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Written Exposure Therapy, a Shorter and Cheaper PTSD Treatment, Shows Promising Results

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If therapy for post-traumatic stress disorder (PTSD) treatment seems to be too long of a process, a study published in JAMA Psychiatry may bring good news. Researchers compared short-term written exposure therapy (WET) to more traditional PTSD treatments that require a longer time commitment and found no difference in the effectiveness of either treatment.

• What is PTSD?

PTSD is a complex mental illness ― it literally changes the structure of your brain, includes body memories depending on your trauma and creates sensory triggers that may fly under your radar at first. Traditional PTSD treatments are known to have a high success rate, but programs such as cognitive processing therapy (CPT) usually require 12 weekly therapy sessions with homework in between. WET requires only five sessions, without homework. It’s a much faster treatment method with a similar outcome for many.

WET consists of a structured, scripted series of writing exercises. A therapist will direct you to focus on your thoughts and feelings about your trauma during each session. Using these guidelines, researchers Denise Sloan, Brian Marx and Daniel J. Lee compared WET to CPT by studying people diagnosed with PTSD. Half the group received WET and the other half did CPT.

Based on the researcher’s conclusions, not only was WET was just as effective as CPT in treating PTSD, the drop-out rate was significantly less. Only 6.3 percent of those in the study who received WET dropped out, compared to 39.7 percent of participants who did CPT. This is significant given the difficulty of facing trauma head-on.

“The findings of the study suggest that PTSD can be treated with fewer sessions than previously thought and with less burden on the patient and the therapist,” Sloan, the lead study author and associate director at the National Center for PTSD, told the National Institute of Mental Health. “Moreover, the brief treatment was well-tolerated — demonstrated by the small number of patients that dropped out.”

Sloan, Marx and Lee’s study isn’t the first time writing has been suggested for trauma survivors. In the 1980s, James. W. Pennebaker found that three sessions of writing could alleviate symptoms. Based on Pennebaker’s work, scientists determined writing works for PTSD because you construct a narrative that gives meaning to your trauma. It also helps regulate your emotions. Once you share your story on paper, you’re more likely to reach out to others in your life for support. All of these benefits are available with only a few guided prompts and writing tools.

Because of its writing-based focus, WET may make PTSD treatment more accessible. The shorter treatment length can remove financial and time barriers if you can’t afford a longer process. It’s also much easier to train mental health professionals to do WET, unlike CPT and other trauma therapies. This means more counselors can provide PTSD therapy to more people.

“While of proven efficacy, structured therapies, such as CPT, require extensive training of therapists,” Dr. Matthew Rudorfer, program chief of adult interventions in the NIMH Division of Services and Intervention Research, said in an NIMH article. “A more streamlined intervention that requires less specialized therapist training and fewer sessions while maintaining therapeutic effectiveness would, therefore, be appealing for treatment of PTSD in the community.”

This recent study certainly points in a positive direction, but there are some things you should keep in mind. The study only included people with a diagnosis of PTSD who were taking medication but were not already in therapy. Those with a high risk of suicide, psychosis or bipolar disorder were excluded. If you have more complex trauma or more than one diagnosis, you may not benefit from shorter treatments. It’s also unclear from this study how WET would affect you if you have PTSD and are not taking medication.

The study also measured the effectiveness of WET compared to CPT by assessing PTSD symptoms at 6, 12, 24 and 36 weeks following the first appointment. Based on these check-ins, researchers concluded WET and CPT were equally effective. The aftereffects of trauma can last a lifetime — well beyond the 36-week check-in point researchers used as part of their study. For this reason, to truly determine whether or not WET is as effective as other PTSD treatments, researchers will need to measure how well study participants are doing years after their initial treatment.

Regardless, WET shows promise as an alternative option for PTSD treatment. Given that 7 to 8 percent of the U.S. will be diagnosed with PTSD at some point in their lives, accessible treatment options are crucial. Thanks to its short duration and the ability for any licensed therapist to administer the exercises, for many, WET may be just what the doctor ordered.

Getty Image via Victor Tongdee

Originally published: August 10, 2018
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