How to Use Journaling to Cope With PTSD

Expressive writing for physical and psychological health with PTSD

Woman writing in journal
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Some psychotherapists are now recommending journaling, also called expressive writing, to help people cope with the symptoms of post-traumatic stress disorder (PTSD). If you have PTSD, here's how journaling can help, as well as how to do it.

Overall Benefits of Journaling

Journaling is one method of helping people cope with any type of traumatic event.

Expressive writing has been found to improve physical and psychological health for people with a number of physical and mental health conditions. One of the benefits of journaling is that it's inexpensive—the cost of paper and a pen—and can be done almost anywhere or anytime.

Some of the general health benefits of journaling include improved cognitive function, counteracting many of the negative effects of stress, and strengthened immune function.

Benefits of Journaling for People with PTSD

In recent years, research has shown that journaling may help people with PTSD in several different ways. Psychologically, expressive writing appears to help people better cope with the symptoms of PTSD, such as anxiety and anger. Physically, journaling can make a difference as well, reducing body tension and restoring focus.

In addition, we are learning that traumatic events may lead not just to post-traumatic stress, but to post-traumatic growth.

In other words, there can be silver linings and experiencing trauma may help you change in positive ways as well. Expressive writing has been found not only to improve the symptoms of PTSD and coping with them, but it also appears to help foster post-traumatic growth, or the ability to find meaning in and have positive life changes following a traumatic event.

Before You Begin

Before journaling, find a notebook and a favorite pen. Some people prefer to have more than one notebook, reserving one to use as a gratitude journal, and the other to include all other thoughts and feelings. You may want to think about where you will keep your journal between writings. Some people prefer to keep it in a private location, whereas others don't feel this need. What's most important is that your words are only accessible to those who you wish to read them.

Steps for Journaling

Follow these six steps to begin journaling:

  1. Find a quiet time and place where there are going to be few distractions. Don't be concerned, however, if there is some noise, or if you only have a short period of time. Some people find that writing at a bus station, on a bus, or even during a five-minute break during the day is very helpful.
  2. Take a few minutes to think about how your PTSD or traumatic event has impacted you and your life.
  3. Begin writing about your deepest thoughts and feelings regarding your PTSD or the traumatic event you experienced. If possible, write for at least 20 minutes. (Note, this is ideal, but again, any amount of time is often helpful, especially if you find it hard isolating this amount of time every day.)
  1. Once you've finished writing, read what you wrote and pay attention to how you feel. Notice any changes in your thoughts or feelings as a result of writing.
  2. Although long-term benefits of writing have been found, writing about your PTSD or traumatic event will naturally initially bring up some distressing thoughts and feelings, so make sure you have a plan for how to manage this distress.
  3. Repeat steps 1 through 5, writing about the same topic for at least two more days. It has been found that writing about the same topic on consecutive days can help organize and improve the clarity of your thoughts and feelings about a stressful event. You may be surprised at the clarity that journaling can bring.

    Journaling Tips

    Here are some other tips to keep in mind while you're writing:

    1. Don't worry about spelling or grammar. Focus simply on getting all of your thoughts and feelings down.
    2. Try to be as descriptive as possible in your writing. For example, when you're describing your feelings, write about the thoughts connected to those feelings and how those emotions felt in your body (for instance, "My heart was racing," or "My muscles were very tense."). This will help increase your awareness and the clarity of your emotions and thoughts.
    3. You may find it helpful to keep what you write so that you can look at it to see how your thoughts and feelings have changed over the course of using this coping strategy. However, if you're concerned about others finding your writings, you should find a safe and secure way of throwing them away.
    4. It may be important to at first set aside some time every day to write. However, you can also use expressive writing whenever something stressful happens. It can be a good coping strategy to add to your healthy coping repertoire.

    Journaling Prompts

    Here are a few prompts to get you started or to continue when you feel stuck:

    • Write about your traumatic experience. Be as detailed as you can with what happened and how it made you feel, both emotionally and physically.
    • Write about what you learned from the experience, whether it's good or bad.
    • How does the experience affect you now? Give details.
    • What do you wish you could do differently or change? Why?
    • Describe some of the key causes of stress in your life now. Has this changed since your traumatic experience? If so how? Can you pinpoint why?
    • How did your experience impact others? This could be either others that were involved or the people in your life now.
    • Is there anything you wish you had really taken the time to appreciate before the experience or that you'd give anything to have back?
    • Are there ways in which you can use your experience to help others? Brainstorm ideas.

    Looking for the Positive

    Knowing that people with PTSD experience not just stress but post-traumatic growth may bring a small ray of light to a difficult situation. Some people have found that taking the time to write about these positive changes, in essence, writing about gratitude, is helpful as they heal.

    If you're looking for evidence of post-traumatic growth in your life, think of anything you might call a "silver lining" of your experience. Some people speak of the "gifts of PTSD" or the "benefits of PTSD" when speaking of these changes. Certainly, you may need to make a stretch in doing this, especially if you have only recently developed PTSD and the traumatic event that stimulated your distress is fairly recent. In time, and in addition to working through the difficulties in your life related to your diagnosis, you may begin to have moments when you catch yourself writing "what PTSD has taught me." Expressing your thoughts in writing in this way may not only help you work through the awfulness of the trauma, but it can make you more aware of your healing along the way.

    Sources:

    Angel CM. Resilience, Post-Traumatic Stress, and Posttraumatic Growth: Veterans’ and Active Duty Military Members’ Coping Trajectories Following Traumatic Event Exposure. Nurse Education Today. December 2016;47:57-60. doi:10.1016/j.nedt.2016.04.001.

    Krupnick J, Green B, Amdur R, et al. An Internet-Based Writing Intervention for PTSD in Veterans: A Feasibility and Pilot Effectiveness Trial. Psychological Trauma. July 2017;9(4):461-470. doi:10.1037/tra0000176.

    Roberts N, Roberts P, Jones N, Bisson J. Psychological Therapies for Post-Traumatic Stress Disorder and Comorbid Substance Use Disorder. Cochrane Database of Systematic Reviews. April 2016;4:CD010204. doi: 10.1002/14651858.CD010204.pub2.

    Sayer N, Noorbaloochi S, Frazier P, et al. Randomized Controlled Trial of Online Expressive Writing to Address Readjustment Difficulties Among U.S. Afghanistan and Iraq War Veterans. Journal of Trauma and Stress. October 2015;28(5):381-90. doi: 10.1002/jts.22047.

    Sloan D, Sawyer A, Lowmaster S, Wernick J, Marx B. Efficacy of Narrative Writing as an Intervention for PTSD: Does the Evidence Support Its Use?  Journal of Contemporary Psychotherapy. December 2015;45(4):215-225.