Feasibility and acceptability of written exposure therapy in addressing posttraumatic stress disorder in Iranian patients with breast cancer

Abstract

Objective This study examined the feasibility and acceptability of written exposure therapy (WET) in reducing symptoms of posttraumatic stress disorder (PTSD) in Iranian women with breast cancer. Secondary aims included examining the influence of WET on quality of life (QoL), overgeneral memory and illness perceptions. Method Forty‐six females with breast cancer and clinical symptoms of PTSD referred to the Razi Hospital in Rasht, Iran were randomly assigned to either WET (n = 23) or control (n = 23) groups. WET is a 5‐session low‐intensity exposure‐based intervention for treating PTSD. The control group had no additional contact. Measures assessing PTSD, illness perceptions, overgeneral memory, and QoL were administered at baseline, post‐intervention and 3‐month follow‐up. Results Acceptability of WET was high; all participants completed all WET sessions. At post‐intervention, 95.65% of the WET group met criteria for reliable change and 100% met criteria for minimal clinically important difference (MCID) and clinically significant change in PTSD symptom improvement. At follow‐up, all WET participants met criteria for reliable change, MCID and clinically significant change in PTSD symptom improvement. No participants in the control group met reliable change, MCID or clinically significant change. The WET group had improved QoL and memory specificity and decreased threatening illness perceptions at post‐intervention and follow‐up when compared to controls. Conclusion WET may be a useful intervention for use with breast cancer patients with PTSD symptoms and may be an important adjunct to medical and pharmacological treatments, particularly in low‐ and middle‐income countries. This study indicates further research in this area is warranted.

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.…”

“…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.…”

“…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).…”

“…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).…”

Global psycho‐oncology in low middle‐income countries: Challenges and opportunities

“…Psychosocial research included in this Special Issue identifies individual resiliency factors, such as self‐compassion, in patients with cancer in Xi’An, China 19 and pilot studies are reported demonstrating the feasibility of written exposure therapy for posttraumatic stress disorder in Iranian women with breast cancer 20 and of acceptance and commitment therapy for parents of children with a haematological malignancy or a solid tumour. 21 Asuzu et al 22 report a pilot psychosocial intervention group in Nigeria that shows potential in supporting breast cancer patients.…”