A pilot test of Written Exposure Therapy for PTSD in residential substance use treatment

Abstract

Background and ObjectivesPosttraumatic stress disorder (PTSD) is highly comorbid with substance use disorders (SUD) and can impede SUD recovery. Residential SUD treatment is a crucial opportunity to address PTSD. However, PTSD treatment is lacking in residential SUD care.MethodsWe conducted a nonrandomized feasibility study of Written Exposure Therapy (WET), a brief, evidence‐based treatment for PTSD, with patients in residential SUD treatment. We assessed attitudes towards treatment (Credibility and Expectancy Questionnaire, Barriers to Treatment Participation Scale) and mental health indicators (PTSD Checklist for DSM‐5, Trauma Coping Self‐Efficacy, Difficulties in Emotion Regulation‐Short Form, and Brief Assessment of Recovery Capital).ResultsThirty of 49 eligible participants completed WET (61%) and 92% (n = 45) attended at least one WET session. Paired sample t‐tests revealed significant posttreatment improvement across all mental health indicators, with medium to large effect sizes.Discussion and ConclusionsAttendance and completion rates compared favorably to prior exposure‐based treatment for PTSD in SUD settings. Although causality cannot be inferred without a randomized controlled trial, mental health indicators, including PTSD, improved significantly following WET.Scientific SignificanceThese findings provide evidence that PTSD can be successfully treated in short‐term residential care using brief exposure‐based interventions, which is a crucial clinical need that has been minimally studied in the past.

A systematic review of written exposure therapy for the treatment of posttraumatic stress symptoms.

“…Table 1 displays information regarding each of the 17 articles included in the review. Notably, 14 (82%) articles were published since 2020 (Ahmadi et al, 2022; Andrews et al, 2022; Ellis et al, 2023; LoSavio et al, 2023; Morissette et al, 2023; Nillni et al, 2023; Park et al, 2021; Schacht et al, 2023; Schumacher et al, 2023; Sloan et al, 2022, 2023; Tyler et al, 2022; Yun & Lee, 2022; Zolfa et al, 2023). Study sample sizes ranged from three to 277.…”

“…One of the ten open trial studies was a large ( N = 277) hybrid implementation-effectiveness study conducted within the Department of Veterans Affairs (LoSavio et al, 2023); LoSavio et al is one of only three (Morrissette et al, 2023; Sloan et al, 2023) effectiveness studies conducted to date, with the remaining studies representing efficacy design. Seven studies (38%) were published by authors other than the developers of WET (Ahmadi et al, 2022; Andrews et al, 2022; Ellis et al, 2023; Park et al, 2021; Schacht et al, 2023; Yun & Lee, 2022; Zolfa et al, 2023).…”

“…Two studies examined treatment outcome when WET was delivered using a group format (Ahmadi et al, 2022; Schumacher et al, 2023). Three studies delivered WET using a massed format in which sessions were delivered multiple times within a week (Schacht et al, 2023; Schumacher et al, 2023; Tyler et al, 2022). Five of the 17 studies used a language translation version of the manual for a non-English-speaking sample (Ahmadi et al, 2022; Andrews et al, 2022; Park et al, 2021; Yun & Lee, 2022; Zolfa et al, 2023).…”

“…Ten of the 17 included studies required a PTSD diagnosis for inclusion (LoSavio et al, 2023; Park et al, 2021; Schumacher et al, 2023; Sloan et al, 2012, 2013, 2018, 2022, 2023; Tyler et al, 2022; Yun & Lee, 2022), whereas seven studies used a cutoff score on a PTSD self-report measure for inclusion (Ahmadi et al, 2022; Andrews et al, 2022; Ellis et al, 2023; Morissette et al, 2023; Nillni et al, 2023; Schacht et al, 2023; Zolfa et al, 2023).…”

“…In addition to examining telehealth delivery and group format, several studies delivered the treatment using a massed format in which sessions were conducted once or twice a day during a psychiatric inpatient stay (Tyler et al, 2022) or approximately three times per week within a residential treatment program for substance use disorders (Schacht et al, 2023; Schumacher et al, 2023). Taken together, the findings suggest that treatment gains for WET continue to be observed when the format is altered.…”