simple guidelines recommended by Pennebaker:[41].

Writing topic. You can write about the same event all four days or different events each day. What you choose to write about should be something that is extremely personal and important for you.

Length and frequency. Write for 15-20 minutes each day for four consecutive days if you can. It is a bit more effective than writing four days over the course of several weeks.

Write continuously. Once you begin writing, write continuously without stopping. Don’t worry about spelling or grammar. If you run out of things to say, simply repeat what you have already written. Keep writing about the topic until the time is up.

Write only for yourself. You are writing for yourself and no one else. After you complete the expressive writing exercise, you may want to destroy or hide what you have written. Remember this writing can be for your eyes only.

What to avoid. If you feel that you cannot write about a particular event because it would be too upsetting, then don’t write about it. Just write about events or situations that you can handle now.

What to expect. It is common for people to feel somewhat saddened or depressed after writing, especially on the first day or two. Know that this is completely normal if this happens to you. Typically, the feeling usually lasts just a few minutes or a few hours. It is a good idea to plan some time to yourself after your writing session to reflect on the issues you have been writing about and support yourself in any emotions that come up.

Considerations. Writing about the same topic day after day for too many days is not helpful. If, after several sessions, you feel you are not making progress, then you might need to stop and contact a health care practitioner.

When to discontinue the journaling exercise. Writing exercises aren’t for everyone. If the writing exercise evokes strong feelings that you cannot cope with, stop immediately and do something soothing for yourself. Experiencing symptoms of hypervigilance, stress or distress are signals to discontinue this journaling exercise immediately. Take care of yourself by doing something like practicing diaphragmatic breathing, reaching out to a friend or loved one, or going for a walk to center and calm yourself. If you experience lingering negative feelings, you might benefit from some additional help. It is recommended to seek the professional advice of a psychologist, counselor, or physician to discuss these feelings and experiences.