AIM: Coronary heart disease (CHD) is typically associated with impaired quality of life, depression, anxiety and psychological stress. Expressive writing (EW) has shown beneficial effects on such variables in patients with a variety of chronic illnesses. We sought to determine for the first time whether EW benefits also patients with CHD. METHODS: A prospective, randomized, controlled trial was carried out in order to evaluate the psychological and physical effects of administering EW to patients with CHD (N=64) participating in a residential cardiac rehabilitation (CR) program. Patients were randomly assigned to write thoughts and emotions (EW group) or facts (control group) about heart disease and treatment. Depression, anxiety, health-related quality of life, post-traumatic growth and weight were recorded at baseline, at the end of the 4-week CR program, at 3 months and at 6 months after discharge. RESULTS: Physical health significantly improved in both groups at 3 months and no between-group effect was evident in longitudinal multilevel regression modeling. Post-traumatic growth showed a significant improvement only within EW group. CONCLUSION: EW showed additional psychological and physical benefits in patients with CHD when included as a component of residential cardiac rehabilitation.