In a paper published by JAMA Network Open earlier this week, researchers say the five-session treatment, called written exposure therapy, may be more appealing and convenient to military personnel, thus improving their chances of finishing treatment. For military mental health providers balancing heavy patient loads, it could also be a game changer.
PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event, according to the National Institutes of Mental Health. They may have flashbacks, nightmares and/or disturbing thoughts, in addition to feeling more fearful and reactive.
In written exposure therapy, a trained facilitator guides the servicemember through detailed instructions on how to write about their traumatic experience in as much detail as possible, as well as the emotions and thoughts they had at the time of the event. By confronting the memory, they can effectively address their post-traumatic stress symptoms.
“What we're trying to do is get them to have a more coherent memory of the events,” said Denise Sloan, the study’s principal investigator and associate director of the Behavioral Science Division of the National Center for PTSD. “Oftentimes, when people have a coherent memory of the event, misattributions or thoughts they had — like ‘I was responsible’ or ‘I could have stopped this’ — get corrected. It's more cohesive. Like, ‘Oh, wait, I did everything I could have done.’”
The study was funded by the Department of Defense and carried out by researchers at the Department of Veterans Affairs’ National Center for PTSD, Boston University School of Medicine, and UT Health San Antonio. It’s part of the work of the STRONG STAR Consortium.
Researchers put 169 active duty men and women from Fort Hood in Killeen, Texas, into two groups. One received written exposure therapy while the other got cognitive processing therapy, a form of treatment where a patient speaks with a therapist over twelve sessions and learns to confront harmful thought patterns. Both groups saw improvement in their PTSD symptoms, but the dropout rates for written exposure therapy were a lot lower.
“What we’re hoping over time is that we have many different tools in the clinician’s toolkit,” said Dr. Alan Peterson, the study’s co-investigator and a professor in the Department of Psychiatry and Behavioral Sciences at UT Health San Antonio. “There's probably not one treatment by itself for post-traumatic stress disorder that's going to work for everyone.”
He added that patients tend to see better outcomes when they have a choice in their course of treatment.
Though other PTSD treatments like prolonged exposure and cognitive processing therapy are still widely used, written exposure therapy has gained ground over the last few years. The original treatment manual for therapists was published in 2019, and it is now included in the Department of Veterans Affairs - Department of Defense clinical practice guidelines for the management of PTSD. The VA is currently teaching the method to providers at its regional medical centers.
As part of an upcoming training initiative, the STRONG STAR Consortium may teach a cohort of civilian providers how to administer written exposure therapy to military personnel and veterans.
