Long-term treatment gains of a brief exposure-based treatment for PTSD

Thompson‐Hollands, Johanna; Marx, Brian P.; Lee, Dong Hoon; Resick, Patricia A.; Sloan, Denise M.

doi:10.1002/da.22825

Cited by 41 publications

(30 citation statements)

References 24 publications

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“…Although WET has already been included in the VA/DoD Clinical Practice Guidelines for the Management of PTSD (2017), there is limited data on its efficacy among veterans. To date, one open trial [ 11 ] demonstrated promising efficacy and low treatment dropout (i.e., 14%) and a subsample of 17 veterans included in a randomized controlled trial (RCT) of WET versus CPT found that veterans randomized to WET displayed a significant reduction in PTSD symptoms and only 5% dropped out [ 12 ]. However, these promising findings were preliminary and included a small sample.…”

Section: Introductionmentioning

confidence: 99%

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

Sloan

Marx

Acierno

et al. 2021

Contemporary Clinical Trials Communications

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Posttraumatic stress disorder (PTSD) is highly prevalent among veterans. Although there are effective treatment approaches for PTSD, such as Prolonged Exposure (PE) and Cognitive Processing Therapy, many providers trained in these approaches do not use them, or use them without sufficient fidelity, and veterans drop out of these treatments at very high rates. The time intensive nature of these treatments is frequently cited as a barrier to receiving the treatment among veterans and delivering the treatment among providers. According, there is an urgent need to establish more efficient and effective PTSD treatment approaches in order to meet the needs of veterans seeking care. Written exposure therapy (WET) is an efficient, exposure-based treatment, and may represent a plausible alternative treatment option to address PTSD in veterans. Although WET has been found to be effective and non-inferior to more time intensive trauma-focused treatment, it has not yet been investigated with a veteran sample. In an ongoing randomized controlled trial (RCT) we are investigating whether WET is non-inferior in treating PTSD compared with the more time intensive PE. The study sample will include 150 men and women veterans diagnosed with PTSD who are randomly assigned to either WET ( n = 75) or PE ( n = 75). Participants are assessed prior to treatment and 10-, 20-, and 30-weeks after the first treatment session. The primary outcome is PTSD symptom severity assessed with the Clinician Administered PTSD Scale for DSM-5. Establishing that PTSD can be treated effectively with fewer treatment sessions would represent a significant advance in improving access to evidence-based care for veterans with PTSD.

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Section: Introductionmentioning

confidence: 99%

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

Sloan

Marx

Acierno

et al. 2021

Contemporary Clinical Trials Communications

Self Cite

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show abstract

“…Figure 1 details the study selection process and reasons for study exclusion. Thirteen RCTs and one follow‐up study (Thompson‐Hollands et al., 2018), which provided outcomes related to another included study (Sloan et al., 2018), were included. The characteristics of the included and excluded studies (full‐text screen only) are presented in Supplementary Materials S2.…”

Section: Resultsmentioning

confidence: 99%

Exposure‐Based Writing Therapies for Subthreshold and Clinical Posttraumatic Stress Disorder: A Systematic Review and Meta‐Analysis

Dawson

Calear

McCallum

et al. 2020

Journal of Traumatic Stress

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We undertook a systematic review to assess the efficacy of exposure‐based writing therapies (WTs) for trauma‐exposed adults with subthreshold or clinical levels of posttraumatic stress disorder. Four databases (PsycINFO, Medline, Wiley Online, PILOTS) were searched for randomized controlled trials (RCTs) of exposure‐based WTs. A total of 13 RCTs that reported on results from 17 WT versus control comparisons were included. The primary outcomes were posttraumatic stress symptom severity at posttreatment and/or clinical response. An overall unclear or high risk of bias was identified in 84.6% of studies. In comparison to both waitlist k = 3, Hedges’ g = −0.97, 95% CI [‐1.20, ‐0.73], and placebo writing conditions, k = 9, Hedges’ g = −0.48, 95% CI [‐0.87, ‐0.08], WTs were more beneficial to participants. There was no evidence of a difference between WTs that were longer in duration compared to other psychotherapy, k = 2; pooled OR = 1.42; 95% CI [0.83, 2.43]. These findings indicate that exposure‐based WTs are effective when compared to waitlist and placebo writing control conditions. The evidence needs to be considered in the context of the modest number of studies conducted to date, the high methodological heterogeneity between the studies, and the high or unclear risk of bias across many studies. Further research is needed to increase the evidence base regarding the efficacy of WTs for posttraumatic stress. Future research should also measure the mediators and predictors of outcomes to further develop protocols and understand which variants of WTs work for different populations or individuals.

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“…Numerous studies have demonstrated reductions in PTSD and related psychopathologies with exposure therapy. 15,16,20,33 However, global functioning is another measure of symptom reduction. Improvements in PTSD with exposure therapy were associated with improvements in psychosocial functioning.…”

Section: Discussionmentioning

confidence: 99%

“…15 The effects of treatment were also long-term, specifically lasting for 60 weeks. 16,17 In order to apply WET to Korean patients, we must consider their different cultural background, which is dissimilar to Westerners. According to a study conducted in Japan, which is culturally similar to Korea, only 15% of respondents choose to disclose their trauma.…”

Section: Introductionmentioning

confidence: 99%

An Open Pilot Trial of Written Exposure Therapy for Patients With Post-Traumatic Stress Disorder in Korea

Park¹,

Choi²,

Han

et al. 2021

Psychiatry Investig

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cused cognitive behavioral therapy, cognitive processing therapy (CPT), and prolonged exposure therapy (PE). These are strongly recommended first-line therapies in major PTSD treatment guidelines. 9 Recently, Sloan and Marx' s 10 research team introduced a fivesession exposure-based PTSD treatment protocol called written exposure therapy (WET). WET is recommended for the treatment of PTSD in clinical practice guidelines (Department of Veterans Affairs/Department of Defense, 2017). Like other EBTs, it comprises critical components considered to be responsible for the successful treatment of PTSD symptoms, such as therapeutic exposure and cognitive processing/cognitive restructuring. [10][11][12] However, WET requires a smaller number of sessions, shorter session durations, and no between-session assignments. 10,13 The efficacy of WET was evaluated using a randomized controlled trial, and this study reported a significant reduction in PTSD symptom severity at the post-treatment follow-up, and symptom reduction was maintained three and six months later with 7% of drop-out rate. 14 A study that directly compared WET

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Long-term treatment gains of a brief exposure-based treatment for PTSD

Abstract: WET is a treatment that is non-inferior to CPT with regard to PTSD symptoms, with treatment effects that are long-lasting. Additionally, both WET and CPT demonstrated substantial effects on depressive symptoms. WET should be considered a good option for PTSD treatment.

Cited by 41 publications

References 24 publications

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

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

Exposure‐Based Writing Therapies for Subthreshold and Clinical Posttraumatic Stress Disorder: A Systematic Review and Meta‐Analysis

An Open Pilot Trial of Written Exposure Therapy for Patients With Post-Traumatic Stress Disorder in Korea

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