Five therapist-guided writing sessions can treat PTSD, and solo journaling does less

Key takeaways

• In a 2018 VA trial, five therapist-guided sessions of written exposure therapy eased PTSD about as well as a standard 12-session therapy, and only 4 of 63 people dropped out, compared with 25 of 63.
• A 2023 review of 31 randomized trials found that writing about hard feelings on your own lowered stress, anxiety and low mood by a small amount, with the benefit showing up later rather than right away.
• An analysis of 39 studies found no benefit from expressive writing on self-rated depression, so it shouldn’t stand in for depression treatment.
• Among recently separated adults who kept searching for answers about the breakup, expressive writing left them worse off months later than a plain log of daily activities.
• Match the writing to the goal: a hard memory, a hopeful future, a thought spiral and a busy bedtime mind each call for a different kind of page.

At a Veterans Affairs medical facility between 2013 and 2016, researchers tried something that sounds almost too simple. They asked adults with post-traumatic stress disorder (PTSD) to sit down and write, in detail, about one traumatic event from their past¹².

The treatment was five sessions long. There was no homework. The comparison was cognitive processing therapy, a well-established PTSD treatment that takes 12 weekly sessions and assignments between visits¹².

The 126 people in the study were assigned by chance to one treatment or the other. Over the next 36 weeks, the writing group improved about as much as the cognitive therapy group at every check². And people stuck with it. Only 4 of 63 dropped out of the writing treatment, compared with 25 of 63 in the longer therapy².

That treatment, written exposure therapy, shows what focused writing can do. It also shows how far it is from the journal on your nightstand. It was built for a diagnosed condition and delivered with a therapist, using strict instructions.

Writing on your own can help too, but less, and more slowly than many people expect. Some kinds of writing even backfire. Here is what the research shows, and how to pick the kind of page that fits what you need.

A five-session writing therapy held its own against longer PTSD treatment

Written exposure therapy, or WET, follows a script. In each session, you write for about 30 minutes about one specific traumatic event³⁴. You focus on what happened and on the thoughts and feelings you had at the time.

A therapist explains the method, reads what you wrote and gives feedback so the next session stays on track³⁴. You won’t need to talk the trauma through with the therapist³. There’s no homework. The one request is that you stop dodging memories of the event when they surface on their own³.

The 2018 trial, published in JAMA Psychiatry and funded by the National Institute of Mental Health, was led by Denise Sloan of the VA’s National Center for PTSD¹. Later trials have extended it to other groups:

• Active-duty service members: a 2022 trial found WET was not inferior to cognitive processing therapy⁴.
• Veterans: a 2023 VA-funded trial of 178 veterans at three VA medical centers compared WET with prolonged exposure, a therapy of 8 to 15 sessions lasting 90 minutes each. Both groups improved significantly, and people in the WET group were more likely to finish⁵.
• Inpatients: an early report found WET helped service members on a psychiatric inpatient unit, and a 2025 trial tested it with high-risk patients on a military psychiatric unit⁴.

There are honest limits. Many of the trials were run by Sloan and her collaborators, who also wrote the VA’s provider guide to WET⁴. As of August 2026, that guide said no meta-analysis, a study that pools trials, had been published⁴.

Expert panels also rank WET a step below the best-known options. The 2023 VA and Department of Defense guideline gives its top recommendation to prolonged exposure, cognitive processing therapy, and eye movement desensitization and reprocessing (EMDR). It lists WET as a second-line choice for when those aren’t available or aren’t preferred⁴⁶. An American Psychological Association guideline found too little evidence at the time to recommend for or against it⁴.

Finding WET can take some asking. The VA calls it “somewhat available,” offered in some medical centers’ PTSD programs and sometimes by video³. The VA does not recommend phone-only sessions without video⁴.

The classic writing exercise helps a little, and the benefit arrives late

Most “journaling for health” advice traces back to a 1986 experiment by psychologist James Pennebaker and a colleague. Our article on contemplative practices tells that story. The method that grew from it asks you to pour your deepest thoughts and feelings about something painful onto the page for 15 to 20 minutes on a few days in a row, without fussing over spelling or grammar⁷.

The early pooled results looked strong. A 1998 analysis in the Journal of Consulting and Clinical Psychology pooled 13 studies in healthy people and found a medium-sized benefit for psychological health⁷.

Newer work tells a more modest story:

• A small, delayed effect. A 2023 analysis in the British Journal of Clinical Psychology pooled 31 randomized trials with 4,012 healthy or mildly distressed people, all with follow-up checks⁸. Writing lowered depression, anxiety and stress by a small amount. The benefit tended to show up at follow-up, not right away.
• Spacing mattered. Sessions one to three days apart worked better than sessions spaced further apart⁸. The number of sessions, the instructions and the way the writing was delivered made no clear difference.
• Not for depression. A 2018 analysis by Reinhold, Bürkner and Holling, as summarized by a later research team, found no benefit from expressive writing in 39 studies that measured self-rated depression⁷.
• Not everywhere. A separate 2023 analysis of 11 trials in Asian populations, with 1,188 people, found no benefit at follow-up⁹. The author suggested writing programs need to fit the culture they’re used in.

A large 2023 test of 833 college students adds a twist⁷. Classic expressive writing did no better than writing about time management. A version that encouraged writers to accept their feelings helped only the most engaged students, those who wrote 1,722 words or more⁷.

The takeaway isn’t that writing is useless. It’s that the effect is small, it takes time, and it seems to depend on how deeply you engage.

Writing about your best future is gentler, and it lifts optimism for a while

Not all helpful writing digs into the past. In 2001, psychologist Laura King asked 81 college students to write for 20 minutes a day, four days in a row¹⁰.

Some wrote about their most traumatic experience. Others wrote about their “best possible self,” a future in which things had gone as well as they could. Others wrote about both, or about a neutral topic.

The future-focused writing upset people less than the trauma writing did, and it raised well-being three weeks later¹⁰. Five months on, health center data showed less illness in the trauma, best-possible-self and combined groups than in the neutral group¹⁰.

The exercise has since been tested widely. A 2019 analysis in PLOS One pooled 29 studies with 2,909 people¹¹. The best-possible-self exercise improved optimism, positive mood and well-being by small to moderate amounts, and it eased negative mood and depressive symptoms slightly. In studies that included both, it beat gratitude exercises on positive and negative mood¹¹.

Treat it as a boost for mood and hope, not a cure.

A thought record turns a spiral into columns

Cognitive behavioral therapy, or CBT, uses a different kind of page. A thought record is a worksheet for catching a thought that sends your mood down, then testing it.

There is no single version. A 2019 review collected 110 different thought records from key texts in the field and from certified cognitive therapists¹². The authors noted that the field tends to treat them as interchangeable, though limited research hints that different versions may work differently¹².

Here is a simple form in our own words:

1. The moment: where you were and what happened, in one line.
2. The thought: the exact words that ran through your head.
3. The feeling: name it and rate it from 0 to 10.
4. The case for and against: facts that support the thought, then facts that don’t.
5. A fairer version: a thought that fits all the facts.
6. Re-rate: how strong is the feeling now?

Thought records are a tool inside therapy, not a full treatment. Writing has a place in some PTSD therapies, too: cognitive processing therapy can include a written account of the trauma, though the VA says that part is now optional⁶.

Writing things down is also one of the oldest self-care habits people have. Diaries, prayer journals and letters cost almost nothing, need no prescription and keep you in charge of your own story. The research simply helps you aim that habit where it’s most likely to help.

Writing can make things worse when it becomes replaying

In 2012, researchers at the University of Arizona reported on 90 adults who had recently separated from a spouse¹³. They were assigned by chance to write for 20 minutes a day, three days in a row.

Some described their feelings about the marriage. Others shaped those feelings into a story with a clear arc. A third group kept a dry record of the day’s activities, leaving out feelings and opinions¹³.

Eight months later, the results surprised the team. People who tended to ruminate, brooding over the breakup and hunting for answers, reported the least distress if they’d been in the plain activity-log group¹³. For them, expressive writing seemed to slow recovery. People who didn’t ruminate did about the same in every group.

Psychologist David Sbarra, who led the study, noted that expressive writing has helped in many other studies¹³. The lesson is narrower: if you already replay a loss over and over, putting it on paper may deepen the groove. Our wellness-journal article explains the difference between reflecting and brooding.

Some discomfort is expected. The VA notes that WET itself can stir up some distress during the writing, and that it tends to pass quickly³. But distress that builds week after week is a signal to change course.

Timing matters too. After a frightening event, most people recover, and their reactions fade with time, according to the National Institute of Mental Health (NIMH)¹⁴. We found no strong evidence that writing in the first days after a trauma prevents PTSD.

If something terrible just happened, lean first on sleep, routines and people you trust¹⁴. Our upcoming article on trauma covers this in more depth.

Pick your page: match the writing to what you need

This guide is ours, built from the studies above. It hasn’t been tested as a set. Pick one row and try it for a week or two.

What you want	Kind of writing	How much	What the evidence says	Stop or switch if
Make sense of a hard experience from months or years ago	Expressive writing	15 to 20 minutes, three or four sessions, a day or two apart	Small, delayed benefit in one large review; mixed elsewhere89	You feel worse after each session or keep writing the same paragraph
Feel more hopeful about what’s ahead	Best possible self	15 to 20 minutes, a few sessions	Short-term lift in optimism and mood11	It turns into a list of everything you’re not
Untangle a thought that hijacks your mood	Thought record	About 10 minutes, when a feeling spikes	Core CBT tool; not tested well on its own12	You argue in circles; bring it to a therapist
Trauma memories that keep intruding for more than a month	Written exposure therapy with a therapist	Five sessions, about 30 minutes of writing each	Strong in randomized trials24	Don’t try the full method alone
Stop replaying a breakup or loss	A few plain lines about what you did today	5 to 10 minutes	One trial in separated adults13	Your log turns into a hunt for answers

Prompts to start with (in our own words):

• Expressive writing: “What happened, what did I feel then, and what do I understand now that I didn’t before?” On the last day, add: “What do I want to carry forward from this?”
• Best possible self: “It’s five years from now and things went as well as they reasonably could. What does an ordinary Tuesday look like? Who’s there? What did I do to get here?”
• Thought record: “What exactly did I tell myself just now, and would I say it to a friend in the same spot?”
• Plain daily log: “Three things I did today, and one small thing I’ll do tomorrow.”

Some writing has its own home in the library. For lists of things you’re thankful for, see our companion article on gratitude. For worry lists, see our article on 3 a.m. worry.

For a bedtime to-do list, see our evening-routine article. For paper versus apps and privacy, see our wellness-journal article.

What the evidence says, rated

Claim	Evidence rating	What it rests on
Therapist-led written exposure therapy eases PTSD about as well as longer trauma therapies	Strong evidence	Randomized trials against cognitive processing therapy (2018, 2022) and prolonged exposure (2023); mostly one research team; guidelines rank it second tier2456
Expressive writing on your own gives a small, delayed lift in stress, anxiety and mood	Promising but early	Decades of trials, but mixed: one review of 31 trials found a small, delayed effect, while a review of Asian samples and a large 2023 trial found none789
Best-possible-self writing gives a short-term lift in optimism and positive mood	Strong evidence	29 studies with 2,909 people; small to moderate effects11
A thought record helps on its own, outside therapy	Not enough evidence	Many versions in use, little research comparing them12
Writing in the first days after a trauma prevents PTSD	Not enough evidence	We found no strong trials; most people recover on their own14
Expressive writing treats depression	Evidence says no, or unsafe	No benefit across 39 studies of self-rated depression7
Expressive writing helps people who keep replaying a breakup	Evidence says no, or unsafe	One trial found worse outcomes for ruminators than a plain activity log13

Questions readers ask

The bottom line

Writing can be powerful when it’s aimed well. A short, scripted writing therapy, guided by a clinician, now rivals longer treatments for PTSD. On your own, expressive writing gives a small lift that arrives late, and it isn’t a treatment for depression.

Pick the page that fits the problem: a hard memory, a hopeful future, a stubborn thought or a busy mind at night. Stop when writing turns into replaying. If distress lasts or deepens, the most useful thing to write may be a list of questions for a professional¹⁴.

Related reading

• Writing down what you do helps you change, while brooding on the page doesn’t
• Tai chi, prayer and journaling: what research can measure and what it can’t
• Worry gets louder at 3 a.m., and a few tested tricks can turn it down
• A warm shower and a to-do list do more for sleep than a nightcap
• How to tell psychiatrists, psychologists and therapists apart

Sources

1. National Institute of Mental Health. “A Shorter, but Effective, Treatment for PTSD” (on Sloan DM, Marx BP, Lee DJ, Resick PA, JAMA Psychiatry, 2018). NIMH Science Update, August 8, 2018. nimh.nih.gov
2. Sloan DM, Marx BP, Lee DJ, Resick PA. “A Brief Exposure-Based Treatment vs Cognitive Processing Therapy for Posttraumatic Stress Disorder: A Randomized Noninferiority Clinical Trial.” JAMA Psychiatry, 2018;75(3):233-239 (abstract via Duke Scholars). scholars.duke.edu
3. U.S. Department of Veterans Affairs, National Center for PTSD. “Written Exposure Therapy (WET) for PTSD.” VA, last updated September 25, 2026. ptsd.va.gov
4. Sloan DM, Marx BP. “Written Exposure Therapy for PTSD” (provider page). VA National Center for PTSD, last updated August 3, 2026. ptsd.va.gov
5. VA Boston Healthcare System. “Study finds written exposure therapy effective option for treating PTSD” (on Sloan DM, et al., JAMA Psychiatry, 2023). VA, August 23, 2023. va.gov
6. U.S. Department of Veterans Affairs, National Center for PTSD. “Overview of Psychotherapy for PTSD.” VA, last updated November 17, 2025. ptsd.va.gov
7. Rude SS, Lantrip C, Aguirre VA, Schraegle WA. “Chasing elusive expressive writing effects: emotion-acceptance instructions and writer engagement improve outcomes.” Frontiers in Psychology, 2023;14:1192595. frontiersin.org
8. Guo L. “The delayed, durable effect of expressive writing on depression, anxiety and stress: A meta-analytic review of studies with long-term follow-ups.” British Journal of Clinical Psychology, 2023;62(1):272-297, doi:10.1111/bjc.12408 (abstract via NYU Silver School of Social Work, Information for Practice). ifp.nyu.edu
9. Guo L. “Find a Resting Place for Your Emotions and Make it Yours: A Meta-Analysis of Expressive Writing Interventions Among Asian Populations.” Cognitive Therapy and Research, 2023;47:936-957. link.springer.com
10. King LA. “The health benefits of writing about life goals.” Personality and Social Psychology Bulletin, 2001;27(7):798-807 (abstract). stafforini.com
11. Carrillo A, Rubio-Aparicio M, Molinari G, Enrique Á, Sánchez-Meca J, Baños RM. “Effects of the Best Possible Self intervention: A systematic review and meta-analysis.” PLoS One, 2019;14(9):e0222386. nutrition-evidence.com
12. Waltman SH, Frankel SA, Hall BC, Williston MA, Jager-Hyman S. “Review and Analysis of Thought Records: Creating a Coding System.” Current Psychiatry Research and Reviews, 2019;15(1):11-19. doi.org
13. University of Arizona. “Post-Divorce Journaling May Hinder Healing for Some, UA Study Finds” (on Sbarra DA, Boals A, Mason AE, Larson GM, Mehl MR, Clinical Psychological Science, 2013). UA News, November 28, 2012. news.arizona.edu
14. National Institute of Mental Health. “Coping With Traumatic Events.” NIH, last reviewed May 2024. nimh.nih.gov
15. National Institute of Mental Health. “Post-Traumatic Stress Disorder.” NIH Publication No. 23-MH-8124, revised 2023. nimh.nih.gov