Thursday, August 24, 2023

Written Exposure Therapy May Be Viable Treatment for PTSD

Veterans with posttraumatic stress disorder (PTSD) who participated in written exposure therapy experienced similar improvements as those in a more intensive, prolonged exposure therapy, according to a study published this week in JAMA Psychiatry. Veterans in the written exposure therapy group were also less likely to drop out of the therapy.

While there are several evidence-based psychotherapies for PTSD, such as prolonged exposure therapy, these therapies can be time intensive and many patients drop out before completing them, wrote Denise Sloan, Ph.D., of the Veterans Affairs Boston Healthcare System and colleagues. “Written exposure therapy is emerging as an alternative, efficacious brief intervention for PTSD that requires less time and fewer resources,” the authors continued.

Sloan and colleagues recruited veterans who were seeking treatment for PTSD from three Veterans Affairs medical centers across the country. Participants were randomized to receive either weekly sessions of written exposure therapy or prolonged exposure therapy. The severity of their PTSD symptoms was assessed using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), with 0 indicating no PTSD symptoms and 80 indicating severe symptoms. Assessments occurred before treatment and at 10, 20, and 30 weeks after the first treatment session. All therapists had doctorate degrees in clinical psychology.

Written exposure therapy treatment included five sessions in which individuals were instructed to write for 30 minutes about a specific traumatic experience. In the first three sessions, they focused on the details of the event and their feelings during it, while in the last two sessions they focused on how the event had affected their lives. At the end of each session, the therapist and patient briefly discussed the writing experience. During the first 60-minute session, the participants received information about PTSD symptoms and the rationale for treatment. Subsequent sessions were 45 minutes. Therapists were permitted to add up to two sessions to ensure participants received adequate exposure to the trauma memory before advancing to focusing on the event’s effect on their lives.

Prolonged exposure therapy consisted of eight to 15 90-minute sessions. Participants were asked to describe the details of the traumatic event, focusing on their most distressing traumatic memories. Between sessions, they were instructed to confront people, places, and situations that they had been avoiding and were related to their traumatic experiences.

A total of 178 veterans (about 75% men) were included in the study, and the mean CAPS-5 score was about 35 for both groups at baseline. By the 30-week assessment, CAPS-5 scores fell to about 26 for all participants, regardless of their treatment group. Those assigned to prolonged exposure therapy were significantly more likely to drop out prematurely (35.6%) compared with participants assigned to written exposure therapy (12.5%). In both groups, 60% of participants continued to meet PTSD diagnostic criteria at the final assessment.

“[Written exposure therapy] is poised to slide into place among those extensively studied and highly regarded treatments for PTSD,” wrote Charles Taylor, Ph.D., and Murray Stein, M.D., M.P.H., of the University of California, San Diego, in an accompanying commentary. “Yet, work can be done to determine who is best suited to [written exposure therapy] and to identify an optimal dose (or dose range). But even at this juncture a case could be made for starting the least burdensome treatment ([written exposure therapy]) and progressing to more intensive treatments.”

For related information, see the Psychiatric News article “Virtual Exposure Therapy Found Effective for PTSD.”

(Image: iStock/fizkes)

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