Over the past two decades there has been increasing interest in, and research undertaken on, the potential benefits of expressive writing interventions for health and wellbeing. Expressive writing interventions are low-intensity psychological interventions which can largely be self-administered by individuals taking part.
Positive expressive writing was an adaptation to research on written emotional disclosure, which found that writing emotionally, not just factually, about a personally difficult experience was associated with positive health and psychological effects (Frattaroli, 2006). The common factor in positive expressive writing interventions is that instead of inviting participants to write about how they might reduce negative feelings, or to reflect on problems, the focus is on cultivating positive feelings or thoughts, in common with other positive psychology interventions (PPIs). The intention behind these ‘positive’ expressive writing interventions is not to altogether replace written emotional disclosure as an approach in therapeutic writing, but to minimise the possibility of participants feeling short-term negative emotions [which can come after negative disclosure] and the associated risk of feeling burdened, but without support.
A systematic review on the relationship, if any, between writing interventions regarded as “positive expressive writing interventions” and subjective health and wellbeing, has been published by researchers at Northumbria University (Hoult et al, 2025). There are various writing techniques understood as potentially therapeutic in nature, including writing that encourages emotional disclosure, which involves writing about a stressful or traumatic experience. This study focuses instead on techniques that align with positive psychology interventions (PPIs) that centre writing to promote “positive emotions, strengths and virtues”, so for example writing about things for which individuals are grateful, or writing that supports individuals to identify and name positives even where stressful experiences have occurred.
The systematic review centred on two questions:
- ‘What are the optimal conditions under which positive expressive writing benefits self-reported physical and psychological health and wellbeing?’
- ‘Which positive expressive writing techniques work best, on what health and wellbeing outcomes, and for whom?’
Writing emotionally, not just factually, about difficult experiences is associated with positive health and wellbeing effects. But which techniques work best, on what health and wellbeing outcomes and for whom?
Methods
This systematic review, published in May 2025, was conducted by accessing four databases (Web of Science, Scopus, PubMed, and ProQuest: APA PsychArticles). The population of interest was non-clinical adults and the outcomes of interest were subjective wellbeing (e.g., life satisfaction, positive affect, negative affect; Diener, 1984), psychological wellbeing (e.g., personal growth, purpose in life; Ryff, 1989), self-reported psychological health (e.g., anxiety, depression, stress) and physical health. The review did not explore ‘objective’ health and wellbeing outcomes and behaviours. Comparator groups included participants being instructed only to write neutrally about routine or non-emotive topics, such as time management and other aspects of daily life.
Peer-reviewed articles published in the English language between 1930 and August 2023 were included in the review. Each article was quality assessed using the National Institutes of Health (NIH) Quality Assessment of Controlled Intervention Studies which comprises fourteen criteria, including adequacy of randomisation, and analysis of all randomised participants (i.e., intention-to-treat). Studies with fatal flaws (e.g., a high overall and/or differential dropout rates ) were considered significant risk for bias and were rated as poor.
Results
51 studies were included in the final review and 31 of these were rated as poor in quality.
Seven positive expressive writing techniques were identified including expressive writing on best possible self, positive experiences, gratitude, benefit finding, satisfaction processes, writing about three good things and keeping a resource diary. The majority of studies were conducted using the conventional mode first introduced for written emotional disclosure interventions; three to four bursts of writing, each lasting 15-20 minutes and taking place on consecutive days.
The three most commonly researched interventions were the interventions of looking at one’s ‘best possible self’, writing about ‘positive experiences’ and gratitude exercises.
Eighteen studies explored the ‘best possible self’ writing technique. Despite variations in how they applied the exercise (e.g. altering the domains of self that were looked at in the writing), they typically resulted in improved psychological and wellbeing outcomes, including enhanced optimism, happiness and self-efficacy, as well as reductions in ruminative thinking, psychological distress and self-criticism. The researchers state that the findings on positive affect, negative affect, depression and life satisfaction were “mixed, though most studies found significant benefits across the measures.” Interestingly, where physical health outcomes were considered (in one study only), there were reductions in health centre visits at a five month follow-up (King, 2001).
Sixteen studies explored ‘writing about positive experiences’. These interventions required participants to write about intensely positive experiences on consecutive days or in clustered bursts of activity. Of interest is that these studies assessed more physical health outcomes relative to the other writing interventions, but the results here were mixed. Self-reported physical symptoms were found to decrease in two studies, but did not improve in another three. However, all sixteen studies exploring this kind of intervention, found that positive experience writing led to improvements in optimism, stress appraisal, and positive affect.
Eleven studies assessed gratitude as an expressive writing intervention, where participants were instructed to write about aspects of life for which they were grateful, or a letter expressing gratitude to a person or persons of choice. As with the ‘best possible self’ techniques, benefits of gratitude interventions were observed for subjective wellbeing outcomes such as happiness and life satisfaction. It’s also clear with ‘gratitude’ exercises that the results are mixed and possibly muted for outcomes of self-reported psychological health, such as depression and anxiety.
There was one other expressive writing technique with sufficient studies under review to merit examination; benefit finding techniques. ‘Benefit finding’ encourages participants to write about the benefits or positives following a stressful or upsetting experience. From the five studies included in the review, little concrete information could be added.
Writing about the ‘best possible self’ and gratitude-related writing exercises showed the strongest improvements in wellbeing outcomes such as happiness.
Conclusions
The ‘best possible self’ and ‘gratitude’ interventions seem, on the basis of quality studies available to review, to contain the most promise.
This is largely caveated by the highly heterogeneous quality of the overall number of reviews and analyses conducted hitherto, underscoring the need for more rigour and consistency of approach in future such studies on positive expressive writing interventions. It is hard to be precise and distinguish whether, for ‘best possible self’ and ‘gratitude’, what we are seeing is a genuinely more effective approach in how they tackle this idea of positive expressive writing, or whether in this systematic review, we are simply seeing a larger number of psychological wellbeing outcomes assessed compared with other interventions, (e.g. benefit finding) which were examined with a bigger, and trickier, spotlight on whether they led instead to changes in health.
Positive expressive writing interventions tended to have a greater effect on wellbeing outcomes than health outcomes in this review.
Strengths and limitations
As a tutor of expressive writing, working with adults with brain tumours, adults with chronic kidney disease (CKD), as well as populations that might be deemed as ‘non-clinical’, (e.g. caregivers), the biggest limitation of the review is the absence of analysis or discussion as to why non-clinical populations might uniquely benefit from positive writing interventions.
There are many valid reasons why studies would only consider the value of positive expressive writing, and outcomes achieved, in non-clinical populations. For example, there is a growing body of evidence that suggests student populations, the focus of many of the studies in this systematic review, might indeed benefit from positive writing interventions, but this isn’t placed into a truly analytical context.
Neither does the review share any view, or contain any discussion on the long-run effects of the Covid 19 pandemic, and why populations not considered to be clinical, so for example health and care professionals, might still benefit from positive expressive writing interventions, even if, for the purposes of this review, they are ‘non-clinical’.
In reality it is hard to separate out clinical and non-clinical populations, and many students and caregivers, or care professionals, will have undiagnosed health and care needs, including anxiety and depression. Whilst it’s important we investigate and examine the value of writing interventions across different populations, and how interventions play out in different ways across these populations, the research doesn’t sufficiently allow for the possibility that these populations are becoming ever more blended. It wasn’t entirely clear, for example, how nonclinical populations were screened for and recruited in the different studies, and given the extent to which adults aged 18 and over either don’t have a diagnosis for a health problem, aren’t therefore undergoing treatment, or don’t yet recognise or know they have a problem, it wasn’t entirely obvious why the studies selected were confined in the way they were: to so-called nonclinical populations. This serves to obscure and underplay why certain sectors and institutions would do well to prioritise positive writing interventions – for example hospitals and care teams who might roll out or pilot the intervention with their under pressure and often fatigued workforce.
Can we really separate out clinical and non-clinical populations?
Implications for practice
This review highlights that individual differences relating to emotional, social and wellbeing factors (e.g. emotional processing and coping), may “moderate intervention effectiveness”. This is possibly underplayed, and clearly warrants more analysis. The researchers highlight fifteen moderating effects on intervention effectiveness in total, but not one study within the systematic review looked at more than a single moderator.
With regards to how interventions should be delivered, not just what the interventions are, there was again significant ‘heterogeneity’ in intervention delivery which the researchers conclude, “makes it challenging to draw inferences regarding…control group, the writing duration and spacing of sessions, and length of follow-up.” This is a valuable review, and timely too as access to creative health continues to be discussed as a social determinant in preventing or managing ill health (Fancourt, 2019). Rightly, though, the researchers conclude much more research is needed in future. Future studies of positive expressive writing interventions will need to have added rigour in determining and defining which health outcomes and variables they’re targeting.
This review is timely given the mounting evidence that creative interventions can prevent or manage ill health.
Statement of interests
Andrew Kaye Kauffman has no interests to declare.
Edited by
Laura Hemming.
Links
Primary paper
Hoult LM, Wetherell MA, Edginton T, Smith MA (2025) Positive expressive writing interventions, subjective health and wellbeing in non-clinical populations: A systematic review. PLoS One 20(5): e0308928.
Other references
Diener, E. (1984) Subjective well-being. Psychology Bulletin 95(3), 542–75.
Fancourt, D. & Finn, S. (2019). What is the evidence on the role of the arts in improving health and well-being? A scoping review. World Health Organization. Regional Office for Europe.
King, L.A. (2001). The Health Benefits of Writing about Life Goals. Personality and Social Psychology Bulletin 27(7), 798-807.
Ryff, C.D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069–1081.
