Two Weeks of Journaling Reduced Anxiety and Depression Symptoms After Major Surgery: What the Study Showed

A simple writing exercise can be a useful part of recovery after a stay in intensive care. In a randomized study, liver transplant patients who kept a special diary with nurses and loved ones for two weeks reported less anxiety, stress, and depression symptoms.

The effect became noticeable after just seven days and increased by the end of the second week.

However, an important caveat: this is not proof that an ordinary personal diary can treat clinical depression. The researchers studied a specific group of patients and a specific technique — the intensive care unit diary, or ICU diary.

What the Researchers Tested

The study was conducted in the intensive care unit of a medical center in northern Taiwan from April 2024 to October 2025.

Participants were adult patients who had undergone liver transplantation. This treatment does not end with the operation itself: afterward, the person spends some time in intensive care, where they face physical pain, complex treatment, and significant emotional stress all at once.

The study initially randomized 56 people. 52 patients completed it fully.

Some received standard postoperative care. Others additionally participated in a diary program for 14 days after the surgery.

Psychological state was assessed before the intervention, on the seventh and fourteenth day using the DASS-21 scale, which measures the severity of depression, anxiety, and stress symptoms.

What an Intensive Care Diary Is

An ICU diary differs from the usual advice to "write down your feelings."

It is a structured diary of the stay in the intensive care unit. It can record treatment events, changes in the patient’s condition, experiences, and important recovery milestones.

Not only the patients themselves but also healthcare workers and relatives can participate in its creation.

The person can then read the notes and gradually reconstruct the sequence of events that happened to them during a serious illness and treatment.

This is especially important for intensive care patients. After major surgery, sedation, painkillers, and sleep disruption, memories can be fragmentary. Some people remember individual frightening episodes but have a poor understanding of what happened in between.

The diary helps turn a set of such fragments into a more coherent story: what happened, why a certain procedure was performed, and how the condition gradually changed.

What Changed Over Two Weeks

Compared to the control group, patients who participated in the diary program had emotional distress decline faster.

The difference between the groups was statistically significant already on the seventh day, and by the fourteenth day it became even more pronounced.

The researchers found improvements not only in the overall emotional distress scale, but also separately in its three components:

• depression symptoms;
• anxiety;
• stress.

The authors believe that such a practice can be used as a simple non-pharmacological element of psychological support during postoperative recovery.

Why the Psyche Is Especially Vulnerable After Transplantation

Liver transplantation is one of the most serious surgical interventions. In addition to physical recovery, the patient has to cope with a whole complex of fears.

These include pain, changes in the body, possible complications, fear of rejection of the donor organ, uncertainty about future health, and the need to strictly adhere to medication regimens.

The authors of the study note that in the first year after liver transplantation, previous works found symptoms of depression in about 25% of patients, and anxiety in about 29%.

Psychological state in this case has not only emotional significance. Distress can hinder adherence to treatment regimens and reduce quality of life after surgery.

Why Writing May Help at All

Scientists consider several possible mechanisms.

The first is emotional expression. It is easier for a person to structure their experiences when they put them into words.

The second is reconstructing the sequence of events. After intensive care, the patient gets a more complete understanding of what happened to them during treatment.

The third is communication. The diary becomes an additional channel of communication between the patient, relatives, and healthcare workers.

Finally, the notes allow progress to be seen. The condition after major surgery can change slowly, and the patient does not always notice improvements over just a few days. In the diary, this path becomes more obvious.

ICU Diary Studies Are Not New

The Taiwanese work adds to existing research on diaries in intensive care units.

A meta-analysis of 11 randomized studies, including a total of 1682 patients, previously showed that the use of ICU diaries was associated with lower rates of depressive and post-traumatic symptoms in intensive care patients.

However, results from different studies are not consistent.

In a larger review of 15 systematic reviews and meta-analyses, researchers concluded that ICU diaries potentially improve psychological outcomes and quality of life, but the quality of much of the existing evidence remains low or very low.

That is, the idea looks promising, but the scientific picture is not yet final.

Why This New Study Also Cannot Be Applied to Everyone

The work has several important limitations.

First, the study was small — only 52 people completed it.

Second, it was conducted in one medical center and only among patients after liver transplantation.

Third, observation lasted only two weeks. The study shows short-term changes in psychological symptoms but does not answer whether they persist months later.

Additionally, the condition was assessed using the DASS-21 questionnaire. It measures symptom severity but does not itself establish a diagnosis of major depressive disorder.

Therefore, the results cannot be interpreted as proof that two weeks of ordinary journaling treats depression.

Should You Just Start Writing Down Your Feelings?

For a healthy person, a personal diary can be a convenient way to make sense of events and one’s own emotions. But the new study tested a completely different scenario — a nurse-organized practice in intensive care conditions after major surgery.

It was used in addition to standard medical care, not instead of it.

Thus, a person with prolonged low mood, loss of interest in usual activities, significant anxiety, or other serious psychological symptoms should not view journaling as a substitute for professional help.

But for hospitals, the study’s conclusion is interesting precisely because of its simplicity. An ICU diary does not require complex equipment or medications and can be integrated into the routine work of a department, engaging the patient, nurses, and family at the same time.

Sometimes an important part of recovery after intensive care is not only what doctors did to the patient’s body, but also the ability for the person to understand and coherently tell what they went through.