A systematic review of written exposure therapy for the treatment of posttraumatic stress symptoms.

Abstract

Objective: Written exposure therapy (WET) is a brief treatment for posttraumatic stress disorder (PTSD), with an increasing number of studies published over the past several years. The current study conducted a systematic review to evaluate the current state of evidence for WET as a treatment for PTSD symptom severity. Method: Four databases were searched: PsycInfo, PTSDpubs, MEDLINE, and PubMed. Inclusion criteria included a peer-reviewed study of WET, a PTSD treatment outcome measure at preand posttreatment, and full-text available in English. Results: Seventeen studies were identified for inclusion, seven of which were randomized controlled trials. Study sample sizes ranged from three to 277, with most studies (88%) examining adults. Five studies used a language translation version of WET, two studies examined a group format, and three studies examined PTSD symptom outcome when WET was delivered via telehealth. Within condition effect sizes for PTSD treatment outcome were moderate to large (d range = 0.48-6.45), and between condition effect sizes were large (d range = 1.05-5.25), except for three studies that included a trauma-focused treatment comparison condition (d range = 0.01-0.31). Dropout rates for WET were generally low, and less when compared with other trauma-focused treatments. Conclusions: The published studies indicate that WET is an efficacious and effective treatment for PTSD symptoms across a variety of samples, settings, and counties. Future work in this area should include investigation of the implementation and dissemination of WET. Clinical Impact StatementThe published literature examining written exposure therapy (WET) for posttraumatic stress symptoms was reviewed. The research to date indicates that WET is both efficacious and effective for reducing posttraumatic stress symptoms across a variety of samples, settings, and countries. WET also compares favorably with more time intensive trauma-focused treatments, while having lower treatment dropout rates. WET is a promising treatment approach but additional randomized controlled trial studies and implementation studies are needed.