Written Exposure Therapy: An Efficient and Effective Treatment for PTSD

Posted February 18, 2022

Denise M. Sloan, Ph.D.
National Center for PTSD at VA Boston Healthcare System &
Boston University School of Medicine

Denise Sloan, Ph.D., Boston University School of Medicine Dr. Denise M. Sloan

Military Service Members and Veterans are at an increased risk of posttraumatic stress disorder (PTSD) as compared to civilians. This risk increases when Service Members are combat-deployed or have reported combat experience. Additionally, the incidence of PTSD is often associated with at least one other mental or behavioral health condition.1 Cognitive processing therapy (CPT) is an effective available treatment; however, the time demands associated with this treatment are often an obstacle for Service Members who do not seek treatment or who prematurely end treatment. To retain these patients, there is a need for a more efficient approach to PTSD treatment.

Alan Peterson, Ph.D., The University of Texas Health Science Center at San Antonio Alan Peterson, Ph.D.,
The University of Texas Health Science Center at San Antonio

With a Fiscal Year 2014 Traumatic Brain Injury/Post-Traumatic Stress Disorder Clinical Trial Award funded by the Psychological Health and Traumatic Brain Injury Research Program, Dr. Denise Sloan and her colleagues conducted a randomized noninferiority trial to determine if written exposure therapy (WET) would be a more efficient, yet equally effective, treatment option for active-duty Service Members suffering from PTSD. The study included 169 active-duty military participants who received either WET (85) or CPT (84). WET included one weekly session for five weeks, during which participants wrote about the details of their traumatic experience that resulted in PTSD and the feelings and thoughts they had during that experience. CPT included twice weekly sessions for twelve weeks, focused on changing maladaptive thoughts surrounding their traumatic experience. Participants were assessed at baseline (before treatment) and at 10-, 20-, and 30- weeks after their first therapy session. The primary outcome measure was an evaluation of the severity of PTSD symptoms using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5).

In an article published in JAMA Network Open in January 2022, Dr. Sloan, Dr. Alan Peterson and their team reported their findings from this study.2 The study found that participants assigned to both treatments had a significant reduction in their PTSD symptoms, and WET was found to be just as effective as CPT. However, 65 (76.5%) participants in the WET group completed treatment, whereas 47 (56.0%) of the CPT group completed treatment. Follow-on research is needed to determine the long-term effects from this short-term treatment compared to the CPT approach. With almost a one-third retention rate difference, these findings support the need for implementation of a more efficient, yet effective, approach to PTSD treatment. If PTSD-afflicted Service Members could more easily adhere to a treatment, more lives could benefit from treatment; such adherence could also help mitigate the mental or behavioral health conditions related to living with PTSD.


1Crum-Cianflone NF, Powell TM, LeardMann CA, Russell DW, and Boyko EJ. 2016. Mental health and comorbidities in U.S. military members. Military Medicine 181(6):537-545.

2Sloan DM, Marx BP, Resick PA, et al. 2022. Effect of written exposure therapy vs. cognitive processing therapy on increasing treatment efficiency among military service members with posttraumatic stress disorder: A randomized noninferiority trial. JAMA Netw Open. 2022;5(1):e2140911. doi:10.1001/jamanetworkopen.2021.40911


Public and Technical Abstracts: Brief Treatment for PTSD: Enhancing Treatment Engagement and Retention

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Last updated Thursday, May 26, 2022