Alternative PTSD treatment found to increase patient retention

Key points:

• Prolonged exposure therapy sessions are frequent and longer than written exposure therapy — WET — sessions

• As PE treatment is strongly recommended for people living with PTSD, researchers sought to uncover whether WET treatment would compare

• WET sessions not only matched the efficacy of PE treatment, but had a reduced drop-out rate among participants in the study

A new study has uncovered the potential for a new form of treatment for veterans living with post-traumatic stress disorder to write about their lived experiences. The treatment rivalled the results of the ‘gold standard’ method — prolonged exposure therapy, known as PE — in which, those with PTSD would talk about the source of their trauma during 90-minute sessions, for up to 15 sessions. 

The new form of therapy, written exposure therapy, was the subject of a randomised clinical trial following 178 U.S. veterans living with PTSD. Those assigned to WET treatment were given five to seven 45 – 60 minute sessions, wherein they would write for 30 minutes and then discuss the process with a supervised therapist afterwards.

Study investigator Dr Denise Sloan, co-author of ‘Written Exposure Therapy for PTSD,’ 2019, developed the WET treatment method to meet the growing need for timely support and to reduce the rate at which patients dropped out.

The three alternative forms of treatment recommended for veterans with PTSD, such as eye movement desensitisation and reprocessing, cognitive processing therapy and PE, all had drop-out rates of anywhere between 18 and 50 percent.

Researchers reported that 32 participants receiving PE had dropped out prematurely, in contrast to the 11 participants who were receiving WET sessions. Notably, of the 32 PE recipients to discontinue therapy, 30 had dropped out by session 7, which indicated that the number of sessions may not be the cause.

Prior to the PE/WET study, a randomised clinical trial involving 169 active-duty service members diagnosed with PTSD was conducted to compare WET treatment to cognitive processing therapy. Researchers found that symptoms improved in those attending WET sessions at a greater rate and with fewer participants dropping out than those receiving CPT.

In 1986, James Pennebaker, PhD and Sandra Klihr-Beall published ‘Confronting a Traumatic Event: Toward an Understanding of Inhibition and Disease,’ which observed 46 introductory psychology students from Dallas, Texas. Researchers observed the blood pressure of each student rise as they wrote the essay, but fewer health centre visits in the six months thereafter.

The increased heart rate, blood pressure and negative mood of each participant following each essay writing session were followed by a sense of catharsis, according to Pennebaker and Klihr-Beall.

“Writing about earlier traumatic experiences was associated with both short-term increases in physiological arousal and long-term decreases in health problems,” the report discussion stated.

“Although these effects were most pronounced among subjects who wrote about the trauma and their emotions associated with the trauma, there was substantial overlap in effects with those subjects who wrote only about their emotions associated with traumatic events.

“Subjects who were instructed to write only about previous traumatic events — without referring to their own emotions — were similar to control condition subjects on most physiological, health and self-report measures.”

If you believe that you may be at risk of post-traumatic stress disorder, depression or poor mental health, please reach out to the following support resources:

Alcoholics Anonymous — 1300 222 222

Beyond Blue — 1300 22 4636

Dementia Support Australia — 1800 699 799

Lifeline — 13 11 14

Mental Health Emergency — 13 14 65

Phoenix Australia — +61 3 9035 5599