Treating Acute Stress Disorder and Posttraumatic Stress Disorder with Cognitive Behavioral Therapy or Structured Writing Therapy: A Randomized Controlled Trial

Abstract

Background: Writing assignments have shown promising results in treating traumatic symptomatology. Yet no studies have compared their efficacy to the current treatment of choice, cognitive behavior therapy (CBT). The present study evaluated the efficacy of structured writing therapy (SWT) and CBT as compared to a waitlist control condition in treating acute stress disorder (ASD) and posttraumatic stress disorder (PTSD). Methods: A randomized controlled trial was conducted at an outpatient clinic. Participants (n = 125) (a) satisfied DSM-IV criteria for ASD or PTSD, (b) were 16 years or older, (c) were sufficiently fluent in Dutch or English, (d) had no psychiatric problems except ASD or PTSD that would hinder participation or required alternative clinical care, and (e) received no concurrent psychotherapy. Treatment consisted of five 1.5-hour sessions of CBT or SWT for participants with ASD or acute PTSD and ten 1.5-hour sessions for participants with chronic PTSD. Outcome measures included the Structured Clinical Interview for DSM-IV, Impact of Event Scale, Beck Depression Inventory, State-Trait Anxiety Inventory and the Dissociative Experiences Scale. Results: At posttest and follow-up, treatment was associated with improved diagnostic status and lower levels of intrusive symptoms, depression and state anxiety, while a trend was noted for the reduction of avoidance symptoms. Treatment did not result in lower levels of trait anxiety or dissociation. No differences in efficacy were detected between CBT and SWT. Conclusions: The present study confirmed the efficacy of CBT for ASD and PTSD and identified SWT as a promising alternative treatment.

Treatment of post‐traumatic stress disorder in children using cognitive behavioural writing therapy

“…In the adult literature, structured writing is emerging as an alternative set of procedures for imaginal exposure and cognitive restructuring (e.g. Lange et al, 2003;Van Emmerik, Kamphuis, & Emmelkamp, 2008). Written exposure is thought to be effective through similar mechanisms as conventional cognitive behavioural interventions in which the patient is exposed to aversive stimuli either imaginally or in vivo (Sloan, Marx, & Epstein, 2005;Sloan, Marx, Epstein & Lexington, 2007).…”

“…This element is called social sharing (Lange et al, 2003) and may be especially important, since the absence of social support following trauma is an important predictor of the development of PTSD (Brewin, Andrews, & Valentine, 2000;Ozer & Weinstein, 2004). In adults, cognitive behavioural writing therapy for PTSD is equally effective to face-to-face cognitive behavioural treatment (Van Emmerik et al, 2008).…”

“…While adult patients in cognitive behavioural writing therapy typically complete their writing assignments at home (e.g. Van Emmerik et al, 2008;Lange et al, 2003), children in the present therapy completed their assignments on a computer during the treatment sessions, aided by the therapist. In TF-CBT (e.g.…”

Emergence of Delayed Posttraumatic Stress Disorder Symptoms Related to Sexual Trauma: Patient-Centered and Trauma-Cognizant Management by Physical Therapists

“…A written journal is a practical option when time or privacy is limited for individual communication about the triggers during physical therapy treatment. 23 Initially, completely avoiding triggers was necessary, but once the patient was ready, stressors were reintroduced (desensitization) gradually.…”

“…14 Psychotherapy for PTSD involves individual or group treatment 16,17 using psychodynamic 17,18 or cognitivebehavioral approaches. 19,20 Other treatments include systematic desensitization to stimuli in a controlled manner, 21 eye movement desensitization and reprocessing, 22 selfanalysis (journaling), 23 hypnosis, 24 and relaxation techniques. 25 Psychotherapeutic techniques are often combined with antianxiety or antidepressant medication.…”