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Written exposure therapy rivals cognitive processing therapy for PTSD


 

FROM JAMA Psychiatry

Cognitive processing therapy may offer a greater benefit over time for posttraumatic stress disorder, but writing therapy offers a viable treatment in fewer sessions.

“Our results add to mounting research showing that the dose of therapy needed for beneficial outcomes for individuals with PTSD is not as large as what was once previously thought,” wrote Denise M. Sloan, PhD, of the National Center for PTSD, Boston, and her colleagues. “Our findings extend those prior studies by demonstrating that not only can PTSD symptoms be reduced significantly with less therapeutic exposure but that not as many therapy sessions are required.”

In a 1:1 randomized clinical trial, Dr. Sloan and her colleagues compared the effectiveness of written exposure therapy (WET) and cognitive processing therapy (CPT) in treating PTSD in 126 veteran and nonveteran adults, split evenly into the two therapy groups. The WET protocol included 5 sessions in which the patient wrote for 30 minutes about a traumatic event and focused on details of the event, including thoughts and feelings associated with it. The CPT intervention was a 12-session trauma-focused therapy with a limited take-home writing component. It focused on helping patients recognize and challenge dysfunctional cognitions associated with traumatic events, the investigators wrote in JAMA Psychiatry.

When Dr. Sloan and her colleagues looked at the patients’ mean Clinician Administered PTSD Scale for DSM-5, or CAPS-5 score, a measure of PTSD symptom severity, they found that the WET and CPT groups’ scores were similar at 6 weeks, 12, weeks, and 36 weeks. At the 24-week assessment, the CAPS-5 score for those in the CPT group (20.92) was significantly lower than it was for those in the WET group (25.23) (mean difference, 4.31 points; 95% confidence interval, –1.37 to 9.99).

In addition, the CPT group had a higher dropout rate (31.7%) than did the WET group (6.3%). The investigators concluded, however, that both therapies are effective. “Written exposure therapy should be considered by clinicians to be a viable treatment option that can address some of the barriers to receiving and implementing CPT and prolonged exposure that have been noted in health care settings,” Dr. Sloan and her colleagues wrote.

This study was funded by a grant from the National Institute of Mental Health. None of the authors had financial conflicts to report. Further details on this information can be found here.

SOURCE: Sloan DM. 2018 Jan 17. doi: 10.1001/jamapsychiatry.2017.4249.

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