Comparing written exposure therapy to Prolonged Exposure for the treatment of PTSD in a veteran sample: A non-inferiority randomized design

Sloan, Denise M.; Marx, Brian P.; Acierno, Ron; Messina, Michael; Cole, Travis A.

doi:10.1016/j.conctc.2021.100764

Cited by 11 publications

(11 citation statements)

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“…However, future research is needed to examine the effects of adding additional sessions to WET and to ensure flexibility while maintaining the brevity and efficiency that is a potential advantage of this protocol. A current RCT of WET in the VA is examining the frequency with which additional sessions are needed when treating veterans with PTSD (Sloan et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of written exposure therapy for posttraumatic stress disorder in the Department of Veterans Affairs Healthcare System.

LoSavio¹,

Worley²,

Aajmain³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and Policy

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Objective: Written Exposure Therapy (WET) for posttraumatic stress disorder (PTSD) has been shown to be efficacious in clinical trials; however, research is needed to determine WET's effectiveness in clinical practice settings. Additionally, research is needed to understand whether patient characteristics or treatment delivery format moderate outcomes. Method: Patient outcomes (n = 277) were assessed as part of a multisite training and implementation program in the Department of Veterans Affairs (VA). During treatment, patients completed self-report measures of PTSD, depression, and functional impairment. Patient characteristics (i.e., demographics, psychiatric comorbidity, trauma type) and treatment delivery format (i.e., telehealth vs. in-person) were assessed as treatment moderators. Results: Intent-totreat analyses indicated that WET was effective in reducing PTSD symptoms (d = .84), depression symptoms (d = .47), and functional impairment (d = .36) during treatment. Approximately one quarter of patients dropped out of treatment prematurely. No moderators of PTSD treatment outcome were observed; however, telehealth delivery was associated with lower dropout. Conclusions: WET was an effective approach across a range of patient characteristics in this sample of veterans with PTSD. WET was also effective whether delivered in-person or via telehealth. WET is a promising treatment option for veteran patients in VA clinical care settings. Clinical Impact StatementVeterans receiving WET from therapists in the VA had significant symptom improvement. There was similar symptom reduction across patient characteristics and regardless of whether care was inperson or via telehealth. These findings provide support for WET's effectiveness and show it can be successfully delivered via telehealth.

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Section: Discussionmentioning

confidence: 99%

Effectiveness of written exposure therapy for posttraumatic stress disorder in the Department of Veterans Affairs Healthcare System.

LoSavio¹,

Worley²,

Aajmain³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and Policy

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“…Additional information regarding the therapists and treatment fidelity ratings is described in eMethods 2 in Supplement 2. Detailed information on the study design is reported elsewhere …”

Section: Methodsmentioning

confidence: 99%

Written Exposure Therapy vs Prolonged Exposure Therapy in the Treatment of Posttraumatic Stress Disorder

Sloan,

Marx,

Acierno

et al. 2023

JAMA Psychiatry

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ImportanceEvidence-based treatments for posttraumatic stress disorder (PTSD) exist, but all require 8 to 15 sessions and thus are less likely to be completed than brief treatments. Written exposure therapy (WET) is a brief and efficacious treatment that has not been directly compared with prolonged exposure therapy (PE), a more time-intensive, exposure-based treatment.ObjectiveTo determine whether WET is noninferior to PE in treating PTSD among veterans.Design, Setting, and ParticipantsA randomized noninferiority clinical trial was conducted between September 9, 2019, and April 30, 2022. Participants were 178 veterans with PTSD presenting to 1 of 3 Veterans Affairs medical centers. Inclusion criteria consisted of a primary diagnosis of PTSD and stable medication. Exclusion criteria included current psychotherapy for PTSD, high suicide risk, active psychosis, unstable bipolar disorder, and severe cognitive impairment. Independent evaluations were conducted at baseline and 10, 20, and 30 weeks after the first treatment session. Data were analyzed from January 1 to March 31, 2023.InterventionsParticipants assigned to WET (n = 88) received five to seven 45- to 60-minute sessions. Participants assigned to PE (n = 90) received eight to fifteen 90-minute sessions. The WET sessions included 30 minutes of writing-based imaginal exposure conducted in session, whereas PE sessions included 40 minutes of in-session imaginal exposure and between-session in vivo exposures.Main Outcomes and MeasuresThe primary outcome was change in PTSD symptom severity measured with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) from baseline to the 20-week assessment; noninferiority was defined as a less than 10-point difference between the 2 treatment groups. Difference in treatment dropout was also examined.ResultsOf the 178 participants, 134 (75.3%) were men, and the mean (SD) age was 44.97 (13.66) years. In terms of race, 37 participants (20.8%) were Black, 112 (62.9%) were White, 11 (6.2%) were more than 1 race, and 18 (10.1%) were of other race (including American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific Islander [some participants did not specify their race when selecting the category “other”]); in terms of ethnicity, 19 participants (10.7%) were Hispanic. Changes in PTSD symptom severity from baseline to all subsequent assessments among individuals randomized to WET were noninferior relative to individuals randomized to PE. The largest difference between treatments was observed at 10 weeks and was in favor of WET (mean difference, 2.42 [95% CI, 0.35-1.46] points). Participants were significantly less likely to drop out of WET compared with PE (11 [12.5%] vs 32 [35.6%]; χ2 = 12.91; Cramer V = 0.27).Conclusions and RelevanceIn this study, WET was noninferior to PE in PTSD symptom change and was associated with significantly less attrition. Findings suggest that WET may transcend previously observed barriers to PTSD treatment for both patients and clinicians.Trial RegistrationClinicalTrials.gov Identifier: NCT03962504

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“…Because the purpose of the written exposures is to address the trauma memory, writing quality (i.e., grammar, sentence structure, spelling) is unimportant. WET is noninferior to Cognitive Processing Therapy and work is underway on a noninferiority comparison with PE 18,19 . Because of its simplicity and brevity, WET may be more readily implemented in SUD residential care than other exposure‐based approaches for PTSD.…”

Section: Introductionmentioning

confidence: 99%

“…WET is noninferior to Cognitive Processing Therapy and work is underway on a noninferiority comparison with PE. 18,19 Because of its simplicity and brevity, WET may be more readily implemented in SUD residential care than other exposure-based approaches for PTSD. However, to date the only test of WET among people with comorbid SUD is the case study series of group WET, in which only one of the three participants completed treatment.…”

Section: Introductionmentioning

confidence: 99%

A pilot test of Written Exposure Therapy for PTSD in residential substance use treatment

Schacht,

Wenzel,

Meyer

et al. 2023

American J Addict

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Background and ObjectivesPosttraumatic stress disorder (PTSD) is highly comorbid with substance use disorders (SUD) and can impede SUD recovery. Residential SUD treatment is a crucial opportunity to address PTSD. However, PTSD treatment is lacking in residential SUD care.MethodsWe conducted a nonrandomized feasibility study of Written Exposure Therapy (WET), a brief, evidence‐based treatment for PTSD, with patients in residential SUD treatment. We assessed attitudes towards treatment (Credibility and Expectancy Questionnaire, Barriers to Treatment Participation Scale) and mental health indicators (PTSD Checklist for DSM‐5, Trauma Coping Self‐Efficacy, Difficulties in Emotion Regulation‐Short Form, and Brief Assessment of Recovery Capital).ResultsThirty of 49 eligible participants completed WET (61%) and 92% (n = 45) attended at least one WET session. Paired sample t‐tests revealed significant posttreatment improvement across all mental health indicators, with medium to large effect sizes.Discussion and ConclusionsAttendance and completion rates compared favorably to prior exposure‐based treatment for PTSD in SUD settings. Although causality cannot be inferred without a randomized controlled trial, mental health indicators, including PTSD, improved significantly following WET.Scientific SignificanceThese findings provide evidence that PTSD can be successfully treated in short‐term residential care using brief exposure‐based interventions, which is a crucial clinical need that has been minimally studied in the past.

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Comparing written exposure therapy to Prolonged Exposure for the treatment of PTSD in a veteran sample: A non-inferiority randomized design

Cited by 11 publications

References 54 publications

Effectiveness of written exposure therapy for posttraumatic stress disorder in the Department of Veterans Affairs Healthcare System.

Effectiveness of written exposure therapy for posttraumatic stress disorder in the Department of Veterans Affairs Healthcare System.

Written Exposure Therapy vs Prolonged Exposure Therapy in the Treatment of Posttraumatic Stress Disorder

A pilot test of Written Exposure Therapy for PTSD in residential substance use treatment

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