Skip to main content

Advertisement

SpringerLink
Log in

Brief Novel Therapies for PTSD: Written Exposure Therapy

  • PTSD (S Creech and L Sippel, Section Editors)
  • Published:
Current Treatment Options in Psychiatry Aims and scope Submit manuscript

Abstract

Purpose of Review

Written exposure therapy (WET) is a five-session exposure-based intervention for the treatment of post-traumatic stress disorder (PTSD). WET was developed through a series of systematic evaluations of the expressive writing procedure. It is an efficient intervention, requiring limited patient and therapist time, and no between-session assignments. The treatment results in statistically and clinically significant symptom change among individuals, including veterans, with PTSD.

Recent Findings

WET has been shown to be non-inferior to cognitive processing therapy (CPT), a more intensive form of PTSD treatment. Additionally, WET resulted in substantially lower rates of treatment dropout compared with CPT (6% versus 39%). Moderator analyses of the rate of symptom change during treatment indicated that WET performed equally well for participants regardless of age, gender, comorbid depression, or estimated full scale IQ.

Summary

WET represents a viable option for the efficacious, brief treatment of PTSD and may have significant strengths compared with other manualized psychotherapeutic approaches.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. • Sloan DM, Marx BP. Written exposure therapy for PTSD: a brief treatment approach for mental health professionals. Washington, DC: American Psychological Press; 2019. Therapy handbook for WET.

    Book  Google Scholar 

  2. Pennebaker JW, Beall SK. Confronting a traumatic event: toward an understanding of inhibition and disease. J Abnorm Psychol. 1986;95:274–81. https://doi.org/10.1037/0021-843X.95.3.274.

    Article  CAS  PubMed  Google Scholar 

  3. Sloan DM, Marx BP. A closer examination of the structured written disclosure procedure. J Consult Clin Psychol. 2004;72:165–75. https://doi.org/10.1037/0022-006X.72.2.165.

    Article  PubMed  Google Scholar 

  4. Sloan DM, Marx BP, Epstein EM, Lexington J. Does altering the writing instructions influence outcome associated with written disclosure? Behav Ther. 2007;38:155–68. https://doi.org/10.1016/j.beth.2006.06.005.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Sloan DM, Marx BP, Epstein EM. Further examination of the exposure model underlying written emotional disclosure. J Consult Clin Psych. 2005;73:549–54. https://doi.org/10.1037/0022-006X.73.3.549.

    Article  Google Scholar 

  6. Sloan DM, Marx BP, Greenberg EM. A test of written emotional disclosure as an intervention for posttraumatic stress disorder. Behav Res Ther. 2011;49:299–304. https://doi.org/10.1016/j.brat.2011.02.001.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sloan DM, Marx BP. Commentary on the implementation of written exposure therapy (WET) for veterans diagnosed with PTSD. Pragmat Case Studies in Psychotherapy. 2017;13:154–64.

    Article  Google Scholar 

  8. Weathers F, Keane TM, Davidson J. Clinician-administered PTSD scale: a review of the first ten years of research. Depress Anxiety. 2001;13:132–56. https://doi.org/10.1002/da.1029.

    Article  CAS  PubMed  Google Scholar 

  9. Sloan DM, Marx BP, Bovin MJ, Feinstein BA, Gallagher MW. Written exposure as an intervention for PTSD: a randomized clinical trial with motor vehicle accident survivors. Behav Res Ther. 2012;50:627–35. https://doi.org/10.1016/j.brat.2012.07.001.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Imel ZE, Laska K, Jakupcak M, Simpson TL. Meta-analysis of dropout in treatments for posttraumatic stress disorder. J Consult Clin Psychol. 2013;81:394–404. https://doi.org/10.1037/a0031474.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Foa EB, Hembree E, Rothbaum BO. Prolonged exposure therapy for PTSD: emotional processing of traumatic experiences therapist guide. New York: Oxford University Press; 2007.

    Book  Google Scholar 

  12. Resick PA, Monson CM, Chard KM. Cognitive processing therapy for PTSD: a comprehensive manual. New York: Guilford Press; 2016.

    Google Scholar 

  13. Steenkamp MM, Litz BT, Hoge CW, Marmar CR. Psychotherapy for military-related PTSD: a review of randomized clinical trials. JAMA. 2015;314:489–500. https://doi.org/10.1001/jama.2015.8370.

    Article  CAS  PubMed  Google Scholar 

  14. Sloan DM, Lee D, Litwack S, Sawyer AT, Marx BP. Written exposure therapy for veterans diagnosed with PTSD: a pilot study. J Trauma Stress. 2013;26:776–9. https://doi.org/10.1002/jts.21858.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Department of Veteran Affairs and Department of Defense. Clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder. https://www.healthquality.va.gov/guidelines/mh/ptsd/; 2017.

  16. Sloan DM, Marx BP, Resick PA. Brief treatment for PTSD: a non-inferiority trial. Contemp Clin Trials. 2016;47:66–74. https://doi.org/10.1016/j.cct.2016.04.003.

    Article  Google Scholar 

  17. Weathers FW, Blake DD, Schnurr PP, Kaloupek DG, Marx BP, Keane TM. The Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Instrument available from the National Center for PTSD at www.ptsd.va.gov; 2013

  18. Sloan DM, Marx BP, Lee DJ, Resick PA. A brief exposure-based treatment vs cognitive processing therapy for posttraumatic stress disorder: a randomized noninferiority clinical trial. JAMA Psychiatry. 2018. https://doi.org/10.1001/jamapsychiatry.2017.4249. A non-inferiority RCT comparing WET to cognitive processing therapy (CPT). Results indicated that WET was non-inferior to CPT in PTSD outcomes.

  19. • Thompson-Hollands J, Marx BP, Lee DJ, Resick PA, Sloan DM. Long-term treatment gains of a brief exposure-based treatment for PTSD. Depress Anxiety. 2018;35:985–91. https://doi.org/10.1002/da.22825. Long-term PTSD and depression outcomes from the non-inferiority trial comparing WET with CPT. Both treatments showed large effects on PTSD symptoms over 60 weeks and medium effects on depression symptoms.

    Article  PubMed  Google Scholar 

  20. Marx BP, Thompson-Hollands J, Lee DJ, Resick PA, Sloan DM. Who reaps the benefits of PTSD treatment? An examination of two trauma-focused interventions. Under review.

  21. Foa EB, Kozak MJ. Emotional processing of fear: exposure to corrective information. Psychol Bull. 1986;99:20–35. https://doi.org/10.1037//0033-2909.99.1.20.

    Article  CAS  PubMed  Google Scholar 

  22. Bradley MM, Lang PJ. Measuring emotion: the Self-Assessment Manikin and the semantic differential. J Behav Ther Exp Psychiatry. 1994;25:49–59. https://doi.org/10.1016/0005-7916(94)90063-9.

    Article  CAS  PubMed  Google Scholar 

  23. Wisco BE, Baker AS, Sloan DM. Mechanisms of change in exposure treatment of PTSD. Behav Ther. 2016;47:66–74. https://doi.org/10.1016/j.beth.2015.09.005.

    Article  PubMed  Google Scholar 

  24. Galovski TE, Blain LM, Mott JM, Elwood L, Houle T. Manualized therapy for PTSD: flexing the structure of cognitive processing therapy. J Consult Clin Psychol. 2012;80:968–81. https://doi.org/10.1037/a0030600.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Nacasch N, Huppert JD, Yi-Jen S, Kivity Y, Dinshtein Y, Yeh R, et al. Are 60-minute prolonged exposure sessions with 20-minute imaginal exposure to traumatic memories sufficient to successfully treat PTSD? A randomized noninferiority clinical trial. Behav Ther. 2015;46:328–41. https://doi.org/10.1016/j.beth.2014.12.002.

    Article  PubMed  Google Scholar 

  26. Schauer M, Neuner F, Elbert T. Narrative exposure therapy, (2nd ed.). A short-term treatment for traumatic-stress disorders. Cambridge: Hogrefe Publishing; 2011.

    Google Scholar 

  27. van Minnen A, Foa EB. The effect of imaginal exposure length on outcome of treatment for PTSD. J Trauma Stress. 2006;19:427–38. https://doi.org/10.1002/jts.20146.

    Article  PubMed  Google Scholar 

  28. Robinson PJ, Reiter JT. Behavioral consultation and primary care. New York: Springer; 2007.

    Book  Google Scholar 

  29. Cigrang JA, Rauch SAM, Avila LL, Bryan CJ, Goodie JL, Hryshko-Mullen A, et al. Treatment of active duty military with PTSD in primary care: early findings. Psychol Serv. 2011;8:104–13. https://doi.org/10.1037/a0022740.

    Article  Google Scholar 

  30. Cigrang JA, Rauch SA, Mintz J, Brundige AR, Mitchell JA, Najera E, et al. Moving effective treatment for posttraumatic stress disorder to primary care: a randomized controlled trial with active duty military. Fam Syst Health. 2017;35:450–62. https://doi.org/10.1037/fsh0000315.

    Article  PubMed  Google Scholar 

  31. Mausbach BT, Moore R, Roesch S, Cardenas V, Patterson TL. The relationship between homework compliance and therapy outcomes: an updated meta-analysis. Cogn Ther Res. 2010;34:429–38. https://doi.org/10.1007/s10608-010-9297-z.

    Article  Google Scholar 

Download references

Funding

The study was funded by grant R01 MH095737 awarded to Denise Sloan from the National Institute of Mental Health. Johanna Thompson-Hollands was supported by the U.S. Department of Veterans Affairs (Clinical Sciences Research and Development Service) under Career Development Award No. IK2 CX001589.

Author information

Authors and Affiliations

  1. National Center for PTSD, Boston, MA, USA

    Johanna Thompson-Hollands Ph.D., Brian P. Marx Ph.D. & Denise M. Sloan Ph.D.

  2. VA Boston Healthcare System, 150 S. Huntington Ave (116B-4), Boston, MA, 02130, USA

    Johanna Thompson-Hollands Ph.D., Brian P. Marx Ph.D. & Denise M. Sloan Ph.D.

  3. Boston University School of Medicine, Boston, MA, USA

    Johanna Thompson-Hollands Ph.D., Brian P. Marx Ph.D. & Denise M. Sloan Ph.D.

Authors
  1. Johanna Thompson-Hollands Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brian P. Marx Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Denise M. Sloan Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Denise M. Sloan Ph.D..

Ethics declarations

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Conflict of Interest

Denise M. Sloan received a grant from the National Institute of Mental Health.

Johanna Thompson-Hollands received a grant from the U.S. Department of Veterans Affairs.

Denise M. Sloan and Brian P. Marx have a treatment manual book 2019 at the American Psychological Association.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on PTSD

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thompson-Hollands, J., Marx, B.P. & Sloan, D.M. Brief Novel Therapies for PTSD: Written Exposure Therapy. Curr Treat Options Psych 6, 99–106 (2019). https://doi.org/10.1007/s40501-019-00168-w

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40501-019-00168-w

Keywords

Search

Navigation