Written exposure therapy may be more efficient way to treat PTSD in military personnel

Due to its relatively brief course of treatment, written exposure therapy may be a more efficient method in reducing PTSD symptoms among U.S. military members, according to a randomized clinical trial published in JAMA Network Open.

“Prior studies suggest that service members with PTSD may be treated effectively with evidence-based treatments, such as prolonged exposure and cognitive processing therapy (CPT),” Denise M. Sloan, PhD, of the Behavioral Science Division at the National Center for PTSD at VA Boston Healthcare System, and colleagues wrote. “Unfortunately, service members are often reluctant to seek mental health care, and when they do receive care for PTSD, a higher percentage drop out of treatment prematurely compared with civilians who receive PTSD treatment.”

Sloan and colleagues sought to determine if written exposure therapy (WET) could produce comparable effects to CPT in reducing symptoms of PTSD, given that retention is a challenge due to a number of factors, including length and number of sessions, timing and location of sessions, opportunity to complete therapeutic activities and travel and deployment concerns.

Participants were recruited between 2016 and 2020 among active-duty U.S. military personnel undergoing treatment for PTSD and were stationed at two bases in Texas. To be included, participants had to be at least 18 years old and have no plans to relocate for a minimum of 3 months. Enrollees prescribed psychotropic medication were required to remain on a stable dosage for at least 4 weeks before participating. From an initial cohort of 231 individuals, the researchers included 169. Of those chosen, 80.5% were men, the mean age of the participants was 34 years and 98.8% were members of the Army.

Sloan and colleagues randomly assigned participants to two equal groups, each receiving either WET, which consisted of 5 weekly sessions, or CPT, which consisted of 12 twice-weekly sessions. Participants were evaluated prior to the study’s commencement, then at intervals of 10, 20 and 30 weeks after the initial treatment sessions. The main outcome measure was severity of PTSD symptoms, using a Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Data showed lower dropout rates for WET than CPT. Out of 85 participants assigned to WET, 65 completed the full circuit of treatment, and among 84 assigned to CPT, only 47 lasted through all treatment sessions. At the 30-week evaluation point, 12 of 32 participants in the CPT group and 17 of 36 in the WET group demonstrated a noticeable change in symptom severity; the researchers noted the difference was not “statistically significant.”

The findings suggest WET is an effective, efficient and less time-consuming pathway to treat PTSD and maximize positive outcomes, the researchers wrote.

“The efficiency of WET has particular value for the military setting, where the time to receive PTSD treatment may be limited due to several factors,” Sloan and colleagues wrote. “The efficiency of WET pertains not only to the total number of treatment sessions but also to the fact that there are no between-session assignments, and less time is needed for provider training.”