Delivery of written exposure therapy for PTSD in a university counseling center.

Abstract

Posttraumatic stress disorder (PTSD) occurs at high rates among college students, and there is an urgent need to develop brief and accessible interventions to help these at-risk students achieve academic and career success. This open-trial pilot study tested the feasibility and effectiveness of Written Exposure Therapy (WET; Sloan & Marx, 2019), a brief, five-session exposure-based treatment, when delivered in a real-world Counseling Services Center. Students who met criteria for probable PTSD were assessed at baseline, posttreatment, and 3-month follow-up using self-report assessments of PTSD and depression. Of 28 eligible college students, 22/28 (78.6%) completed at least one treatment session, and of those students, 14/22 (63.6%) completed the full five sessions, 12 of whom completed both the posttreatment assessment and the 3-month follow-up assessment. Data were analyzed using intent-to-treat (N = 22) and per-protocol (n = 12) samples. As hypothesized, in both samples, PTSD symptoms decreased from baseline to posttreatment (η2 = .60–.81; very large effects), and these improvements were maintained at the 3-month follow-up. Similar findings were observed with respect to decreases in self-reported depression, but not with respect to decreases in educational impairment or increases in academic self-efficacy. Qualitative data indicated that both students and therapists found the treatment credible and acceptable. These findings offer preliminary support for the utility of WET for PTSD when delivered in a student counseling services center. Suggestions for adapting WET within a student counseling services environment are discussed.

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.…”

“…Seven (43%) of the studies used an RCT design, with four of these studies comparing WET with a more time-intensive trauma-focused treatment for PTSD (Ahmadi et al, 2022; Sloan et al, 2018, 2022, 2023); one RCT compared WET to a trauma-focused expressive writing condition (Ellis et al, 2023), and the other two RCTs compared WET with a no treatment condition (Sloan et al, 2012; Zolfa et al, 2023). 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).…”

“…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).…”

The dynamic relationship of negative emotional content in the context of trauma-focused writing interventions on improvements in cognitive reappraisal: A pilot study.

“…The expressive writing (EW) literature boasts overall benefits for health that appear to be strengthened in trauma-exposed populations, but not all writing is equally beneficial. Specifically, writing about trauma appears to be more effective at targeting PTSS (Kloss & Lisman, 2002; LoSavio et al, 2023; Morissette et al, 2023; Pavlacic et al, 2018; Sloan et al, 2015, 2018) and is perceived as tolerable, and valuable (Hernandez et al, 2005). Data from studies manipulating writing instructions for EW tasks suggest that writing about the same traumatic experience repeatedly (Sloan et al, 2005), greater emotional engagement in writing (Sloan et al, 2007), and greater physiological arousal during writing (Epstein et al, 2005) were associated with greater improvement in PTSS and other domains of functioning.…”

An examination of individual and organizational theory in a pilot virtual facilitated learning collaborative to implement written exposure therapy.

“…Written exposure therapy (WET; Sloan & Marx, 2019) is an evidence-based psychotherapy (EBP) for posttraumatic stress disorder (PTSD) with strong empirical support from multiple clinical trials (Sloan et al, 2012, 2013, 2018, 2022) as well as recent clinical effectiveness studies (LoSavio et al, 2021; Morissette et al, 2022). WET offers several potential advantages over other trauma-focused therapies including short duration (typically five sessions) and no formal between-session assignments.…”