Brezsny is the first well-known horoscope columnist to use first-person narrative in his column. His writing employs a more personal, optimistic and literary approach than conventional horoscopes. Utne Reader described Brezsny's column Real Astrology as breathing "new life into the tabloid mummy of zodiac advice columns". British horoscope writer Jonathan Cainer told interviewer Eric Francis that Brezsny inspired him to begin his own column in the mid 1980s, saying that Brezsny was the first person who showed him that a horoscope could be done intelligently.

Brezsny is author of the books Images Are Dangerous, The Televisionary Oracle, and Pronoia Is the Antidote for Paranoia: How All of Creation Is Conspiring To Shower You with Blessings. Robert Anton Wilson described The Televisionary Oracle as "A book so weird it just might drive you stark raving sane." Tom Robbins stated "I've seen the future of American literature, and its name is Rob Brezsny." His most recent work derives its name from the concept of pronoia, a term John Perry Barlow defined as "the suspicion the Universe is a conspiracy on your behalf."

Brezsny was a singer/songwriter for the early 1990s band World Entertainment War and the late 70's / early 80's bands Tao Chemical, Mystery Spot, and Youth In Asia. World Entertainment War was nominated for a Bammie in 1991 and the Brezsny penned song "Dark Ages" appears on Deep Space / Virgin Sky by Jefferson Starship.

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